School Attendance Problems Among Children with Neurodevelopmental Conditions One year Following the Start of the COVID-19 Pandemic

PURPOSE

The present study investigated school absence among 1,076 5-15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK.

METHODS

Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance.

RESULTS

During May 2021, 32% of children presented with persistent absence (missing ≥ 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers.

CONCLUSION

COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship.

Protocol for the development and testing of the schiZotypy Autism Questionnaire (ZAQ) in adults: a new screening tool to discriminate autism spectrum disorder from schizotypal disorder

BACKGROUND

Autism spectrum disorder (ASD) and schizotypal disorder (SD) both have a heterogenous presentation, with significant overlaps in symptoms and behaviour. Due to elevated recognition and knowledge of ASD worldwide, there is a growing rate of referrals from primary health professionals to specialised units. At all levels of assessment, the differential diagnostic considerations between ASD and SD exert major challenges for clinicians. Although several validated screening questionnaires exist for ASD and SD, none have differential diagnostic properties. Accordingly, in this study, we aim to develop a new screening questionnaire, the schiZotypy Autism Questionnaire (ZAQ), which provides a combined screening for both conditions, while also indicating the relative likelihood of each.

METHODS

We aim to test 200 autistic patients and 100 schizotypy patients recruited from specialised psychiatric clinics and 200 controls from the general population (Phase 1). The results from ZAQ will be compared to the clinical diagnoses from interdisciplinary teams at specialised psychiatric clinics. After this initial testing phase, the ZAQ will be validated in an independent sample (Phase 2).

CONCLUSIONS

The aim of the study is to investigate the discriminative properties (ASD vs. SD), diagnostic accuracy, and validity of the schiZotypy Autism Questionnaire (ZAQ).

FUNDING

Funding was provided by Psychiatric Centre Glostrup, Copenhagen Denmark, Sofiefonden (Grant number: FID4107425), Trygfonden (Grant number:153588), Takeda Pharma.

TRIAL REGISTRATION

Clinical Trials, NCT05213286, Registered 28 January 2022, clinicaltrials.gov/ct2/show/NCT05213286?cond = RAADS&draw = 2&rank = 1.

The association between home learning during COVID-19 lockdowns and subsequent school attendance among children with neurodevelopmental conditions

BACKGROUND

Children with neurodevelopmental conditions have high levels of school absence. During the COVID-19 pandemic, schools closed for many students. The relationship between home learning during school closures and subsequent school attendance requires attention to better understand the impact of pandemic education policy decisions on this population. This study aims to investigate the association between home learning, hybrid learning and school learning during school closures (in January-March 2021) with subsequent school attendance (in May 2021) in children with neurodevelopmental conditions.

METHODS

An online survey was completed by 809 parents/carers of 5- to 15-year-old autistic children and/or children with intellectual disability. Regression models examined the association of learning location during school closures with subsequent school absence (i.e., total days missed, persistent absence and school refusal).

RESULTS

Children who were learning from home during school closures later missed 4.6 days of a possible 19. Children in hybrid and school learning missed 2.4 and 1.6 school days, respectively. The rates of school absence and persistent absence were significantly higher in the home learning group even after adjusting for confounders. Learning location was not associated with subsequent school refusal.

CONCLUSIONS

Policies for school closures and learning from home during public health emergencies may exacerbate school attendance problems in this group of vulnerable children.

Elective home education of children with neurodevelopmental conditions before and after the COVID-19 pandemic started

COVID-19 brought disruptions to children's education and mental health, and accelerated school de-registration rates. We investigated Elective Home Education (EHE) in families of children with a neurodevelopmental condition. A total of 158 parents of 5-15 year-old children with neurodevelopmental conditions (80% autistic) provided information on reasons for de-registration, their experience of EHE, and children's mental health. Few differences were found between children participating in EHE before and after the pandemic started. Low satisfaction with school for not meeting children's additional needs was the main reason for de-registering in both groups. COVID-19 had a more limited role in parents' decision to de-register. The main advantage of EHE reported in both groups was the provision of personalised education and one-to-one support. Levels of anxiety, internalising and externalising problems were similar between children participating in EHE before and after the pandemic started, and also similar between all children in EHE and school-registered children (N = 1,079).

Predictors of Change in Stepping Stones Triple Interventions: The Relationship between Parental Adjustment, Parenting Behaviors and Child Outcomes

The current study explored the process of change in Stepping Stones Triple P (SSTP) using a community-based sample of 891 families of children with developmental disabilities (DD) who participated in an SSTP intervention at a community level. A preliminary analysis of outcome data indicated that SSTP intervention was effective in reducing parental adjustment difficulties, coercive parenting, and children's behavioral and emotional difficulties immediately after the intervention. The effects were maintained at 12-month follow-up. The results also indicated that change in parental adjustment over the course of intervention was significantly associated with a change in parenting behaviors. However, change in parenting behaviors but not change in parental adjustment, predicted children's behavioral and emotional problems following the intervention. The results suggest that positive parenting skills are the most salient ingredient driving the change in child behaviors in SSTP interventions.

Parental Adjustment Scale: Validation of a brief, five-item measure of parental adjustment for use with families of typically developing children and children with developmental and/or intellectual disabilities in Australia

BACKGROUND

Explores the validity of the five-item parental adjustment scale, a subscale of the previously validated Parenting and Family Adjustment Scales.

AIM

The aim was to assess the factor structure and convergent validity of a measure of parental adjustment within parents of typically developing children and parents of childiren with developmental and/or intellectual disabilities.

METHODS AND PROCEDURES

Cross-sectional survey data was analysed from Australian parents of children aged 2-12 years who were typically developing children (N = 683) and had developmental and/or intellectual disabilities (N = 756). Confirmatory factor analyses and multi-group structural equation modelling examined if the factor structure performed similarly across the two populations. Convergent validity was assessed.

OUTCOMES AND RESULTS

The confirmatory factor analysis supported the hypothesised one-factor structure for the parental adjustment scale in both populations. Partial measurement invariance confirmed that the scale was structurally consistent within both parent groups. The convergent validity was supported by significant correlations with the DASS-21 in the disability population and the K10 in the typically developing population.

CONCLUSIONS AND IMPLICATIONS

This brief, easily administered, five-item scale demonstrates strong potential in assessing parental adjustment, within both parents of typically developing children and parents of children with developmental and/or intellectual disabilities.

Coercive parenting: modifiable and nonmodifiable risk factors in parents of children with developmental disabilities

BACKGROUND

Parents of children with developmental or intellectual disabilities tend to report greater use of coercive parenting practices relative to parents of typically developing children, increasing the risk of adverse child outcomes. However, to date, there is limited research exploring the role and relative contribution of modifiable and nonmodifiable risk factors in parents of children with a disability. The present study aimed to explore the role of various modifiable and nonmodifiable parenting, family and sociodemographic factors associated with the use of coercive parenting practices in parents of children with a disability.

METHODS

Caregivers (N = 1392) enrolled in the Mental Health of Young People with Developmental Disabilities (MHYPeDD) programme in Australia completed a cross-sectional survey about their parenting and their child aged 2-12 years with a disability. Measures covered a range of domains including relevant demographic and family background, use of coercive parenting practices, intensity of child behavioural difficulties and questions relating to parent and family functioning such as parental self-efficacy, adjustment difficulties and quality of family relationships.

RESULTS

Parents of older children, those who were younger at the birth of their child, and parents who were co-parenting or working reported more use of coercive parenting practices. Greater intensity of child difficulties, poorer parental self-efficacy and parent-child relationships, and more parental adjustment difficulties were also significantly associated with more use of coercive parenting. Examination of the relative contribution of variables revealed parent-child relationship was a key contributing factor, followed by intensity of child behaviour problems, parent adjustment and parent confidence.

CONCLUSIONS

These findings highlight a range of factors that should be targeted and modified through upstream prevention programmes and further inform our understanding of how coercive practices may be influenced through targeted parenting interventions.

Participation in sport and physical activity in adults with intellectual disabilities

BACKGROUND

People with intellectual disability face a number of barriers to participation in physical activity. This paper aimed to determine rates of sport and physical activity participation in an Australian sample of adults with intellectual disability, compared with rates of participation in the general Australian population. A secondary aim was to investigate factors that may contribute to participation of adults with intellectual disability.

METHOD

Participants were part of the Australian Child to Adult Development (ACAD) study, consisting of a community sample with intellectual disability (n = 305), groups of adults with autism (n = 94), Down syndrome (n = 64), fragile X syndrome (n = 52), Williams syndrome (n = 45), and Prader-Willi syndrome (n = 30). Participation in sport/physical activity was reported over the past 3 months. Rates of participation were reported for adults with intellectual disability and compared with rates in a general Australian population sample. The relationship between participation in physical activity and age, degree of intellectual disability, physical mobility, living situation, socio-economic disadvantage, and behaviour and emotional problems were also conducted.

RESULTS

Participants in the ACAD community sample with intellectual disability participated in sport/physical activity at lower rates than the general Australian population (42% compared with 71%). Having no physical mobility impairment was significantly associated with higher rates of participation. Those with Down syndrome participated in sport/physical activity at higher rates than the community sample with intellectual disability, while no difference in sport/physical activity participation was observed in the groups with autism or other syndromes.

CONCLUSION

Australian adults with intellectual disability participate in sport and physical activity at lower rates than the general population. Having a physical mobility impairment was associated with lower rates of participation. However, people living in supported accommodation were more likely to participate than those in other living situations. Having Down syndrome was associated with a higher participation rate than the community sample.

Types and correlates of school non-attendance in students with autism spectrum disorders

School non-attendance in autism spectrum disorders has received very little attention to date. The study aimed to provide a comprehensive description of school non-attendance in students with autism spectrum disorders. Through an online survey, parents of 486 children (mean age: 11 years) reported on school attendance over 1 month and reasons for instances of non-attendance. On average, students missed 5 days of school of a possible 23 days. Persistent non-attendance (absent on 10%+ of available sessions) occurred among 43% of students. School non-attendance was associated with child older age, not living in a two-parent household, parental unemployment and, especially, attending a mainstream school. School refusal accounted for 43% of non-attendance. School exclusion and school withdrawal each accounted for 9% of absences. Truancy was almost non-existent. Non-problematic absenteeism (mostly related to medical appointments and illness) accounted for 32% of absences. Non-problematic absenteeism was more likely among those with intellectual disability, school refusal was more likely among older students and school exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings suggest that school non-attendance in autism spectrum disorders is a significant issue, and that it is important to capture detail about attendance patterns and reasons for school non-attendance.

Structural and functional brain abnormalities in children with schizotypal disorder: a pilot study

Schizotypal disorder lies in the schizophrenia spectrum and is widely studied in adult populations. Schizotypal disorder in children (SDc) is less well described. This study examined brain morphological and functional connectivity abnormalities in SDc (12 SDc and 9 typically developing children), focusing on the default mode and executive control brain networks. Results indicated that SDc is associated with reduced grey matter volume (GMV) in superior and medial frontal gyri, and increased resting-state functional connectivity between the superior frontal gyrus and inferior parietal lobule, compared to typically developing children (cluster-level FWE-corrected p < 0.05). The brain structure abnormality (GMV in left superior frontal gyrus) was correlated with clinical symptoms in SDc (r = −0.66, p = 0.026) and functional connectivity abnormality was correlated with extra-dimensional shifting impairments in all participants (r = 0.62, p = 0.011), suggesting their contribution to the underlying mechanisms of clinical presentation. These preliminary results motivate further work to characterize the neural basis of SDc and its significance as a risk factor for later psychosis.

Adverse events reported by anxious school refusing adolescents receiving cognitive behavioral therapy with and without fluoxetine

BACKGROUND

Investigating adverse events associated with antidepressant treatments in adolescents is important given the concerns about increased risk of suicidal ideation and behavior in this age group. The aim of this study is to investigate adverse and serious adverse events associated with the treatment of anxiety (cognitive behavioral therapy (CBT)-only, CBT-plus-placebo, and CBT-plus-fluoxetine) in anxious school-refusing adolescents.

METHODS

A side-effect symptom checklist was completed by participants prior to commencing treatment and during treatment (weekly/fortnightly).

RESULTS

CBT-plus-fluoxetine was well tolerated and not associated with higher levels of adverse events than the other treatments. Adverse events in all groups decreased over time, and the only adverse event distinct to fluoxetine was nausea. Baseline anxiety predicted higher levels of adverse events. There was one suicide attempt in the CBT-plus-placebo group but no statistically significant difference in suicide attempts between groups. Participants with a comorbid depressive disorder were more likely to report self-injury ideation but not suicidal ideation compared with those who did not have comorbid depressive disorder. Frequency of suicidal ideation and non-suicidal self-injury was significantly lower in the CBT-plus-fluoxetine group compared with the CBT-only group. Frequency of self-injury ideation was significantly lower in the CBT-plus-fluoxetine group compared with both other groups.

CONCLUSIONS

Overall, the treatments were well tolerated and fluoxetine plus CBT appeared to be protective against suicidal ideation, non-suicidal self-injury, and self-injury ideation in this sample.

Moderating Effect of Motor Proficiency on the Relationship Between ADHD Symptoms and Sleep Problems in Children With Attention Deficit Hyperactivity Disorder-Combined Type

OBJECTIVES/BACKGROUND

A high proportion of children with Attention Deficit Hyperactivity Disorder- Combined type (ADHD-CT) experience sleep and motor problems. This study investigated (a) whether motor proficiency moderated the relationship between ADHD symptoms and sleep problems in children with and without ADHD-CT and (b) whether this moderation differed as a function of ADHD diagnosis.

PARTICIPANTS

A sample of 70 primary school male children between 8-15 years were recruited; children with ADHD-CT (n = 38; mean age 10 years, 2 months [SD = 1 year, 6 months]) and a typically developing (TD) (n = 32; mean age 9 years, 6 months [SD = 1 year, 5 months]) group.

METHODS

Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition (MABC-2), ADHD symptoms were measured using the Conners' Parent Rating Scale (CPRS) and parent reported sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Children who reported higher ADHD symptoms and lower motor proficiency scores reported more sleep problems. The moderation effect only held in children with a diagnosis of ADHD-CT and not in the typically developing group.

CONCLUSIONS

These findings indicate that children who experience greater severity of ADHD symptoms who also have lower motor proficiency may be at increased risk of experiencing sleep problems. These findings also illustrate the importance of considering motor proficiency when exploring risk factors for sleep problems in children with ADHD-CT as well as sleep interventions.

Assessment of Placental Cortisol Pathway Gene Expression in Term Pregnant Women with Anxiety

INTRODUCTION

The aim of this study was to expand on this field of work by examining, within a cohort of pregnant women with diagnosed clinical anxiety, the mRNA expression of a panel of genes associated with the cortisol pathway and comparing them to controls.

METHODS

Placental samples were obtained from 24 pregnant women, 12 with a diagnosed anxiety disorder and 12 with no psychiatric history, within 30 min of delivery. Differential expression analysis of 85 genes known to be involved in glucocorticoid synthesis, metabolism or signalling was conducted for the: (1) full sample, (2) those at term without labour (5 cases, 7 controls) and (3) those at term with labour (7 cases, 5 controls). Correlation analyses between gene expression and measures of anxiety and depressive symptom severity were also conducted.

RESULTS

No robust difference in placental gene expression between pregnant women with and without anxiety disorder was found nor did we detect robust differences by labour status. However, correlational analyses putatively showed a decrease in PER1 expression was associated with an increase in anxiety symptom severity, explaining up to 32% of the variance in anxiety symptom severity.

DISCUSSION

Overall, the strongest correlation was found between a decrease in placental PER1 expression and increased anxiety scores. Labour status was found to have a profound effect on mRNA expression. The placental samples obtained from women following labour produced greater numbers of significant differences in mRNA species expression suggesting that in long-standing anxiety the placenta may respond differently under conditions of chronic stress.

The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder–related functioning. World Health Organization’s International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder—one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (⩾17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder–related functioning in educational, administrative, clinical, and research settings.

Attentional set-shifting and social abilities in children with schizotypal and comorbid autism spectrum disorders

OBJECTIVE

While diagnostically independent, autism and schizotypal disorders can co-occur. Their concurrent impact on outcomes and phenotypes has not been investigated. We investigated the impact of comorbid autism and schizotypal disorders in children on executive functioning and socio-pragmatic skills - core features of both disorders.

METHOD

Executive functioning (assessed with the Cambridge Neuropsychological Test Automated Battery) and socio-pragmatic skills (assessed using the Melbourne Assessment of Schizotypy in Kids) were investigated in a total of 67 (6-12 year old) children with autism ( n = 15; M/F = 10/5), schizotypal disorder ( n = 8; M/F = 5/3) and comorbid autism and schizotypal disorder ( n = 12; M/F = 5/7) and typically developing children ( n = 32; M/F = 17/15).

RESULTS

Both the autism and schizotypal disorder groups performed more poorly than the typically developing group on socio-pragmatic skills and overall performance (i.e. number of stages completed) of the intra-/extra-dimensional set-shifting task (all ps < 0.001). Clear distinctions between the autism and schizotypal groups were present in the intra-/extra-dimensional task relative to the typically developing group - the autism group had difficulties with extra-dimensional shifts ( p < 0.001), and the schizotypal disorder group with intra-dimensional shifts ( p = 0.08). Interestingly, the overall performance of the comorbid group on the intra-/extra-dimensional task was not significantly different from the typically developing group, and they were superior to both the autism ( p = 0.019) and schizotypal disorder ( p = 0.042) groups on socio-pragmatic skills.

CONCLUSION

The phenotypical overlap between autism and schizotypal disorders may be precipitated by different cognitive styles and/or mechanisms associated with attention and information processing. We propose that sustaining and switching attention represent two poles of irregularities across the autism and schizotypal spectra, which appear to converge in a compensatory manner in the comorbid group. Our findings highlight the importance of investigating children with a dual diagnosis of autism and schizotypal disorders, and raise intriguing questions about possible mechanisms to explain the attenuated impairment observed in the group of children with comorbid autism and schizotpyal disorders.

Parenting and family adjustment scales (PAFAS): validation of a brief parent-report measure for use with families who have a child with a developmental disability

BACKGROUND

Children with a developmental disability are three to four times more likely than their typically developing peers of developing significant emotional and behavioural problems. There is strong evidence to suggest that individual biological and psychological factors interact with family functioning to precipitate and perpetuate these problems.

AIMS

This study examined the psychometric properties of a brief measure, the Parent and Family Adjustment Scales (PAFAS) for use with parents of children with a developmental disability.

METHODS

A sample of 914 parents of children (M=6.27years) with a developmental disability participated in the study. Disabilities included Autism Spectrum Disorder and Intellectual Disability RESULTS: A confirmatory factor analysis supported a 16-item, four factor model of PAFAS Parenting, and an 11-item, three factor model of PAFAS Family Adjustment. The Parenting Scale measures parental consistency, coercive practices, use of encouragement and the quality of parent-child relationship. The Family Adjustment Scale measures parental emotional adjustment and partner and family support in parenting.

CONCLUSIONS

The current study indicated that the PAFAS demonstrates promise as a brief measure of multiple domains of family functioning important for families who have a child with a developmental disability.

Psychopathology of adolescents with an intellectual disability who present to general hospital services

OBJECTIVE

Adolescents with intellectual disability have increased rates of psychopathology compared with their typically developing peers and present to hospital more frequently for ambulant conditions. The aim of this study is to describe the psychopathology and related characteristics of a sample of adolescents with intellectual disability who presented to general hospital services.

METHOD

We investigated a cohort of adolescents with intellectual disability in South East Queensland, Australia between January 2006 and June 2010. Demographic and clinical data were obtained via mailed questionnaires and from general practice notes. Psychopathology was measured with the Short Form of the Developmental Behaviour Checklist.

RESULTS

Of 98 individuals presenting to hospital, 71 (72.5%) had significant levels of psychopathology. Unknown aetiology for the intellectual disability was associated with presence of problem behaviours. Adolescents with more severe intellectual disability were more likely to have major problem behaviours. Co-morbid physical health issues were not associated with psychopathology. Only 12 (12.1%) adolescents had undergone specialized mental health intervention.

CONCLUSIONS

The general hospital environment may offer opportunities for liaison psychiatry services to screen and provide management expertise for adolescent individuals with intellectual disability presenting for physical health issues.

Prevalence of mood disturbance in Australian adults with chronic spinal cord injury

BACKGROUND

There is little understanding of the prevalence of mental health issues in people with spinal cord injury (SCI) after they leave rehabilitation or how mental health issues can alter over time.

AIM

The aims were to (i) determine the prevalence of mood disturbance in adults with chronic SCI living in the community, (ii) ascertain whether the prevalence of mood disturbance had changed since a previous study in 2004-2005 and (iii) establish whether people with chronic SCI remain vulnerable to mood disturbance, irrespective of time since injury.

METHODS

Prospective, open-cohort case series. Participants were 573 community-based adults with a chronic SCI. The depression, anxiety and stress scale - short version was used. Analyses included simple descriptors, Chi-squared and repeated measures t-tests.

RESULTS

Nearly half of participants (n = 263/573; 46%) reported symptoms indicating mood disturbance, which was similar to the level found in the previous study. While the presence of mood disturbance persisted in 23% of adults (n = 26) and 46 (41%) were in the 'below threshold' category, just over a third of the adults who participated in both studies (n = 111) experienced a change (n = 21, 19% mood disturbance resolved and n = 18, 16% mood disturbance developed).

CONCLUSION

Both resilience and change are common. At no time after SCI is the risk of mental health problems considered reduced or even stable. These results highlight the importance of regular mental health reviews even in those who have previously displayed good resilience.

Functioning and disability in autism spectrum disorder: A worldwide survey of experts

Objective: This study is the second of four to prepare International Classification of Functioning, Disability and Health (ICF; and Children and Youth version, ICF(‐CY)) Core Sets for Autism Spectrum Disorder (ASD).The objective of this study was to survey the opinions and experiences of international experts on functioning and disability in ASD. Methods: Using a protocol stipulated by the World Health Organization (WHO) and monitored by the ICF Research Branch, an email‐based questionnaire was circulated worldwide among ASD experts, and meaningful functional ability and disability concepts were extracted from their responses. These concepts were then linked to the ICF(‐CY) by two independent researchers using a standardized linking procedure. Results: N = 225 experts from 10 different disciplines and all six WHO‐regions completed the survey. Meaningful concepts from the responses were linked to 210 ICF(‐CY) categories. Of these, 103 categories were considered most relevant to ASD (i.e., identified by at least 5% of the experts), of which 37 were related to Activities and Participation, 35 to Body functions, 22 to Environmental factors, and 9 to Body structures. A variety of personal characteristics and ASD‐related functioning skills were provided by experts, including honesty, loyalty, attention to detail and creative talents. Reported gender differences in ASD comprised more externalizing behaviors among males and more internalizing behaviors in females. Conclusion: The ICF(‐CY) categories derived from international expert opinions indicate that the impact of ASD on functioning extends far beyond core symptom domains. Autism Res2016, 9: 959–969. © 2016 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research

A randomised control trial of an Internet-based cognitive behaviour treatment for mood disorder in adults with chronic spinal cord injury

STUDY DESIGN

Prospective parallel waitlist randomised controlled trial.

OBJECTIVES

Evaluate the feasibility and effectiveness of an Internet-based psychological intervention treating comorbid mood disorder in adults with spinal cord injury (SCI). Improved mood and satisfaction with life were primary outcomes.

SETTING

Victoria, Australia.

INTERVENTION

Electronic Personal Administration of Cognitive Therapy (ePACT).

MEASURES

Depression, Anxiety and Stress Scale-Short Form (DASS21), Personal Well-being Index, Helplessness subscale of the Spinal Cord Lesion Emotional Well-being Scale v1 Australia, at each time point.Participant qualifying criteria:Adults (18-70 years), chronic SCI, attend SCI review clinic at Austin or Caulfield Hospital and score above normative threshold of the Depression, Anxiety and Stress Scale-Short Form (DASS21).

METHODS

Forty-eight participants completed Time 2 post intervention (n=23) or time equivalent for waitlist control group (n=25) telephone interviews. The measures were repeated a third time (Time 3) for a small subgroup (n=12) at 6 months post intervention within the study implementation time frame.

RESULTS

Univariate within group analyses revealed significant improvement in mood in the intervention group at Time 2: (lower depression (effect size (ES)=0.4), anxiety (ES=0.4) and stress (ES=0.3)) and higher satisfaction with life (ES=0.2). Waitlist control group improved in depression only (ES=0.3) by Time 2. Multilevel variance components analyses, although not as positive, were still encouraging. Improvement in mood symptoms was maintained in the small group reinterviewed at Time 3.

CONCLUSION

Although Internet-based interventions for mental health issues in SCI not a solution for all, our results indicate that they are a potentially valuable addition to the currently available options.

A comprehensive scoping review of ability and disability in ADHD using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY)

This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to use a comprehensive scoping review approach to identify the concepts of functional ability and disability used in the scientific ADHD literature and link these to the nomenclature of the ICF-CY. Systematic searches were conducted using Medline/PubMed, PsycINFO, ERIC and Cinahl, to extract the relevant concepts of functional ability and disability from the identified outcome studies of ADHD. These concepts were then linked to ICF-CY by two independent researchers using a standardized linking procedure. Data from identified studies were analysed until saturation of ICF-CY categories was reached. Eighty studies were included in the final analysis. Concepts contained in these studies were linked to 128 ICF-CY categories. Of these categories, 68 were considered to be particularly relevant to ADHD (i.e., identified in at least 5 % of the studies). Of these, 32 were related to Activities and participation, 31 were related to Body functions, and five were related to environmental factors. The five most frequently identified categories were school education (53 %), energy and drive functions (50 %), psychomotor functions (50 %), attention functions (49 %), and emotional functions (45 %). The broad variety of ICF-CY categories identified in this study underlines the necessity to consider ability and disability in ADHD across all dimensions of life, for which the ICF-CY provides a valuable and universally applicable framework. These results, in combination with three additional preparatory studies (expert survey, focus groups, clinical study), will provide a scientific basis to define the ICF Core Sets for ADHD for multi-purpose use in basic and applied research, and every day clinical practice.

Ability and Disability in Autism Spectrum Disorder: A Systematic Literature Review Employing the International Classification of Functioning, Disability and Health-Children and Youth Version

Objective: This study is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Autism Spectrum Disorder (ASD). The objective was to use a systematic review approach to identify, number, and link functional ability and disability concepts used in the scientific ASD literature to the nomenclature of the ICF‐CY (Children and Youth version of the ICF, covering the life span). Methods: Systematic searches on outcome studies of ASD were carried out in Medline/PubMed, PsycINFO, ERIC and Cinahl, and relevant functional ability and disability concepts extracted from the included studies. These concepts were then linked to the ICF‐CY by two independent researchers using a standardized linking procedure. New concepts were extracted from the studies until saturation of identified ICF‐CY categories was reached. Results: Seventy‐one studies were included in the final analysis and 2475 meaningful concepts contained in these studies were linked to 146 ICF‐CY categories. Of these, 99 categories were considered most relevant to ASD (i.e., identified in at least 5% of the studies), of which 63 were related to Activities and Participation, 28 were related to Body functions, and 8 were related to Environmental factors. The five most frequently identified categories were basic interpersonal interactions (51%), emotional functions (49%), complex interpersonal interactions (48%), attention functions (44%), and mental functions of language (44%). Conclusion: The broad variety of ICF‐CY categories identified in this study reflects the heterogeneity of functional differences found in ASD—both with respect to disability and exceptionality—and underlines the potential value of the ICF‐CY as a framework to capture an individual's functioning in all dimensions of life. The current results in combination with three additional preparatory studies (expert survey, focus groups, and clinical study) will provide the scientific basis for defining the ICF Core Sets for ASD for multipurpose use in basic and applied research and every day clinical practice of ASD. Autism Res2015, 8: 782–794. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research

Influence of the environment on participation in social roles for young adults with down syndrome

Background

The concept of disability is now understood as a result of the interaction between the individual, features related to impairment, and the physical and social environment. It is important to understand these environmental influences and how they affect social participation. The purpose of this study is to describe the social participation of young adults with Down syndrome and examine its relationship with the physical and social environment.

Methods

Families ascertained from the Down syndrome ‘Needs Opinion Wishes’ database completed questionnaires during 2011. The questionnaires contained two parts, young person characteristics and family characteristics. Young adults’ social participation was measured using the Assessment of Life Habits (LIFE-H) and the influences of environmental factors were measured by the Measure of the Quality of the Environment (MQE). The analysis involved descriptive statistics and linear and logistic regression.

Results

Overall, participation in daily activities was higher (mean 6.45) than in social roles (mean 5.17) (range 0 to 9). When the physical and/or social environment was reported as a facilitator, compared to being no influence or a barrier, participation in social roles was greater (coef 0.89, 95%CI 0.28, 1.52, coef 0.83, 95%CI 0.17, 1.49, respectively). The relationships between participation and both the physical (coef 0.60, 95% CI −0.40, 1.24) and social (coef 0.20, 95%CI −0.47, 0.87) environments were reduced when age, gender, behavior and functioning in ADL were taken into account.

Conclusion

We found that young adults’ participation in social roles was influenced more by the physical environment than by the social environment, providing a potentially modifiable avenue for intervention.

Characterization of aromatase expression in the adult male and female mouse brain. I. Coexistence with oestrogen receptors α and β, and androgen receptors

Aromatase catalyses the last step of oestrogen synthesis. There is growing evidence that local oestrogens influence many brain regions to modulate brain development and behaviour. We examined, by immunohistochemistry, the expression of aromatase in the adult male and female mouse brain, using mice in which enhanced green fluorescent protein (EGFP) is transcribed following the physiological activation of the Cyp19A1 gene. EGFP-immunoreactive processes were distributed in many brain regions, including the bed nucleus of the stria terminalis, olfactory tubercle, medial amygdaloid nucleus and medial preoptic area, with the densest distributions of EGFP-positive cell bodies in the bed nucleus and medial amygdala. Differences between male and female mice were apparent, with the density of EGFP-positive cell bodies and fibres being lower in some brain regions of female mice, including the bed nucleus and medial amygdala. EGFP-positive cell bodies in the bed nucleus, lateral septum, medial amygdala and hypothalamus co-expressed oestrogen receptor (ER) α and β, or the androgen receptor (AR), although single-labelled EGFP-positive cells were also identified. Additionally, single-labelled ERα-, ERβ- or AR-positive cell bodies often appeared to be surrounded by EGFP-immunoreactive nerve fibres/terminals. The widespread distribution of EGFP-positive cell bodies and fibres suggests that aromatase signalling is common in the mouse brain, and that locally synthesised brain oestrogens could mediate biological effects by activating pre- and post-synaptic oestrogen α and β receptors, and androgen receptors. The higher number of EGFP-positive cells in male mice may indicate that the autocrine and paracrine effects of oestrogens are more prominent in males than females.

Changing interpretation of chromosomal microarray over time in a community cohort with intellectual disability

Chromosomal microarray (CMA) is the first-line diagnostic test for individuals with intellectual disability, autism, or multiple congenital anomalies, with a 10-20% diagnostic yield. An ongoing challenge for the clinician and laboratory scientist is the interpretation of variants of uncertain significance (VOUS)-usually rare, unreported genetic variants. Laboratories differ in their threshold for reporting VOUS, and clinical practice varies in how this information is conveyed to the family and what follow-up is arranged. Workflows, websites, and databases are constantly being updated to aid the interpretation of VOUS. There is a growing literature reporting new microdeletion and duplication syndromes, susceptibility, and modifier copy number variants (CNVs). Diagnostic methods are also evolving with new array platforms and genome builds. In 2010, high-resolution arrays (Affymetrix 2.7 M Oligo and SNP, 50 kB resolution) were performed on a community cohort of 67 individuals with intellectual disability of unknown aetiology. Three hundred and one CNVs were detected and analyzed using contemporary resources and a simple scoring system. Thirteen (19%) of the arrays were assessed as potentially pathogenic, 4 (6%) as benign and 50 (75%) of uncertain clinical significance. The CNV data were re-analyzed in 2012 using the contemporary interpretative resources. There was a statistically significant difference in the assessment of individual CNVs (P < 0.0001). An additional eight patients were reassessed as having a potentially pathogenic array (n = 21, 31%) and several additional susceptibility or modifier CNVs were identified. This study highlights the complexity involved in the interpretation of CMA and uniquely demonstrates how, even on the same array platform, it can be subject to change over time.

Understanding macrographia in children with autism spectrum disorders

It has been consistently reported that children with autism spectrum disorders (ASD) show considerable handwriting difficulties, specifically relating to accurate and consistent letter formation, and maintaining appropriate letter size. The aim of this study was to investigate the underlying factors that contribute to these difficulties, specifically relating to motor control. We examined the integrity of fundamental handwriting movements and contributions of neuromotor noise in 26 children with ASD aged 8-13 years (IQ>75), and 17 typically developing controls. Children wrote a series of four cursive letter l's using a graphics tablet and stylus. Children with ASD had significantly larger stroke height and width, more variable movement trajectory, and higher movement velocities. The absolute level of neuromotor noise in the velocity profiles, as measured by power spectral density analysis, was significantly higher in children with ASD; relatively higher neuromotor noise was found in bands >3 Hz. Our findings suggest that significant instability of fundamental handwriting movements, in combination with atypical biomechanical strategies, contribute to larger and less consistent handwriting in children with ASD.

Persistent sleep disturbance is associated with treatment response in adolescents with depression

BACKGROUND

Sleep disturbances are highly prevalent in adolescents with depressive disorders. To date there is limited evidence of the extent to which sleep disturbances are associated with treatment response in adolescents. This study aimed to examine the extent to which self-reported sleep disturbances are associated with treatment response in adolescents with depression.

METHOD

Sleep data were gathered from a sample of 166 adolescents (aged 12-18 years) with a diagnosis of a DSM-IV depressive disorder who underwent 3 months of treatment (psychosocial and/or pharmacotherapy (sertraline)) in community-based research programs. The subjective report of sleep disturbance within depressive disorders was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children at three time points: pre-treatment, post-treatment and 6-month follow-up.

RESULTS

Sixty-nine percent of participants had a sleep disturbance pre-treatment and approximately 75% of these participants had threshold symptoms. Threshold sleep disturbances that persisted from pre- to post-treatment assessments were positively associated with depression at the 6-month follow-up. An ordered logistic regression model controlling for gender, treatment group and comorbid anxiety estimated a 70% risk of depression or partial remission for those with persistent sleep disturbance. Treatment group, anxiety and gender generally had no significant effect on the relationship between sleep and depression.

CONCLUSION

Sleep disturbances were highly related to depressive state and were associated with poorer treatment response in adolescents with depression. These results provide a rationale for further exploration of sleep-related treatments for adolescents with depression. Knowledge of patient-reported persistent sleep disturbances can help clinicians to predict treatment outcomes and may direct them to augment treatment or focus on sleep-related treatment strategies.

Towards the prevention of behavioural and psychiatric disorders in people with intellectual disabilities

Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.

A closer look at visually guided saccades in autism and Asperger's disorder

Motor impairments have been found to be a significant clinical feature associated with autism and Asperger’s disorder (AD) in addition to core symptoms of communication and social cognition deficits. Motor deficits in high-functioning autism (HFA) and AD may differentiate these disorders, particularly with respect to the role of the cerebellum in motor functioning. Current neuroimaging and behavioral evidence suggests greater disruption of the cerebellum in HFA than AD. Investigations of ocular motor functioning have previously been used in clinical populations to assess the integrity of the cerebellar networks, through examination of saccade accuracy and the integrity of saccade dynamics. Previous investigations of visually guided saccades in HFA and AD have only assessed basic saccade metrics, such as latency, amplitude, and gain, as well as peak velocity. We used a simple visually guided saccade paradigm to further characterize the profile of visually guided saccade metrics and dynamics in HFA and AD. It was found that children with HFA, but not AD, were more inaccurate across both small (5°) and large (10°) target amplitudes, and final eye position was hypometric at 10°. These findings suggest greater functional disturbance of the cerebellum in HFA than AD, and suggest fundamental difficulties with visual error monitoring in HFA.

A randomised group comparison controlled trial of 'preschoolers with autism': a parent education and skills training intervention for young children with autistic disorder

AIM

To determine the effect of parent education on adaptive behaviour, autism symptoms and cognitive/language skills of young children with autistic disorder.

METHOD

A randomised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample. Two rural and two metropolitan regions were randomly allocated to intervention groups (n = 70) or control (n = 35). Parents from autism assessment services in the intervention regions were randomly allocated to parent education and behaviour management (n = 35) or parent education and counselling (n = 35).

RESULTS

Parent education and behaviour management resulted in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour. Parent education and behaviour management was superior to parent education and counselling. We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children.

Trajectory of behavior and emotional problems in autism

High rates of behavior and emotional problems have been consistently reported in children and adolescents with autism. Elevated rates of mental health problems have also been reported in adults with autism. Little is known, however, about the longitudinal development of behavior and emotional problems in autism. This study followed a cohort of children and adolescents over 18 years. Outcomes were evaluated in terms of behavior and emotional problems and autism symptomatology. The role of childhood factors (age, gender, IQ, behavior, and emotional problems) and the environment (socioeconomic disadvantage) were considered in terms of adult outcomes. Overall, improvements in comorbid behavior and emotional problems and autism symptomatology were observed. However, rates of comorbid behavior and emotional problems in adulthood remained high.

Developing and PilotingePACT: A Flexible Psychological Treatment for Depression in People Living With Chronic Spinal Cord Injury

Accessibility, stigma and adverse effects of self-reliance can hinder the receipt of psychological treatments, especially in people living with chronic illness or disability. The aim of this study was to develop and pilot a flexible online psychological treatment using CBT and positive-psychology based techniques, for individuals with spinal cord injury (SCI) who also lived with depression or both depression and anxiety. A multiple case study approach provided in-principle evidence of the acceptability of the Electronic Personal Administration of Cognitive Therapy:ePACT. Three adults living with SCI completed pre- and post-intervention interviews and multiple modules ofePACT. The interviews used the Structural Clinical Interview for DSM Disorders (SCID/-N/P) for diagnosis and the standardised survey instruments: Depression Anxiety and Stress Scale — short version (DASS-21), Personal Wellbeing Index 4th edition (PWI) and the Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ v1 Australia). The results indicated that the online program was acceptable, and they all showed some improvement in symptoms. All participants indicated that they would not have sought face-to-face therapy for reasons of access and stigma. They all had a strong sense of independence and felt this would have been questioned if they sought therapy.

The behavioral phenotype of Mowat-Wilson syndrome

Mowat-Wilson syndrome (MWS) is caused by a heterozygous mutation or deletion of the ZEB2 gene. It is characterized by a distinctive facial appearance in association with intellectual disability (ID) and variable other features including agenesis of the corpus callosum, seizures, congenital heart defects, microcephaly, short stature, hypotonia, and Hirschsprung disease. The current study investigated the behavioral phenotype of MWS. Parents and carers of 61 individuals with MWS completed the Developmental Behavior Checklist. Data were compared with those for individuals selected from an epidemiological sample of people with ID from other causes. The behaviors associated with MWS included a high rate of oral behaviors, an increased rate of repetitive behaviors, and an under-reaction to pain. Other aspects of the MWS behavioral phenotype are suggestive of a happy affect and sociable demeanor. Despite this, those with MWS displayed similarly high levels of behavioral problems as those with intellectual disabilities from other causes, with over 30% showing clinically significant levels of behavioral or emotional disturbance. These findings have the potential to expand our knowledge of the role of the ZEB2 gene during neurodevelopment. Furthermore, they are a foundation for informing interventions and management options to enhance the independence and quality of life for persons with MWS.

The Self-Efficacy Questionnaire for Depressed Adolescents: a measure to predict the course of depression in depressed youth

OBJECTIVE

Self-efficacy can be conceptualised as a person's perception of their own ability to produce a desired outcome. Low self-efficacy has been reported to be a mediating variable in developing depression. The Self-Efficacy Questionnaire for Depressed Adolescents (SEQ-DA) is a 12-item inventory, designed to measure self-perceived ability of the young person to cope with depressive symptoms. This paper presents further information on the psychometric properties of the SEQ-DA in a clinical sample of depressed adolescents.

METHOD

The SEQ-DA was administered to a clinical sample of 130 adolescents with a depressive disorder at baseline, at the end of 3 months of therapy and 6 months following therapy. A diagnosis of depression was made using the Schedule for Affective Disorders and Schizophrenia for School Aged Children. The ability of the SEQ-DA to identify those adolescents who had a diagnosis of major depressive disorder at baseline, following treatment and at 6-month follow-up was evaluated. Receiver operating characteristic (ROC) analysis of the SEQ-DA in this clinical sample of depressed adolescents was undertaken to establish cut-off scores of the SEQ-DA.

RESULTS

The SEQ-DA score at baseline of < 36 and following treatment of < 43 were predictive of a depressive disorder.

CONCLUSIONS

The SEQ-DA is a very simple self-report measure that can be used to predict which adolescents treated for depression are likely to remain depressed, thus prompting more intensive treatment and follow-up.

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

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

Autism spectrum disorders

BACKGROUND

Autism spectrum disorders (ASDs) are serious neurodevelopmental disorders affecting approximately one in 160 Australians. Symptoms are apparent during the second year of life causing impairments in social interaction, communication and behaviour with restricted and stereotyped interests.

OBJECTIVE

To increase the general practitioner's awareness of the presenting symptoms of ASDs and their associated problems in children, screening for ASDs, and the assessment process, treatment options and outcomes.

DISCUSSION

This article discusses the five red flags that are autism alerts in young children. These red flags can enable GPs to play a key surveillance role in determining which young children might require further screening and referral for an ASD assessment. Because ASDs are lifelong, neurodevelopmental disorders and symptoms change over time. Therefore the GP has an ongoing role to support, educate and advise parents, other carers and the individual with an ASD. Treatment and pharmacological interventions are also discussed.

Neuropsychological deficits in adolescent unipolar depression

Although neuropsychological deficits in adult depression are relatively well established, findings in children/adolescents have been inconsistent and thus require further investigation. The current study investigated verbal fluency (VF), cognitive speed, motor speed, and executive functions in adolescents with unipolar depression. Results indicated that adolescents with minor depression showed working memory deficits and poorer VF (letter task). Adolescents with major depression showed working memory deficits and processing speed deficits from the early stages of information processing to the later stages of motor output. Executive function deficits of set-shifting and response inhibition that are well established in adults were not found, but may reflect task differences. Thus, it appears that depression subtype or severity of symptoms may impact on neuropsychological functioning and may in part explain previous inconsistent results.

Lexical processing in individuals with high-functioning autism and Asperger's disorder

The presence or absence of clinically delayed language development prior to 3 years of age is a key, but contentious, clinical feature distinguishing autism from Asperger's disorder. The aim of this study was to examine language processing in children with high-functioning autism (HFA) and Asperger's disorder (AD) using a task which taps lexical processing, a core language ability. Eleven individuals with HFA, 11 with AD and 11 typically developing (TD) individuals completed a masked priming task, a psycholinguistic paradigm that directly examines lexical processes. Within-group analyses revealed the AD and TD groups had intact lexical processing systems and orthographic processing of the written word. The outcomes for the HFA group were ambiguous, suggesting that their lexical processing system is either delayed or is structurally different. This suggests that fundamental differences in lexical processing exist between HFA and AD and remain evident later in development.

Outcome of adolescent depression: 6 months after treatment

OBJECTIVE

To evaluate the demographic and clinical factors that predicted depression in adolescents at 6 months after treatment.

METHOD

A total of 130 adolescents (aged 12 to 18 years) who had been clinically referred for treatment with a DSM-IV major depressive disorder, dysthymic disorder or minor depression were treated with either CBT, sertraline, their combination or supportive psychotherapy, in two randomized clinical trials using the same assessment instruments. Assessments in both studies were conducted at initial assessment, three months later at the conclusion of treatment, and at 6-month follow up. The data of these two trials were pooled. The primary outcome measures were the presence of a depressive disorder and the Reynolds Adolescent Depression Scale (RADS) score at 6-month follow up.

RESULTS

At baseline, only the Self Efficacy Questionnaire for Depressed Adolescents (SEQ-DA) predicted depression at 6-month follow up. Individual measures following 3 months of acute treatment that predicted depression at 6-month follow up were SEQ-DA, RADS, Revised Children's Manifest Anxiety Scale-total score, Global Assessment of Function, adolescent-rated Family Assessment Device General Functioning Subscale and adolescent-rated Visual Analogue Scores of mood states.

CONCLUSION

Clinical variables as reported by the adolescent and identified by the clinician at baseline assessment and following 3 months of treatment predicted depression at 6-month follow up. No demographic variables were predictive of depression at 6-month follow up.

Oxidative pathways as a drug target for the treatment of autism

IMPORTANCE OF THE FIELD

Autism is a severe, pervasive developmental disorder, the aetiology of which is poorly understood. Current pharmacological treatment options for autism are often focused on addressing comorbid behavioural problems, rather than core features of the disorder. Investigation of a new treatment approach is needed.

AREAS COVERED IN THIS REVIEW

Recent research has indicated a possible role of abnormalities in oxidative homeostasis in the pathophysiology of autism, based on reports that a range of oxidative biomarkers are significantly altered in people with autism. This article reviews the current findings on oxidative stress in autism, including genetic links to oxidative pathways, changes in antioxidant levels and other oxidative stress markers. We conducted a search of the literature up to June 2010, using Medline, Pubmed, PsycINFO, CINAHL PLUS and BIOSIS Previews.

WHAT THE READER WILL GAIN

This review provides an overview of the current understanding of the role of oxidative stress in autism. This will assist in highlighting areas of future therapeutic targets and potential underlying pathophysiology of this disorder.

TAKE HOME MESSAGE

Abnormalities in oxidative homeostasis may play a role in the pathophysiology of autism. Antioxidant treatment may form a potential therapeutic pathway for this complex disorder.

The normative development of emotion regulation strategy use in children and adolescents: a 2-year follow-up study

BACKGROUND

Emotion regulation involves intrinsic and extrinsic processes responsible for managing one's emotions toward goal accomplishment. Research on emotion regulation has predominantly focused on early developmental periods and the majority of emotion regulation research examining the pre-adult years has lacked a comprehensive theoretical framework. The current study examined the use of two strategies of emotion regulation during childhood and adolescents, as conceptualised within Gross's (1998) process-oriented model.

METHODS

To determine the use, norms and development of the Expressive Suppression and Cognitive Reappraisal strategies, the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) was administered to 1,128 participants aged between 9 and 15 years. Three data collection phases, each one year apart, enabled investigation of developmental patterns in the use of the two strategies.

RESULTS

As predicted, Suppression use was found to be lower for older participants compared to their younger peers, and over time participants reported less use of this strategy. Older participants also scored lower on Reappraisal but stability over time was found. Also as expected, males reported more Suppression use compared to females.

CONCLUSIONS

By documenting the development and norms for Cognitive Reappraisal and Expressive Suppression in a community sample of children and adolescents, the current study makes a significant contribution to our understanding of these two ER strategies during these developmental periods.

Attentional blink in young people with high-functioning autism and Asperger's disorder

The aim of the study was to examine the temporal characteristics of information processing in individuals with high-functioning autism and Asperger's disorder using a rapid serial visual presentation paradigm. The results clearly showed that such people demonstrate an attentional blink of similar magnitude to comparison groups. This supports the proposition that the social processing difficulties experienced by these individuals are not underpinned by a basic temporal-cognitive processing deficit, which is consistent with Minshew's complex information processing theory. This is the second study to show that automatic inhibitory processes are intact in both autism and Asperger's disorder, which appears to distinguish these disorders from some other frontostriatal disorders. The finding that individuals with autism were generally poorer than the comparison group at detecting black Xs, while being as good in responding to white letters, was accounted for in the context of a potential dual-task processing difficulty or visual search superiority.