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Chan MMY, Choi CXT, Tsoi TCW, Shea CKS, Yiu KWK, Han YMY. Effects of multisession cathodal transcranial direct current stimulation with cognitive training on sociocognitive functioning and brain dynamics in autism: A double-blind, sham-controlled, randomized EEG study. Brain Stimul 2023; 16:1604-1616. [PMID: 37918630 DOI: 10.1016/j.brs.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Few treatment options are available for targeting core symptoms of autism spectrum disorder (ASD). The development of treatments that target common neural circuit dysfunctions caused by known genetic defects, namely, disruption of the excitation/inhibition (E/I) balance, is promising. Transcranial direct current stimulation (tDCS) is capable of modulating the E/I balance in healthy individuals, yet its clinical and neurobiological effects in ASD remain elusive. OBJECTIVE This double-blind, randomized, sham-controlled trial investigated the effects of multisession cathodal prefrontal tDCS coupled with online cognitive remediation on social functioning, information processing efficiency and the E/I balance in ASD patients aged 14-21 years. METHODS Sixty individuals were randomly assigned to receive either active or sham tDCS (10 sessions in total, 20 min/session, stimulation intensity: 1.5 mA, cathode: F3, anode: Fp2, size of electrodes: 25 cm2) combined with 20 min of online cognitive remediation. Social functioning, information processing efficiency during cognitive tasks, and theta- and gamma-band E/I balance were measured one day before and after the treatment. RESULTS Compared to sham tDCS, active cathodal tDCS was effective in enhancing overall social functioning [F(1, 58) = 6.79, p = .012, ηp2 = 0.105, 90% CI: (0.013, 0.234)] and information processing efficiency during cognitive tasks [F(1, 58) = 10.07, p = .002, ηp2 = 0.148, 90% CI: (0.034, 0.284)] in these individuals. Electroencephalography data showed that this cathodal tDCS protocol was effective in reducing the theta-band E/I ratio of the cortical midline structures [F(1, 58) = 4.65, p = .035, ηp2 = 0.074, 90% CI: (0.010, 0.150)] and that this reduction significantly predicted information processing efficiency enhancement (b = -2.546, 95% BCa CI: [-4.979, -0.113], p = .041). CONCLUSION Our results support the use of multisession cathodal tDCS over the left dorsolateral prefrontal cortex combined with online cognitive remediation for reducing the elevated theta-band E/I ratio in sociocognitive information processing circuits in ASD patients, resulting in more adaptive regulation of global brain dynamics that is associated with enhanced information processing efficiency after the intervention.
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Affiliation(s)
- Melody M Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Coco X T Choi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Tom C W Tsoi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Caroline K S Shea
- Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong Special Administrative Region; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Klaire W K Yiu
- Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong Special Administrative Region
| | - Yvonne M Y Han
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
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Smith MJ, Sherwood K, Sung C, Williams ED, Ross B, Sharma S, Sharma A, Harrington M, Brown C, Telfer D, Bond J, Toda S, Kearon D, Morrow S, Lovelace T, Dababnah S, Kattari SK, Magaña S, Watkins T, Liggett C, Riddle E, Smith JD, Hume K, Dawkins T, Baker-Ericzén M, Eack SM, Sinco B, Burke-Miller JK, Olsen D, Elkins J, Humm L, Steacy C. Enhancing pre-employment transition services: A type 1 hybrid randomized controlled trial protocol for evaluating WorkChat: A Virtual Workday among autistic transition-age youth. Contemp Clin Trials Commun 2023; 34:101153. [PMID: 37456506 PMCID: PMC10338963 DOI: 10.1016/j.conctc.2023.101153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 07/18/2023] Open
Abstract
Autistic transition-age youth experience high rates of unemployment and underemployment, in part due to the social challenges they may face when having conversations in the workplace. In an effort to help enhance conversational abilities in the workplace, our collaborative team partnered to develop WorkChat: A Virtual Workday. Specifically, our team of scientists, community partners, and diversity and inclusion experts participated in a community-engaged process to develop WorkChat using iterative feedback from autistic transition-age youth and their teachers. With initial development complete, this study reports on the protocol that our collaborative team developed, reviewed, and approved to conduct a randomized controlled trial (RCT) to evaluate the real-world effectiveness and initial implementation process outcomes of WorkChat when integrated into post-secondary pre-employment transition services (Pre-ETS). Our aims are to: 1) evaluate whether services-as-usual in combination with WorkChat, compared to services-as-usual with an attention control, enhances social cognition and work-based social ability (between pre- and post-test); reduces anxiety about work-based social encounters (between pre- and post-test), and increases sustained employment by 9-month follow-up; 2) evaluate whether social cognitive ability and work-based social ability mediate the effect of WorkChat on sustained employment; and 3) conduct a multilevel, mixed-method process evaluation of WorkChat implementation.
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Affiliation(s)
- Matthew J. Smith
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Kari Sherwood
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Psychology, Ann Arbor, MI, USA
| | - Connie Sung
- Michigan State University, East Lansing, MI, USA
| | - Ed-Dee Williams
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Brittany Ross
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Sagun Sharma
- Michigan State University, East Lansing, MI, USA
| | - Apara Sharma
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | | | | | | | - Justine Bond
- Michigan Rehabilitation Services, Lansing, MI, USA
| | - Sen Toda
- Michigan Career and Technical Institute, Plainwell, MI, USA
| | | | | | - Temple Lovelace
- Advanced Education Research & Development Fund, Oakland, CA, USA
| | - Sarah Dababnah
- University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Shanna K. Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Sandra Magaña
- University of Texas, School of Social Work, Austin, TX, USA
| | - Tikia Watkins
- Walled Lake Consolidated Schools, Walled Lake, MI, USA
| | | | | | - Justin D. Smith
- University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kara Hume
- University of North Carolina, School of Education, Chapel Hill, NC, USA
| | - Tamara Dawkins
- University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA
| | - Mary Baker-Ericzén
- San Diego State University, Interwork Institute and Department of Administration, Rehabiliation, and Post-Secondary Education, San Diego, CA, USA
| | - Shaun M. Eack
- University of Pittsburgh, School of Social Work and Department of Psychiatry, Pittsburgh, PA, USA
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Kourtesis P, Kouklari EC, Roussos P, Mantas V, Papanikolaou K, Skaloumbakas C, Pehlivanidis A. Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions. Behav Sci (Basel) 2023; 13:bs13040336. [PMID: 37102850 PMCID: PMC10136366 DOI: 10.3390/bs13040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/14/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.
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Affiliation(s)
- Panagiotis Kourtesis
- Department of Psychology, National and Kapodistrian University of Athens, 157 84 Athens, Greece
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9AD, UK
| | - Evangelia-Chrysanthi Kouklari
- Department of Child Psychiatry, Aghia Sophia Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- 1st Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Petros Roussos
- Department of Psychology, National and Kapodistrian University of Athens, 157 84 Athens, Greece
| | - Vasileios Mantas
- 1st Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Katerina Papanikolaou
- Department of Child Psychiatry, Aghia Sophia Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Christos Skaloumbakas
- Department of Child Psychiatry, P. & A. Kyriakou Children's Hospital, 115 28 Athens, Greece
- Habilis, R&D Team, 141 22 Athens, Greece
| | - Artemios Pehlivanidis
- 1st Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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Biggs AT, Littlejohn LF. Cognitive Coaching in Special Operations: Design Principles and Best Practices. ERGONOMICS IN DESIGN 2022. [DOI: 10.1177/10648046221144484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cognitive enhancement platforms have received growing interest as a means to improve workplace performance. Among the many commercial and professional organizations exploring cognitive training, the United States military has begun exploring the potential added value of cognitive enhancement tools. Whereas most platforms offer automated or algorithm-based solutions to support cognitive training, special operations have developed the role of a cognitive coach to support training. The current discussion provides several lessons learned when trying to bridge cognitive systems and enhancement tools within military operations that should apply to any organization seeking to improve cognitive performance among already high-performing personnel.
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Affiliation(s)
- Adam T. Biggs
- Naval Special Warfare Command, San Diego, CA California, United States
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Chancel R, Miot S, Dellapiazza F, Baghdadli A. Group-based educational interventions in adolescents and young adults with ASD without ID: a systematic review focusing on the transition to adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-21. [PMID: 32889578 DOI: 10.1007/s00787-020-01609-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
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Affiliation(s)
- Raphael Chancel
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Stephanie Miot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHU de Montpellier, Université de Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier, France
| | - Florine Dellapiazza
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
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Baker-Ericzén MJ, ElShamy R, Kammes RR. Current Status of Evidence-Based Practices to Enhance Employment Outcomes for Transition Age Youth and Adults on the Autism Spectrum. Curr Psychiatry Rep 2022; 24:161-170. [PMID: 35192114 DOI: 10.1007/s11920-022-01327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides a highlight of existing evidence-based practices and community support systems that exist to enhance employment outcomes for autistic transition-age youth (TAY) and adults. An update is provided on the current status of these programs and the impact they are having on employment outcomes for this population. RECENT FINDINGS Many programs exist that prove to be efficacious in improving employment outcomes. These programs can be categorized as vocational rehabilitation service system level interventions, provider and consumer level interventions targeting skills related to employment, and consumer level interventions delivered within community vocational rehabilitation or education settings. A more recent increase in programs is consistent with multiple research and policy calls for amplified programming in this area. Despite these recent increases, there is still a need to further develop effective programming to support employment outcomes as the growing autistic population age into adulthood. Community-based research and practice should continue to be developed and tested.
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Affiliation(s)
- Mary J Baker-Ericzén
- Department of Administration, Rehabilitation and Post-Secondary Education, San Diego State University, San Diego, CA, USA.
- Interwork Institute, 6367 Alvarado Court, Suite 350, San Diego, CA, 92120, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- Intricate Mind Institute, San Diego, CA, USA.
| | | | - Rebecca R Kammes
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
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Hajri M, Abbes Z, Yahia HB, Jelili S, Halayem S, Mrabet A, Bouden A. Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition. Front Psychiatry 2022; 13:917121. [PMID: 36003981 PMCID: PMC9393361 DOI: 10.3389/fpsyt.2022.917121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is associated with neurocognitive impairment, including executive dysfunctioning and social cognition (SC) deficits. Cognitive remediation (CR) is a behavioral training-based intervention aiming to improve cognitive processes. Its first use in psychiatry interested patients with schizophrenia, in whom promising results have been shown. Integrated CR programs targeting both social and non-social cognition have demonstrated to be effective in improving both cognitive domains and functional outcomes. CR studies in children and adolescents with ASD are still new, those regarding CR approaches combining social and executive functioning remediation are scares. One study examining the efficacy of cognitive enhancement therapy (CET) for improving cognitive abilities in ADS adults, showed significant differential increases in neurocognitive function and large social-cognitive improvements. Therefore, taking into account the overlap between ASD and schizophrenia, and considering the close link between executive functions (EF) and SC, we suggest that integrative approach in ASD could result in better outcomes. The present perspective aimed to highlight cognitive remediation (CR) programs contributions in ASD (especially in children and adolescents), and to discuss the value of combining social and non-social programs.
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Affiliation(s)
- Melek Hajri
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Zeineb Abbes
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Houda Ben Yahia
- Razi Hospital Child and Adolescent Psychiatry Department, Manouba, Tunisia
| | - Selima Jelili
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Soumeyya Halayem
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Ali Mrabet
- Health Minsitery, General Directorate of Military Health, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Asma Bouden
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
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Ozsivadjian A, Hollocks MJ, Magiati I, Happé F, Baird G, Absoud M. Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. J Child Psychol Psychiatry 2021; 62:715-724. [PMID: 32827150 DOI: 10.1111/jcpp.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU. METHODS Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest. RESULTS Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only. CONCLUSIONS The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia (UWA), Crawley, WA, Australia
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Kim JH, Kim YA, Song DY, Cho HB, Lee HB, Park JH, Lim JI, Hong MH, Chae PK, Yoo HJ. An Intervention Program Targeting Daily Adaptive Skills Through Executive Function Training for Adults with Autism Spectrum Disorder: A Pilot Study. Psychiatry Investig 2021; 18:513-522. [PMID: 34218640 PMCID: PMC8256144 DOI: 10.30773/pi.2020.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Adults with autism spectrum disorders (ASD) experience significant difficulties with executive functioning (EF) and related adaptive skills, yet the lack of interventions in South Korea targeting these areas has resulted in a heightened need to develop an evidence- based program. Therefore, we developed a novel intervention aiming to enhance everyday EF and daily adaptive skills in adults with high-functioning ASD and conducted a pilot study to evaluate the validity and feasibility of the program. METHODS A behavioral intervention of 10-weekly sessions was developed based on literature searches and focus group interviews. Seven adults with high-functioning ASD (mean age=20.29) participated in a single-group pilot trial. We used self and parent-report questionnaires as well as skills measured by assessment instruments to analyze differences before and after the intervention. RESULTS Significant improvements were shown in everyday EF, including time management, organization, self-restraint, and regulation of emotions. Additionally, results demonstrated an enhancement in adaptive functioning, especially in the subdomains of daily living skills. Analyses of parental outcomes only revealed a significant decrease in the scores of emotion regulation. CONCLUSION The current study provides good evidence for the validity and feasibility of an intervention to improve everyday EF and adaptive skills in adults with ASD.
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Affiliation(s)
- Joo Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Ah Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hwi Bin Cho
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Han Bit Lee
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Hye Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung In Lim
- Korea VHS (Veterans Health Service) Medical Center, Seoul, Republic of Korea
| | | | | | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Tayyar Iravanlou F, Soltani M, Alsadat Rahnemaei F, Abdi F, Ilkhani M. Non- Pharmacological Approaches on the Improvement of Sleep Disturbances in Patients with Autism Spectrum Disorder (ASD). IRANIAN JOURNAL OF CHILD NEUROLOGY 2021; 15:79-91. [PMID: 33558816 PMCID: PMC7856440 DOI: 10.22037/ijcn.v15i2.25539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/09/2020] [Indexed: 11/21/2022]
Abstract
Abstract Autism is a type of neurodegenerative disorder, caused by genetic and environmental factors. Children with autism spectrum disorder (ASD) have symptoms of attention deficit and behavioral problems. Child’s sleep pattern has a significant effect on mood. Sleep problems are more common in children with ASD. The current study aimed to investigate the effect of non-pharmacological approaches on the improvement of sleep disturbances in patients with ASD. Materials & Methods We systematically searched PubMed, EMBASE, Web of Science, Scopus, and Science Direct to identify relevant articles published from January 2009 to May 2019. All original articles from observational and interventional studies were reviewed. The CONSORT Statement and Strengthening the Reporting of Observational Studies in Epidemiology(STROBE) checklist were used to assess the quality of selected papers. Results Reviewing 18 eligible articles according to the CONSORT checklist(for interventional studies) and STROBE (for descriptive studies) demonstrated that behavioral interventions, such as cognitivebehavioral therapy, bedtime fading with response cost, and functional behavioral assessment, physical activity such as aerobic exercise, swimming, and aquatic exercise and weighted blankets can improve sleep disturbances. Conclusion: Restlessness, tantrums, increased stereotypic activities, and reduced learning level and speaking power in children with autism were. caused by poor sleep quality and sleep deficiency, which may affect other dimensions of life. Non- pharmacological approaches to sleep disturbances could improve both sleep quality and quality of life of children with ASD with no adverse effect.
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Affiliation(s)
- Faraz Tayyar Iravanlou
- Psychiatric Nursing Student, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soltani
- Psychiatric Nursing Student, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Alsadat Rahnemaei
- Student Research Committee, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Ilkhani
- School of Nursing and Midwifery,Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Di Sarro R, Di Santantonio A, Desideri L, Varrucciu N. Profiling planning skills and cognitive flexibility of adults with autism spectrum disorders: Preliminary results from an exploratory service-based study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:651-657. [PMID: 36210889 PMCID: PMC9542481 DOI: 10.1080/20473869.2020.1871311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 05/30/2023]
Abstract
Background: Executive functions (EF) impairments have long been observed in children and youths with autism spectrum disorders (ASD). Until very recently, little attention has been paid to examine EF profiles of adults with ASD. Given the importance of EF to cope with the demands of daily life and participate in society (e.g. maintaining an employment), this study reports on a preliminary investigation aimed at exploring planning skills and cognitive flexibility in a sample of adults with ASD and without intellectual disability. A secondary aim was to explore the contribution of both intellectual functioning and socio-demographic variables on efficiency of EF. Method: Twenty-nine autistic adults (age range 18-50) were assessed using the Tower of London (ToL) test and the Wisconsin Card Sorting Test (WCST). Intellectual functioning was assessed with the Wechsler Adult Intelligence Scale - IV. Results: From the evaluations emerged poor performances in sub-processes related to planning skills as assessed by ToL (number of Moves, Correct Reponses, and Execution time). In contrast, WCST performance did not result impaired in any of the indicators considered. Exploratory analyses revealed a strong relationship between the time needed to complete the planning tasks and visuo-spatial reasoning. Further, strong inverse associations were found between global intellectual functioning and chronological age in the WCST. Conclusions: The results of this study highlight mixed EF profiles in a sample of adults with ASD. Future investigations may build on the results of the present study to understand whether evaluating planning abilities of adults with ASD by means of measures that do not require a time-limit would yield different results compared to time-constrained assessment procedures.
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Affiliation(s)
- Rita Di Sarro
- Integrated Program Disability and Health, Emilia-Romagna Region, Bologna, Italy
| | - Anna Di Santantonio
- Integrated Program Disability and Health, Emilia-Romagna Region, Bologna, Italy
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lorenzo Desideri
- Department of Psychology, University of Bologna, Bologna, Italy
- Regional Centre for Assistive Technology, Bologna, Italy
| | - Niccolò Varrucciu
- Integrated Program Disability and Health, Emilia-Romagna Region, Bologna, Italy
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Plemeniti Tololeski B, Suhodolčan Grabner A, Kumperscak HG. Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin. Front Psychiatry 2021; 12:686030. [PMID: 34413796 PMCID: PMC8369034 DOI: 10.3389/fpsyt.2021.686030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.
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Affiliation(s)
- Barbara Plemeniti Tololeski
- Centre for Mental Health, Unit for Adolescent Psychiatry, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Hojka Gregoric Kumperscak
- Department for Child and Adolescent Psychiatry, University Medical Centre, Maribor, Slovenia.,Faculty for Medicine, University of Maribor, Maribor, Slovenia
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Wieckowski AT, Flynn LT, Richey JA, Gracanin D, White SW. Measuring change in facial emotion recognition in individuals with autism spectrum disorder: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1607-1628. [PMID: 32551983 PMCID: PMC11078255 DOI: 10.1177/1362361320925334] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
LAY ABSTRACT Children and adults with autism spectrum disorder show difficulty recognizing facial emotions in others, which makes social interaction challenging. While there are many treatments developed to improve facial emotion recognition, there is no agreement on the best way to measure such abilities in individuals with autism spectrum disorder. The purpose of this review is to examine studies that were published between January 1998 and November 2019 and have measured change in facial emotion recognition to evaluate the effectiveness of different treatments. Our search yielded 65 studies, and within these studies, 36 different measures were used to evaluate facial emotion recognition in individuals with autism spectrum disorder. Only six of these measures, however, were used in different studies and by different investigators. In this review, we summarize the different measures and outcomes of the studies, in order to identify promising assessment tools and inform future research.
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McCauley JB, Pickles A, Huerta M, Lord C. Defining Positive Outcomes in More and Less Cognitively Able Autistic Adults. Autism Res 2020; 13:1548-1560. [PMID: 32851813 DOI: 10.1002/aur.2359] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 02/03/2023]
Abstract
Identifying positive outcomes for a wide range of intellectual abilities in autism spectrum disorder (ASD) remains a challenge. Several past studies of autistic adults have used outcome definitions that do not reflect the experiences of less cognitively able adults. The aim of the current study was to (1) define three domains of outcomes: autonomy, social relationships, and purpose, and (2) examine how these outcomes relate to concurrent aspects of adult functioning. Using data from a longitudinal sample of 126 adults (85% diagnosed with ASD at some point), mean age 26, who first entered the study in early childhood, we generated distinct outcomes for less (daily living skills above an 8-year-old level, having regular activities outside the home, and social contacts outside the family) and more cognitively able adults (living independently, having paid employment, and at least one true friend). Verbal IQ, assessed in adulthood, was a significant predictor of more outcomes achieved for individuals within more and less cognitively able groups. For less cognitively able adults, having ever received a formal ASD diagnosis (in contrast to current Autism Diagnostic Observation Schedule [ADOS] CSS scores) was associated with lower odds of positive outcomes. For more cognitively able adults, living skills and happiness measures were positively associated with number of outcomes met; higher ADOS CSS, internalizing and externalizing symptoms, being racially diverse, and having caregiver education below college graduation were all negatively associated with the number of positive outcomes. Tailoring outcomes to ability levels may lead to better identification of goals and service needs. LAY SUMMARY: This article describes the outcomes of autistic adults who are more and less cognitively able. For less cognitively able individuals, an earlier autism diagnosis was negatively related to outcomes. Several factors that were associated with positive outcomes for more cognitively able individuals, including daily living skills, fewer mental health problems, family demographics, and subjective measures of happiness. Our study identifies several important factors for families, individuals, and service providers to consider and discuss when planning the transition to adulthood. Autism Res 2020, 13: 1548-1560. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- James B McCauley
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marisela Huerta
- Centre for Autism and the Developing Brain, Weill Cornell Medicine, New York City, New York, USA
| | - Catherine Lord
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
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Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Front Psychiatry 2020; 11:722. [PMID: 32793009 PMCID: PMC7393993 DOI: 10.3389/fpsyt.2020.00722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research. METHOD The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review. RESULTS The 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants. CONCLUSIONS CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Cindy Toloza
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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16
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Kuo SS, Wojtalik JA, Mesholam-Gately RI, Keshavan MS, Eack SM. Transdiagnostic validity of the MATRICS Consensus Cognitive Battery across the autism-schizophrenia spectrum. Psychol Med 2020; 50:1623-1632. [PMID: 31298174 PMCID: PMC9812023 DOI: 10.1017/s0033291719001582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) and schizophrenia are neurodevelopmental disorders which share substantial overlap in cognitive deficits during adulthood. However, treatment evaluation in ASD and treatment comparisons across ASD and schizophrenia are limited by a dearth of empirical work establishing the validity of a standard cognitive battery across ASD and schizophrenia. Promisingly, the MATRICS Consensus Cognitive Battery (MCCB) has been validated in schizophrenia and encompasses cognitive domains that are impacted in ASD. Thus, this study aimed to establish MCCB's generalizability from schizophrenia to ASD. METHODS Community-residing adults with schizophrenia (N = 100) and ASD (N = 113) underwent MCCB assessment. Using multigroup confirmatory factor analysis, MCCB's transdiagnostic validity was evaluated by examining whether schizophrenia and ASD demonstrate the same configuration, magnitude, and directionality of relationships within and among measures and their underlying cognitive domains. RESULTS Across schizophrenia and ASD, the same subsets of MCCB measures inform three cognitive domains: processing speed, attention/working memory, and learning. Except for group means in category fluency, continuous performance, and spatial span, both groups show vastly comparable factor structures and characteristics. CONCLUSIONS To our knowledge, this study is the first to establish the validity of a standard cognitive battery in adults with ASD and furthermore the first to establish a cognitive battery's comparability across ASD and schizophrenia. Cognitive domain scores can be compared across new samples using weighted sums of MCCB scores resulting from this study. These findings highlight MCCB's applicability to ASD and support its utility for standardizing treatment evaluation of cognitive outcomes across the autism-schizophrenia spectrum.
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Affiliation(s)
- Susan S. Kuo
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Raquelle I. Mesholam-Gately
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matcheri S. Keshavan
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shaun M. Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Faith LA, Collins JO, Decker J, Grove A, Jarvis SP, Rempfer MV. Experiences of empowerment in a community cognitive enhancement therapy program: an exploratory qualitative study. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1632920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Laura A. Faith
- Department of Psychology, The University of Missouri, Kansas City, MO, USA
| | - Jen O. Collins
- Department of Psychology, The University of Missouri, Kansas City, MO, USA
| | - Jenna Decker
- Department of Psychology, The University of Missouri, Kansas City, MO, USA
| | - Amber Grove
- Department of Psychology, The University of Missouri, Kansas City, MO, USA
| | - Stephen P. Jarvis
- Truman Medical Center Behavioral Health, Kansas City, MO, USA
- Department of Psychiatry, University of Missouri, Kansas City, MO, USA
| | - Melisa V. Rempfer
- Department of Psychology, The University of Missouri, Kansas City, MO, USA
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19
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Sasson NJ, Morrison KE, Kelsven S, Pinkham AE. Social cognition as a predictor of functional and social skills in autistic adults without intellectual disability. Autism Res 2019; 13:259-270. [DOI: 10.1002/aur.2195] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Noah J. Sasson
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Kerrianne E. Morrison
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Skylar Kelsven
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Amy E. Pinkham
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
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20
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Kuo SS, Wojtalik JA, Mesholam-Gately RI, Keshavan MS, Eack SM. Establishing a standard emotion processing battery for treatment evaluation in adults with autism spectrum disorder: Evidence supporting the Mayer-Salovey-Caruso Emotion Intelligence Test (MSCEIT). Psychiatry Res 2019; 278:116-124. [PMID: 31163301 PMCID: PMC9671709 DOI: 10.1016/j.psychres.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia are neurodevelopmental disorders which show markedly similar deficits in emotion processing, yet treatment evaluation in ASD and treatment comparisons across ASD and schizophrenia are constrained by a lack of empirical work validating a standard emotion processing battery across ASD and schizophrenia. Encouragingly, the Mayer-Salovey-Caruso Emotion Intelligence Test, version 2.0 (MSCEIT (Mayer et al., 2003) spans the range of emotion processing deficits in schizophrenia and ASD. This study therefore aimed to establish MSCEIT's factorial, measurement, and structural invariance in community-residing adults with schizophrenia (N = 103) and ASD (N = 113) using multigroup confirmatory factor analysis. Consistent with prior studies in normative populations, a two-factor structure comprised of emotional experiencing and emotional reasoning was supported in ASD and schizophrenia. Both groups operationalize MSCEIT measures similarly, with all measures except for Facilitation and Management showing comparability across groups. To our knowledge, this study is not only the first to establish the measurement and structural invariance of a standard emotion perception battery in adults with ASD, it is also the first to establish its comparability across ASD and schizophrenia. Ultimately, these findings underscore MSCEIT's utility for standardizing treatment evaluation of social cognitive outcomes across the autism-schizophrenia spectrum.
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Affiliation(s)
- Susan S Kuo
- Department of Psychology, University of Pittsburgh, 4209 Sennott Square, 210 S Bouquet St., Pittsburgh, PA 15213, United States.
| | - Jessica A Wojtalik
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA 15260, United States.
| | - Raquelle I Mesholam-Gately
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Matcheri S Keshavan
- Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Ave, Pittsburgh, PA 15260, United States; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
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21
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Applicability and Effectiveness of Social Competence Group Intervention on Adults with Autism Spectrum Disorder in a Chinese Context: A Community-Based Study with Self- and Parent-Report. J Autism Dev Disord 2019; 49:3440-3452. [DOI: 10.1007/s10803-019-04066-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Salem-Guirgis S, Albaum C, Tablon P, Riosa PB, Nicholas DB, Drmic IE, Weiss JA. MYmind: a Concurrent Group-Based Mindfulness Intervention for Youth with Autism and Their Parents. Mindfulness (N Y) 2019; 10:1730-1743. [PMID: 31976019 PMCID: PMC6945985 DOI: 10.1007/s12671-019-01107-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives The current study evaluated the use of MYmind, a concurrent mindfulness program in which youth with autism and their parents simultaneously receive group specific mindfulness training. Youth with autism can experience emotional and behavioral challenges, which are associated with parental stress. Mindfulness-based programs are emerging as a promising support for these challenges, for both children and parents. While two studies have documented the use of concurrent parent-child programs, neither involve control conditions. Methods Using a within-subject repeated measures design with a baseline component, 23 parent-child dyads were assessed on mindfulness, mental health, and youth emotion regulation and autism symptoms. Participants also rated their perceived improvement on a social validity questionnaire. Results There was improvement in youth autism symptoms, emotion regulation, and adaptive skills, and in parent reports of their own mindfulness following the program. There was also some indication of a waitlist effect for parent mental health, but not for other outcome variables. Participant feedback was mainly positive. Conclusions MYmind has the potential to contribute to emotion regulation and adaptability in youth with autism, and mindfulness in parents, though more rigorous controlled trials are needed.
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Affiliation(s)
| | - Carly Albaum
- 2Department of Psychology, York University, Toronto, Canada
| | - Paula Tablon
- 2Department of Psychology, York University, Toronto, Canada
| | | | - David B Nicholas
- 4Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, Canada
| | - Irene E Drmic
- 5Ron Joyce Children's Health Centre, Hamilton Health Sciences, Hamilton, Ontario Canada
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Pallathra AA, Cordero L, Wong K, Brodkin ES. Psychosocial Interventions Targeting Social Functioning in Adults on the Autism Spectrum: a Literature Review. Curr Psychiatry Rep 2019; 21:5. [PMID: 30706149 PMCID: PMC6666386 DOI: 10.1007/s11920-019-0989-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW There is a perceived shortage of evidence-based treatment programs for adults on the autism spectrum. This article reviews the recent research literature on psychosocial/behavioral interventions targeting social functioning in autistic adults without intellectual disability. RECENT FINDINGS We identified only 41 peer-reviewed studies published from 1980 to 2017 that tested intervention programs focused on one or more of the behavioral components of social functioning (i.e., social motivation, social anxiety, social cognition, and social skills) in more than one adult with autism spectrum disorder (ASD). The studies demonstrated substantial variability in treatment objectives, intervention procedures, assessment methods, and methodologic quality. The results indicate a strong need for additional research to develop and rigorously test interventions for autistic adults that target the many behavioral components of social functioning and that include procedures to promote generalization of knowledge and skills to community settings.
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Affiliation(s)
- Ashley A. Pallathra
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Translational Research Laboratory, 125 South 31st Street, Room 2202, Philadelphia, PA 19104-3403, USA
| | - Lucero Cordero
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Translational Research Laboratory, 125 South 31st Street, Room 2202, Philadelphia, PA 19104-3403, USA
| | - Kennedy Wong
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Translational Research Laboratory, 125 South 31st Street, Room 2202, Philadelphia, PA 19104-3403, USA
| | - Edward S. Brodkin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Translational Research Laboratory, 125 South 31st Street, Room 2202, Philadelphia, PA 19104-3403, USA
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Zwick GP. Neuropsychological assessment in autism spectrum disorder and related conditions. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29398932 PMCID: PMC5789214 DOI: 10.31887/dcns.2017.19.4/gzwick] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuropsychological assessment provides a profound analysis of cognitive functioning in people with autism spectrum disorder (ASD). Individuals on the autistic spectrum often show a high level of anxiety and are frequently affected by comorbidities that influence their quality of life. Yet, they also have cognitive strengths that should be identified in order to develop effective support strategies. This article presents an overview of five cognitive areas that are essential for neuropsychological evaluation (ie, intelligence, attention, executive function, social cognition, and praxis) and explores the underlying causes of behavioral problems in persons with ASD. Furthermore, it stresses the importance of meticulous neuropsychological testing with regard to cognitive remediation, a method that can help to enhance single cognitive processes in a targeted manner. Objective test results suggest it might be possible to promote an improved sense of coherence. In line with the salutogenic model, this may be fundamental for human health and well-being.
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Bishop-Fitzpatrick L, Dababnah S, Baker-Ericzén MJ, Smith MJ, Magaña SM. Autism spectrum disorder and the science of social work: A grand challenge for social work research. SOCIAL WORK IN MENTAL HEALTH 2018; 17:73-92. [PMID: 31105472 PMCID: PMC6521880 DOI: 10.1080/15332985.2018.1509411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The social work profession has not yet taken a leadership role in addressing the myriad of challenges that individuals on the autism spectrum encounter across the lifespan. In this essay, we argue that social workers are well equipped to engage in research and practice aimed at promoting full and meaningful inclusion in society, as well as social and economic justice, for individuals on the autism spectrum. We highlight short- and long-term goals that provide the social work profession with a framework to engage in research, practice, education, and advocacy aimed at supporting individuals on the autism spectrum and their families.
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Affiliation(s)
| | | | - Mary J. Baker-Ericzén
- Child and Adolescent Services Research Center at Rady Children’s Hospital, San Diego, CA, USA
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Bishop-Fitzpatrick L, Mazefsky CA, Eack SM. The combined impact of social support and perceived stress on quality of life in adults with autism spectrum disorder and without intellectual disability. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:703-711. [PMID: 28666391 PMCID: PMC5711618 DOI: 10.1177/1362361317703090] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Identifying modifiable correlates of good quality of life in adults with autism spectrum disorder is of paramount importance for intervention development as the population of adults with autism spectrum disorder increases. This study sought to examine social support and perceived stress as potential modifiable correlates of quality of life in adults with autism spectrum disorder. We hypothesized that adults with autism spectrum disorder without co-occurring intellectual disabilities ( N = 40; aged 18-44 years) would report lower levels of social support and quality of life than typical community volunteers who were matched for age, sex, and race ( N = 25). We additionally hypothesized that social support would buffer the effect of perceived stress on quality of life in adults with autism spectrum disorder. Results indicated that adults with autism spectrum disorder reported significantly lower levels of social support and quality of life than matched typical community volunteers. In addition, findings showed significant direct effects of social support and perceived stress on quality of life in adults with autism spectrum disorder. Social support did not buffer the effect of perceived stress on quality of life. Interventions that teach adults with autism spectrum disorder skills to help them better manage stress and cultivate supportive social relationships have the potential to improve quality of life.
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Brief Report: Relationship Between ADOS-2, Module 4 Calibrated Severity Scores (CSS) and Social and Non-Social Standardized Assessment Measures in Adult Males with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2018; 47:4018-4024. [PMID: 28875421 DOI: 10.1007/s10803-017-3293-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The ADOS-2 Modules 1-3 now include a standardized calibrated severity score (CSS) from 1 to 10 based on the overall total raw score. Subsequent research published CSS for Module 4 (Hus, Lord, Journal of Autism and Developmental Disorders 44(8):1996-2012, 2014); however more research is needed to examine the psychometric properties of this CSS. Forty males with ASD completed an assessment battery consisting of ADOS-2 Module 4 and other clinical measures assessing core ASD symptomology and comorbidity. Pearson correlation analyses found that CSS did not correlate with measures that assessed core social deficits of ASD or general psychiatric co-morbidity, but CSS did correlate negatively with intellectual quotient. These findings provide information on the limitations and relevance of CSS to be taken into account in future clinical evaluations of ASD.
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Wojtalik JA, Eack SM, Smith MJ, Keshavan MS. Using Cognitive Neuroscience to Improve Mental Health Treatment: A Comprehensive Review. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2018; 9:223-260. [PMID: 30505392 PMCID: PMC6258037 DOI: 10.1086/697566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health interventions do not yet offer complete, client-defined functional recovery, and novel directions in treatment research are needed to improve the efficacy of available interventions. One promising direction is the integration of social work and cognitive neuroscience methods, which provides new opportunities for clinical intervention research that will guide development of more effective mental health treatments that holistically attend to the biological, social, and environmental contributors to disability and recovery. This article reviews emerging trends in cognitive neuroscience and provides examples of how these advances can be used by social workers and allied professions to improve mental health treatment. We discuss neuroplasticity, which is the dynamic and malleable nature of the brain. We also review the use of risk and resiliency biomarkers and novel treatment targets based on neuroimaging findings to prevent disability, personalize treatment, and make interventions more targeted and effective. The potential of treatment research to contribute to neuroscience discoveries regarding brain change is considered from the experimental-medicine approach adopted by the National Institute of Mental Health. Finally, we provide resources and recommendations to facilitate the integration of cognitive neuroscience into mental health research in social work.
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Affiliation(s)
- Jessica A Wojtalik
- Doctoral candidate at the University of Pittsburgh School of Social Work
| | - Shaun M Eack
- Professor at the University of Pittsburgh School of Social Work and Department of Psychiatry
| | - Matthew J Smith
- Associate professor at the University of Michigan School of Social Work
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Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial. Autism Res 2017; 11:519-530. [PMID: 29286586 DOI: 10.1002/aur.1913] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/31/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
Cognitive remediation is a promising approach to treating core cognitive deficits in adults with autism, but rigorously controlled trials of comprehensive interventions that target both social and non-social cognition over a sufficient period of time to impact functioning are lacking. This study examined the efficacy of cognitive enhancement therapy (CET) for improving core cognitive and employment outcomes in adult autism. Verbal adult outpatients with autism spectrum disorder (N = 54) were randomized to an 18-month, single-blind trial of CET, a cognitive remediation approach that integrates computer-based neurocognitive training with group-based training in social cognition, or an active enriched supportive therapy (EST) comparison focused on psychoeducation and condition management. Primary outcomes were composite indexes of neurocognitive and social-cognitive change. Competitive employment was a secondary outcome. Intent-to-treat analyses indicated that CET produced significant differential increases in neurocognitive function relative to EST (d = .46, P = .013). Both CET and EST were associated with large social-cognitive improvements, with CET demonstrating an advantage at 9 (d = .58, P = 0.020), but not 18 months (d = .27, P = 0.298). Effects on employment indicated that participants treated with CET were significantly more likely to gain competitive employment than those in EST, OR = 6.21, P = 0.023, which was mediated by cognitive improvement. CET is a feasible and potentially effective treatment for core cognitive deficits in adult autism spectrum disorder. The treatment of cognitive impairments in this population can contribute to meaningful improvements in adult outcomes. Autism Res 2018, 11: 519-530. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Cognitive enhancement therapy (CET), an 18-month cognitive remediation intervention designed to improve thinking and social understanding, was found to be more effective than supportive therapy at improving mental quickness, attention, and employment in adults living with autism. Social understanding was equally improved in CET and supportive therapy. Cognitive remediation interventions are feasible and may confer significant functional benefits to adults with autism.
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Affiliation(s)
- Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan S Hogarty
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deborah P Greenwald
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maralee Y Litschge
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Shannondora A Porton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nancy J Minshew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Zwick GP. Neuropsychological assessment in autism spectrum disorder and related conditions. DIALOGUES IN CLINICAL NEUROSCIENCE 2017; 19:373-379. [PMID: 29398932 PMCID: PMC5789214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Neuropsychological assessment provides a profound analysis of cognitive functioning in people with autism spectrum disorder (ASD). Individuals on the autistic spectrum often show a high level of anxiety and are frequently affected by comorbidities that influence their quality of life. Yet, they also have cognitive strengths that should be identified in order to develop effective support strategies. This article presents an overview of five cognitive areas that are essential for neuropsychological evaluation (ie, intelligence, attention, executive function, social cognition, and praxis) and explores the underlying causes of behavioral problems in persons with ASD. Furthermore, it stresses the importance of meticulous neuropsychological testing with regard to cognitive remediation, a method that can help to enhance single cognitive processes in a targeted manner. Objective test results suggest it might be possible to promote an improved sense of coherence. In line with the salutogenic model, this may be fundamental for human health and well-being.
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Marinopoulou M, Lugnegård T, Hallerbäck MU, Gillberg C, Billstedt E. Asperger Syndrome and Schizophrenia: A Comparative Neuropsychological Study. J Autism Dev Disord 2017; 46:2292-304. [PMID: 26936160 DOI: 10.1007/s10803-016-2758-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There has been an increasing interest in possible connections between autism spectrum disorder (ASD) and schizophrenia in the last decade. Neuropsychological comparison studies have, however, been few. The present study examined similarities and differences in intellectual and executive functioning between adults with Asperger syndrome (AS) and adults with schizophrenic psychosis (SP). A group with AS and a group with SP were assessed neuropsychologically with WAIS-III and D-KEFS. Similarities were found between groups, as displayed by an uneven cognitive profile, limitations in working memory, processing speed and some aspects of executive functioning. Full Scale IQ was higher in the AS group. These results add to the current research illuminating similarities and differences between ASD and schizophrenia on a cognitive level.
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Affiliation(s)
- Maria Marinopoulou
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,County Council of Värmland, Neuropsychiatric Clinic, Central Hospital, 651 85, Karlstad, Sweden.
| | - Tove Lugnegård
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Unenge Hallerbäck
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Brief Report: Feasibility and Preliminary Efficacy of Individual Mindfulness Therapy for Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 48:290-300. [DOI: 10.1007/s10803-017-3312-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Okuda T, Asano K, Numata N, Hirano Y, Yamamoto T, Tanaka M, Matsuzawa D, Shimizu E, Iyo M, Nakazato M. Feasibility of cognitive remediation therapy for adults with autism spectrum disorders: a single-group pilot study. Neuropsychiatr Dis Treat 2017; 13:2185-2191. [PMID: 28860776 PMCID: PMC5565247 DOI: 10.2147/ndt.s141555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Set-shifting (SS) difficulties and weak central coherence (CC) are commonly associated with autism spectrum disorders (ASD). Cognitive remediation therapy (CRT) aims to improve such cognitive processing; however, there are no reports on CRT for patients with ASD. This pilot study aimed to provide preliminary evidence to support the use of CRT for individuals with ASD and provide data to inform future studies. PARTICIPANTS AND METHODS Nineteen individuals with ASD were recruited and administered a series of neuropsychological and questionnaire measures to examine cognitive function and clinical outcomes such as anxiety and depression. Participants received CRT, and cognitive function and clinical variables were re-evaluated at postintervention and after 3 months. RESULTS The participants demonstrated significant improvement in CC and anxiety at postintervention, which was maintained at 3-month follow-up. Although SS scores had improved with a large effect size, this was not statistically significant. CONCLUSION CRT improved CC and anxiety scores for individuals with ASD, suggesting that CRT is an effective treatment for individuals with ASD.
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Affiliation(s)
- Tomoko Okuda
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Department of Psychiatry, Chibaken Saiseikai Narashino Hospital, Narashino
| | - Kenichi Asano
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
| | - Noriko Numata
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Yoshiyuki Hirano
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
| | | | - Mari Tanaka
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Daisuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Eiji Shimizu
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University
| | - Masaomi Iyo
- Center for Forensic Mental Health, Chiba University
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- Division of Cognitive Behavioral Science, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Chiba-shi, Chiba
- Research Center for Child Mental Development, Chiba University
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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Lorenc T, Rodgers M, Marshall D, Melton H, Rees R, Wright K, Sowden A. Support for adults with autism spectrum disorder without intellectual impairment: Systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:654-668. [DOI: 10.1177/1362361317698939] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Adults with autism spectrum disorder without intellectual impairment may benefit from a range of support services. This article presents the results of a systematic review assessing the effectiveness of supportive interventions for adults with autism spectrum disorder without intellectual impairment. A total of 32 studies were included; most focused on younger male participants. Although evidence was lacking for most types of intervention, employment programmes and social skills training were found to be effective for more proximal outcomes such as social skills. Evidence that any intervention improves mental health or well-being was very limited. Most interventions focused on mitigating specific deficits, rather than on providing broader support. Further research is needed on the effectiveness of supportive interventions such as advocacy and mentoring.
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García-Villamisar D, Dattilo J, Muela C. Effects of therapeutic recreation on adults with ASD and ID: a preliminary randomized control trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:325-340. [PMID: 27465318 DOI: 10.1111/jir.12320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The purpose of this research was to examine effects of a therapeutic recreation (TR) program designed to increase executive function (EF), social skills, adaptive behaviours and well-being of adults with autism spectrum disorder (ASD) and intellectual disability (ID). METHOD A preliminary pre-test, post-test randomized control group experimental design was used to measure effects of a 40-week TR program designed to increase EF (TR-EF). The TR-EF used instructional electronically based games delivered during 200 1-h sessions (5/week). RESULTS Participants (experimental group, n = 19; wait-list group, n = 18) were evaluated at baseline and 10 months later. There was a positive and direct impact of the program on several EF and indirect effect on social skills, adaptive behaviour and personal well-being. CONCLUSIONS Findings provide support for inclusion of EF enrichment as a way to enhance effects of TR interventions for adults with ASD and ID. Preliminary results of this study can be considered in planning TR services in the future. In addition to TR-EF program primary effects on EF, there were indirect benefits on adaptive behaviours, personal well-being and social skills.
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Affiliation(s)
- D García-Villamisar
- Universidad Complutense, Department of Personality and Clinical Pschology, Madrid, Madrid, Spain
| | - J Dattilo
- The Pennsylvania State University, Department of Recreation, Park, and Tourism Management, University Park, PA, USA
| | - C Muela
- Asociacion Nuevo Horizonte, Technical Direction, Las Rozas, Madrid, Spain
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Bishop-Fitzpatrick L, Mazefsky CA, Eack SM, Minshew NJ. Correlates of Social Functioning in Autism Spectrum Disorder: The Role of Social Cognition. RESEARCH IN AUTISM SPECTRUM DISORDERS 2017; 35:25-34. [PMID: 28839456 PMCID: PMC5565224 DOI: 10.1016/j.rasd.2016.11.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) experience marked challenges with social function by definition, but few modifiable predictors of social functioning in ASD have been identified in extant research. This study hypothesized that deficits in social cognition and motor function may help to explain poor social functioning in individuals with ASD. METHOD Cross-sectional data from 108 individuals with ASD and without intellectual disability ages 9 through 27.5 were used to assess the relationship between social cognition and motor function, and social functioning. RESULTS Results of hierarchical multiple regression analyses revealed that greater social cognition, but not motor function, was significantly associated with better social functioning when controlling for sex, age, and intelligence quotient. Post-hoc analyses revealed that, better performance on second-order false belief tasks was associated with higher levels of socially adaptive behavior and lower levels of social problems. CONCLUSIONS Our findings support the development and testing of interventions that target social cognition in order to improve social functioning in individuals with ASD. Interventions that teach generalizable skills to help people with ASD better understand social situations and develop competency in advanced perspective taking have the potential to create more durable change because their effects can be applied to a wide and varied set of situations and not simply a prescribed set of rehearsed situations.
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Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions. Contemp Clin Trials Commun 2017; 5:80-85. [PMID: 29740624 PMCID: PMC5936690 DOI: 10.1016/j.conctc.2017.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/05/2016] [Accepted: 01/03/2017] [Indexed: 12/27/2022] Open
Abstract
Background To our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD. Methods/design Twelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up. Trial registration The Netherlands National Trial Register NTR5788. Registered 01 April 2016.
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Key Words
- ABA, Applied Behavior Analysis
- APA, American Psychiatric Association
- AS, Asperger's disorder
- ASD, autism spectrum disorder
- Autism spectrum disorder
- CBT, Cognitive behavioral therapy
- CET, Cognitive enhancement therapy
- DSM, Diagnostic and Statistical Manual of mental disorders
- IQ, Intelligence quotient
- Multiple-baseline case series study
- N.S., not significant
- PD, personality disorder
- PDs, personality disorders
- Personality disorder
- RCT, randomized controlled trial
- SCID-II, Structured Clinical Interview for Axis II Personality Disorders
- SCL-90, Symptom Check List
- SMI, Schema Mode Inventory
- SRS-A, Social Responsiveness Scale – Adult version
- Schema therapy
- VAS, visual analogue scales
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Bishop-Fitzpatrick L, Minshew NJ, Mazefsky CA, Eack SM. Perception of Life as Stressful, Not Biological Response to Stress, is Associated with Greater Social Disability in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1-16. [PMID: 27696184 PMCID: PMC5225258 DOI: 10.1007/s10803-016-2910-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined differences between adults with autism spectrum disorder (ASD; N = 40) and typical community volunteers (N = 25) on measures of stressful life events, perceived stress, and biological stress response (cardiovascular and cortisol reactivity) during a novel social stress task. Additional analyses examined the relationship between stress and social functioning as measured by the Social Adjustment Scale-II and the Waisman Activities of Daily Living scale. Results indicated that adults with ASD experienced significantly more stressful life events and perceived stress, and greater systolic blood pressure reactivity than typical community volunteers. Results also indicated that perceived stress and stressful life events were significantly associated with social disability. Interventions targeting stress management might improve social function in adults with ASD.
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Affiliation(s)
| | - Nancy J Minshew
- University of Pittsburgh School of Medicine, Webster Hall - Suite 300, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Carla A Mazefsky
- University of Pittsburgh School of Medicine, Webster Hall - Suite 300, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Shaun M Eack
- University of Pittsburgh, School of Social Work, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA
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Lehnhardt FG, Falter CM, Gawronski A, Pfeiffer K, Tepest R, Franklin J, Vogeley K. Sex-Related Cognitive Profile in Autism Spectrum Disorders Diagnosed Late in Life: Implications for the Female Autistic Phenotype. J Autism Dev Disord 2016; 46:139-154. [PMID: 26319250 DOI: 10.1007/s10803-015-2558-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Females with high-functioning ASD are known to camouflage their autistic symptoms better than their male counterparts, making them prone to being under-ascertained and delayed in diagnostic assessment. Thus far the underlying cognitive processes that enable such successful socio-communicative adaptation are not well understood. The current results show sex-related differences in the cognitive profile of ASD individuals, which were diagnosed late in life exclusively. Higher verbal abilities were found in males (n = 69) as opposed to higher processing speed and better executive functions in females with ASD (n = 38). Since both sexes remained unidentified during childhood and adolescence, these results are suggestive for sex-distinctive cognitive strategies as an alternative to typically-developed reciprocal social behavior and social mimicry in high functioning ASD.
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Affiliation(s)
- Fritz-Georg Lehnhardt
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christine Michaela Falter
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Astrid Gawronski
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Pfeiffer
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ralf Tepest
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Computer Science and Epidemiology (IMSIE), University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine - Cognitive Neurosciences (INM-3), Research Center Juelich, 52425, Juelich, Germany
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Murphy CM, Wilson CE, Robertson DM, Ecker C, Daly EM, Hammond N, Galanopoulos A, Dud I, Murphy DG, McAlonan GM. Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatr Dis Treat 2016; 12:1669-86. [PMID: 27462160 PMCID: PMC4940003 DOI: 10.2147/ndt.s65455] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by pervasive difficulties since early childhood across reciprocal social communication and restricted, repetitive interests and behaviors. Although early ASD research focused primarily on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. However, although health and education services for children with ASD are relatively well established, service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD. This article reviews available evidence regarding the etiology, legislation, diagnosis, management, and service provision for adults with ASD and considers what is needed to support adults with ASD as they age. We conclude that health services research for adults with ASD is urgently warranted. In particular, research is required to better understand the needs of adults with ASD, including health, aging, service development, transition, treatment options across the lifespan, sex, and the views of people with ASD. Additionally, the outcomes of recent international legislative efforts to raise awareness of ASD and service provision for adults with ASD are to be determined. Future research is required to identify high-quality, evidence-based, and cost-effective models of care. Furthermore, future health services research is also required at the beginning and end of adulthood, including improved transition from youth to adult health care and increased understanding of aging and health in older adults with ASD.
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Affiliation(s)
- Clodagh M Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - C Ellie Wilson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
- Individual Differences, Language and Cognition Lab, Department of Developmental and Educational Psychology, University of Seville, Spain
| | - Dene M Robertson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Eileen M Daly
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Neil Hammond
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Anastasios Galanopoulos
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Iulia Dud
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Declan G Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Grainne M McAlonan
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
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Reiersen AM. Collection of developmental history in the evaluation of schizophrenia spectrum disorders. Scand J Child Adolesc Psychiatr Psychol 2016; 4:36-43. [PMID: 27294074 DOI: 10.21307/sjcapp-2016-007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Schizophrenia is a heterogeneous disorder that is characterized by varying levels of hallucinations, delusions, negative symptoms, and disorganized features. The presence and severity of neurodevelopmental precursors and premorbid psychopathology also vary among individuals. To fully understand individual patients and to sort out phenotypic heterogeneity for genetic research studies, instruments designed to collect developmental history relevant to schizophrenia may be helpful. OBJECTIVE The goal was to describe a pair of self-report and parent-report instruments developed for the purpose of collecting the developmental history of patients with known or suspected schizophrenia spectrum disorders. METHOD Two developmental history instruments were designed for use in studies of brain morphology and cognition in schizophrenia probands and their unaffected siblings. The instruments focus mainly on motor abnormalities and other features that have been described as schizophrenia precursors. RESULTS The Motor Skills History Form is a brief self-report form that asks about patients' childhood and adolescent motor abilities as well as their current motor functioning. The Developmental & Motor History Form is a more detailed parent-rated form that covers aspects of patients' early (infant/preschool) development; their childhood and adolescent motor abilities; any childhood behaviors that may be related to later psychosis risk; and their history of any neurological, emotional, or cognitive disorders diagnosed during childhood or adolescence. The instruments can be used either for interviews or as self-administered questionnaires. The parent-rated form has been used for research and for the clinical assessment of children and adolescents with complex neurodevelopmental presentations with or without strong evidence of schizophrenia risk. CONCLUSIONS The collection of developmental history information is important when evaluating individuals with schizophrenia and related disorders. The Motor Skills History Form and the Developmental & Motor History Form can be used to collect this information for clinical evaluation or research purposes.
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Zimmerman DL, Ownsworth T, O'Donovan A, Roberts J, Gullo MJ. Independence of Hot and Cold Executive Function Deficits in High-Functioning Adults with Autism Spectrum Disorder. Front Hum Neurosci 2016; 10:24. [PMID: 26903836 PMCID: PMC4742532 DOI: 10.3389/fnhum.2016.00024] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ > 70) with ASD. A conceptual distinction is commonly made between "cold" and "hot" executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18-66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d = 0.54 - 1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognize emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs.
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Affiliation(s)
- David L Zimmerman
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Tamara Ownsworth
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Analise O'Donovan
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Jacqueline Roberts
- School of Education and Professional Studies, Griffith University Mt. Gravatt, QLD, Australia
| | - Matthew J Gullo
- Centre for Youth Substance Abuse Research, University of Queensland St. Lucia, QLD, Australia
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Abstract
Purpose
– Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and adolescents with ASD derive clinically meaningful benefits from psychological interventions, including those designed to reduce socio-communication deficits and mental health conditions. Relatively little is known about the effectiveness of these interventions for the adult ASD population. The paper aims to discuss this issue.
Design/methodology/approach
– A selective search of English language, peer-reviewed publications was undertaken, in order to summarise the empirical data pertaining to psychological interventions for adults with high-functioning ASD (HF-ASD).
Findings
– Thus far, social skills interventions, cognitive behaviour therapy techniques, and mindfulness-based approaches have been researched most extensively. Interventions have primarily sought to: reduce the impact of core ASD characteristics; enhance skills; and improve co-morbid mental health symptoms. Methodological and clinical heterogeneity render it difficult to generalise study findings across population samples, but overall, interventions appear to be associated with reductions in co-morbid symptom severity, and improved functioning.
Research limitations/implications
– Further studies that seek to improve functioning, reduce co-morbid characteristics, and enhance the propensity for attaining and maintaining independence are now needed.
Practical implications
– Adaptations to standard treatment protocols are likely required in order to enhance engagement and optimise treatment gains.
Originality/value
– This is one of the first reviews to focus specifically on psychological interventions for adults with HF-ASD.
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Shashi V, Harrell W, Eack S, Sanders C, McConkie-Rosell A, Keshavan MS, Bonner MJ, Schoch K, Hooper SR. Social cognitive training in adolescents with chromosome 22q11.2 deletion syndrome: feasibility and preliminary effects of the intervention. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:902-913. [PMID: 25871427 PMCID: PMC5824427 DOI: 10.1111/jir.12192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Children with chromosome 22q11.2 deletion syndrome (22q11DS) often have deficits in social cognition and social skills that contribute to poor adaptive functioning. These deficits may be of relevance to the later occurrence of serious psychiatric illnesses such as schizophrenia. Yet, there are no evidence-based interventions to improve social cognitive functioning in children with 22q11DS. METHODS Using a customised social cognitive curriculum, we conducted a pilot small-group-based social cognitive training (SCT) programme in 13 adolescents with 22q11DS, relative to a control group of nine age- and gender-matched adolescents with 22q11DS. RESULTS We found the SCT programme to be feasible, with high rates of compliance and satisfaction on the part of the participants and their families. Our preliminary analyses indicated that the intervention group showed significant improvements in an overall social cognitive composite index. CONCLUSIONS SCT in a small-group format for adolescents with 22q11DS is feasible and results in gains in social cognition. A larger randomised controlled trial would permit assessment of efficacy of this promising novel intervention.
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Affiliation(s)
- V Shashi
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - W Harrell
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - S Eack
- School of Social Work and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Sanders
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - A McConkie-Rosell
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - M S Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - M J Bonner
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - K Schoch
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - S R Hooper
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Williams DL, Minshew NJ, Goldstein G. Further understanding of complex information processing in verbal adolescents and adults with autism spectrum disorders. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 19:859-67. [PMID: 26019307 DOI: 10.1177/1362361315586171] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
More than 20 years ago, Minshew and colleagues proposed the Complex Information Processing model of autism in which the impairment is characterized as a generalized deficit involving multiple modalities and cognitive domains that depend on distributed cortical systems responsible for higher order abilities. Subsequent behavioral work revealed a related dissociation between concept formation and concept identification in autism suggesting the lack of an underlying organizational structure to manage increases in processing loads. The results of a recent study supported the impact of this relative weakness in conceptual reasoning on adaptive functioning in children and adults with autism. In this study, we provide further evidence of the difficulty relatively able older adolescents and adults with autism have with conceptual reasoning and provide evidence that this characterizes their difference from age- and ability-matched controls with typical development better than their differences in language. For verbal adults with autism, language may serve as a bootstrap or compensatory mechanism for learning but cannot overcome an inherent weakness in concept formation that makes information processing challenging as task demands increase.
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Tchanturia K, Lounes N, Holttum S. Cognitive remediation in anorexia nervosa and related conditions: a systematic review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:454-62. [PMID: 25277720 DOI: 10.1002/erv.2326] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/07/2022]
Abstract
Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Trust Eating Disorders National Service, UK; Illia University Tbilisi, Georgia
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Keshavan MS, Vinogradov S, Rumsey J, Sherrill J, Wagner A. Cognitive training in mental disorders: update and future directions. Am J Psychiatry 2014; 171:510-22. [PMID: 24700194 PMCID: PMC4114156 DOI: 10.1176/appi.ajp.2013.13081075] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article reviews the conceptual basis, definitions, and evolution of cognitive training approaches for the treatment of mental disorders. METHOD The authors review the current state of the knowledge on cognitive training in psychiatric illnesses, and its neural and behavioral targets, and summarize the factors that appear to relate to a successful response, including learner characteristics that influence clinical outcome. They also discuss methodological issues relevant to the development and testing of cognitive training approaches, with the goal of creating maximally efficient and effective approaches to training. Finally, they identify gaps in existing knowledge and outline key research directions for the future. RESULTS While much of the early research has been conducted in schizophrenia, cognitive training has more recently been applied to a widening range of neuropsychiatric illnesses, including attention deficit hyperactivity disorder, mood disorders, and substance use disorders. Cognitive training harnesses the inherent neuroplastic capacities of the brain, targeting neural system function across psychiatric disorders, thus improving the cognitive processes that play a role in emotion regulation, clinical symptoms, and adaptive community functioning. CONCLUSIONS Cognitive training offers considerable promise, especially given the limited efficacy of pharmacological interventions in ameliorating cognitive deficits. However, more research is needed to understand the mechanisms underlying cognitive training, predictors of response, generalization and real-world applicability, and approaches to dissemination in practice settings.
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Commonalities in social and non-social cognitive impairments in adults with autism spectrum disorder and schizophrenia. Schizophr Res 2013; 148:24-8. [PMID: 23768814 PMCID: PMC3732579 DOI: 10.1016/j.schres.2013.05.013] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/21/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia are both conditions that are characterized by impairments in social and non-social cognition, yet commonalities in the magnitude and domains of cognitive deficits across these two conditions remain unclear. This study examined neurocognitive and social-cognitive functioning in 47 outpatients with schizophrenia, 43 verbal adults with ASD, and 24 healthy volunteers. A comprehensive neuropsychological battery assessing processing speed, attention, memory, and problem-solving domains was administered along with a social-cognitive battery of emotion processing. Results demonstrated large and significant impairments in emotion processing and neurocognition relative to healthy individuals in participants with autism (d=-.97 and -1.71, respectively) and schizophrenia (d=-.65 and -1.48, respectively). No significant differences were observed between those with ASD and schizophrenia on any cognitive domain assessed, and the areas of greatest impairment were identical across both disorders and included slowness in speed of processing and an inability to understand emotions. These findings indicate a high degree of similarity in the cognitive challenges experienced by verbal adults with autism and schizophrenia, and the potential need for trans-diagnostic remediation approaches to enhance cognition in these conditions.
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