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Birtwell K, Goldin R, Saro H, McDougle C, Horick N, Ravichandran C, Nowinski L. Using Restricted Interests in Cognitive Behavioral Therapy for Children With Autism Spectrum Disorder: Results From a Preliminary Randomized Controlled Trial. J Cogn Psychother 2024; 38:186-202. [PMID: 38991740 DOI: 10.1891/jcp-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Children with autism spectrum disorder (ASD) exhibit significant deficits in social communication and emotion regulation skills. While cognitive behavioral therapy (CBT) applications appear promising, trials to date have largely excluded social communication skill development and have not been designed to include a wider range of emotional challenges. To our knowledge, the present study is the first to pilot a uniquely modified CBT program targeting emotion regulation, including social communication training, and explicitly focusing on the child's areas of circumscribed interest in order to teach skills and promote generalization. Forty participants were randomly assigned to either the CBT group or a waitlist control (WLC) group, resulting in 20 school-aged children in each group. The treatment approach was determined to be feasible and acceptable, and therapy engagement and attendance were reasonably high. Caregivers expressed high satisfaction with the program, qualitatively citing gains in skills such as social problem-solving, emotion identification, and identifying and processing cognitive distortions. The primary outcome of postintervention changes was not significantly different between the groups (CBT vs. WLC). The mean Social Skills Improvement System score decreased by 0.44 points (95% confidence interval [CI]: -5.04, 4.15) in the CBT group and increased by 0.41 points (95% CI: -4.23, 5.04) in the WLC group, and the postintervention changes were not significantly different between the groups (difference: -0.85; 95% CI: -7.29, 5.60; p = .79). The estimated rate of emotional dysregulation episodes decreased by a factor of 0.94 (95% CI: 0.57, 1.56) in the CBT group and increased by a factor of 1.07 (95% CI: 0.51, 2.24) for WLC (p = .74). Among those who reported emotional dysregulation episodes, the mean duration decreased by 1.39 minutes (95% CI: -3.90, 6.67) less for CBT than waitlist (p = .60). Although satisfaction, acceptability, and emotional dysregulation outcome results from this preliminary CBT treatment for ASD are promising, sample size and measurement limitations will be important considerations to inform future trials.
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Affiliation(s)
- Kirstin Birtwell
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Goldin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Hannah Saro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nora Horick
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Lisa Nowinski
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Kilburn TR, Rapee RM, Lyneham HJ, Thastum M, Thomsen PH. Testing a cognitive behavioural therapy program for anxiety in autistic adolescents: a feasibility study. Nord J Psychiatry 2024; 78:421-430. [PMID: 38690784 DOI: 10.1080/08039488.2024.2338206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Autism includes core symptoms affecting general and social development. Up to 60% of autistic adolescents experience co-occurring anxiety disorders negatively influencing educational, social, and general development together with quality of life. A manualised cognitive behavioural therapy (CBT) program 'Cool Kids - Autism Spectrum Adaptation (ASA)' has previously demonstrated efficacy in reducing anxiety in children with co-occurring autism. The current study investigates the feasibility of adapting this program for adolescents. METHODS Fifteen autistic adolescents, aged 14-17 years, with co-occurring anxiety disorders were enrolled in the study. Outcome measures collected from both adolescents and parents pre-, post-treatment and at 3-month follow-up included participant evaluation of the program, scores from a semi-structured anxiety interview, and questionnaires on anxiety symptoms, life interference, and quality of life. RESULTS 92% of the families who completed the program found it useful and would recommend it to other families in a similar situation. At follow-up, 55% no longer met the criteria for their primary anxiety diagnosis and 34% of adolescents were free of all anxiety diagnoses. Of the five adolescents who did not attend school before treatment three (60%) had returned to school after treatment. CONCLUSION This study suggests that the adaptation of the program 'Cool Kids - ASA' into an adolescent version is feasible and has the potential to show good effects thus enhancing the possibility of education, development and independence in future life for this group. Larger RCTs studies are, however, needed to examine the efficacy of the adolescent version.
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Affiliation(s)
- Tina R Kilburn
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Heidi J Lyneham
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mikael Thastum
- Centre for the Psychological Treatment of Children and Adolescents (CEBU), Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
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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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Rosenau KA, Kim J, Cho ACB, Seltzer M, Ugueto AM, Weisz JR, Wood JJ. Meta-analysis of Psychotherapy for Autistic Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01686-2. [PMID: 38580853 DOI: 10.1007/s10578-024-01686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/07/2024]
Abstract
In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.
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Affiliation(s)
- Kashia A Rosenau
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
| | - Junok Kim
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - An-Chuen Billy Cho
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Michael Seltzer
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Ana M Ugueto
- University of Texas Health Science Center at Houston, Houston, USA
| | | | - Jeffrey J Wood
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
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Lei J, Leigh E, Charman T, Russell A, Hollocks MJ. Understanding the relationship between social camouflaging in autism and safety behaviours in social anxiety in autistic and non-autistic adolescents. J Child Psychol Psychiatry 2024; 65:285-297. [PMID: 37632264 DOI: 10.1111/jcpp.13884] [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] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Social camouflaging (hereafter camouflaging) in autism includes factors such as masking and compensating for one's neurodevelopmental differences, and to assimilate or 'fit in' with non-autistic peers. Efforts to hide one's authentic self and autism traits (masking) resemble impression management (IM) in safety behaviours identified in Clark and Wells' (1995) cognitive model of social anxiety (SA). This study explores the relationship between camouflaging in autism and safety behaviours in SA among autistic and non-autistic adolescents. METHODS One hundred fifteen adolescents (14-19 years) with (n = 61; 36 female) and without (n = 54; 37 female) a clinical diagnosis of autism matched on age and SA symptom severity were recruited from clinics, schools and online. Adolescents completed online measures including autism traits, SA symptoms, camouflaging behaviours, SA-related safety behaviours and SA-related negative cognitions. Partial and bivariate Pearson's correlations and structural equation modelling were used to understand the relationship between camouflaging, safety behaviours, autism traits and SA in both groups. Exploratory factor analysis assessed item-level factor cross-loadings between camouflaging and safety behaviours. RESULTS Across both groups, masking and IM were significantly associated with SA symptom severity, not autism traits, via SA-related social cognitions. Exploratory factor analysis indicated construct overlap across masking, assimilation, IM and avoidance behaviours and identified factors analogous to self-focused attention, social avoidance and mental rehearsal identified in the Clark and Wells' (1995) model of SA. CONCLUSIONS This is the first study using group-matched design to identify that masking (factor in social camouflaging) and IM both relate to SA in autistic and non-autistic adolescents. Assessment and formulation of construct overlap between masking and IM may inform psychoeducation and adaptation of SA treatment for autistic adolescents.
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Affiliation(s)
- Jiedi Lei
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
| | - Matthew J Hollocks
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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Chung KM, Chung E, Lee H. Behavioral Interventions for Autism Spectrum Disorder: A Brief Review and Guidelines With a Specific Focus on Applied Behavior Analysis. Soa Chongsonyon Chongsin Uihak 2024; 35:29-38. [PMID: 38204739 PMCID: PMC10774556 DOI: 10.5765/jkacap.230019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
We conducted a comprehensive review of behavioral and educational interventions for individuals with autism spectrum disorder (ASD). The most prominent type of intervention, Comprehensive Early Intervention, often referred to as Early Intensive Behavioral Intervention (EIBI), has been found to be particularly effective in improving intelligence and adaptive behaviors. The naturalistic developmental behavioral intervention, designed to enhance social and communication abilities, showed effectiveness in improving language, cognitive function, and social initiation. However, more studies are needed to examine its effectiveness. Intensive individualized intervention, which provides a tailored intervention for a specific target behavior, was effective in improving social skills and communication, as well as reducing sleep, eating, and toileting problems. Cognitive behavioral therapy (CBT) is the most effective method for dealing with emotional difficulties, but it has not been widely used because of the shortage of trained experts. Parent-mediated intervention (PMI) involves parents acquiring knowledge and specific skills to improve their child's functioning or reduce challenging behaviors. Speech and language therapy, sensory integration, Treatment and Education of Autistic and related Communications Handicapped Children, developmental approaches, and social stories are frequently used interventions. However, evidence of their effectiveness has yet to be well established. Based on these findings, intervention recommendations for autism include EIBI, Early Start Denver Model, intensive individualized intervention, CBT, and PMI. The choice of intervention should be tailored to the individual's needs and delivered by qualified professionals with expertise in the specific intervention.
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Affiliation(s)
- Kyong-Mee Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Eunsun Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Hoomyung Lee
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
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Norris LA, Rabner JC, Storch EA, Wood JJ, Kerns C, Lewin AB, Small BJ, Kendall PC. Idiographic Coping Outcomes in Youth with Autism Spectrum Disorder and Co-Occurring Anxiety: Results from the TAASD Study. J Autism Dev Disord 2023; 53:4711-4718. [PMID: 36129626 PMCID: PMC10027616 DOI: 10.1007/s10803-022-05716-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
Versions of cognitive behavioral therapy (Coping Cat, CC; Behavioral Interventions for Anxiety in Children with Autism, BIACA) have shown efficacy in treating anxiety among youth with autism spectrum disorder. Measures of efficacy have been primarily nomothetic symptom severity assessments. The current study examined idiographic coping outcomes in the Treatment of Anxiety in Autism Spectrum Disorder study (N = 167). Longitudinal changes in coping with situations individualized to youth fears (Coping Questionnaire) were examined across CC, BIACA and treatment as usual (TAU) in a series of multilevel models. CC and BIACA produced significantly greater improvements than TAU in caregiver-reported coping. Youth report did not reflect significant differences. Results show the efficacy of CC and BIACA in improving idiographic caregiver-, but not youth-, reported youth coping.
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Affiliation(s)
- Lesley A Norris
- Temple University, Philadelphia, PA, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, USA.
| | | | | | - Jeffrey J Wood
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Connor Kerns
- University of British Columbia, Vancouver, BC, Canada
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Gallant C, Roudbarani F, Ibrahim A, Maddox BB, Weiss JA. Clinician Knowledge, Confidence, and Treatment Practices in Their Provision of Psychotherapy to Autistic Youth and Youth with ADHD. J Autism Dev Disord 2023; 53:4214-4228. [PMID: 36076117 PMCID: PMC10539421 DOI: 10.1007/s10803-022-05722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
Autistic youth have an increased risk of mental health problems. Despite the efficacy of various psychotherapeutic approaches for autistic youth, they often do not receive these interventions. Research is needed to identify patterns of effective treatment for autistic youth and whether they differ from those used for youth with other neurodevelopmental conditions (e.g., attention-deficit hyperactivity disorder; ADHD). We compared clinicians' (N = 557) knowledge, confidence and practices when treating autistic youth and youth with ADHD. Although ratings were moderately high overall and similar interventions were used for both groups, clinicians were significantly less knowledgeable and confident when supporting autistic clients compared to clients with ADHD. Thus, improving clinician perspectives may help facilitate treatment for autistic youth with mental health problems.
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Affiliation(s)
- Caitlyn Gallant
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada.
| | - Flora Roudbarani
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
| | - Alaa Ibrahim
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
| | - Brenna B Maddox
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan A Weiss
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
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Chan V, Albaum CS, Khanlou N, Westra H, Weiss JA. Parent Involvement in Mental Health Treatment for Autistic Children: A Grounded Theory-Informed Qualitative Analysis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01621-x. [PMID: 37847326 DOI: 10.1007/s10578-023-01621-x] [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: 10/07/2023] [Indexed: 10/18/2023]
Abstract
Cognitive behavior therapy (CBT) is an effective treatment for many autistic children experiencing mental health problems, and parents are particularly involved in their psychotherapy. This study presents a conceptual framework of successful parent involvement in CBT for autistic children. Seventeen therapists (94% female) and 11 mothers were interviewed about their involvement in a CBT program for autistic children ages 8-13 years. The conceptual framework depicts how parent involvement varies depending on child, parent, and environmental factors. Parents' contributions to therapy were grouped into five main roles. Parents' beliefs and attitudes toward therapy also influenced their involvement. This is the first study to empirically investigate how parents of autistic children contribute to the therapeutic process in CBT.
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Affiliation(s)
- Victoria Chan
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada.
| | - Carly S Albaum
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | | | - Henny Westra
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Oshima F, Mandy W, Seto M, Hongo M, Tsuchiyagaito A, Hirano Y, Sutoh C, Guan S, Nitta Y, Ozawa Y, Kawasaki Y, Ohtani T, Masuya J, Takahashi N, Sato N, Nakamura S, Nakagawa A, Shimizu E. Cognitive behavior therapy for autistic adolescents, awareness and care for my autistic traits program: a multicenter randomized controlled trial. BMC Psychiatry 2023; 23:661. [PMID: 37679711 PMCID: PMC10485995 DOI: 10.1186/s12888-023-05075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Autistic people demonstrate focused interests, sensitivity to sensory stimulation, and, compared with the general population, differences in social communication and interaction. We examined whether a combination of the Awareness and Care for My Autistic Traits (ACAT) program and treatment-as-usual is more effective than only treatment-as-usual in increasing the understanding of autistic attributes, reducing treatment stigma, and improving mental health and social adaptation among autistic adolescents and their parents/guardians. METHODS Forty-nine adolescents and their parents/guardians were randomly assigned to either a combination of ACAT and treatment-as-usual or only treatment-as-usual. The combined group received six weekly 100-minute ACAT sessions, while the treatment-as-usual group received no additional intervention. The primary outcome was the change in understanding of autistic attributes (Autism Knowledge Quiz-Child), administered from pre- to post-intervention. The secondary outcomes included the change in Autism Knowledge Quiz-Parent, reduced treatment stigma, and improved mental health and social adaptation among autistic adolescents and their parents/guardians. A primary outcome measure scale was scored by assessors who were blind to the group assignment. RESULTS The combined group (both autistic adolescents and their parents/guardians) showed an increase in Autism Knowledge Quiz scores compared to those in the treatment-as-usual group. Autistic adolescents in the combined group also demonstrated a decrease in treatment-related stigma and an improvement in general mental health compared to those in the treatment-as-usual group, while there were no group differences in the change in social adaptation. For parents/guardians, there were no group differences in the change in treatment-related stigma, general mental health, adaptive skills, or attitudes toward their children. CONCLUSIONS The ACAT program could be an effective treatment modality to increase the understanding of autistic attributes among both autistic adolescents and their parents/guardians. The ACAT program positively affects self-understanding, reduces treatment stigma, and stabilizes behavioral issues for autistic adolescents as a part of mental health measures, but it does not effectively reduce treatment barriers or improve mental health for parents/guardians. Further research should consider whether additional support for parents/guardians could be beneficial. TRIAL REGISTRATION The study was registered in UMIN (UMIN000029851, 06/01/2018).
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Affiliation(s)
- Fumiyo Oshima
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan.
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan.
| | - William Mandy
- Research Department of Clinical, Educational & Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Mikuko Seto
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Minako Hongo
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan
| | - Aki Tsuchiyagaito
- Laureate Instituto for Brain Research, 6655 S Yale Ave, Tulsa, OK, 74136, USA
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Siqing Guan
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Yusuke Nitta
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
| | - Toshiyuki Ohtani
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan
- Safety and Health Organization, Chiba University, Chiba, Japan
| | - Jiro Masuya
- Department of Psychiatry, Tokyo Medical University Ibaraki, Medical Center, 3-20-1 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan
| | - Noriko Takahashi
- Fukushima University Child Mental Health-Care Center, 1 Kanayagawa, Fukushima, 960-1296, Japan
| | - Noriyuki Sato
- Fukushima University Child Mental Health-Care Center, 1 Kanayagawa, Fukushima, 960-1296, Japan
| | - Shizuka Nakamura
- Fukushima University Child Mental Health-Care Center, 1 Kanayagawa, Fukushima, 960-1296, Japan
| | - Akiko Nakagawa
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, 260-8670, Chiba, Japan
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Chiba University, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, University of Fukui, Chiba, Japan
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11
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Oakley B, Boatman C, Doswell S, Dittner A, Clarke A, Ozsivadjian A, Kent R, Judd A, Baldoza S, Hearn A, Murphy D, Simonoff E. Molehill Mountain feasibility study: Protocol for a non-randomised pilot trial of a novel app-based anxiety intervention for autistic people. PLoS One 2023; 18:e0286792. [PMID: 37406026 PMCID: PMC10321642 DOI: 10.1371/journal.pone.0286792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
Up to 50% of autistic people experience co-occurring anxiety, which significantly impacts their quality of life. Consequently, developing new interventions (and/ or adapting existing ones) that improve anxiety has been indicated as a priority for clinical research and practice by the autistic community. Despite this, there are very few effective, evidence-based therapies available to autistic people that target anxiety; and those that are available (e.g., autism adapted Cognitive Behavioural Therapy; CBT) can be challenging to access. Thus, the current study will provide an early-stage proof of concept for the feasibility and acceptability of a novel app-based therapeutic approach that has been developed with, and adapted for, autistic people to support them in managing anxiety using UK National Institute for Health and Care Excellence (NICE) recommended adapted CBT approaches. This paper describes the design and methodology of an ethically approved (22/LO/0291) ongoing non-randomised pilot trial that aims to enrol approximately 100 participants aged ≥16-years with an existing autism diagnosis and mild-to-severe self-reported anxiety symptoms (trial registration NCT05302167). Participants will be invited to engage with a self-guided app-based intervention-'Molehill Mountain'. Primary (Generalised Anxiety Disorder Assessment, Hospital Anxiety and Depression Scale) and secondary outcomes (medication/ service use and Goal Attainment Scaling) will be assessed at baseline (Week 2 +/- 2), endpoint (Week 15 +/- 2) and three follow-ups (Weeks 24, 32 and 41 +/- 4). Participants will also be invited to complete an app acceptability survey/ interview at the study endpoint. Analyses will address: 1) app acceptability/ useability and feasibility (via survey/ interview and app usage data); and 2) target population, performance of outcome measures and ideal timing/ duration of intervention (via primary/ secondary outcome measures and survey/ interview)-with both objectives further informed by a dedicated stakeholder advisory group. The evidence from this study will inform the future optimisation and implementation of Molehill Mountain in a randomised-controlled trial, to provide a novel tool that can be accessed easily by autistic adults and may improve mental health outcomes.
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Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Camberwell, London, United Kingdom
| | - Charlotte Boatman
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Camberwell, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Camberwell, London, United Kingdom
| | - Sophie Doswell
- National Adult ADHD and ASD Psychology Service (NAAAPS), Behavioural & Developmental Psychiatry, Monks Orchard House, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Antonia Dittner
- National Adult ADHD and ASD Psychology Service (NAAAPS), Behavioural & Developmental Psychiatry, Monks Orchard House, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | | | - Ann Ozsivadjian
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Camberwell, London, United Kingdom
| | - Rachel Kent
- Michael Rutter Centre for Children & Young People, Maudsley Hospital, London, United Kingdom
| | | | | | | | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Camberwell, London, United Kingdom
- Sackler Institute for Translational Neurodevelopment, King’s College London, Denmark Hill, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Camberwell, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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12
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Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J. A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01555-4. [PMID: 37353645 DOI: 10.1007/s10578-023-01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.
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Affiliation(s)
- Shir Rozenblat
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | | | | | - Michal Perez
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Judah Koller
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
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13
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Klein J, Kerns C, Hills K, Hogan A, Matherly S, Roberts J. Brief Report: Prevalence and Predictors of DSM-Specific and Distinct Anxiety in Cognitively Impaired Autistic Preschool Children. J Autism Dev Disord 2023:10.1007/s10803-023-05978-9. [PMID: 37039980 DOI: 10.1007/s10803-023-05978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
Autistic individuals are twice as likely to meet criteria for anxiety than neurotypical children; yet we lack understanding of early presentations of anxiety in young autistic children, especially those with cognitive impairment. This study is the first to utilize an autism-specific anxiety diagnostic interview with 28 preschool cognitively impaired, autistic children and 18 neurotypical, age-matched controls. Results indicate that 64% of autistic children met criteria for DSM-specified or "other specified," herein referred to as "distinct," anxiety disorders; 32% met criteria for multiple anxiety disorders, with phobias occurring most often. Results indicate that anxiety is highly prevalent in cognitively-impaired, autistic preschool children, highlighting the need for developmentally-tailored assessment and treatment in early childhood.
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Affiliation(s)
- Jordan Klein
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Connor Kerns
- University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Hills
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Jane Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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14
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Kazzi C, Campbell L, Porter M. Psychological therapies for anxiety in autistic individuals with co-occurring intellectual developmental disorder: A systematic review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AbstractThis systematic review aimed to evaluate the efficacy of psychological therapies for anxiety for people with autism and co-occurring intellectual developmental disorder (AUT + IDD). A systematic search identified 13 studies comprising 49 participants with AUT + IDD, aged between 5 and 41 years. Most studies were single-case experimental designs (n = 7) or case studies or case series (n = 4). Studies implemented cognitive behavioural therapy (n = 4) or exposure therapy techniques (n = 9). All studies reported a reduction in anxiety symptoms, as measured by either quantitative measures or defined as participants meeting end of treatment criterion. However, the conclusions are preliminary due to the methodological limitations of the current literature. The implications of these findings, as well as recommendations for future direction in the field, are discussed.
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15
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Meyer AT, Moody EJ, Keefer A, O'Kelley S, Duncan A, Blakeley-Smith A, Reaven J. Effect of Co-occurring Psychiatric Disorders on Treatment of Children with Autism Spectrum Disorder and Anxiety. J Autism Dev Disord 2023; 53:569-579. [PMID: 32462457 DOI: 10.1007/s10803-020-04540-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Co-occurring psychiatric diagnoses are very common in individuals with ASD. Little is known about the effect that co-occurring psychiatric conditions may have on treatment response to CBT for children with ASD and anxiety. The present study examined the relationship between co-occurring psychiatric diagnoses and response to CBT for anxiety in ninety youth with ASD. Psychiatric complexity did not appear to differentially impact treatment response. A notable portion of youth with anxiety and externalizing disorders such as ADHD, no longer met criteria for those externalizing diagnoses following intervention. Results indicate that youth with ASD and anxiety present with complex psychiatric profiles and CBT for anxiety may positively affect co-occurring diagnoses. In addition, thorough and nuanced assessment of psychiatric symptoms in youth with ASD is needed to ensure the differentiation between diagnoses of anxiety and other co-occurring psychiatric symptoms.
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Affiliation(s)
- Allison T Meyer
- JFK Partners, Department of Pediatrics, University of Colorado School of Medicine, Education 2 South, 13121 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Eric J Moody
- Wyoming Institude for Disabilities, College of Health Sciences, University of Wyoming, Laramie, WY, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Audrey Blakeley-Smith
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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16
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Kilburn TR, Sørensen MJ, Thastum M, Rapee RM, Rask CU, Arendt KB, Carlsen AH, Thomsen PH. Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder: A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting. J Autism Dev Disord 2023; 53:525-538. [PMID: 32219638 DOI: 10.1007/s10803-020-04471-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8-14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting.
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Affiliation(s)
- Tina R Kilburn
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark.
| | - Merete J Sørensen
- Department of Child and Adolescent Psychiatry, Psychiatric Clinic for School Aged Children, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Charlotte U Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatric Clinic for School Aged Children, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristian B Arendt
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Anders H Carlsen
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
| | - Per H Thomsen
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Bobbitt S, Kawamura A, Saunders N, Monga S, Penner M, Andrews D. Anxiety in children and youth: Part 2-The management of anxiety disorders. Paediatr Child Health 2023; 28:52-66. [PMID: 36865757 PMCID: PMC9971334 DOI: 10.1093/pch/pxac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2022] [Indexed: 03/04/2023] Open
Abstract
Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.
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Affiliation(s)
- Susan Bobbitt
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Anne Kawamura
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Natasha Saunders
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Suneeta Monga
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Melanie Penner
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
| | - Debra Andrews
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario, Canada
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18
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Linden A, Best L, Elise F, Roberts D, Branagan A, Tay YBE, Crane L, Cusack J, Davidson B, Davidson I, Hearst C, Mandy W, Rai D, Smith E, Gurusamy K. Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:7-30. [PMID: 35957523 PMCID: PMC9806485 DOI: 10.1177/13623613221117931] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.
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Affiliation(s)
- Audrey Linden
- University College London, UK,Audrey Linden, Centre for Research in
Autism and Education, University College London, London WC1H 0NU, UK.
| | | | | | | | | | | | | | | | | | - Ian Davidson
- Cheshire and Wirral Partnership NHS
Foundation Trust, UK
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19
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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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20
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Preliminary efficacy of cognitive-behavioral therapy on emotion regulation in adults with autism spectrum disorder: A pilot randomized waitlist-controlled study. PLoS One 2022; 17:e0277398. [PMID: 36417403 PMCID: PMC9683545 DOI: 10.1371/journal.pone.0277398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
Previous studies have demonstrated the clinical utility of cognitive-behavioral therapy in improving emotion regulation in children on the autism spectrum. However, no studies have elucidated the clinical utility of cognitive-behavioral therapy in improving emotion regulation in autistic adults. The aim of the present pilot study was to explore the preliminary clinical utility of a group-based cognitive-behavioral therapy program designed to address emotion regulation skills in autistic adults. We conducted a clinical trial based on a previously reported protocol; 31 participants were randomly allocated to the intervention group and 29 to the waitlist control group. The intervention group underwent an 8-week program of cognitive-behavioral therapy sessions. Two participants from the intervention group withdrew from the study, leaving 29 participants (93.5%) in the group. Compared with the waitlist group, the cognitive-behavioral therapy group exhibited significantly greater pre-to-post (Week 0-8) intervention score improvements on the attitude scale of the autism spectrum disorder knowledge and attitude quiz (t = 2.21, p = 0.03, d = 0.59) and the difficulty describing feelings scale of the 20-item Toronto Alexithymia Scale (t = -2.07, p = 0.04, d = -0.57) in addition to pre-to-follow-up (Week 0-16) score improvements on the emotion-oriented scale of the Coping Inventory for Stressful Situations (t = -2.14, p = 0.04, d = -0.59). Our study thus provides preliminary evidence of the efficacy of the group-based cognitive-behavioral therapy program on emotion regulation in autistic adults, thereby supporting further evaluation of the effectiveness of the cognitive-behavioral therapy program in the context of a larger randomized clinical trial. However, the modest and inconsistent effects underscore the importance of continued efforts to improve the cognitive-behavioral therapy program beyond current standards.
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21
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Possible Neural Mechanisms Underlying Sensory Over-Responsivity in Individuals with ASD. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00257-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Interventions for Sensory Over-Responsivity in Individuals with Autism Spectrum Disorder: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101584. [PMID: 36291519 PMCID: PMC9601143 DOI: 10.3390/children9101584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Individuals with autism spectrum disorder (ASD) often exhibit sensory over-responsivity (SOR), which is characterized by an overwhelmingly negative reaction to or avoidance of sensory stimulation. Despite the detrimental effects of SOR on people’s personal and social lives, the knowledge of and interventions for the issue remain limited. This paper collates and reviews studies on SOR and information on the potential for effective interventions for people with ASD. This review reveals evidence that SOR has a close relationship with anxiety, depression, insomnia, and family life impairment and an underlying mechanism related to SOR. Four interventions and their theoretical bases in sensory-motor processing are discussed in this paper, namely, physical activity (PA), sensory integration therapy (SIT), mindfulness-based cognitive therapy (MBCT), and cognitive behavioral therapy (CBT). These interventions focus on establishing coping strategies for regulating the emotional response to sensory information, and they have been found to be effective and to have the potential to help children with ASD reduce their SOR behaviors. This paper provides guidance for selecting appropriate interventions and for further investigation of more effective interventions in the future.
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23
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Brosnan M, Adams S. Adapting Drug and Alcohol Therapies for Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:214-223. [PMID: 36606157 PMCID: PMC9645670 DOI: 10.1089/aut.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Autistic people may be at a higher risk of drug and alcohol misuse than the general population. Autistic people, however, are under-represented within drug and alcohol support services. This is the first survey of drug and alcohol therapists' perceptions of current service provision for autistic clients and recommendations for reasonable adjustments that therapists can make to enhance successful outcomes. Methods We conducted an online survey of 122 drug and alcohol therapists, exploring therapists' demographics, training and experience with autistic clients, approaches and adaptations used with autistic clients, and therapists' confidence with autistic clients. Within two focus groups, 11 members of the autistic and broader autism (e.g., family members, professionals) communities reflected on the reasonable adjustments reported by therapists. Results Most therapists had autistic clients and most therapists had received no autism-specific training. Alcohol misuse was the most common presenting issue, and most therapists reported that treatment outcomes were less favorable for autistic clients than for other groups. Therapists perceived that barriers to successful outcomes were (1) a lack of autism-specific training, (2) a need to adapt therapy for autistic clients, and (3) a lack of shared perspective between the therapist and the autistic client. Previous research has identified a range of reasonable adaptations and, when asked, therapists were moderately confident in their ability to deliver these. Members of the autistic and broader autism communities coproduced guidance detailing how therapists can best adapt their practice for autistic clients including how to structure sessions and the language to use within sessions. Conclusion This study highlights a need for practical and theoretical training for drug and alcohol therapists to support successful adaptation to current service provision for autistic clients and to develop a shared perspective on the desired aims and outcomes of the therapeutic process.
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Affiliation(s)
- Mark Brosnan
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Sally Adams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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24
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Chancel R, Miot S, Dellapiazza F, Baghdadli A. Group-based educational interventions in adolescents and young adults with ASD without ID: a systematic review focusing on the transition to adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-21. [PMID: 32889578 DOI: 10.1007/s00787-020-01609-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
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Affiliation(s)
- Raphael Chancel
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Stephanie Miot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHU de Montpellier, Université de Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier, France
| | - Florine Dellapiazza
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
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25
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Wittkopf S, Stroth S, Langmann A, Wolff N, Roessner V, Roepke S, Poustka L, Kamp-Becker I. Differentiation of autism spectrum disorder and mood or anxiety disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1056-1069. [PMID: 34404245 PMCID: PMC9340140 DOI: 10.1177/13623613211039673] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Symptoms of mood and anxiety disorders overlap with symptoms of autism spectrum disorder, making the diagnostic process challenging. This study found that a combination of communicational deficits and unusual and/or inappropriate social overtures facilitates differentiation between autism spectrum disorder and mood and anxiety disorders. Furthermore, the results confirm the essential need of a behavioral observation with the Autism Diagnostic Observation Schedule in combination with a full Autism Diagnostic Interview-Revised to support diagnostic decisions.
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26
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Yang YJ, Chung KM. Pilot Randomized Control Trial of an App-Based CBT Program for Reducing Anxiety in Individuals with ASD without Intellectual Disability. J Autism Dev Disord 2022; 53:1331-1346. [PMID: 35689137 DOI: 10.1007/s10803-022-05617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
This study developed and tested the effectiveness of an app-based cognitive behavioral therapy (CBT) program in alleviating anxiety among adolescents and adults with autism without co-occurring intellectual disability. Thirty participants from 15 to 35 years old were randomly assigned to either the intervention or waitlist control group, and self- and caregiver proxy report questionnaires were administered, accompanied by direct behavior observation before and after the intervention period. There was a significant decrease in anxiety level, an increase in positive affect, and a decline in stereotypic behaviors, hyperactivity, noncompliance, and inappropriate speech in proxy reports for the intervention group, compared to the control group. A significant rise in passive response in the direct observation was also seen in the intervention group.
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Affiliation(s)
- Yoon Jung Yang
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Kyong-Mee Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea.
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27
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PlanTEA: Supporting Planning and Anticipation for Children with ASD Attending Medical Appointments. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In people with Autism Spectrum Disorder (ASD), skills related to anticipation and mental flexibility are often impaired, so their thinking tends to be very rigid and their behavior is based on establishing routines. For this reason, children with ASD may show disruptive behaviors when faced with disturbing but necessary activities, such as going to a doctor’s appointment. Therefore, it is very convenient and necessary for their families to prepare in advance for the visit and to explain the details of the procedure to be performed at the consultation. The use of anticipation boards in these situations allows to prepare such situations and to reduce stress for both the ASD child and their families or caregivers. In this context, the use of technology can provide great benefits for anticipating a new event, or whatever risks the control of their routines, as well as enhancing developmental skills such as communication, autonomy, social interaction, etc. This article describes a software tool, for mobile devices such as tablets, that allows the planning of the attendance of children with ASD to the necessary medical appointments throughout their childhood and adolescence, as well as communication with specialists. This app, named PlanTEA, has undergone a preliminary evaluation that has yielded very positive results. Most participants found the app useful in helping to anticipate (94.1%) and improve communication (94.2%) for people with ASD in medical contexts, considered it easy to use, with no technical support needed to use it (almost 100%), and would recommend its use (94.2%). This first evaluation has also allowed us to define the next steps to be taken to improve and enhance this tool and thus reach a wider population within the autistic disorder. As a result of the evaluation carried out and the comments received, it is proposed to extend its use to adult users and those with high-functioning autism, which supposes expanding and extending the functionalities of the current version of PlanTEA.
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28
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Meza N, Rojas V, Escobar Liquitay CM, Pérez I, Aguilera Johnson F, Amarales Osorio C, Irarrázaval M, Madrid E, Franco JVA. Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews. BMJ Evid Based Med 2022:bmjebm-2021-111811. [PMID: 35217568 DOI: 10.1136/bmjebm-2021-111811] [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: 01/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children. DESIGN Overview of systematic reviews (SRs). PARTICIPANTS Children aged 12 years and under with ASD. SEARCH METHODS In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication. INTERVENTIONS 17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study). DATA COLLECTION AND ANALYSIS We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs. MAIN OUTCOME MEASURES A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PUBLIC AND PATIENT INVOLVEMENT STATEMENT Organisations of parents of children with ASD participated in external revision of the final version of the report. RESULTS We identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing). CONCLUSIONS Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed. PROSPERO REGISTRATION NUMBER CRD42020206535.
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Affiliation(s)
- Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Valeria Rojas
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Autism program, Hospital Dr Gustavo Fricke, Viña del Mar, Chile
| | | | - Ignacio Pérez
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
| | | | - Claudia Amarales Osorio
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Pediatric Neurology Unit, Hospital Carlos van Buren, Valparaíso, Chile
| | - Matías Irarrázaval
- Department of Mental Health, Ministry of Health, Santiago, Chile
- Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Eva Madrid
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Juan Victor Ariel Franco
- Associate Cochrane Centre - Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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29
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Frank HE, Kagan ER, Storch EA, Wood JJ, Kerns C, Lewin AB, Small BJ, Kendall PC. Accommodation of Anxiety in Youth with Autism Spectrum Disorder: Results from the TAASD Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:219-229. [PMID: 32511015 PMCID: PMC7722072 DOI: 10.1080/15374416.2020.1759075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: Accommodation, or the ways in which families modify their routines and expectations in response to a child's anxiety, is common and interferes with anxiety treatment outcomes. However, little research has examined family accommodation among youth with autism spectrum disorder and anxiety. The current study aimed to (a) identify pre-treatment correlates of accommodation, (b) examine changes in accommodation after treatment, and (c) assess relationships between accommodation and post-treatment anxiety severity.Method: The sample consisted of 167 youth (mean age = 9.90 years; 79.6% male; 18% Latinx) with clinically significant anxiety and a diagnosis of autism spectrum disorder who were enrolled in a randomized clinical trial comparing two cognitive behavioral therapy interventions for anxiety and treatment-as-usual. Participants were evaluated for symptom severity and family accommodation at pre- and post-treatment.Results: Results indicated that clinician-rated anxiety severity and parent-rated externalizing behaviors and autism spectrum disorder severity significantly predicted pre-treatment accommodation. Accommodation significantly decreased from pre- to post-treatment and non-responders showed significantly higher accommodation at post-treatment compared to responders. Finally, youth with higher pre-treatment accommodation had higher post-treatment anxiety.Conclusions: Findings indicate that accommodation for anxiety is common among youth with autism spectrum disorder and anxiety. Furthermore, accommodation is implicated in treatment outcomes and should be targeted in treatment for youth with autism spectrum disorder and anxiety.
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Affiliation(s)
- Hannah E. Frank
- Temple University, Philadelphia, PA,Corresponding author: Hannah Frank, M.A., 1701 N 13th St., Philadelphia, PA 19122,
| | | | | | | | - Connor Kerns
- University of British Columbia, Vancouver, BC, Canada
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30
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Alenezi S, Albawardi IM, Aldakhilallah A, Alnufaei GS, Alshabri R, Alhamid L, Alotaiby A, Alharbi N. Preference, Knowledge, and Attitudes of Parents Toward Cognitive Behavioral Therapy for Their Children in Riyadh, Saudi Arabia. Front Psychol 2021; 12:725083. [PMID: 34925134 PMCID: PMC8675882 DOI: 10.3389/fpsyg.2021.725083] [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] [Received: 06/14/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Cognitive behavioral therapy (CBT) for children and adolescents has shown efficacy in treating different psychiatric disorders. It has been added to multiple clinical guidelines as the first-line treatment. However, despite more studies of its efficacy, CBT is underutilized in clinical settings due to a lack of rigorous training programs and qualified CBT therapists. The limited knowledge of parents in this intervention and their negative attitudes toward it have been considered as possible reasons. Methods: This is a cross-sectional survey-based study among 464 Saudi parents living in Riyadh city. We aimed to evaluate the preference, knowledge, and attitudes of Saudi parents toward CBT for their children. We compared the difference in the level of knowledge and attitudes toward CBT in relation to the characteristics of parents. An online questionnaire that included 39 questions was carefully reconstructed from four validated scales, approved by an expert panel, and piloted. Participants were recruited to participate through online social media. Results: Saudi parents had average knowledge about CBT; however, they had positive attitudes toward the therapy itself and its role in treating the behavioral issues of children. Male participants showed better knowledge than female participants. Participants with higher education and those with high income had more favorable attitudes toward CBT than others. Conclusion: The knowledge of parents is considered inadequate and indicated the need for more awareness and perhaps mass education. In contrast, they maintained positive attitudes and were interested in evidence-based treatment, with more preference toward non-psychopharmacological interventions.
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Affiliation(s)
- Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim M. Albawardi
- Department of Psychiatry, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amirah Aldakhilallah
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghaliah S. Alnufaei
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Alshabri
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lama Alhamid
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alanoud Alotaiby
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah Alharbi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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31
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Sharma S, Hucker A, Matthews T, Grohmann D, Laws KR. Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis. BMC Psychol 2021; 9:151. [PMID: 34598734 PMCID: PMC8487131 DOI: 10.1186/s40359-021-00658-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022] Open
Abstract
Background Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth. Method Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up. Results A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials. Conclusions The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00658-8.
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Affiliation(s)
- Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK.
| | - Abigail Hucker
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Terry Matthews
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Dominique Grohmann
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, UK
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32
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Lee DK, Li SW, Bounni F, Friedman G, Jamali M, Strahs L, Zelinger O, Gabrieli P, Stankovich MA, Demaree J, Williams ZM. Reduced sociability and social agency encoding in adult Shank3-mutant mice are restored through gene re-expression in real time. Nat Neurosci 2021; 24:1243-1255. [PMID: 34253921 PMCID: PMC8410666 DOI: 10.1038/s41593-021-00888-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
Despite a growing understanding of the molecular and developmental basis of autism spectrum disorder (ASD), how the neuronal encoding of social information is disrupted in ASD and whether it contributes to abnormal social behavior remains unclear. Here, we disrupted and then restored expression of the ASD-associated gene Shank3 in adult male mice while tracking the encoding dynamics of neurons in the medial prefrontal cortex (mPFC) over weeks. We find that Shank3 disruption led to a reduction of neurons encoding the experience of other mice and an increase in neurons encoding the animal's own experience. This shift was associated with a loss of ability by neurons to distinguish other from self and, therefore, the inability to encode social agency. Restoration of Shank3 expression in the mPFC reversed this encoding imbalance and increased sociability over 5-8 weeks. These findings reveal a neuronal-encoding process that is necessary for social behavior and that may be disrupted in ASD.
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Affiliation(s)
- Daniel K Lee
- Harvard-MIT Division of Health Sciences and Technology, Boston MA,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - S William Li
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA,Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston MA
| | - Firas Bounni
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Gabriel Friedman
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Mohsen Jamali
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | | | | | | | - Michael A Stankovich
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA
| | | | - Ziv M Williams
- Harvard-MIT Division of Health Sciences and Technology, Boston MA,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston MA,Harvard Medical School, Program in Neuroscience, Boston MA,Correspondence should be made to -
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33
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Wang X, Zhao J, Huang S, Chen S, Zhou T, Li Q, Luo X, Hao Y. Cognitive Behavioral Therapy for Autism Spectrum Disorders: A Systematic Review. Pediatrics 2021; 147:peds.2020-049880. [PMID: 33888566 DOI: 10.1542/peds.2020-049880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT In several studies, authors have reported on cognitive behavioral therapy (CBT) for children and adolescents with autism spectrum disorders (ASDs), but inconsistent treatment effectiveness was revealed from these studies. OBJECTIVE To evaluate the effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD by using a meta-analytic approach. DATA SOURCES Data sources included PubMed, Embase, and the Cochrane Library. STUDY SELECTION We selected randomized controlled trials (RCTs) in which authors reported effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD from database inception to May 2019. DATA EXTRACTION For each study, 2 authors extracted data on the first author's surname, publication year, country, sample size, mean age, CBT target, intervention, outcome measurement, follow-up duration, and investigated outcomes. RESULTS Forty-five RCTs and 6 quasi RCTs of 2485 children and adolescents with ASDs were selected for the final meta-analysis. There was no significant difference between CBT and control for symptoms related to ASD based on self-reported outcomes (standard mean difference: -0.09; 95% confidence interval: -0.42 to 0.24; P = .593), whereas CBT significantly improved the symptoms related to ASD based on informant-reported outcomes, clinician-rated outcomes, and task-based outcomes. Moreover, the pooled standard mean differences indicated that CBT has no significant effect on symptoms of social-emotional problems based on self-reported outcomes. LIMITATIONS The quality of included studies was low to modest, significant heterogeneity among the included studies for all investigated outcomes was detected, and publication bias was inevitable. CONCLUSIONS These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD.
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Lei J, Russell A. I Have a Fear of Negative Evaluation, Get Me Out of Here! Examining Latent Constructs of Social Anxiety and Autistic Traits in Neurotypical and Autistic Young People. J Autism Dev Disord 2021; 51:1729-1747. [PMID: 32808152 PMCID: PMC8084828 DOI: 10.1007/s10803-020-04657-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Understanding shared and unique constructs underlying social communication difficulties in autism spectrum disorder (ASD) and social anxiety disorder (SAD) can address potential diagnostic overshadowing when evaluating SAD in the context of autism. Using self-report measures, factor analyses examined constructs underlying autistic traits, social anxiety, internalising symptoms and wellbeing amongst 267 neurotypical (17-19 years) and 145 autistic (15-22 years) students in the UK. Shared constructs across measures assessed general social communication competency (e.g., social distress in new situations and peer relationships). Fear of Negative Evaluation (FNE) was identified in both samples as a stable construct unique to social anxiety. Adapting interventions targeting SAD in autism should target FNE during adolescence which marks a period of heightened peer interaction and social vulnerability.
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Affiliation(s)
- Jiedi Lei
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK
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35
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Diefenbach GJ, Stevens KT, Dunlap A, Nicholson AM, Grella ON, Pearlson G, Assaf M. Autistic Traits Moderate Reappraisal Success for Depression and Anxiety Symptoms. J Autism Dev Disord 2021; 52:1435-1443. [PMID: 33929680 DOI: 10.1007/s10803-021-05003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 04/12/2023]
Abstract
Cognitive reappraisal is associated with reduced emotional distress; however, little is known about the nature of this relationship in autism. This study tested whether autistic traits moderate reappraisal success (i.e., the negative correlation between reappraisal use and emotional symptom severity). Emotional symptoms were assessed using measures of depression, anxiety, and stress. It was hypothesized that more severe autistic traits would be associated with weaker reappraisal success across all scales. Data were collected from 377 adults using an on-line survey. Structural equation models found moderation effects for depression and anxiety, but not stress. Contrary to hypotheses, more severe autistic traits were associated with stronger reappraisal success. These preliminary results support including reappraisal in emotion regulation treatments for individuals with autistic traits.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA. .,Yale University School of Medicine, New Haven, CT, USA.
| | - Kimberly T Stevens
- Anxiety Disorders Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Amanda Dunlap
- Olin Neuropsychiatry Research Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Alycia M Nicholson
- Olin Neuropsychiatry Research Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Olivia N Grella
- Olin Neuropsychiatry Research Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Godfrey Pearlson
- Yale University School of Medicine, New Haven, CT, USA.,Olin Neuropsychiatry Research Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Michal Assaf
- Yale University School of Medicine, New Haven, CT, USA.,Olin Neuropsychiatry Research Center, The Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
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36
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Oerbeck B, Overgaard KR, Attwood T, Bjaastad JF. "Less stress": a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders. Scand J Child Adolesc Psychiatr Psychol 2021; 9:30-40. [PMID: 33928052 PMCID: PMC8077410 DOI: 10.21307/sjcapp-2021-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment. Methods: Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The “Less Stress” program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS). Results: The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program. Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment. Conclusion: The therapists found the “Less stress” program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.
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Affiliation(s)
- Beate Oerbeck
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
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Anxiety and Depression Reduction as Distal Outcomes of a College Transition Readiness Program for Adults with Autism. J Autism Dev Disord 2021; 51:298-306. [PMID: 32468396 DOI: 10.1007/s10803-020-04549-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Young adults with autism spectrum disorder (ASD) experience increased rates of anxiety and depression which can impact academic success. The Stepped Transition in Education Program for Students with ASD (STEPS) applies cognitive-behavioral principles to help young adults with ASD improve their adjustment to postsecondary education. We aimed to determine if STEPS had an effect on anxiety and depression. Treatment-seeking adults with ASD (n = 32; Mage = 19.74) were randomized to STEPS or transition as usual (TAU; i.e., waitlist control group). STEPS participants evinced significantly greater declines in depressive symptoms from pre-treatment to post-treatment compared to the waitlist. Anxiety symptoms did not significantly change. Results suggest that transition support for young people with ASD may improve mental health.
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Improvement of brain functional connectivity in autism spectrum disorder: an exploratory study on the potential use of virtual reality. J Neural Transm (Vienna) 2021; 128:371-380. [PMID: 33677622 DOI: 10.1007/s00702-021-02321-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/26/2021] [Indexed: 01/11/2023]
Abstract
Patients with Autism Spectrum Disorder (ASD) need to be provided with behavioral, psychological, educational, or skill-building interventions as early as possible. Cognitive Behavior Therapy has proven useful to manage such problems. There is also growing evidence on the usefulness of Virtual Reality Therapy (VRT) in treating various functional deficits in ASD. This exploratory study is aimed at assessing the changes in cognitive functions in children with ASD, and the putative subtending neurophysiological mechanisms, following the provision of rehab training using an innovative VRT system. Twenty patients with ASD, aged 6-15 years, were provided with 24 sessions of VRT by using the pediatric module of the BTS NIRVANA System. Neuropsychological and EEG evaluations were carried out before and at the end of the training. After VRT, all patients showed a significant improvement in their cognitive-behavioral problems concerning attention processes, visuospatial cognition, and anxiety. These findings were paralleled by an evident reshape of frontoparietal connectivity in the alpha and theta frequency range. Our study suggests that VRT could be a useful and promising tool to improve ASD neurorehabilitation outcomes. This improvement is likely to occur through changes in frontoparietal network connectivity following VRT.
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Vulcan M. The "Muscles of the Psyche": From Body Literacy to Emotional Literacy. Front Psychol 2021; 11:548964. [PMID: 33551892 PMCID: PMC7854468 DOI: 10.3389/fpsyg.2020.548964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process.
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Affiliation(s)
- Maya Vulcan
- Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv, Israel
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40
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Brief Report: Mindfulness Training for Chinese Adolescents with Autism Spectrum Disorder and Their Parents in Hong Kong. J Autism Dev Disord 2021; 51:4147-4159. [PMID: 33484370 PMCID: PMC8510984 DOI: 10.1007/s10803-020-04729-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness program (MYmind) on Chinese adolescents with autism spectrum disorder and their parents in Hong Kong, China using a randomized controlled trial with a waitlist control group. Results showed the study had 80% compliance rate, 0% dropout rate, and 89% response rate. Between-group comparisons showed mindfulness had trend effects on parent’s rumination (g = 1.16), mindful parenting (d = 0.6), parenting style (d = 0.59), and parenting stress (d = 0.5). The study demonstrated the feasibility of the MYmind program in the Chinese context. A larger trial with longer follow-up period is suggested to better examine the effect of mindfulness on adolescents with ASD and their parents.
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Tai APL, Lau WKW. Revisit the Effectiveness of Educational Kinesiology on Stress and Anxiety Amelioration in Kindergarteners With Special Needs Using Biological Measures. Front Psychiatry 2021; 12:773659. [PMID: 34955921 PMCID: PMC8702520 DOI: 10.3389/fpsyt.2021.773659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Educational kinesiology is a popular intervention that aims to improve brain functioning via physical movements. Yet, it lacks supporting scientific evidence and is regarded as pseudoscience. Given the popularity of educational kinesiology in school settings, it is important to revisit its effectiveness through scientific research. Previous studies that evaluated the effectiveness of educational kinesiology relied mainly on subjective measures, in which subjective bias is inevitable. Cortisol and oxytocin levels in saliva have been reported to be reliable stress and anxiety markers that provide unbiased objective data. This study explores the effect of educational kinesiology on the changes in salivary cortisol and oxytocin levels in kindergarteners with special needs. Methods: A quasi-experimental design was adopted in this study. Thirty-seven kindergarteners (3.5-6.5 years old) who were either diagnosed with one type of special needs or referred by school principals due to the requirement of special supports at school were assigned to either the intervention group, which received 1-h educational kinesiology intervention weekly for a total of 10 weeks, or the wait-list control group. Saliva samples were collected at baseline and after the completion of intervention programme for the measurement of cortisol and oxytocin levels. Scores of Parent-rated Preschool Anxiety Scale (PAS-TC) were also collected at pre- and post-intervention. Because of the small samples, non-parametric tests such as Mann-Whitney U test, Quade test, and Fisher's exact tests were used in this study where appropriate. Results: After controlled for the effect at baseline, gender and types of special needs, the changes in oxytocin levels were significantly higher in the intervention group compared with control [F (1, 35) = 4.747, p = 0.036, eta2 = 0.119], whereas no significant between-group difference in changes of cortisol levels was observed [F (1, 35) = 0.306, p = 0.584, eta2 = 0.009]. Results from PAS-TC showed significant improvement in anxiety levels after the intervention in the intervention group (p = 0.048, ϕ = 0.344, p = 0.037). Conclusions: Our findings suggest a plausible anti-anxiety effect of educational kinesiology in kindergarteners with special needs by elevating the oxytocin levels. Future studies are warranted to further confirm our findings with a larger sample.
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Affiliation(s)
- Alan Pui-Lun Tai
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Integrated Centre for Wellbeing, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Bioanalytical Laboratory for Educational Sciences, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Way Kwok-Wai Lau
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Integrated Centre for Wellbeing, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Bioanalytical Laboratory for Educational Sciences, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
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43
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A Systematic Review of the Perceived Barriers and Facilitators to Accessing Psychological Treatment for Mental Health Problems in Individuals on the Autism Spectrum. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00226-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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44
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Troisi J, Autio R, Beopoulos T, Bravaccio C, Carraturo F, Corrivetti G, Cunningham S, Devane S, Fallin D, Fetissov S, Gea M, Giorgi A, Iris F, Joshi L, Kadzielski S, Kraneveld A, Kumar H, Ladd-Acosta C, Leader G, Mannion A, Maximin E, Mezzelani A, Milanesi L, Naudon L, Peralta Marzal LN, Perez Pardo P, Prince NZ, Rabot S, Roeselers G, Roos C, Roussin L, Scala G, Tuccinardi FP, Fasano A. Genome, Environment, Microbiome and Metabolome in Autism (GEMMA) Study Design: Biomarkers Identification for Precision Treatment and Primary Prevention of Autism Spectrum Disorders by an Integrated Multi-Omics Systems Biology Approach. Brain Sci 2020; 10:E743. [PMID: 33081368 PMCID: PMC7603049 DOI: 10.3390/brainsci10100743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
Autism Spectrum Disorder (ASD) affects approximately 1 child in 54, with a 35-fold increase since 1960. Selected studies suggest that part of the recent increase in prevalence is likely attributable to an improved awareness and recognition, and changes in clinical practice or service availability. However, this is not sufficient to explain this epidemiological phenomenon. Research points to a possible link between ASD and intestinal microbiota because many children with ASD display gastro-intestinal problems. Current large-scale datasets of ASD are limited in their ability to provide mechanistic insight into ASD because they are predominantly cross-sectional studies that do not allow evaluation of perspective associations between early life microbiota composition/function and later ASD diagnoses. Here we describe GEMMA (Genome, Environment, Microbiome and Metabolome in Autism), a prospective study supported by the European Commission, that follows at-risk infants from birth to identify potential biomarker predictors of ASD development followed by validation on large multi-omics datasets. The project includes clinical (observational and interventional trials) and pre-clinical studies in humanized murine models (fecal transfer from ASD probands) and in vitro colon models. This will support the progress of a microbiome-wide association study (of human participants) to identify prognostic microbiome signatures and metabolic pathways underlying mechanisms for ASD progression and severity and potential treatment response.
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Affiliation(s)
- Jacopo Troisi
- Theoreo srl spin off company of the University of Salerno, Via degli Ulivi, 3, 84090 Montecorvino Pugliano (SA), Italy;
| | - Reija Autio
- Faculty of Social Sciences, Health Sciences Unit, Tampere University, Arvo Ylpön Katu 34, 33014 Tampere, Finland;
| | - Thanos Beopoulos
- Bio-Modeling System, 3, Rue De L’arrivee. 75015 Paris, France; (T.B.); (M.G.); (F.I.)
| | - Carmela Bravaccio
- Department of science medicine translational, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy;
| | | | - Giulio Corrivetti
- Azienda Sanitaria Locale (ASL) Salerno, Via Nizza, 146, 84125 Salerno (SA), Italy;
| | - Stephen Cunningham
- National University of Ireland Galaway, University Road, Galaway, Ireland; (S.C.); (L.J.); (G.L.); (A.M.)
| | - Samantha Devane
- Massachusetts General Hospital, Fruit Street, 55, Boston, MA 02114, USA; (S.D.); (S.K.)
| | - Daniele Fallin
- John Hopkins School of Public Health and the Wendy Klag Center for Autism and Developmental Disabilities, 615 N. Wolfe St, Baltimore, MD 21205, USA; (D.F.); (C.L.-A.)
| | - Serguei Fetissov
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Inserm UMR 1239, Rouen University of Normandy, 25 rue Tesnière, 76130 Mont-Saint-Aignan, France;
| | - Manuel Gea
- Bio-Modeling System, 3, Rue De L’arrivee. 75015 Paris, France; (T.B.); (M.G.); (F.I.)
| | | | - François Iris
- Bio-Modeling System, 3, Rue De L’arrivee. 75015 Paris, France; (T.B.); (M.G.); (F.I.)
| | - Lokesh Joshi
- National University of Ireland Galaway, University Road, Galaway, Ireland; (S.C.); (L.J.); (G.L.); (A.M.)
| | - Sarah Kadzielski
- Massachusetts General Hospital, Fruit Street, 55, Boston, MA 02114, USA; (S.D.); (S.K.)
| | - Aletta Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3508 TB Utrecht, The Netherlands; (A.K.); (L.N.P.M.); (P.P.P.); (N.Z.P.)
| | - Himanshu Kumar
- Danone Nutricia Research, Uppsalalaan, 12, 3584 CT Utrecht, The Netherlands; (H.K.); (R.G.)
| | - Christine Ladd-Acosta
- John Hopkins School of Public Health and the Wendy Klag Center for Autism and Developmental Disabilities, 615 N. Wolfe St, Baltimore, MD 21205, USA; (D.F.); (C.L.-A.)
| | - Geraldine Leader
- National University of Ireland Galaway, University Road, Galaway, Ireland; (S.C.); (L.J.); (G.L.); (A.M.)
| | - Arlene Mannion
- National University of Ireland Galaway, University Road, Galaway, Ireland; (S.C.); (L.J.); (G.L.); (A.M.)
| | - Elise Maximin
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), AgroParisTech, Micalis Institute, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (E.M.); (L.N.); (S.R.); (L.R.)
| | - Alessandra Mezzelani
- Consiglio Nazionale delle Ricerche (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy; (A.M.); (L.M.)
| | - Luciano Milanesi
- Consiglio Nazionale delle Ricerche (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy; (A.M.); (L.M.)
| | - Laurent Naudon
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), AgroParisTech, Micalis Institute, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (E.M.); (L.N.); (S.R.); (L.R.)
| | - Lucia N. Peralta Marzal
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3508 TB Utrecht, The Netherlands; (A.K.); (L.N.P.M.); (P.P.P.); (N.Z.P.)
| | - Paula Perez Pardo
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3508 TB Utrecht, The Netherlands; (A.K.); (L.N.P.M.); (P.P.P.); (N.Z.P.)
| | - Naika Z. Prince
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Universiteitsweg 99, 3508 TB Utrecht, The Netherlands; (A.K.); (L.N.P.M.); (P.P.P.); (N.Z.P.)
| | - Sylvie Rabot
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), AgroParisTech, Micalis Institute, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (E.M.); (L.N.); (S.R.); (L.R.)
| | - Guus Roeselers
- Danone Nutricia Research, Uppsalalaan, 12, 3584 CT Utrecht, The Netherlands; (H.K.); (R.G.)
| | | | - Lea Roussin
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), AgroParisTech, Micalis Institute, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (E.M.); (L.N.); (S.R.); (L.R.)
| | - Giovanni Scala
- Theoreo srl spin off company of the University of Salerno, Via degli Ulivi, 3, 84090 Montecorvino Pugliano (SA), Italy;
| | | | - Alessio Fasano
- European Biomedical Research Institute of Salerno (EBRIS), Via S. de Renzi, 3, 84125 Salerno (SA), Italy;
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Oakley BF, Tillmann J, Ahmad J, Crawley D, San José Cáceres A, Holt R, Charman T, Banaschewski T, Buitelaar J, Simonoff E, Murphy D, Loth E. How do core autism traits and associated symptoms relate to quality of life? Findings from the Longitudinal European Autism Project. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:389-404. [PMID: 33023296 PMCID: PMC7874383 DOI: 10.1177/1362361320959959] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous studies have reported reduced quality of life in autism. Improving quality of life for autistic people is, therefore, a key priority for clinical research and practice. However, the relative impact of core autism traits (e.g. social-communication difficulties), as compared to associated mental health symptoms (e.g. anxiety, depression) on quality of life remains poorly understood. This is despite at least 20%–50% of autistic individuals experiencing associated anxiety and/or depression symptoms. Hence, we measured subjective quality of life in 573 six to thirty-year-olds (autism spectrum disorder N = 344), using two widely validated questionnaires. Adults self-reported on the World Health Organization Quality of Life–Brief instrument. Parents of children/adolescents completed the Child Health and Illness Profile. We assessed individual variability across both measures and modelled associations between quality of life, core autism traits, anxiety, and depression symptoms. Across both age groups and quality of life measures, autistic individuals scored lower than comparison individuals, on average, particularly for physical health in adults (d = −1.24, 95% confidence interval: [−1.56, −0.93]) and school achievement for children/adolescents (d = −1.06, 95% confidence interval: [−1.29, −0.84]). However, a notable proportion of autistic individuals (36%–71% across quality of life domains) did not have reduced quality of life. Across ages and quality of life measures, severity of associated symptoms was significantly related to reduced quality of life on several domains, after accounting for core autism traits. Most notably, depression symptoms were related to reduced physical/psychological well-being in both adults (β ⩾ −0.34) and children/adolescents (β = −0.29, 95% confidence interval: [−0.36, −0.14]). For children/adolescents, anxiety symptoms (β ⩾ −0.28) and core social-communication difficulties (β ⩾ −0.22) were also related to subjective quality of life outcomes. Overall, findings indicate that not all autistic individuals experience reduced subjective quality of life. Variability in quality of life is significantly influenced by associated symptoms, across developmental stage. This may provide a tractable target for mental health services to improve quality of life for autistic individuals over the lifespan.
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Affiliation(s)
| | | | - Jumana Ahmad
- King's College London, UK.,University of Greenwich, UK
| | | | | | | | - Tony Charman
- King's College London, UK.,South London and Maudsley NHS Foundation Trust (SLaM), UK
| | | | - Jan Buitelaar
- Radboud University Nijmegen Medical Center, The Netherlands.,Karakter Child and Adolescent Psychiatry University Center, The Netherlands
| | - Emily Simonoff
- King's College London, UK.,South London and Maudsley NHS Foundation Trust (SLaM), UK
| | - Declan Murphy
- King's College London, UK.,South London and Maudsley NHS Foundation Trust (SLaM), UK
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46
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Tarver J, Pearson E, Edwards G, Shirazi A, Potter L, Malhi P, Waite J. Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:429-439. [PMID: 32998530 PMCID: PMC7874371 DOI: 10.1177/1362361320962366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (mage = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words.
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47
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Perihan C, Burke M, Bowman-Perrott L, Bicer A, Gallup J, Thompson J, Sallese M. Effects of Cognitive Behavioral Therapy for Reducing Anxiety in Children with High Functioning ASD: A Systematic Review and Meta-Analysis. J Autism Dev Disord 2020; 50:1958-1972. [PMID: 30810842 DOI: 10.1007/s10803-019-03949-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children with autism spectrum disorder (ASD) are at greater risk for experiencing high levels of anxiety symptoms. Recent evidence suggests Cognitive behavioral therapy (CBT) may also be effective for anxiety reduction in some presentations of ASD. This meta-analysis evaluated twenty-three studies. Results yielded a moderate effect size (g = - 0.66) for the reduction of anxiety symptoms. Moderators indicated larger effects for studies were achieved with parental involvement (g = - 0.85, p < .05) than with child-only treatments (g = - 0.34, p < .05). Short-term interventions generated a smaller effect (g = - 0.37 p < .05) than either standard-term (g = - 1.02, p < .05) or long-term interventions (g = - 0.69, p < .05).Implications for children with ASD are discussed.
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Affiliation(s)
- Celal Perihan
- Department of Teaching and Education Studies, Idaho State University, 62 E Terry St, 83201, Pocatello, ID, USA.
| | - Mack Burke
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lisa Bowman-Perrott
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Ali Bicer
- School of Teacher Education, University of Wyoming, Laramie, WY, USA
| | - Jennifer Gallup
- Department of Teaching and Education Studies, Idaho State University, 62 E Terry St, 83201, Pocatello, ID, USA
| | - Julie Thompson
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Mary Sallese
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
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48
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Wijnhoven LAMW, Creemers DHM, Vermulst AA, Lindauer RJL, Otten R, Engels RCME, Granic I. Effects of the video game 'Mindlight' on anxiety of children with an autism spectrum disorder: A randomized controlled trial. J Behav Ther Exp Psychiatry 2020; 68:101548. [PMID: 32155470 DOI: 10.1016/j.jbtep.2020.101548] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES In the clinical setting, a large proportion of children with an autism spectrum disorder (ASD) experience impairing anxiety symptoms. Recently, an applied videogame called Mindlight has been developed that focuses on decreasing anxiety in children. The present study involved a randomized controlled trial (RCT) investigating the effect of Mindlight on (sub)clinical anxiety symptoms in children with an ASD. METHODS In total, 109 children of 8-16 years old with an ASD and (sub)clinical anxiety symptoms were randomly assigned to the experimental (N = 53) or the control (N = 56) condition. Children in the experimental condition played Mindlight, children in the control condition played a commercial game (Triple Town) for 1 h per week, for six consecutive weeks. All children and parents completed assessments at baseline, post-intervention and 3-months follow-up. RESULTS Results showed no differences in decrease of child-rated anxiety symptoms between both conditions. However, the decrease of parent-rated anxiety symptoms was significantly larger in the experimental condition. LIMITATIONS Mechanisms of change associated with treatment outcomes were not investigated in the present study. Therefore, it remains unclear which specific or non-specific factors contributed to the decrease in anxiety symptoms in both conditions. CONCLUSIONS The present study provided some preliminary evidence that video games are a promising new intervention vehicle for children with an ASD and anxiety, at least according to parents. However, further research on working mechanisms is needed, in order to specify to what extent and for which children with ASD Mindlight could be an effective anxiety treatment.
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Affiliation(s)
- Lieke A M W Wijnhoven
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
| | - Daan H M Creemers
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
| | - Ad A Vermulst
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands.
| | - Ramón J L Lindauer
- Mental Health Care Institute De Bascule, P.O. Box 303, 1115, ZG, Duivendrecht, the Netherlands; Faculty of Medicine, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - Roy Otten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands; Mental Health Care Institute Pluryn, P.O. Box 53, 6500, AB, Nijmegen, the Netherlands; Arizona State University, REACH Institute, P.O. Box 876005, Tempe, AZ, USA.
| | - Rutger C M E Engels
- Erasmus University, Erasmus School of Social and Behavioral Sciences, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
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49
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McBride NM, Weinzimmer SA, La Buissonnière-Ariza V, Schneider SC, Ehrenreich May J, Lewin AB, McGuire JF, Goodman WK, Wood JJ, Storch EA. The Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Youth with Anxiety and Autism Spectrum Disorder. Child Psychiatry Hum Dev 2020; 51:625-635. [PMID: 32026260 DOI: 10.1007/s10578-020-00961-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The impact of externalizing comorbidity on treatment outcome was examined in 104 youth ages 7-16 (M = 11.09 years) with autism spectrum disorder and primary anxiety/obsessive compulsive disorder who completed modular cognitive behavioral therapy (CBT) for anxiety/OCD. Three comorbidity profiles were utilized for group comparisons: participants with oppositional defiant or conduct disorder with attention-deficit hyperactivity disorder (ODD; CD; ADHD; group EXT, n = 25); those without ODD/CD and only ADHD (group ADHD, n = 46); and those without externalizing comorbidity (NO-EXT, n = 33). Post-treatment outcomes were measured continuously (Pediatric Anxiety Rating Scale, Clinical Global Impression-Severity) and categorically (treatment response, remission). The ADHD group was four times more likely of being a treatment responder compared to NO-EXT (OR 4.05). Comorbidity group did not impact remission. After controlling for pre-treatment scores, there was a significantly greater reduction of the CGI-S for ADHD versus NO-EXT and EXT versus NO-EXT, but results did not significantly differ for the PARS. Results suggest that a modular CBT approach yields positive impact for treatment outcomes in youth with comorbid externalizing problems, particularly among those with comorbid ADHD.
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Affiliation(s)
- Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saira A Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Joseph F McGuire
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Wood
- Department of Educational Psychology, University of California, Los Angeles, CA, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA.
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50
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A Pilot Study of Cardiovascular Reactivity in Children With Autism Spectrum Disorder. Semin Pediatr Neurol 2020; 34:100807. [PMID: 32446441 DOI: 10.1016/j.spen.2020.100807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In preparation for a larger case-control study of children with autism spectrum disorder (ASD) and anxiety, we conducted a pilot study using a noninvasive electrocardiographic device to measure cardiovascular reactivity in 10 children (age range 9-14) with ASD. The 45-minute procedure included 6 conditions: baseline rest, an interview about school, interim rest, an unfair computerized ball-toss game followed by a fair version of the game, and a final rest. Data were successfully collected for 95% of all conditions. Omnibus Skillings-Mack tests suggested that heart rate variability variables including mean heart rate, mean RR interval, and root mean square of successive differences showed statistically significant variation across conditions. The procedure appears feasible and may be an informative biomarker of anxiety in ASD.
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