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Meeder R, Peterson A, Reynard H, Andersen L. Dyadic Work in Conjunction With Electroconvulsive Therapy in a 12-Year-Old Female With Autism Spectrum Disorder and Catatonia. Ochsner J 2024; 24:141-146. [PMID: 38912185 PMCID: PMC11192222 DOI: 10.31486/toj.23.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background: Attachment-based interventions have been extensively studied in neurotypical patient populations. In neurodivergent patient populations, however, emphasis on and current research into attachment-based interventions are centered on early childhood. Minimal research has been conducted in school-aged children with autism spectrum disorder (ASD), and even less research has focused on attachment-based interventions for children with significant comorbidities such as catatonia. Case Report: We present the case of a 12-year-old female that involved dyadic work in conjunction with biologic interventions for the treatment of ASD and catatonia. Psychosocial interventions were centered on an attachment-based framework and behavioral skills training that incorporated elements of parent management training. We observed and tracked the patient's uncooperativeness, underproductive speech, emotional withdrawal, and anxiety via the Brief Psychiatric Rating Scale for Children. Attachment- and behavioral-based interventions in conjunction with psychotropic medications and electroconvulsive therapy resulted in improvements. Conclusion: This case illustrates the potential advantages that attachment- and behavioral-based psychotherapeutic interventions can confer in complex cases involving neurodivergent patients. The case also highlights the lack of current research into and understanding of attachment theory in children and adolescents with ASD. Research is needed into the role of attachment-based interventions in patients with ASD and other psychiatric comorbidities, particularly in patient populations beyond preschool age. Initiating nonbiologic interventions in conjunction with biologic interventions may also enhance outcomes and warrants further investigation.
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Affiliation(s)
| | | | - Hannah Reynard
- Department of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, MI
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Parrella NF, Hill AT, Dipnall LM, Loke YJ, Enticott PG, Ford TC. Inhibitory dysfunction and social processing difficulties in autism: A comprehensive narrative review. J Psychiatr Res 2024; 169:113-125. [PMID: 38016393 DOI: 10.1016/j.jpsychires.2023.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/04/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
The primary inhibitory neurotransmitter γ-aminobutyric acid (GABA) has a prominent role in regulating neural development and function, with disruption to GABAergic signalling linked to behavioural phenotypes associated with neurodevelopmental disorders, particularly autism. Such neurochemical disruption, likely resulting from diverse genetic and molecular mechanisms, particularly during early development, can subsequently affect the cellular balance of excitation and inhibition in neuronal circuits, which may account for the social processing difficulties observed in autism and related conditions. This comprehensive narrative review integrates diverse streams of research from several disciplines, including molecular neurobiology, genetics, epigenetics, and systems neuroscience. In so doing it aims to elucidate the relevance of inhibitory dysfunction to autism, with specific focus on social processing difficulties that represent a core feature of this disorder. Many of the social processing difficulties experienced in autism have been linked to higher levels of the excitatory neurotransmitter glutamate and/or lower levels of inhibitory GABA. While current therapeutic options for social difficulties in autism are largely limited to behavioural interventions, this review highlights the psychopharmacological studies that explore the utility of GABA modulation in alleviating such difficulties.
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Affiliation(s)
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lillian M Dipnall
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Early Life Epigenetics Group, Deakin University, Geelong, Australia
| | - Yuk Jing Loke
- Epigenetics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Talitha C Ford
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Centre for Human Psychopharmacology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
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Giannotti M, Venuti P, De Falco S. Child Attachment Representations and Parenting Stress in Mothers and Fathers of School-Age Children with a Diagnosis of Autism Spectrum Disorder: A Pilot Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1633. [PMID: 37892296 PMCID: PMC10605204 DOI: 10.3390/children10101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Mothers and fathers of autistic children (ASD) tend to report elevated levels of parenting stress. Thus, it is critically important to understand which factors contribute to an imbalance between the perceived demands of parenting and the available psychological resources. To date, little is known about the association between child attachment representations and parenting stress. In this study, we first examined group differences in parenting stress levels based on child diagnosis and parents' gender. Second, we explored the predictive role of child diagnosis, autism severity, and child attachment representations on parenting stress. The study involved 23 school-age children with ASD (IQ > 70), 27 without ASD (7-13 years), and their mothers (n = 50) and fathers (n = 50). Data were collected from 2017 to 2020. Parents completed the Social Responsiveness Scale 2 and the Parenting Stress Index-Short Form, while the children's attachment representations were assessed using the School-age Assessment of Attachment. Parents of children with ASD reported higher stress compared with controls. No differences were found between mothers and fathers. Implicit attachment representations have been found to be associated with parenting stress only in mothers, while the severity of social impairment showed a significant effect on parenting stress in both parents. These findings revealed the potential benefit of adaptive attachment representations not only for children themselves but also for mothers and the family system, suggesting the bidirectional nature of parent-child relationships in the context of ASD. The uniqueness of maternal and paternal parenting experiences should be considered when parenting stress is addressed.
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Affiliation(s)
- Michele Giannotti
- Department of Psychology and Cognitive Science, Observation, Diagnosis and Education Lab, University of Trento, Via Matteo del Ben 5/b, 38068 Rovereto, TN, Italy
| | - Paola Venuti
- Department of Psychology and Cognitive Science, Observation, Diagnosis and Education Lab, University of Trento, Via Matteo del Ben 5/b, 38068 Rovereto, TN, Italy
| | - Simona De Falco
- Department of Psychology and Cognitive Science, Observation, Diagnosis and Education Lab, University of Trento, Via Matteo del Ben 5/b, 38068 Rovereto, TN, Italy
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Cleary M, West S, McLean L, Kornhaber R, Hungerford C. Two Halves of the Same Whole: A Framework to Integrate Autism and Mental Health Services. Issues Ment Health Nurs 2023; 44:93-103. [PMID: 36206026 DOI: 10.1080/01612840.2022.2126570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Given the higher rates of co-occurring mental health issues experienced by autistic people, there is a pressing need to implement an effective framework that integrates autism services with appropriate mental health services. This paper discusses the impact of mental illness on the person with autism and their families, and the current challenges they face when accessing mental health support. A framework for service providers is proposed to support the mental health needs and preferences of autistic people. The paper concludes by highlighting the importance of health professionals utilising mental health interventions appropriate for autistic people, including autism-specific suicide prevention and awareness programs.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Campus, WSLHD, North Parramatta, New South Wales Australia
| | - Rachel Kornhaber
- College of Health and Medicine, University of Tasmania, Sydney, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, New South Wales, Australia.,Faculty of Health, Federation University, Melbourne, Victoria, Australia
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Giannotti M, Bentenuto A, Venuti P, de Falco S. Explicit and implicit attachment representations in cognitively able school-age children with autism spectrum disorder: A window to their inner world. Clin Child Psychol Psychiatry 2022; 27:1048-1064. [PMID: 35794823 DOI: 10.1177/13591045221113390] [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: 11/16/2022]
Abstract
The few studies available on quality of attachment in school-age children with autism spectrum disorder (ASD) exclusively used questionnaires assessing explicit attachment representations. Thus, in the current study we assessed both explicit and implicit attachment representations in 23 children with ASD (without intellectual disability), 22 with learning disabilities and 27 with typical development aged from 7 to 13 years. A self-reported measure on the quality of attachment to parents and a semi-structured interview were administered to the children. In addition, a developmental assessment of the child including measures of intelligence and social-communication impairment was conducted. Despite the lack of group differences on explicit attachment representations, we found that children with ASD showed higher rates of at-risk self-protective strategies and psychological trauma compared to the TD group. Children with SLD also showed a high level of at-risk implicit attachment representations than TD, albeit to a lesser extent compared to children with ASD. These results may be related to several factors associated with ASD impairment and developmental pathways, such as the atypical learning process which occur at interpersonal level, the difficulties in social information processing and reflective functioning. Our findings suggested that children with ASD may experience difficulties in the construction of balanced implicit attachment representations. Thus, a more comprehensive assessment of attachment including both implicit and explicit representations is recommended.
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Affiliation(s)
- Michele Giannotti
- Department of Psychology and Cognitive Sciences, 19034University of Trento, Trento, Italy
| | - Arianna Bentenuto
- Department of Psychology and Cognitive Sciences, 19034University of Trento, Trento, Italy
| | - Paola Venuti
- Department of Psychology and Cognitive Sciences, 19034University of Trento, Trento, Italy
| | - Simona de Falco
- Department of Psychology and Cognitive Sciences, 19034University of Trento, Trento, Italy
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