Emotional and Behavioural Problems in Children with Autism Spectrum Disorder

Early detection of anxiety symptoms in Autism Spectrum Disorder: An exploratory study in a Spanish sample of 3-6 year old children

Current research often overlooks anxiety symptoms in preschoolers with Autism Spectrum Disorder (ASD), focusing on older children. This study examines anxiety symptomatology primarily in young children with ASD by analyzing data from 82 Spanish children aged 3- to 6 years. Parents completed the Anxiety Scale for Children with ASD and the Social Communication Questionnaire. Results indicate that 30.48% of the children exhibit significant anxiety symptoms, "with anxious uncertainty" being the most prevalent. Factor analysis reveals three principal components of the Anxiety Scale, supporting its reliability. Regression analysis highlights stereotypical behaviors as significant predictors of anxiety levels. These findings underscore the importance of early assessment and adaptation of assessment tools for preschoolers with ASD. Stereotypical behaviors are identified as key predictors of anxiety in this population.

Effects of the Early Start Denver Model on emotional dysregulation and behavior problems in children with Autism spectrum disorder : Effects of the early start Denver model on emotional dysregulation and behavior problems in Chinese children with Autism spectrum disorder

BACKGROUND

Most previous studies have focused on the clinical efficacy after intervention of ESDM, particularly in core symptoms. However, only a few have paid attention to the effectiveness of ESDM on emotional dysregulation and behavior problems in children with ASD. This study aimed to explore the effect of the ESDM on addressing emotional dysregulation and behavior problems in children with ASD in China, as well as its correlation with core symptoms of ASD.

METHODS

A total of 319 children aged 1.5 to 5 years were included in this study and received treatment based on the ESDM intervention program Baseline assessment (T0) was conducted before intervention, including Children Behavior Checklist (CBCL), Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS). All children with ASD were examined in the assessment (T1) after 12 weeks of treatment. Emotional dysregulation and behavior problems in children with ASD were measured using CBCL, while ABC and CARS were used to evaluate the core symptoms.

RESULTS

In the T1 assessment, the core symptoms of children with ASD in ABC and CARS showed significant differences. Subscale scores of ABC and the severity of CARS, including senses, relationships, stereotypes objects to use, self-help and social also exhibited significant differences. The children showed significant differences in both total score and subscale scores of CBCL(P < 0.05), which included emotionally/reactive, anxious/depressed, somatic complaints, withdrawal, sleep problems, attention problems, aggressive behavior, internalization and externalization. The children demonstrated significant differences in scores of CBCL-AAA (P < 0.05), taking into account the combined total of attention, aggression and anxious/depressed CBCL T scores. In addition, a consistent positive correlation was observed between the overall scores of CBCL and the core symptoms of children with ASD as indicated by ABC and CARS in both T0 and T1(P < 0.01). In T0, the CBCL-AAA scores were positively associated with the core symptoms of children with ASD as reflected by CARS(P < 0.01), as well as senses of ABC( P < 0.05). During T1, a noteworthy significant positive correlation was observed between the CBCL-AAA scores and the core symptoms of children with ASD as indicated by both ABC and CARS assessment (P < 0.05).

CONCLUSIONS

Children with ASD benefit from ESDM, not only in terms of improving their core symptoms, but also in terms of improving their emotional dysregulation and behavior problems, and ESDM could be considered as one of the early treatment options for overall psychological promotion. The core symptoms of children with ASD are significantly associated with emotional dysregulation and behavior problems in young children, both cross-sectionally and prospectively for the short term over time. Emotional dysregulation and behavior problems represent an important comorbidity, and could be considered as potential treatment targets for treatment for improving emotional stability in ASD.

Brief Report: Psychometric Properties of the Brief Problem Monitor-Parent (BPM-P) 6-18 in a Sample of Children Referred to an Autism Specialty Clinic

Detection and monitoring of emotional and behavior problems is a critical part of clinical care for children diagnosed with autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs), as well as a common focus of research. The Child Behavior Checklist (CBCL) is a well-established caregiver-report instrument that is used for screening and monitoring of emotional and behavior problems in individuals diagnosed with ASD and NDDs. However, it has over 100 items and can be time-consuming to complete. The Brief Problem Monitor Parent Report (BPM-P; Achenbach et al. 2011) includes a subset of the CBCL items and is intended for monitoring emotional and behavior problems. However, its validity has not been examined in ASD or NDD samples. Data from 302 children ages 6-18 years whose caregivers had completed the CBCL were drawn from a clinical research databank. Confirmatory factor analysis of the BPM-P three-factor structure had mixed findings. All BPM-P scales had acceptable internal consistency, and agreement between the BPM-P cutoffs and the corresponding CBCL clinical cutoffs was acceptable for the broad problem scales. The Attention scale demonstrated high sensitivity, but poor specificity. Results provide initial evidence that the BPM-P may be a useful alternative to the CBCL, producing comparable information for broad problems, while requiring much less time from caregivers. BPM-P users may want to consider the Attention scale separately due to poor specificity compared to the CBCL. These results will need to be replicated using larger samples and independent administrations of the BPM-P and the CBCL.

Learning from educators: Implementation of a positive behavior support program targeting challenging behavior in children with autism

Challenging behaviors (CB) are a frequent co-occurring problem in children with autism spectrum disorder (ASD) and hinder their response to recommended interventions such as early intensive behavioral intervention (EIBI). The Prevent-Teach-Reinforce for young children (PTR-YC) program was implemented to meet community-based EIBI educators' training and support needs in managing CB in their day-to-day work with families. Although this positive behavior support program has a strong empirical basis, its implementation by community-based educators has yet to be assessed from a systematic and structured program evaluation perspective. Using Chen's (2015) theoretical framework for program evaluation, this study assessed the quality of implementation of PTR-YC as perceived by 17 educators who received training and supervision on applying PTR-YC among families of children with ASD receiving EIBI services. Educators' post-intervention interviews and questionnaires were analyzed using the logical model for program evaluation to identify obstacles and facilitators to the implementation of PTR-YC.

Parental Representations and Emotional Availability: The Case of Children with Autism and Severe Behavior Problems

Studies suggest that parents' emotional availability (EA) is associated with children's wellbeing, including in the case of children with autism. Our study extended prior research by examining the role of parents' representations in fostering parental EA and by focusing on fathers and on children with autism and severe behavior problems. We expected that parents' positive representations would be associated with higher EA and compared mothers' and fathers' representations and EA. Participants were 79 mothers and 69 fathers (child age range = 61-173 months, 21.95% girls). Representation assessments included the Reaction to Diagnosis Questionnaire, tapping resolution with respect to the child's diagnosis, and the coherence and positive comments in parents' Five Minute Speech Samples about the child. Parents' EA was coded from parent-child play interactions. Controlling for children's autism symptoms and adaptive functioning, mothers' resolution with respect to the child's diagnosis and positive comments (but not coherence) were associated with their EA, and fathers' coherence (but not positive comments and resolution) was associated with their EA. Mothers expressed more positive comments than fathers, and the resolution and EA scores of mothers and fathers were significantly correlated. Our results highlight the importance of considering both parents' representations and EA when studying and working with families of children with autism and severe behavior problems.

LEGO®-Based Therapy in School Settings for Social Behavior Stimulation in Children with Autism Spectrum Disorder: Comparing Peer-Mediated and Expert Intervention

BACKGROUND

LEGO®-based therapy is a social development protocol that uses LEGO® activities to support the development of a wide range of interaction skills, enhancing prosocial behaviors and mitigating the challenges associated with mental health difficulties and behavioral issues commonly observed in children with autism spectrum disorder (ASD).

OBJECTIVES

This study aimed to explore the effects of LEGO®-based therapy on the social behavior and mental health of children with ASD, comparing stimulation mediated by expert and stimulation mediated by non-autistic peers. This study was approved by the Ethical Committee at Mackenzie Presbyterian University, ensuring adherence to ethical standards throughout the research process.

METHODS

This study involved 18 children with ASD, levels 1 or 2, with an intelligence quotient (IQ) above 70, and three typically developing peers, intelligence quotient (IQ) above 80, aged between 5 and 8 years old, of both sexes. Participants were randomized into three groups for stimulation (stimulation mediated by expert, by a non-autistic peer and control group). The measures were the Wechsler Abbreviated Scale of Intelligence, the Strengths and Difficulties Questionnaire (parent and teacher versions), the Inventory of Difficulties in Executive Functions, Regulation, and Aversion to Delay-Child Version, the Developmental Coordination Disorder Questionnaire, the Autism Behavior Checklist, and the Autistic Behavior Inventory.

RESULTS

After 14 sessions of 45 min in school settings, the participants of both groups (mediated by experts and non-autistic children) showed significant gains on social behavior. A statistically significant difference was observed between baseline sessions and probes (χ2 (5) = 25.905, p < 0.001). These gains were maintained in both follow-up points, 30 and 90 days after the completion of the stimulation sessions. Additionally, maladaptive behavior showed a significant decline when compared pre- and post-intervention. These improvements were sustained during follow-up assessments at 30 and 90 days.

CONCLUSIONS

The results suggest that a structured intervention combined with peer-mediated stimulation may be an effective method for promoting adaptive and prosocial behaviors in children with ASD.

Mobile App-Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial

BACKGROUND

In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members.

OBJECTIVE

We aimed to develop and evaluate the feasibility of a mobile app-assisted parent training program for reducing problem behaviors in children with ASD.

METHODS

This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app-assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app-assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior.

RESULTS

Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of -0.5 (95% CI -4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of -2.1 (95% CI -8.5 to 2.5). However, there was no significant difference in Clinical Global Impression-Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference -2, 95% CI -4 to 1). Caregivers' stress evaluated using the Korean Parenting Stress Index Fourth Edition-Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation.

CONCLUSIONS

The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices' accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD.

TRIAL REGISTRATION

CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112.

Parent Training for Disruptive Behaviors in Referred Children with Autism Spectrum Disorder: A Randomized Controlled Trial

The purpose of this study was to investigate whether face-to-face and therapist-assisted online (i.e., blended) behavioral parent training are effective on reducing disruptive behaviors in children with autism spectrum disorder (ASD) in routine mental health care. Ninety-seven children with ASD (4-13 years; 76 boys) were randomized to face-to-face parent training, blended parent training, or a waitlist control condition. We assessed treatment effects on parent-rated child noncompliance (primary outcome) and irritability (secondary outcome). This involved comparing both formats separately to the control condition using linear regression models. Child behaviors at 6 months follow-up were also examined. Children in the face-to-face parent training condition improved significantly more on noncompliance and irritability than children in the waitlist condition and improvements sustained to 6 months follow-up. Children in the blended condition did not improve more than children in the waitlist condition and attrition was high. Our results extend findings from efficacy studies to routine mental health care and advocate the use of face-to-face parent training for disruptive behaviors in children with ASD. More research into blended parent training programs for children with ASD and disruptive behaviors in routine mental health care should be conducted to draw more definite conclusions about the value of blended parent training for these children. Trial registration number NL4712; date of registration 22-10-2014.

Pattern of sleep disorders among children with autism spectrum disorder

BACKGROUND

Sleep disorders (SDs) are among many co-morbid medical conditions that affect children with autism spectrum disorder (ASD). Raising awareness and improving the standard of care for children diagnosed with ASD may result from identifying SDs among them. This study aims to evaluate patterns of SDs among Sudanese children diagnosed with ASD.

METHOD

Using the Childhood Sleep Habit Questionnaire (CSHQ) to gather data on sleep disorders and SPSS version 26.0 for data analysis, a descriptive cross-sectional study was carried out in the five main autistic centres in Khartoum state covering all registered patients with ASD between April and June 2022. Ninety-two children diagnosed with ASD were enrolled in this study after the purpose of the research was explained and consent was obtained from their guardians. A p-value < 0.05 was considered to indicate statistical significance.

RESULTS

The mean age was 6.90 (± 2.6) years with a boys-to-girls ratio of 2.17:1. The prevalence of SDs (at least one sleep condition almost daily) was 95.65%. Sleep onset 71 (77.2%), limit setting 32 (32.6%), resistant onset to sleep 48 (52.2%), and combined 52 (56.5%) insomnia affected the majority of children. Additionally, there were significant associations between sex and Limit-setting insomnia, advanced sleep phase disorder, and narcolepsy type 2 (P values = 0.033, 0.009, and 0.037, respectively). Additionally, there was a significant association between age and sleep-related breathing disorders-snoring (p value = 0.031).

CONCLUSION

The frequency of SDs is significant among children diagnosed with ASD from Sudan, and certain SDs are associated with age and sex. Subsequent studies are required to develop national guidelines for the prevalence, presentation, screening, and treatment of SDs in children diagnosed with ASD.

Psychometric Properties of the Child Behavior Checklist (CBCL) for Ages 6-18 to Identify Autism Spectrum Disorders (ASD) in a Turkish Parent Sample

The Child Behavior Checklist for ages 6-18 (CBCL/6-18) is broadly used for psycho-educational assessment in identifying children's behavior problems in special education and psychology. However, the usefulness of the CBCL/6-18 in a Turkish sample still needs to be investigated. The current study aimed to investigate the psychometric properties of the measures of the CBCL/6-18 within a sample of Turkish parents. The psychometric evaluation includes item calibration using the Partial Credit Model (PCM). We analyzed data from 548 parents who have children with autism spectrum disorder. According to the PCM calibration, the results suggested that the Internalizing, Externalizing, and Total Problem subscales were unidimensional and showed local independence successfully. All subscales demonstrated adequate reliability, indicating that the scale distinguishes between children with different behavior problems. The subscales had varying item step ordering, meaning that transitions from one category to second by parent ratings are relatively straightforward. Some items with easy-to-define behavior problems, for example, Item 42 (constipated), were more likely to be endorsed by parents. Consequently, the CBCL/6-18 has adequate psychometric properties for accurately assessing problem behaviors in children based on parent ratings.

A national research survey of childhood autism assessment services in the UK: empirical evidence of diagnostic practice, challenges and improvement opportunities

BACKGROUND

The UK National Health Service (NHS) Long Term Plan aims to reduce waiting times for childhood autism diagnostic assessment and improve parent and child satisfaction. This empirical research investigated current childhood diagnostic practice provision, and changes made by teams to address challenges faced.

METHODS

Data were collected using an online semi-structured research questionnaire. UK childhood autism diagnostic assessment services (for children aged 1-18 years) were invited to participate through multidisciplinary clinical networks, special interest groups and professionals mailing lists. The study was on the National Institute for Health Research Clinical Research Network portfolio.

RESULTS

128 clinicians from diverse NHS services responded including: 10 (8%) integrated services, 46 (36%) Child and Adolescent Mental Health Services (CAMHS) and 72 (56%) paediatric services. A minority of services (23, 17.9%) reported always meeting the National Institute for Health and Care Excellence guidance for assessment. Referrals rose 115% between 2015 and 2019. Clinicians described increased child and family complexity compared with previously; children had more co-occurring physical, mental health and neurodevelopmental conditions and there were more frequent family health problems and safeguarding concerns. Most services (97, 75.8%) reported recent funding stayed constant/decreased. Incomplete multidisciplinary teams (MDTs) were frequently reported; a minority of services reported increased availability of professionals, and some experienced reductions in key professionals. Many teams were unable to undertake assessments or make recommendations for associated neurodevelopmental and co-existing conditions. Teams described improvement strategies implemented (eg, adapting professionals' roles, supporting parents).

CONCLUSIONS

Most UK autism paediatric and CAMHS diagnostic teams experience significant challenges affecting the assessment of children with possible autism, and recommendations regarding treatment/intervention. Where CAMHS or paediatric services work in isolation, there are often competency gaps in MDTs and ability to deliver full neurodevelopmental and mental health assessments. Teams identified service improvement strategies; however, investment in MDT expertise is required to enable services to implement changes to meet the needs of children and families.

Association of cognitive and adaptive skills with internalizing and externalizing problems in autistic children and adolescents

The presence of an intellectual disability (ID) alongside autism is considered to increase the risk for mental health and behavior problems in children and adolescents. Existing evidence is restricted by looking at ID as a categorical classification. The study aimed to examine the association of cognitive and adaptive behavior skills with internalizing and externalizing problems in a large sample of autistic children and adolescents, across a wide range of cognitive skills. Participants were 2759 children and adolescents aged between 4 and 18 years recruited as part of the Simons Simplex Collection (SSC), of whom 709 (approximately 25%) had ID. Multiple regression models examined associations of internalizing and externalizing problems with cognitive and adaptive skills (communication, daily living, and socialization skills). Cognitive skills were not associated with externalizing problems but were associated with more internalizing problems in autistic children without ID (Cog β: 0.126). All adaptive skill domains were inversely associated with externalizing (Communication β: -0.145; Daily-Living β: -0.132; Socialization β: -0.289) and internalizing problems (Communication β: -0.074; Daily-Living β: -0.064; Socialization β: -0.213) in those without ID. Daily living (β: -0.158) and socialization skills (β: -0.104) were inversely correlated with externalizing problems in autistic children with ID, while only socialization problems (β: -0.099) were associated with internalizing problems in this group. Socialization skills were systematically associated with internalizing and externalizing problems across all levels of cognitive functioning. Supporting social skills development may benefit all aspects of child mental health, while recognizing that children with higher cognitive skills are more vulnerable to internalizing problems might assist with earlier identification of these problems.

Emotion Dysregulation Mediates the Relationship Between Sensory Processing and Behavior Problems in Young Children with Autism Spectrum Disorder: A Preliminary Study

Emotion dysregulation is one of the challenges that children with autism spectrum disorder (ASD) and their families face. It is unclear whether emotion dysregulation plays a mediating role in the relationship between sensory processing patterns and problem behaviors among these children. This study examined the relations between emotion dysregulation, behavioral problems, and sensory processing patterns among fifty-seven young children with ASD. Behavioral problems and sensory processing patterns were moderately to strongly correlated with emotion dysregulation. The relationship between sensory processing patterns and behavioral problems was significant with emotion dysregulation as a mediator. These findings help identify the relationship between emotion dysregulation, sensory processing patterns, and behavioral problems to facilitate the planning of intervention strategies for young children with ASD.

A mixed method examination: how stigma experienced by autistic adults relates to metrics of social identity and social functioning

A recent meta-analysis reveals almost half of autistic individuals experience some form of victimization in their lifetime, including bullying and other forms of stigma. Research among caregivers of autistic individuals demonstrates that stigma can have a long-lasting impact on other aspects of a social identity, such as self-esteem, but less research has specifically examined this among autistic adults themselves, in spite of research suggesting these are likely constructs that contribute to the internalization of stigma and subsequent mental health consequences. The current study used a mixed method approach to assess the relation between stigma and several components of social identity and social functioning. More specifically, among 45 autistic young adults, three dimensions of self-reported stigma (discrimination, disclosure, and positive aspects) were examined in relation to self-esteem, self-efficacy, social satisfaction and adaptive social functioning. Quantitative analyses revealed higher reported discriminative and disclosure stigma were significantly associated with lower self-efficacy. Increased experience with all types of stigma were associated with lower social satisfaction. Greater reported disclosure stigma was also associated with lower self-esteem. Qualitative interviewing among eight autistic young adults helped to better understand the nature of stigma and the impact of these experiences. Thematic analysis of the qualitative data revealed that all of the participants experienced stigma in the form of exclusion or isolation and that a majority also experienced verbal bullying. Many of the negative interactions came from educators, peers, and family members. Most participants indicated that these stigmatizing interactions directly contributed to decreased social satisfaction, diminished self-efficacy, and lowered self-esteem. A greater understanding of the negative consequences of stigma can inform efforts to increase awareness and acceptance of autism.

Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy

Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3-13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.

School Social Capital Mediates Associations Between ASD Traits and Depression Among Adolescents in General Population

Though autism spectrum disorder (ASD) traits are associated with depression, it is unclear if school social capital mediates their association. We examined whether school social capital mediates the association between ASD traits and depression, and moderation effect of sex on the mediation effect among adolescents in a general population sample (1750 males, 1779 females; equivalent 12-15 years old). The results of this study indicate that ASD traits are associated with depression among adolescents, and that this association is partly mediated by school social capital. Furthermore, the results of the moderated mediation analysis suggest that lower level of school social capital can lead to more increase level of depression for females than for males.

Mothers' participation in family gatherings and social events with their children with autism spectrum disorder: A scoping review

INTRODUCTION

Participating in family gatherings can provide enjoyment and quality time together as a family. However, being the primary carers, mothers of children with autism spectrum disorder may experience this phenomenon differently. The purpose of this study is to explore how available literature describes mothers' experiences of participation in family gatherings and social events with their children with autism spectrum disorder.

METHODS

A scoping review was used to explore available literature and identify studies describing mothers' experiences of family gatherings and social events with their children. A thematic synthesis was performed to analyse and synthesise the findings.

RESULTS

A total of 8 articles were included for review. The analysis of the included studies resulted in one central theme-Negative experiences despite strategies-and four analytical themes: Feeling fear, stress, and anxiety; Avoiding family gatherings; Enjoying less and becoming less confident; and Using strategies.

CONCLUSION

These findings indicate that mothers of children with autism spectrum disorder experience difficulties during gatherings even when using strategies, hence limiting their participation.

The effect of family capital on psychological adjustment of Chinese children with autism spectrum disorder in the transition from kindergarten to primary school

Purpose: The present study aimed to investigate how different forms of family capital might affect psychological adjustment in children with autism spectrum disorder (ASD) in the transition from kindergarten to primary school. Methods: Participants (n = 221) were recruited using convenience sampling from Beijing, Xiamen, Chongqing, and Lanzhou in China. With the Chinese version of different measurements such as Strengths and Difficulties Questionnaire, Family Economic Capital Scale, Family Cultural Capital Scale, Social Capital Scale, and the Questionnaire of Parental Involvement in Transition from Kindergarten to Primary School, the hierarchical linear regression was performed to examine the effect of family capital on psychological adjustment of Chinese children with ASD. Results: The results indicated that monthly household income (B = -0.04, SE = 0.03, p < 0.05), parental educational expectations (B= - 0.07, SE = 0.02, p < 0.01), and parental involvement (B= -0.11, SE = -0.04, p < 0.05) have significantly negative effect on emotional symptoms of children with ASD; monthly household income (B= -0.05, SE = 0.01, p < 0.05) and the strength of social ties (B=-0.09, SE =0.03, p < 0.01) were negatively associated with conduct problems; monthly household income negatively predicted hyperactivity/inattention (B=-0.05, SE = 0.02, p < 0.05); social network ties were negatively correlated with peer problems (B=-0.10, SE = 0.03, p < 0.01); the monthly household income (B = 0.04, SE = 0.02, p < 0.05), parental educational expectations (B = 0.07, SE = 0.03, p < 0.05), parental involvement (B = 0.27, SE = 0.04, p < 0.01), and strength of social ties (B = 0.10, SE = 0.05, p < 0.05) positively affected the prosocial behavior. Conclusion: The present study, from a cross-cultural perspective, revealed the negative associations between family capital variables, including family economic, cultural, and social capital, and the difficult domains of psychological adjustment, as well as the positive associations with prosocial behavior. These contribute to the applicability of the family capital theory to explain psychological adjustment of children with ASD.

Emotional and behavioral alterations and their relationship with executive functioning in the pediatric population with autism spectrum disorder and epilepsy: a comparative study

Introduction

The pediatric population with Autism Spectrum Disorder (ASD) and epilepsy presents behavioral and emotional alterations that hinder their correct developmental maturation as well as their integration in different contexts such as school, family or social. This population shows atypical behavioral and emotional patterns, with difficulties in emotional regulation, understanding of emotions, aggressiveness, or low frustration tolerance. They also present alterations in executive functions, which significantly influence the emotional and behavioral characteristics of this population. Research suggests that epilepsy worsens the emotional, behavioral, and executive functioning status.

Objective

To explore differences in behavioral, emotional, and executive functioning profile in individuals with a diagnosis of ASD, epilepsy, and ASD with epilepsy.

Method

In this quasi-experimental and cross-sectional study, a total of 170 participants were selected and distributed into three groups: a group of participants with ASD, a group with epilepsy, and a group of participants with ASD and epilepsy. The SENA, BASC-3, and ENFEN tests were administered to verify the behavioral, emotional, and executive functioning profile in the three groups.

Results

The results indicate that individuals diagnosed with ASD and epilepsy present greater emotional, behavioral, and executive functioning alterations compared to those who only present ASD or epilepsy.

Conclusion

Individuals with ASD and epilepsy present significant alterations in emotional, behavioral, and executive functioning processes, which hinder their adaptation to different contexts, as well as decreasing their quality of life and that of their family.

Is language ability associated with behaviors of concern in autism? A systematic review

This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self-injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty-five publications (n = 11,961) were included. Forty studies were cross-sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high-quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC.

The lived experience of meltdowns for autistic adults

LAY ABSTRACT

There is not a lot known about what it feels like for autistic people to have a meltdown. Past research has focused on what meltdowns are like for parents and what meltdowns look like from the outside without understanding what it is like for the person having the meltdown. We asked 32 autistic adults about what it is like for them to have a meltdown. We asked them to tell us about their thoughts and feelings about having a meltdown. Then, we looked for themes in their responses that summarized the meltdown experience. Our findings showed that meltdowns hold different meaning to different people. During a meltdown, we found that most autistics described feeling overwhelmed by information, senses, and social and emotional stress. They often felt extreme emotions, such as anger, sadness, and fear, and had trouble with thinking and memory during the meltdown. Participants described trying to stay in control of themselves, often feeling like they were not themselves during meltdowns. They described the meltdown as a way of letting go of or releasing the extreme emotions they felt. Participants tried to stay away from things or people that might trigger a meltdown or tried to make sure they were alone if they felt a meltdown may be coming as a way of avoiding harm-including harm to their bodies, their emotions, and their relationships. These findings offer an important look into what it is like for autistic adults to have meltdowns from their own point of view.

Risk and protective factors associated with maternal mental health in mothers of children with autism spectrum disorder

BACKGROUND

Mothers of children with Autism Spectrum Disorder (ASD) experience lower maternal mental health outcomes than mothers of children from other populations, including children with intellectual and developmental disorders.

OBJECTIVES

This study explored risk factors associated with maternal mental health. Several factors including maternal resilience, social support, coping, optimism and family functioning acted as protective factors between child behavioural and emotional problems and maternal mental health.

METHODS

Mothers of 70 children completed a cross-sectional online survey. Twenty-two children were diagnosed with ASD, 16 children were diagnosed with Dyslexia (DYS) and 32 children had no special educational needs diagnosis (NO SEND).

RESULTS

Mothers of children with ASD demonstrated greater maternal mental health problems compared to mothers of children with DYS and NO SEND. Socioeconomic status (SES), child diagnosis, child gender, and child behavioural and emotional problems were significant risk factors associated with reduced maternal mental health. Maternal resilience, family functioning, and practical coping served as protective factors, moderating the relationship between child behavioural and emotional problems and maternal mental health. There is little evidence to suggest social support, optimism, and wishful thinking were protective factors in this relationship between child behavioural and emotional problems and maternal mental health.

IMPLICATIONS

There is a need to support mothers of children with ASD through interventions to promote and increase their mental health.

Occupational therapy incorporating dogs for autistic children and young people: Parent perspectives

Introduction

Dogs may elicit positive therapy outcomes for children/adolescents with autism spectrum disorder (ASD). However, little is known about the parent perspectives of the use of dogs as part of an occupational therapy program for ASD. This study aimed to explore parent perspectives about the Animal Assisted Therapy (AAT) component of the occupational therapy intervention their child/adolescent received across five weekly sessions.

Method

Using a phenomenological approach, 16 semi-structured interviews were conducted with parents (13 mothers and four fathers) following an AAT occupational therapy program. Thematic analysis was conducted.

Results

Three themes were identified relating to the value parents attributed to the AAT occupational therapy program with dogs for their child/adolescent: 1. Stress and anxiety management; 2. Participation and engagement and 3. Social communication. Positive outcomes identified by parents included the dogs being a calming influence and facilitating the participation of their child/adolescent in life-skill activities.

Conclusion

Parents valued AAT occupational therapy involving dogs. Future studies should investigate how to best target this occupational therapy approach for autistic children and adolescents.

Associations of emotional/behavioral problems with accelerometer-measured sedentary behavior, physical activity and step counts in children with autism spectrum disorder

Background

The evidence for associations of emotional/behavioral status with sedentary behavior (SB), physical activity (PA) and step counts is scarce in children with autism spectrum disorder (ASD). Also, ASD-related deficiencies may affect actual levels of PA. We aimed to describe accelerometer-measured SB, PA and step counts in children with ASD, and to examine the associations of emotional/behavioral problems with SB, PA and step counts after assessing associations between accelerometer-measured SB, PA and step counts and ASD-related deficiencies.

Methods

A total of 93 ASD children, aged 6-9 years, were recruited from the Center for Child and Adolescent Psychology and Behavioral Development of Sun Yat-sen University in Guangzhou, China. Participants wore an accelerometer for seven consecutive days. Of the original 93, 78 participants' accelerometer-measured valid PA were obtained, and the data were shown as time spent in SB, light, moderate, moderate-to-vigorous and vigorous PA, and step counts. Participants' emotional/behavioral problems were assessed via the Strengths and Difficulties Questionnaire (SDQ), and anxiety symptoms were evaluated by the Screen for Child Anxiety Related Emotional Disorders (SCARED). ASD-associated deficiencies include restricted repetitive behaviors (Repetitive Behavior Scale-Revised), poor social competence (Social Responsiveness Scale Second Edition) and motor development restrictions (Developmental Coordination Disorder Questionnaire).

Results

Of the 78 participants, daily vigorous PA (VPA) and moderate-to-vigorous PA (MVPA) averaged 15.62 and 51.95 min, respectively. After adjustment for covariates, SDQ emotional symptoms (β = -0.060, p = 0.028) were inversely associated with the average daily minutes in VPA. Meanwhile, SDQ emotional symptoms (β = -0.033, p = 0.016) were inversely associated with the average daily MVPA minutes in the crude model. After adjustment for covariates, SCARED somatic/panic (β = -0.007, p = 0.040) and generalized anxiety (β = -0.025, p = 0.014) were negatively associated with the average daily VPA minutes; SCARED total anxiety (β = -0.006, p = 0.029) was conversely associated with daily MVPA duration. After adjustment for covariates, no significant associations between accelerometer-measured SB, PA and step counts and ASD-related deficiencies were found (p > 0.05).

Conclusions

Accelerometer-measured SB, PA and step counts showed no associations with ASD-related deficiencies. On this basis, we further found that the emotional symptoms were inversely associated with VPA and MVPA. These results emphasize the importance of VPA and MVPA in children with ASD. The longitudinally investigations on the directionality of these associations between emotional symptoms with VPA and MVPA are needed in the future.

Behind the Wheel: Systematic Review of Factors Associated with Safe School Bus Transportation for Children with Neurodevelopmental Disorders

School buses facilitate access to education for many children. This research aimed to systematically review factors associated with safe school bus transportation for children with neurodevelopmental disorders (NDDs). Searches of 5 databases, combining terms denoting NDDs and school buses, for English publications since 2000, yielded only 12 relevant articles among 1524 records. Literature was limited to parent-based studies, guidelines, reviews or commentaries. There was scant attention to the immediate roles of bus drivers and aides. Literature recommendations included increased attention to the needs of children with NDDs and improved communication, collaboration, support and training across all key stakeholders, particularly to improve implementation of individual child safety plans. Further research is needed on this critical support service for many families.

A cross-cultural comparison of sleep patterns between typically developing children and children with ASD living in Saudi Arabia and the United Kingdom

BACKGROUND

Sleep is crucial for child development, especially for children with ASD. While it is known that children with ASD experience more severe sleep problems and that these problems tend to persist compared to their typically developing counterparts, these findings tend to come from only Western countries. A cross-cultural study is important to understand if the prevailing understanding of sleep in children with ASD can be extended to different cultural backgrounds.

AIM

A cross-cultural study is conducted, involving typically developing children and children with ASD aged 5-12 across two countries: Saudi Arabia and the United Kingdom.

METHODS AND PROCEDURES

Using a combination of questionnaires measuring ASD severity (CARS-2), sleep quality (CSHQ), sociodemographic and lifestyle variables and sleep diaries, 244 children were sampled using a mixture of snowball and convenience sampling methods.

OUTCOMES AND RESULTS

Children with ASD experience more sleep problems compared to typically developing children in Saudi Arabia, and these problems similarly persist across time. Specifically, it was found that children with ASD in Saudi Arabia experience greater sleep onset latency and a greater number of night awakenings. Additionally, across the ASD groups, it was found that children from Saudi Arabia generally experienced poorer sleep than children in the United Kingdom in terms of shorter sleep duration, although children in the United Kingdom tended to report more instances of sleep anxiety and parasomnias.

CONCLUSIONS AND IMPLICATIONS

Several reasons such as parental education about sleep hygiene, cultural influences and social hours were put forward as potential explanations for cross-cultural differences. Findings served to emphasise the importance of culturally-appropriate interventions and public education regarding child sleep.

Developing an arabic questionnaire to assess sensory processing disorders among preschool Egyptian children

BACKGROUND

Sensory processing disorder (SPD) is a neurophysiologic disorder in which sensory input is poorly detected, modulated, interpreted and/or to which atypical responses occur. The objective of this study was to validate an Arabic questionnaire for identification of SPD among preschool Arabic-speaking children with Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

METHODS

A newly constructed Arabic questionnaire for assessment of SPD was completed by parents of 100 Egyptian Arabic-speaking children including 40 typically-developing children (control group), 30 children with ASD, and 30 children with ADHD in the age range 3-6 years RESULTS AND CONCLUSION: Sensory processing differences were detected between typically-developing children and children with ASD and ADHD. Significant differences were found in auditory processing, visual processing, oral sensory processing, olfactory processing, total scores and emotional/social response. The current study revealed non-significant differences between ASD and ADHD children as regards auditory, visual, touch, oral sensory, olfactory and total processing scores. On the other hand, ASD children showed higher scores in proprioceptive processing and lower scores in emotional/social response than children with ADHD. The designed Arabic questionnaire is a valid and reliable assessment tool for identification of SPD in preschool Arabic-speaking children.

What is the concordance between parent- and education professional-reported adaptive functioning in autistic children using the VABS-II?

Adaptive functioning of autistic children is traditionally measured through informant-report, often from parents. Behaviour varies across settings though, and context-specific reports should be considered. Limited and inconsistent results show low parent-education professional concordance, but no research has yet explored item level response variation. We investigated Vineland Adaptive Behaviour Scales-II concordance using 233 lower ability autistic children from the PACT-G sample. Domain and item level agreement was low, but better on objectively measured behaviours. Higher child nonverbal ability improved concordance. Where disagreements occurred, education professionals identified emergent skills more and parents were more likely to rate present/absent. Parents and education professionals view the adaptive abilities of autistic children differently and both should be considered when developing personalised interventions and support.

A Preliminary Evaluation of a Brief Behavioral Parent Training for Challenging Behavior in Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) often exhibit challenging behaviors. Existing behavioral parent trainings (BPT) address ASD symptomology, but are lengthy and associated with significant attrition. In the current pilot study, a longitudinal randomized controlled trial was used to evaluate a novel brief BPT targeting caregivers of children with ASD ages 5–9. The 6-session BPT, delivered in a group format, focused on high-frequency challenging behaviors (e.g., problem behaviors, feeding and sleep issues). Caregivers who received BPT (n = 29), relative to an active control (psychoeducation/supportive therapy; n = 9), reported higher treatment satisfaction and acceptability. Challenging behaviors were reduced in the BPT and active control groups. The novel BPT was a feasible and acceptable intervention to target challenging behaviors in youth with ASD.

Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning

OBJECTIVE

Emotional and behavioral problems (EBPs) may co-occur with autism spectrum disorder (ASD) and impair children's functioning beyond autism symptomatology. We compared the prevalence of EBPs in youths with or without ASD and evaluated their unique contribution to impairment in ASD.

METHODS

We surveyed 1267 children (79.4% boys, mean age: 9.2 years, range: 3-17) recruited at 3 sites in Kaiser Permanente and OCHIN primary care clinical networks, with confirmed International Classification of Diseases-10th ed. diagnosis of ASD (N = 564), asthma (N = 468), or neither (N = 429). Children from the 2 comparison groups were age-matched and sex-matched to the ASD group. EBPs and impairment were measured by the Strengths and Difficulties Questionnaire and autism symptomatology by the Social Responsiveness Scale in the ASD group only.

RESULTS

EBPs and impairment mean scores were significantly (p < 0.001) higher in participants with ASD compared with children from the 2 comparison groups, across sexes and age groups, with no significant difference between the asthma and control groups. Among children with ASD, both EBPs and autistic symptoms were significantly correlated with impairment (r = 0.64 and r = 0.65, respectively) and explained a significant proportion of impairment variance (R2 = 0.525; p < 0.001) in multiple linear regression. In the relative importance analysis, EBPs and autistic symptoms explained comparable proportions of impairment variance (46% and 52%, respectively) with no significant difference between their relative weights (mean difference: 0.03; 95% confidence interval: -0.049 to 0.114).

CONCLUSION

Among youth with ASD, high levels of EBPs impair daily functioning as much as autistic symptoms. Systematic detection and management of EBPs may improve functioning and outcomes in youth with ASD.

Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism

LAY ABSTRACT

This study examined the impact of physical exercise on sleep and behavioral functioning in children (aged 8-12 years) with autism spectrum disorders. It also investigated whether exercise would alter endogenous melatonin level among the population. Participants were divided into two groups: exercise group (12-week, 30-min morning jogging intervention) and a control group (i.e. did not receive any physical exercise intervention during the study period). Significant improvements on sleep and behavioral functioning were found in the exercise group, but not in the control group Moreover, a significant increase in melatonin level was also shown in the exercise group. Findings of this study reconfirmed the sleep and behavioral benefits of exercise in children with autism spectrum disorder. Melatonin-mediated mechanism should be further explored to develop an effective treatment intervention.

Chronic consumption of a high linoleic acid diet during pregnancy, lactation and post-weaning period increases depression-like behavior in male, but not female offspring

Polyunsaturated fatty acids (PUFAs) play an essential role in brain development. Emerging data have suggested a possible link between an imbalance in PUFAs and cognitive behavioral deficits in offspring. A diet rich in high linoleic acid (HLA), typically from preconception to lactation, leads to an increase in the ratio of omega-6 (n-6) to omega-3 (n-3) fatty acids in the fetus. Arising research has suggested that a deficiency in omega-3 fatty acids is a potential risk factor for inducing autism spectrum disorder (ASD)-like behavioral deficits. However, the impact of a high n- diet during preconception, pregnancy, lactation, and post-weaning on the brain development of adolescent offspring are yet to be determined. This study examined whether consumption of an HLA diet during pregnancy, lactation, and post-weaning induced social and cognitive impairments in female and male offspring rats that resemble autistic phenotypes in humans. Female Wistar Kyoto rats were fed with either HLA or low linoleic acid (LLA) control diet for 10 weeks before mating, then continued with the same diet throughout the pregnancy and lactation period. Female and male offspring at 5 weeks old were subjected to behavioral tests to assess social interaction behavior and depression-/anxiety-like behavior. Our result showed that chronic consumption of an HLA diet did not affect sociability and social recognition memory, but induced depression-like behavior in male but not in female offspring.

Those in the shadow of the pandemic: impacts of the COVID-19 outbreak on the mental health of children with neurodevelopmental disorders and their parents

This study aimed to investigate the emotional and behavioral responses of children with neurodevelopmental disorders and their parents during the recent novel coronavirus disease (COVID-19) pandemic and the associated factors. Our study included 299 children and adolescents with neurodevelopmental disorders and 299 mothers or fathers. Participant groups were as follows: autism spectrum disorder (n = 131, 43.8%); intellectual disability (n = 103, 34.4%); specific learning disorder (n = 46, 15.4%); and communication disorder (n = 19, 6.4%). A data form was created to investigate the emotional, behavioral, sleep problems, and appetite changes of the cases, and it was adapted for online application and conveyed to the parents in the form of emails. Our study indicated that children and adolescents' emotional problems were 44.5%, behavioral problems 33.4%, sleep problems 65.2%, and appetite problems 32.4%. Irritability (35.5%), hyperactivity (37.8%), stereotyped behavior (29.8%), delayed sleep phase (51.5%) were the most common problems reported by the parents. The frequencies of emotional and behavioral problems in the ASD group were higher than in the other groups (p < .05). In addition, the Hospital Anxiety Depression Scale (HADS) was used to determine the parents' anxiety and depression symptoms. Mean HADS anxiety and depression scores of parents were 8.5 ± 4.3 and 7.8 ± 4.2, respectively. Our study demonstrated that the COVID-19 pandemic and lockdown negatively affected children with neurodevelopmental disorders and their parents in many areas. It is necessary that these children and their families are evaluated and supported by local professionals, as the ongoing pandemic can exacerbate the current challenges. The findings of our study reflect the early period of the pandemic. For this reason, longitudinal studies about the long-term consequences of the pandemic are needed.

Family Impact During the Time Between Autism Screening and Definitive Diagnosis

Over the past 10 years, identification of Autism Spectrum Disorder (ASD) risk has dramatically increased due to the wide-spread implementation of screening programs; yet, there is limited understanding about parent perceptions and experiences during the time period when risk is identified, but prior to receiving a formal diagnosis-a period that can last months to years given the long wait-lists for formal ASD evaluations. The current study aimed to examine parent perceptions of family impact (i.e., the impact their child's behaviors have on the family) between the time of risk-identification and formal diagnosis among 277 children identified as at-risk for ASD through screening positive in primary care. We aimed to compare family impact among those whose child met diagnostic criteria for ASD and those who did not. Parents of children who received a non-ASD diagnosis reported a higher baseline level of family impact (F[1, 274] = 5.82, p = .017); however, perceived difficult child behavior was a stronger predictor of family impact (t[6] = 13.11, p < .001) than later diagnostic group (t[6] = - 2.10, p = .037), and child functioning did not predict family impact (t[6] = -0.31, p = .76). These results suggest that in this population, perceived difficult child behavior is a stronger predictor of family impact than later diagnostic category and should be considered an important factor in family support.

Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (N = 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.

Direct observation in a large-scale randomized trial of parent training in children with autism spectrum disorder and disruptive behavior

A direct observation strategy (Standardized Observation Analogue Procedure, SOAP) was used in a large-scale randomized trial of parent training versus parent education in young children with autism spectrum disorder (ASD) and disruptive behavior. The 16-minute SOAP, modified from an earlier version of this same measure, included parentchild interaction to assess child behavior in a clinical laboratory setting. Despite study entry criteria for all child participants requiring moderate levels of disruptive behavior in this project, 126 of 168 children with complete SOAP data at baseline showed no disruptive behavior on this measure. Although the primary purpose of the study was to determine whether the SOAP could detect differences between the two conditions (i.e.,parent training (PT) and parent education (PE)), baseline observation data was not consistent with parent ratings at baseline or subsequent follow up visits, leaving little room to demonstrate improvement with this observation measure. This and the challenging, time-consuming and resource intensive effort involved in using such a measure in a large randomized scale trial, raises fundamental questions about the validity of the SOAP as an outcome measure in such a study. Further consideration related to the feasibility and practicality of using direct observation as a primary measure in larger scale efforts overall are also discussed.

Making Research Possible: Barriers and Solutions For Those With ASD and ID

Participation in research can provide direct and indirect benefit to individuals with autism spectrum disorder (ASD), their caregivers, families, and society at large. Unfortunately, individuals with high support needs, including those with intellectual disability, cognitive disability or minimal verbal ability, are often systematically excluded from research on ASD. This limits the ability to generalize discoveries to all people with ASD, and results in a disparity in who benefits from research. This piece outlines the importance and extent of the problem, which is part of a broader lack of inclusivity in ASD research. It also provides examples of studies that have directly addressed issues that arise when conducting inclusive research and makes recommendations for researchers to reduce disparities in research participation.

Affect and gaze responses during an Emotion-Evoking Task in infants at an increased likelihood for autism spectrum disorder

Background

The majority of research examining emotional difficulties in autism spectrum disorder (ASD) prior to age 2 relies on parent report.

Methods

We examined behavioral responses (affect and gaze) during emotionally salient tasks designed to elicit mildly positive and negative emotional states in infants. At 12 and 18 months, infants at an increased likelihood for an ASD diagnosis (IL; have an older sibling with ASD; n = 60) and low likelihood (LL; no family history of ASD; n = 21) completed the Emotion-Evoking (EE) Task and parents completed the Infant Behavior Questionnaire-Revised (IBQ-R). All children received an Autism Diagnostic Observation Scale—second Edition assessment for ASD symptomatology at 24 months.

Results

The main findings were (1) the IL group displayed higher rates of negative affect and spent less time looking at the task objects compared to the LL group, and (2) affect and gaze scores at 12 and 18 months, but not scores on the IBQ-R, predicted ASD symptoms at 24 months.

Limitations

The data were drawn from an IL sample and may not be generalizable to the general ASD population, and the children were not followed to determine a diagnosis of ASD.

Conclusion

These results suggest that behavioral responses can provide important information that complements parent reports of emotional regulation in IL infants as early as 12 months of age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-021-00468-0.

Predictors of parenting stress in parents of children diagnosed with autism spectrum disorder: a scoping review

Introduction

Identifying the predictors of parenting stress in parents of children with autism spectrum disorder is crucial to provide the best health-care services.

Main text

The scoping review was conducted. Search engines (EBSCO, Springer, PubMed, Ovid, Google Scholar, and Science Direct) were used to collate published studies between the years 2009 and 2020. Keywords used were parenting stress, parental stress, predictors of parenting stress, Autism disorder, Autism, and scoping review. Primary screening of the titles and abstracts of 1039 articles was conducted. The secondary screening of 348 articles resulted in 27 articles included in this review. The reviewed articles revealed core symptoms of the disorder, namely, behavior problems, and socio-communication impairments strongly linked with the high level of parenting stress.

Conclusion

This scoping review is the initial step toward encouraging future efforts to provide supportive interventions for parents of children with autism spectrum disorder.

Behavioural and physiological response to frustration in autistic youth: associations with irritability

Background

Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well-known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field.

Methods

In the current study, fifty-two autistic adolescents aged 13–17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response to experimentally induced frustration during the task. Age and baseline HR (for the physiological data only) were included as covariates.

Results

Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio (IRR) =.98, p=.06), and a significant association with the slope of physiological response (b=−.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. The pattern of results largely remained in sensitivity analyses, although the association with physiological response became non-significant when adjusting for IQ, autism symptom severity, and medication use (b=−.10, p=.10).

Conclusions

Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11689-021-09374-1.

Effects of an attachment-based parent intervention on mothers of children with autism spectrum disorder: preliminary findings from a non-randomized controlled trial

BACKGROUND

Caregivers of children with autism spectrum disorders (ASD) often experience difficulties in responding appropriately to the needs of those children, who typically express attachment in distinct and nonconventional ways. This highlights the need for an attachment-based approach targeted at caregivers of children with ASD. Circle of Security Parenting (COSP), an attachment-based parenting program, is designed to increase caregivers' sensitivity to children's attachment needs. The aim of this study was to provide verification of the effectiveness of COSP in mothers of children with ASD.

METHODS

This study was a non-randomized controlled trial. Sixty mothers of children with ASD aged 4-12 were recruited. Twenty mothers received the COSP intervention, while 40 did not. The characteristics of children in the control group were matched with those of the intervention group. To evaluate the outcomes of the intervention, changes in parental self-efficacy and mental health were assessed using the Tool to Measure Parenting Self-Efficacy (TOPSE) and the General Health Questionnaire-30 (GHQ-30). The children's improvement in emotional and behavioral problems was assessed from the mothers' perspective using the Child Behavior Checklist (CBCL). Both groups completed the assessments in parallel. Evaluations were compared between baseline (T1) and 6-month follow-up (T2).

RESULTS

Scores for self-efficacy and mental health of mothers and behavior of children were significantly improved from T1 to T2 in the intervention group, but not in the control group. Participants' mental health was markedly worsened in the control group.

CONCLUSION

This study demonstrated that the COSP program for mothers of children with ASD improved their parental self-efficacy and mental health, and reduced their subjective sense of difficulties related to their children's behaviors. Our findings support the effectiveness of the attachment-based program for mothers of children with ASD, providing the groundwork for further studies of the attachment-based intervention for children with ASD and their families. Future studies with larger samples and randomization are also needed for direct evaluation of the improvement of children's attachment security, and for exploration of the synergistic relationship between various family support strategies and COSP. Trial Registration This trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (No. UMIN000039574).

Early-Life Environmental and Child Factors Associated with the Presence of Disruptive Behaviors in Seven-Year-Old Children with Autistic Traits in the Avon Longitudinal Study of Parents and Children

We studied the association of early-life environmental and child factors with disruptive behaviors in children with autistic traits around age 7, in the Avon Longitudinal Study of Parents and Children (n = 6,401). Logistic regression with the least absolute shrinkage and selection operator indicated that disruptive behaviors were associated with prenatal smoking, no seafood-consumption during pregnancy, breech presentation at delivery, neonatal feeding problems, low social-economic situation, suboptimal preschool family environment, maternal depression, maternal antisocial behavior, male sex, and difficult child temperament. Compared to controls, male sex, maternal depression, and suboptimal preschool family environment were related to autistic traits without disruptive behaviors. Thus, there may be a difference in early-life factors related to autism spectrum disorder with and without disruptive behaviors.

Attention deficit hyperactivity disorder (ADHD) symptoms, comorbid psychopathology, behaviour problems and gastrointestinal symptoms in children and adolescents with autism spectrum disorder

OBJECTIVES

The study aims to investigate attention deficit hyperactivity disorder (ADHD) symptoms, gastrointestinal (GI) symptoms, comorbid psychopathology and behaviour problems in children and adolescents with autism spectrum disorder (ASD).

METHODS

Parents of 147 children and adolescents with ASD aged 6-18 years completed the Conners 3 Parent-Short Form, Gastrointestinal Symptom Inventory, Behavior Problems Inventory-Short Form and Autism Spectrum Disorder-Comorbid for Children.

RESULTS

Fifty-six per cent of children and adolescents had a comorbid diagnosis of ADHD, yet over 70% presented with clinically significant ADHD symptoms. Forty per cent of participants received a diagnosis of ADHD before ASD and 25.6% received a diagnosis of ASD first. Relationships were found between ADHD symptoms and comorbid psychopathology, GI symptoms, and behaviour problems.

CONCLUSIONS

The outcomes suggest that ADHD is being underestimated as a comorbid disorder of ASD. This may have implications on treatment and interventions for children and adolescents who have a diagnosis of both ASD and ADHD.

Autism Spectrum Disorder Parent Report for Outcome Monitoring: A Preliminary Report of Development and Clinical Utility

OBJECTIVE

Children with autism spectrum disorder (ASD) face challenges across many functional domains. A tool that gathers relevant clinical information before visits, emphasizing symptoms that are likely to change over development and inform clinical interventions, could improve health care quality, allowing for more patient-centered and efficient care. This study evaluated the clinical utility and preliminary psychometrics of the ASD Parent Report for Outcome Monitoring (ASD-PROM), a web-based measure assessing competence in core features of ASD, along with the breadth of concerns and comorbidities that frequently co-occur with ASD.

METHODS

An interdisciplinary team drafted the ASD-PROM and made iterative revisions based on parent feedback. Parents of 62 children completed the ASD-PROM before their autism-specialty clinical visit, 53 completed the ASD-PROM twice, and 48 completed the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) concurrently. Parents (n = 25) and clinicians (n = 13) completed postvisit surveys to assess utility (phase 1). The ASD-PROM was then released for general clinical use (phase 2).

RESULTS

On a Likert scale (1 = very poorly, 10 = very well), parents found that ASD-PROM items described their child's abilities well (median = 8.0; interquartile range [IQR]: 7.0-9.5) and had a positive effect on care (median = 8.0; IQR: 7.0-10.0). Clinicians found the ASD-PROM effective in assessing parent-reported patient abilities (median = 9.0, IQR: 7.0-9.0) and felt the ASD-PROM helped make their care more patient-centered and efficient (both median = 8.0, IQR: 6.0-9.0). Two-week test-retest reliability was acceptable (0.95). ASD-PROM scores correlated positively with scores from similar domains on the Vineland-II (Pearson r 0.30-0.50, medium to large effects).

CONCLUSION

The ASD-PROM is a freely available tool to gather information on developmental and behavioral functioning in children with ASD before autism-specialty clinical visits. Clinical utility and preliminary psychometrics are promising, although limitations (including a low response rate during clinical use and a need for additional in-depth assessments and potential resulting modifications to the tool) remain to be addressed. Ultimately, the ASD-PROM may help promote patient-centered and efficient care for children across a wide range of ages and developmental levels.

Which Factors Influence Teacher Report of Adaptive Functioning in Autistic Children?

A wealth of parent-report research shows adaptive functioning difficulties in autistic children, with parent-report influenced by a number of child factors. Adaptive functioning in autistic children is known to vary across settings; however, no research has yet explored factors influencing education professional-report. This study investigated the rate and profile of impairment, and child factors influencing education professional-reported adaptive skills in 248 autistic children. Twelve children were < 3 years (min age for available normative data on the adaptive function measure), so were removed from the analyses. Results replicated parent-literature; adaptive skills were negatively associated with age and informant-reported autism severity, and positively associated with nonverbal ability and expressive language. Adaptive functioning is important for real-world outcomes, e.g. educational attainment, independence, and support needs. Improving our understanding of adaptive functioning in the education context may support opportunities for shared learning and enhance personalised support .

Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review

OBJECTIVE

Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high.

METHODS

A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data.

OUTCOMES MEASURES

The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review.

RESULTS

A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children.

CONCLUSION

This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.

[Leisure Opportunities for Autistic Children and Adolescents: How Satisfied are Parents and what do they Think their Children Would Like?]

Leisure Opportunities for Autistic Children and Adolescents: How Satisfied are Parents and what do they Think their Children Would Like? Like all children and youth, autistic children and adolescents have the right to participate in cultural life including recreational, leisure and sporting activities. Therefore, arrangements have to be made to ensure access to these areas for these particular population (Art. 30 UN-BRK, §§76, 78 BTHG). Thus far, no research has been conducted that examines the need for leisure time facilities for autistic children and/or adolescents in Germany. Therefore, it is unclear if an equal participation in leisure time opportunities is provided. This study presents a first assessment of this topic based on an online-survey of parents of autistic children and adolescents (N = 327). The results indicate, that there is a substantial need for leisure opportunities. Parents of children with infantile and atypical autism show a greater need for more leisure opportunities than parents of children with Asperger Syndrome. In general, the findings show that an equal participation has not been achieved yet. Overall, there is a need for (small) group and sporting activities and especially younger parents asked for specific experiential environments. Possible approaches to a need-oriented organization of leisure facilities for autistic children and adolescents and for an enhancement of leisure opportunities are discussed. The paper further outlines the need for more research in order to provide an empirical basis for equal participation possibilities in public life for autistic children and adolescents.

Daily intake of Lactobacillus alleviates autistic-like behaviors by ameliorating the 5-hydroxytryptamine metabolic disorder in VPA-treated rats during weaning and sexual maturation

Probiotic therapy targeting gut-brain axis has been proven to be effective in treating autistic patients. The present study aimed to assess the ability of three Lactobacillus strains (L. helveticus CCFM1076, L. acidophilus La28, and L. acidophilus JCM 1132) to alleviate autistic-like behavioral symptoms in VPA-treated rats from weaning to sexual maturation. For the first time, we assessed the synthesis of 5-hydroxytryptamine (5HT) and the metabolic capacity of the 5HT system in the peripheral and central nervous systems (PNS and CNS, respectively) based on tryptophan metabolism based on VPA-induced autism model. We also assessed gut microbiota, and short-chain fatty acids (SCFAs) at the end of week 8. While improving autistic-like behavioral symptoms, we found L. helveticus CCFM1076 was more beneficial in regulating 5HT anabolism and catabolism, balancing excitatory and inhibitory neurotransmitter release in the PNS and CNS, and increasing oxytocin (OT) synthesis in the hypothalamus. A significant correlation was noted between 5HT levels and the release of GABA, glutamate (Glu), and OT, suggesting that 5HT plays a vital role in the neuroendocrine network. Analyses of the gut microbiota and SCFA levels revealed greater Turicibacter abundance and lower butyric acid levels in VPA-treated rats, which have been reported to be associated with 5HT levels. L. helveticus CCFM1076 helped reduce Turicibacter abundance and up-regulate butyric acid levels, while L. acidophilus La28 and L. acidophilus JCM 1132 did not. L. helveticus CCFM1076 restored neurotransmitter homeostasis by improving the balance of the 5HT system in the PNS and CNS, thereby ameliorating autistic-like behaviors. This finding will help in the development of bioproducts for treating autism and in the establishment of a treatment model mimicking the intestinal environment of autistic patients.

Sleep Disorders in Autism Spectrum Disorder Pre-School Children: An Evaluation Using the Sleep Disturbance Scale for Children

Background and Objectives: Sleep disorders are common in children with Autism Spectrum Disorder (ASD). The aims of this study were to describe the incidence and characteristics of sleep disorders using a questionnaire completed by the caregiver in a sample of preschool-aged children with ASD and to identify possible differences in a control group of peers. Materials and Methods: Sleep disorders were investigated with the Sleep Disturbance Scale for Children (SDSC) in a population of pre-school-aged (3-5 years) ASD children and in a control group. The Autism Diagnostic Observation Schedule-second ed. (ADOS-2) was further used to assess autism symptom severity. A total of 84 children (69 males; mean age 3.9 ± 0.8 years) with a diagnosis of ASD and 84 healthy controls (65 males; mean age of 3.7 ± 0.8 years) that were matched for age and sex were enrolled. Results: ASD children reported significantly higher (pathological) scores than the control group on the SDSC total scores and in some of the factor scores, such as Difficulty in Initiating and Maintaining Sleep (DIMS), disorders of excessive somnolence (DOES), and sleep hyperhidrosis. A total of 18% of ASD children had a pathological SDSC total T-score, and 46% had an abnormal score on at least one sleep factor; DIMS, parasomnias, and DOES showed the highest rates among the sleep factors. Younger children (3 years) reported higher scores in DIMS and sleep hyperhidrosis than older ones (4 and 5 years). No specific correlation was found between ADOS-2 and SDSC scores. Conclusions: Pre-school children with ASD showed a high incidence of sleep disorders with different distributions of specific sleep factors according to their age. We suggest a screening assessment of sleep disorders using the SDSC in these children with a more in-depth evaluation for those reporting pathological scores on the questionnaire.