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Haar T, Brownlow C, Hall G, Heyworth M, Lawson W, Poulsen R, Reinisch T, Pellicano E. 'We have so much to offer': Community members' perspectives on autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241248713. [PMID: 38741516 DOI: 10.1177/13623613241248713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
LAY ABSTRACT Autism research is changing. Autistic activists and researchers want Autistic people in the community to have more of a say about what is researched and how. But we haven't asked people in the community what they think. This study used the information obtained from 55 community members, including Autistic people, their families, and professionals working with Autistic people, from an existing study on their priorities for autism research. We re-looked at what was said to see if we could understand community members' views and experiences of autism research. People agreed strongly that research can play a powerful role in shaping good Autistic lives. They also felt that big changes were needed for research to do this. Some of these changes were that researchers should stop thinking about autism narrowly and in a negative way, where Autistic people are seen as the problem. Researchers need to think more about how to improve systems, experiences and how other people respond to Autistic people. They also want the autism community to be more involved in what is researched and how it is researched. The findings from our study here highlight the potential for research to be positive when Autistic people and their families are listened to, approached with understanding, and are respected and valued as individuals in the research process.
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Affiliation(s)
- Tori Haar
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Reframing Autism, Australia
| | - Charlotte Brownlow
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- University of Southern Queensland, Australia
| | - Gabrielle Hall
- Macquarie University, Australia
- ORIMA Research, Australia
| | - Melanie Heyworth
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Reframing Autism, Australia
| | - Wenn Lawson
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Rebecca Poulsen
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Reframing Autism, Australia
| | | | - Elizabeth Pellicano
- Macquarie University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- University College London, UK
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Walton KM, Borowy AR, Gordon RA, Wainer AL. Enhancing stakeholder roles in autism early interventions in the United States: A stakeholder-driven research agenda. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1120-1134. [PMID: 37679945 PMCID: PMC10918025 DOI: 10.1177/13623613231195743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
LAY ABSTRACT In this article, we outline a stakeholder-driven research agenda to guide future early intervention research for children with autism. Our research team collaborated with autism service providers, parents of individuals with autism, and autistic people to create this research agenda by (1) conducting workshops with community members and (2) distributing a survey to a larger number of community members around the country. The finalized research agenda includes (1) Guiding Principles for current and future research, (2) Research Priorities focused on early intervention for individuals with autism, and (3) Systems Implications to consider in future clinical, research, and policy efforts for early intervention. The full version of the research agenda is available in Supplemental Material. This article lists the main points of the research agenda and discusses unique themes highlighted by the community members. One main conclusion is that researchers need to include community members in decision-making and consultant positions throughout the research process to best meet the needs of the broader autism community. We have created a researcher workbook which we hope may facilitate these community consultation efforts. This workbook is available in Supplemental Material.
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Peters BC, Gabriels R, Schmid AA, Lassell RKF, Pan Z, Hoffman A, Hepburn S. Occupational Therapy Using Zones of Regulation™ Concepts: A Feasibility Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241246549. [PMID: 38659367 DOI: 10.1177/15394492241246549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There is a lack of peer-reviewed research on occupational therapy using Zones of Regulation™ concepts for autistic youth. The purpose of this article is to describe the feasibility of a newly-developed occupational therapy intervention using Zones of Regulation™ concepts (OT-ZOR) for autistic youth. Specifically, we aimed to evaluate: (a) participant recruitment, retention, and attendance; (b) intervention fidelity, safety, and assessment completion; (c) intervention acceptability; and (d) preliminary participant outcomes. A single-arm feasibility study was completed with outcome measures before and after 10 weeks of OT-ZOR. Fourteen autistic youth ages 6 to 13 completed the study. Youth attended 94% of OT-ZOR sessions. Providers achieved 97% fidelity to the intervention. Occupational therapists and caregivers expressed overall satisfaction with the OT-ZOR intervention. Youth demonstrated significant decreases in irritability, hyperactivity, emotional reactivity, and dysphoria. OT-ZOR is feasible to implement, acceptable to providers and caregivers, and may improve self-regulation in autistic youth.
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Allan S, Ward T, Eisner E, Bell IH, Cella M, Chaudhry IB, Torous J, Kiran T, Kabir T, Priyam A, Richardson C, Reininghaus U, Schick A, Schwannauer M, Syrett S, Zhang X, Bucci S. Adverse Events Reporting in Digital Interventions Evaluations for Psychosis: A Systematic Literature Search and Individual Level Content Analysis of Adverse Event Reports. Schizophr Bull 2024:sbae031. [PMID: 38581410 DOI: 10.1093/schbul/sbae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Digital health interventions (DHIs) have significant potential to upscale treatment access to people experiencing psychosis but raise questions around patient safety. Adverse event (AE) monitoring is used to identify, record, and manage safety issues in clinical trials, but little is known about the specific content and context contained within extant AE reports. This study aimed to assess current AE reporting in DHIs. STUDY DESIGN A systematic literature search was conducted by the iCharts network (representing academic, clinical, and experts by experience) to identify trials of DHIs in psychosis. Authors were invited to share AE reports recorded in their trials. A content analysis was conducted on the shared reports. STUDY RESULTS We identified 593 AE reports from 18 DHI evaluations, yielding 19 codes. Only 29 AEs (4.9% of total) were preidentified by those who shared AEs as being related to the intervention or trial procedures. While overall results support the safety of DHIs, DHIs were linked to mood problems and psychosis exacerbation in a few cases. Additionally, 27% of studies did not report information on relatedness for all or at least some AEs; 9.6% of AE reports were coded as unclear because it could not be determined what had happened to participants. CONCLUSIONS The results support the safety of DHIs, but AEs must be routinely monitored and evaluated according to best practice. Individual-level analyses of AEs have merit to understand safety in this emerging field. Recommendations for best practice reporting in future studies are provided.
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Affiliation(s)
- Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Thomas Ward
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Matteo Cella
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Ziauddin University and Hospital Karachi, Karachi, Pakistan
- Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tayyeba Kiran
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aansha Priyam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Cara Richardson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Ulrich Reininghaus
- School of Mental Health and Psychological Sciences, Department of Psychology Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anita Schick
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias Schwannauer
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Suzy Syrett
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Bottema-Beutel K, McKinnon R, Mohiuddin S, LaPoint SC, Kim SY. Problems with "problem behavior": A secondary systematic review of intervention research on transition-age autistic youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241229159. [PMID: 38389134 DOI: 10.1177/13623613241229159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
LAY ABSTRACT In a previous study, we looked at research done on strategies to support autistic people who were between 14 and 22 years old. For this study, we looked at all of the studies in our previous study that tried to decrease or stop autistic people from doing certain things-many researchers call these things "problem behavior." There were 48 studies that tried to reduce problem behavior, and most of them used strategies like prompting and reinforcement to try get autistic people to change their behavior. We found many things wrong with these studies. Most of them did not define the group of behaviors they were trying to stop autistic people from doing. None of the studies looked at whether any side effects happened when they tried the strategy they were studying. Also, most of the studies tried to stop autistic people from doing behaviors that probably were not harmful, like stereotypic behavior. Most of the studies did not say how they decided that the behaviors they tried to stop were a problem for the autistic people in the study, and most studies did not try to figure out why the autistic people in the study did the behaviors the researchers were trying to stop them from doing.
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Sandbank M, Bottema-Beutel K, Syu YC, Caldwell N, Feldman JI, Woynaroski T. Evidence-b(i)ased practice: Selective and inadequate reporting in early childhood autism intervention research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241231624. [PMID: 38345030 DOI: 10.1177/13623613241231624] [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] [Indexed: 03/06/2024]
Abstract
LAY ABSTRACT When researchers fail to report their findings or only report some of their findings, it can make it difficult for clinicians to provide effective intervention recommendations. However, no one has examined whether this is a problem in studies of early childhood autism interventions. We studied how researchers that study early childhood autism interventions report their findings. We found that most researchers did not register their studies when they were supposed to (before the start of the study), and that many researchers did not provide all of the needed information in the registration. We also found that researchers frequently did not publish their findings when their studies were complete. When we looked at published reports, we found that many of the studies did not report enough information, and that many studies were reported differently from their registrations, suggesting that researchers were selectively reporting positive outcomes and ignoring or misrepresenting less positive outcomes. Because we found so much evidence that researchers are failing to report their findings quickly and correctly, we suggested some practical changes to make it better.
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Affiliation(s)
| | | | - Ya-Cing Syu
- The University of North Carolina at Chapel Hill, USA
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Schuck RK, Dwyer P, Baiden KMP, Williams ZJ, Wang M. Social Validity of Pivotal Response Treatment for Young Autistic Children: Perspectives of Autistic Adults. J Autism Dev Disord 2024; 54:423-441. [PMID: 36427175 PMCID: PMC10821825 DOI: 10.1007/s10803-022-05808-4] [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] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
The social validity of autism behavioral intervention has been questioned. Naturalistic Developmental Behavioral Interventions (NDBIs) attempt to address some concerns, but it is unclear whether autistic people consider NDBIs socially valid. Social validity of an NDBI, Pivotal Response Treatment (PRT), was investigated through autistic adults commenting on videos of autistic children receiving PRT. Qualitative coding of responses generated three themes: respect for individuals; assessment of intervention implementation; and socioemotional considerations. Although video brevity limits the scope of the present study's conclusions, participants highlighted PRT components that appeared socially valid (e.g., reinforcing attempts, following the child's lead) and aspects appearing invalid (e.g., overemphasis on spoken language). Therefore, adjustments appear necessary for PRT to be fully acceptable to the autistic community.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
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Schwartzman JM, Roth MC, Paterson AV, Jacobs AX, Williams ZJ. Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613231213543. [PMID: 38009186 PMCID: PMC11128473 DOI: 10.1177/13623613231213543] [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] [Indexed: 11/28/2023]
Abstract
LAY ABSTRACT Depression in youth is a significant public health problem worldwide, particularly for autistic youth who are over twice as likely to experience depression than their non-autistic peers. Although pathways to depression are complex, emotional reactivity and negative self-esteem are two risk factors for depression in autistic and non-autistic youth. Although autistic youth are more likely to experience depression than their non-autistic peers, psychotherapy options for autistic youth are very limited; community guidance in the development and testing of psychotherapy programs is a promising approach in autism. Therefore, in this study, we designed an autism-adapted CBT-DAY, in collaboration with autistic community members. Specifically, CBT-DAY combined neurodiversity-affirming and cognitive behavioral approaches to target emotional reactivity and self-esteem in youth to improve depressive symptom severity in a group setting across 12 weeks. We examined the preliminary feasibility, acceptability, and efficacy of CBT-DAY in a pilot non-randomized trial. In addition, we implemented a rigorous protocol for assessing, monitoring, and addressing potential harms in this intervention. Results from 24 autistic youth (11-17 years old) suggest that CBT-DAY may be feasible to use in an outpatient clinical setting and generally acceptable to youth and their caregivers. Participation in CBT-DAY may be associated with significant improvements in youth emotional reactivity and self-esteem, as well as depressive symptom severity per self-report only. Exploratory analyses showed that participation in CBT-DAY may also be associated with significant improvements in internalizing symptoms. Findings demonstrate the potential promise of neurodiversity-affirming and cognitive behavioral approaches to treating depressive symptoms in some autistic youth.
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Sandbank M, Bottema-Beutel K, Crowley LaPoint S, Feldman JI, Barrett DJ, Caldwell N, Dunham K, Crank J, Albarran S, Woynaroski T. Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis. BMJ 2023; 383:e076733. [PMID: 37963634 PMCID: PMC10644209 DOI: 10.1136/bmj-2023-076733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To summarize the breadth and quality of evidence supporting commonly recommended early childhood autism interventions and their estimated effects on developmental outcomes. DESIGN Updated systematic review and meta-analysis (autism intervention meta-analysis; Project AIM). DATA SOURCES A search was conducted in November 2021 (updating a search done in November 2017) of the following databases and registers: Academic Search Complete, CINAHL Plus with full text, Education Source, Educational Administration Abstracts, ERIC, Medline, ProQuest Dissertations and Theses, PsycINFO, Psychology and Behavioral Sciences Collection, and SocINDEX with full text, Trials, and ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Any controlled group study testing the effects of any non-pharmacological intervention on any outcome in young autistic children younger than 8 years. REVIEW METHODS Newly identified studies were integrated into the previous dataset and were coded for participant, intervention, and outcome characteristics. Interventions were categorized by type of approach (such as behavioral, developmental, naturalistic developmental behavioral intervention, and technology based), and outcomes were categorized by domain (such as social communication, adaptive behavior, play, and language). Risks of bias were evaluated following guidance from Cochrane. Effects were estimated for all intervention and outcome types with sufficient contributing data, stratified by risk of bias, using robust variance estimation to account for intercorrelation of effects within studies and subgroups. RESULTS The search yielded 289 reports of 252 studies, representing 13 304 participants and effects for 3291 outcomes. When contributing effects were restricted to those from randomized controlled trials, significant summary effects were estimated for behavioral interventions on social emotional or challenging behavior outcomes (Hedges' g=0.58, 95% confidence interval 0.11 to 1.06; P=0.02), developmental interventions on social communication (0.28, 0.12 to 0.44; P=0.003); naturalistic developmental behavioral interventions on adaptive behavior (0.23, 0.02 to 0.43; P=0.03), language (0.16, 0.01 to 0.31; P=0.04), play (0.19, 0.02 to 0.36; P=0.03), social communication (0.35, 0.23 to 0.47; P<0.001), and measures of diagnostic characteristics of autism (0.38, 0.17 to 0.59; P=0.002); and technology based interventions on social communication (0.33, 0.02 to 0.64; P=0.04) and social emotional or challenging behavior outcomes (0.57, 0.04 to 1.09; P=0.04). When effects were further restricted to exclude caregiver or teacher report outcomes, significant effects were estimated only for developmental interventions on social communication (0.31, 0.13 to 0.49; P=0.003) and naturalistic developmental behavioral interventions on social communication (0.36, 0.23 to 0.49; P<0.001) and measures of diagnostic characteristics of autism (0.44, 0.20 to 0.68; P=0.002). When effects were then restricted to exclude those at high risk of detection bias, only one significant summary effect was estimated-naturalistic developmental behavioral interventions on measures of diagnostic characteristics of autism (0.30, 0.03 to 0.57; P=0.03). Adverse events were poorly monitored, but possibly common. CONCLUSION The available evidence on interventions to support young autistic children has approximately doubled in four years. Some evidence from randomized controlled trials shows that behavioral interventions improve caregiver perception of challenging behavior and child social emotional functioning, and that technology based interventions support proximal improvements in specific social communication and social emotional skills. Evidence also shows that developmental interventions improve social communication in interactions with caregivers, and naturalistic developmental behavioral interventions improve core challenges associated with autism, particularly difficulties with social communication. However, potential benefits of these interventions cannot be weighed against the potential for adverse effects owing to inadequate monitoring and reporting.
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Affiliation(s)
- Micheal Sandbank
- Division of Occupational Science and Occupational Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Jacob I Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | | | - Nicolette Caldwell
- Department of Curriculum and Instruction, University of Arkansas, Fayetteville, AR, USA
| | - Kacie Dunham
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | | | - Suzanne Albarran
- Department of Special Education, University of Texas at Austin, Austin, TX, USA
| | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Nashville, TN, USA
- Department of Communication Sciences and Disorders, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
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Ne'eman A, Richman KA, McCarthy AM, Wilkenfeld D. A Passing Problem: Evaluating Harm and Benefit in Autism Research. Ethics Hum Res 2023; 45:2-18. [PMID: 37988276 DOI: 10.1002/eahr.500188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Autism research frequently seeks to evaluate interventions or inform their development. Unfortunately, researchers often assume that autism intervention should reduce autistic traits, effectively setting as a goal of treatment that autistic people attempt to "pass" as nonautistic. A growing body of evidence highlights serious potential harms from passing demands. We discuss why it is important for institutional review boards (IRBs) to scrutinize autism research for clinical passing demands, and we document the existence of such demands in outcome measures commonly employed in autism research. We propose an ethical framework for IRBs and others to make use of in evaluating the ethical appropriateness of particular treatment goals in autism intervention or intervention-adjacent research, emphasizing that treatment goals should be in pursuit of a beneficial nonpassing purpose and be the least burdensome means of accomplishing such a purpose. We also highlight potential promising practices for IRBs, investigators, and other stakeholders seeking to address these issues in autism research.
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Affiliation(s)
- Ari Ne'eman
- PhD candidate in health policy at Harvard University
| | - Kenneth A Richman
- Professor of philosophy and health care ethics at the Massachusetts College of Pharmacy and Health Sciences (officially known as MCPHS University)
| | - Allison M McCarthy
- Assistant professor of psychiatry and behavioral sciences and a faculty member with the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center
| | - Daniel Wilkenfeld
- Associate professor in the Department of Acute and Tertiary Care in the School of Nursing at the University of Pittsburgh
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Lodewyk K, Bagnell A, Courtney DB, Newton AS. Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. Child Adolesc Ment Health 2023. [PMID: 37463769 DOI: 10.1111/camh.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders. METHOD Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines. RESULTS In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause. CONCLUSIONS To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.
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Affiliation(s)
| | | | - Darren B Courtney
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Rodríguez Mega E. 'The best way to get it right is to listen to us' - autistic people argue for a stronger voice in research. Nature 2023; 617:238-241. [PMID: 37165246 DOI: 10.1038/d41586-023-01549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Chow J, Zhao H, Sandbank M, Bottema-Beutel K, Woynaroski T. Empirically-Derived Effect Size Distributions of Interventions for Young Children on the Autism Spectrum. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:271-283. [PMID: 35076326 PMCID: PMC9309195 DOI: 10.1080/15374416.2021.2007485] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to present a set of empirically derived effect size distributions to provide field-based benchmarks for interpreting the observed effects of interventions for young children on the autism spectrum, and for planning future studies. METHOD We generated effect size distributions and reported quartile values for each by outcome domain, and by boundedness, proximity, and assessment approach using 1552 effect sizes from 144 early childhood autism intervention studies gathered for a previously published meta-analysis. RESULTS Quartile values represent considerable heterogeneity in effect size distributions across outcome domains, as well as variability as a function of outcome boundedness, proximity, and assessment approach. CONCLUSIONS Our results serve as field- and outcome-specific benchmarks (e.g., contextual guides for small, medium, and large effects) that will help autism intervention researchers easily incorporate information from relevant prior empirical literature when conducting power analyses to plan for future studies. Benchmarks will also assist researchers seeking to interpret the magnitude of observed effects in clinical trials relative to the broader distribution of intervention effects on similar outcomes. Nuanced discussions that contextualize study findings in light of relevant empirical benchmarks will better assist practitioners in understanding the magnitude and scope of demonstrated change relative to studies with similar outcomes and selecting interventions for clinical practice. We discuss the limitations of these data, our analyses, as well as directions for future work.
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Affiliation(s)
- Jason Chow
- Department of Counseling, Higher Education, and Special Education, University of Maryland at College Park
| | - Hongyang Zhao
- Department of Human Development and Quantitative Methodology, University of Maryland at College Park
| | | | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Gómez Bergin AD, Valentine AZ, Rennick-Egglestone S, Slade M, Hollis C, Hall CL. Identifying and Categorizing Adverse Events in Trials of Digital Mental Health Interventions: Narrative Scoping Review of Trials in the International Standard Randomized Controlled Trial Number Registry. JMIR Ment Health 2023; 10:e42501. [PMID: 36811940 PMCID: PMC9996423 DOI: 10.2196/42501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To contextualize the benefits of an intervention, it is important that adverse events (AEs) are reported. This is potentially difficult in trials of digital mental health interventions, where delivery may be remote and the mechanisms of actions less understood. OBJECTIVE We aimed to explore the reporting of AEs in randomized controlled trials of digital mental health interventions. METHODS The International Standard Randomized Controlled Trial Number database was searched for trials registered before May 2022. Using advanced search filters, we identified 2546 trials in the category of mental and behavioral disorders. These trials were independently reviewed by 2 researchers against the eligibility criteria. Trials were included where digital mental health interventions for participants with a mental health disorder were evaluated through a completed randomized controlled trial (protocol and primary results publication published). Published protocols and primary results publications were then retrieved. Data were extracted independently by 3 researchers, with discussion to reach consensus when required. RESULTS Twenty-three trials met the eligibility criteria, of which 16 (69%) included a statement on AEs within a publication, but only 6 (26%) reported AEs within their primary results publication. Seriousness was referred to by 6 trials, relatedness by 4, and expectedness by 2. More interventions delivered with human support (9/11, 82%) than those with only remote or no support (6/12, 50%) included a statement on AEs, but they did not report more AEs. Several reasons for participant dropout were identified by trials that did not report AEs, of which some were identifiable or related to AEs, including serious AEs. CONCLUSIONS There is significant variation in the reporting of AEs in trials of digital mental health interventions. This variation may reflect limited reporting processes and difficulty recognizing AEs related to digital mental health interventions. There is a need to develop guidelines specifically for these trials to improve future reporting.
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Affiliation(s)
- Aislinn D Gómez Bergin
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Althea Z Valentine
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Medicine and Health Sciences, Nord University, Namsos, Norway
| | - Chris Hollis
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L Hall
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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15
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Bottema-Beutel K. We must improve the low standards underlying "evidence-based practice". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:269-274. [PMID: 36588301 DOI: 10.1177/13623613221146441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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Linden A, Best L, Elise F, Roberts D, Branagan A, Tay YBE, Crane L, Cusack J, Davidson B, Davidson I, Hearst C, Mandy W, Rai D, Smith E, Gurusamy K. Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:7-30. [PMID: 35957523 PMCID: PMC9806485 DOI: 10.1177/13623613221117931] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.
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Affiliation(s)
- Audrey Linden
- University College London, UK,Audrey Linden, Centre for Research in
Autism and Education, University College London, London WC1H 0NU, UK.
| | | | | | | | | | | | | | | | | | - Ian Davidson
- Cheshire and Wirral Partnership NHS
Foundation Trust, UK
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17
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Botha M, Cage E. "Autism research is in crisis": A mixed method study of researcher's constructions of autistic people and autism research. Front Psychol 2022; 13:1050897. [PMID: 36506950 PMCID: PMC9730396 DOI: 10.3389/fpsyg.2022.1050897] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction While not all autism research is ableism, autism researchers can be ableist, including by talking about autistic people in sub-human terms (dehumanization), treating autistic people like objects (objectification), and making othering statements which set autistic people apart from non-autistic people, and below in status (stigmatization). Method This mixed-method study aimed to investigate how autism researchers construct autistic people and autism research, and to investigate whether including autistic people more in research relates to lower ableism in narratives about autistic people. We used a survey with autism researchers (N = 195) asking five open-ended questions about autism and autism research, as well as demographics, career length, contact with autistic people (familial and non-familial) and degree to which researchers involve autistic people in their research. We used content analysis to categorize narratives used by autism researchers and cues for ableism (dehumanization, objectification, and stigmatization). We then used binary-logistic regression to identify whether narrative or higher inclusion of autistic people predicted fewer ableist cues, controlling for career length and connections to autistic people. Results and discussion Using medicalized narratives of autism predicted higher odds of ableist cues compared to employing social model or neutral embodiment narratives. Greater inclusion of autistic people in research predicted significantly lower odds of ableist cues, while controlling for other contact with autistic people and career length. Next, we used reflexive thematic analysis to analyze researcher's perceptions of autistic people and autism research. Narratives reflected core ideological disagreements of the field, such as whether researchers consider autism to be an intrinsic barrier to a good life, and whether researchers prioritize research which tackles "autism" versus barriers to societal inclusion for autistic people. Instrumentality (a form of objectification) was key to whether researchers considered a person to have social value with emphasis revolving around intellectual ability and independence. Lastly, language seemed to act as a tool of normalization of violence. Researchers relied on an amorphous idea of "autism" when talking about prevention or eradication, potentially because it sounds more palatable than talking about preventing "autistic people," despite autism only existing within the context of autistic people.
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Affiliation(s)
- Monique Botha
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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18
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Keates N, Waldock KE, Dewar E. Tensions Between Autistic Sociality, Communication, and Social Skills Research: A Response to Bambara (2022) and Camarata (2022). JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4346-4350. [PMID: 36256585 DOI: 10.1044/2022_jslhr-22-00331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this letter to the editor is to further elucidate the arguments Keates (2022) and Beechey (2022) stated in their letters to the editor. Both Bambara (2022) and Camarata (2022) pose comments that require clarifying the original arguments, particularly regarding power and autistic sociality, which we feel will provide further clarity to this highly significant and growing topic within autism research. CONCLUSION We recommend teaching not autistic people but rather non-autistic individuals about autistic sociality, in order to lower the burden on autistic interlocutors in cross-neurotype interactions and socialization (as per previous literature, Bottema-Beutel et al., 2018). We provide recommendations to address difficulties in cross-neurotype interactions-for example, bridging the neurotype gap through practice or psychosocial interventions for acceptance of autistic people and their system of interpretation, as per Jones et al. (2021).
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Affiliation(s)
- Nathan Keates
- Tizard Centre, University of Kent, Canterbury, United Kingdom
| | | | - Eleanor Dewar
- Tizard Centre, University of Kent, Canterbury, United Kingdom
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19
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Bottema-Beutel K, LaPoint SC, Kim SY, Mohiuddin S, Yu Q, McKinnon R. An evaluation of intervention research for transition-age autistic youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:890-904. [PMID: 36189778 DOI: 10.1177/13623613221128761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT In this study, we assess the quality of intervention research that focuses on autistic youth who are 14-22 years old. We found 193 different studies on this topic, and carefully reviewed them. Most of these studies tested strategies that were behavioral. This means that they used procedures like prompting and rewards to change participants' behavior. We found that the majority of studies had problems that make it hard to determine whether or not the intervention worked. The problems related to how researchers designed their studies, and how they measured the study outcomes. We also found that researchers rarely tried to find out if the strategies they studied had unintended negative effects for participants. Because of these issues, we make suggestions for how researchers might design better studies that will let people know how well the strategies worked.
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20
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Schuck RK, Tagavi DM, Baiden KMP, Dwyer P, Williams ZJ, Osuna A, Ferguson EF, Jimenez Muñoz M, Poyser SK, Johnson JF, Vernon TW. Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord 2022; 52:4625-4645. [PMID: 34643863 PMCID: PMC9508016 DOI: 10.1007/s10803-021-05316-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/25/2022]
Abstract
Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA.
| | - Daina M Tagavi
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, CA, USA
- Center for Mind and Brain, University of California, Davis, Davis, CA, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Anthony Osuna
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily F Ferguson
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Maria Jimenez Muñoz
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Samantha K Poyser
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ty W Vernon
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
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21
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Pearson A, Rees J, Forster S. "This Was Just How This Friendship Worked": Experiences of Interpersonal Victimization Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:141-150. [PMID: 36605970 PMCID: PMC9645672 DOI: 10.1089/aut.2021.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The victimization of autistic people by familiar others (interpersonal victimization) is an understudied phenomenon despite suggestions that prevalence rates may be disproportionately high. We know very little about the way autistic people perceive these experiences, and how to support them. The aim of the current study was to explore experiences of interpersonal victimization among autistic adults from their own perspective. Methods We recruited 43 autistic adults to take part in a qualitative online study, and asked about their experiences of being victimized or taken advantage of by people they know in the past. We analyzed their comments at the semantic level using inductive thematic analysis, from a critical realist perspective. Results We identified two key themes in the data. The first theme, "cycles of victimization" highlighted the occurrence of polyvictimization in the sample. The second ("perceptions of victimization") focused on how these experiences were related to difficulties with trust (of both self and others), the recognition of victimization, and heightened compliance. The participants expressed difficulty with saying no to people, and found it difficult to identify when someone had negative or manipulative intentions. Conclusions Our findings suggest that autistic adults experience victimization from a range of close others, and may find it difficult to recognize when someone is acting in an abusive manner. Many participants had experienced heightened compliance in response to unreasonable requests from others, however, reasons for this were varied (e.g., fear and desire to avoid confrontation) and require further investigation. These findings have implications for developing supports that enable autistic adults to recognize their own boundaries and advocate for themselves, in addition to helping them to recognize what a healthy relationship looks like.
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Affiliation(s)
- Amy Pearson
- Faculty of Health and Wellbeing, School of Psychology, University of Sunderland, Sunderland, United Kingdom.,Address correspondence to: Amy Pearson, PhD, Faculty of Health Sciences and Wellbeing, School of Psychology, University of Sunderland, Helen McArdle House, City Campus, Sunderland SR1 3SD, United Kingdom
| | - Jon Rees
- Faculty of Health and Wellbeing, School of Psychology, University of Sunderland, Sunderland, United Kingdom
| | - Samantha Forster
- School of Social Sciences, University of Sunderland, United Kingdom
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22
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Ai W, Cunningham WA, Lai MC. Reconsidering autistic ‘camouflaging’ as transactional impression management. Trends Cogn Sci 2022; 26:631-645. [DOI: 10.1016/j.tics.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022]
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23
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Pellicano E, den Houting J. Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science. J Child Psychol Psychiatry 2022; 63:381-396. [PMID: 34730840 PMCID: PMC9298391 DOI: 10.1111/jcpp.13534] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/17/2022]
Abstract
Since its initial description, the concept of autism has been firmly rooted within the conventional medical paradigm of child psychiatry. Increasingly, there have been calls from the autistic community and, more recently, nonautistic researchers, to rethink the way in which autism science is framed and conducted. Neurodiversity, where autism is seen as one form of variation within a diversity of minds, has been proposed as a potential alternative paradigm. In this review, we concentrate on three major challenges to the conventional medical paradigm - an overfocus on deficits, an emphasis on the individual as opposed to their broader context and a narrowness of perspective - each of which necessarily constrains what we can know about autism and how we are able to know it. We then outline the ways in which fundamental elements of the neurodiversity paradigm can potentially help researchers respond to the medical model's limitations. We conclude by considering the implications of a shift towards the neurodiversity paradigm for autism science.
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Affiliation(s)
- Elizabeth Pellicano
- Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia,Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneQldAustralia
| | - Jacquiline den Houting
- Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia,Cooperative Research Centre for Living with Autism (Autism CRC)BrisbaneQldAustralia
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24
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 121.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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25
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McFayden TC, Kennison SM, Bowers JM. Echolalia from a transdiagnostic perspective. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221140464. [PMID: 36451974 PMCID: PMC9703477 DOI: 10.1177/23969415221140464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND & AIMS Echolalia, the repetition of one's or others' utterances, is a behavior present in typical development, autism spectrum disorder, aphasias, Tourette's, and other clinical groups. Despite the broad range of conditions in which echolalia can occur, it is considered primarily through a disorder-specific lens, which limits a full understanding of the behavior. METHOD Empirical and review papers on echolalia across disciplines and etiologies were considered for this narrative review. Literatures were condensed into three primary sections, including echolalia presentations, neural mechanisms, and treatment approaches. MAIN CONTRIBUTION Echolalia, commonly observed in autism and other developmental conditions, is assessed, observed, and treated in a siloed fashion, which reduces our collective knowledge of this communication difference. Echolalia should be considered as a developmental, transdiagnostic, and communicative phenomenon. Echolalia is commonly considered as a communicative behavior, but little is known about its neural etiologies or efficacious treatments. CONCLUSIONS This review is the first to synthesize echolalia from a transdiagnostic perspective, which allows for the direct comparisons across and within clinical groups to inform assessment, treatment, conceptualization, and research recommendations. IMPLICATIONS Considering echolalia transdiagnostically highlights the lack of consensus on operationalization and measurement across and within disorders. Clinical and research future directions need to prioritize consistent definitions of echolalia, which can be used to derive accurate prevalence estimates. Echolalia should be considered as a communication strategy, used similarly across developmental and clinical groups, with recommended strategies of shaping to increase its effectiveness.
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Affiliation(s)
- Tyler C McFayden
- Tyler C McFayden, Carolina Institute for Developmental Disabilities, University of North Carolina-Chapel Hill, 101 Renee Lynne Court, Carrboro, NC 27510, USA.
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26
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INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: A proof-of-concept randomised controlled trial. Transl Psychiatry 2021; 11:644. [PMID: 34930893 PMCID: PMC8688472 DOI: 10.1038/s41398-021-01698-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/02/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is first diagnosed during middle childhood, when patterns of difficulty are often established. Pre-emptive approaches that strengthen developing cognitive systems could offer an alternative to post-diagnostic interventions. This proof-of-concept randomised controlled trial (RCT) tested whether computerised gaze-based attention training is feasible and improves attention in infants liable to develop ADHD. Forty-three 9- to 16-month-old infants with a first-degree relative with ADHD were recruited (11/2015-11/2018) at two UK sites and randomised with minimisation by site and sex to receive 9 weekly sessions of either (a) gaze-contingent attention training (intervention; n = 20); or (b) infant-friendly passive viewing of videos (control, n = 23). Sessions were delivered at home with blinded outcome assessments. The primary outcome was a composite of attention measures jointly analysed via a multivariate ANCOVA with a combined effect size (ES) from coefficients at baseline, midpoint and endpoint (Registration: ISRCTN37683928 ). Uptake and compliance was good but intention-to-treat analysis showed no significant differences between 20 intervention and 23 control infants on primary (ES -0.4, 95% CI -0.9 to 0.2; Complier-Average-Causal Effect ES -0.6, 95% CI -1.6 to 0.5) or secondary outcomes (behavioural attention). There were no adverse effects on sleep but a small increase in post-intervention session fussiness. Although feasible, there was no support for short-term effects of gaze-based attention training on attention skills in early ADHD. Longer-term outcomes remain to be assessed. The study highlights challenges and opportunities for pre-emptive intervention approaches to the management of ADHD.
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27
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Manzini A, Jones EJ, Charman T, Elsabbagh M, Johnson MH, Singh I. Ethical dimensions of translational developmental neuroscience research in autism. J Child Psychol Psychiatry 2021; 62:1363-1373. [PMID: 34405894 PMCID: PMC7611913 DOI: 10.1111/jcpp.13494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Since the 1990s, increasing research has been devoted to the identification of biomarkers for autism to help attain more objective diagnosis; enable early prediction of prognosis; and guide individualized intervention options. Early studies focused on the identification of genetic variants associated with autism, but more recently, research has expanded to investigate neurodevelopmental markers. While ethicists have extensively discussed issues around advances in autism genomics, much less ethical scrutiny has focused on research on early neurodevelopment and on the interventions being developed as a result. OBJECTIVES We summarize the current state of the science on the identification of early markers for autism and its potential clinical applications, before providing an overview of the ethical issues arising from increasing understanding of children's neurodevelopment in very early life. RESULTS Advances in the understanding of brain and behavioral trajectories preceding later autism diagnosis raise ethical concerns around three themes: (a) New models for understanding autism; (b) Risks and benefits of early identification and intervention; and (c) Communication of early concerns to families. These ethical issues should be further investigated in research conducted in partnership with autistic people and their families. CONCLUSIONS This paper highlights the need for ethical scrutiny of early neurodevelopmental research in autism. Scrutiny requires expertise and methods from the basic sciences and bioethics, as well as constructive collaborations among autistic people, their parents, and autism researchers to anticipate early interventions that serve the community's interests and accommodate the varied experiences and preferences of people on the spectrum and their families.
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Affiliation(s)
- Arianna Manzini
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
- Radcliffe Department of Medicine, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Emily J.H. Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Mayada Elsabbagh
- Azrieli Centre for Autism Research, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mark H. Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
- Department of Psychology, University of Cambridge, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Precision Autism: Genomic Stratification of Disorders Making Up the Broad Spectrum May Demystify Its "Epidemic Rates". J Pers Med 2021; 11:jpm11111119. [PMID: 34834471 PMCID: PMC8620644 DOI: 10.3390/jpm11111119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decade, Autism has broadened and often shifted its diagnostics criteria, allowing several neuropsychiatric and neurological disorders of known etiology. This has resulted in a highly heterogeneous spectrum with apparent exponential rates in prevalence. I ask if it is possible to leverage existing genetic information about those disorders making up Autism today and use it to stratify this spectrum. To that end, I combine genes linked to Autism in the SFARI database and genomic information from the DisGeNET portal on 25 diseases, inclusive of non-neurological ones. I use the GTEx data on genes’ expression on 54 human tissues and ask if there are overlapping genes across those associated to these diseases and those from SFARI-Autism. I find a compact set of genes across all brain-disorders which express highly in tissues fundamental for somatic-sensory-motor function, self-regulation, memory, and cognition. Then, I offer a new stratification that provides a distance-based orderly clustering into possible Autism subtypes, amenable to design personalized targeted therapies within the framework of Precision Medicine. I conclude that viewing Autism through this physiological (Precision) lens, rather than viewing it exclusively from a psychological behavioral construct, may make it a more manageable condition and dispel the Autism epidemic myth.
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Trembath D, Waddington H, Sulek R, Varcin K, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Silove N, Whitehouse A. An evidence-based framework for determining the optimal amount of intervention for autistic children. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:896-904. [PMID: 34672993 DOI: 10.1016/s2352-4642(21)00285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.
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Affiliation(s)
- David Trembath
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Hannah Waddington
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Kandice Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Catherine Bent
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney Local Health District and Ingham Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kristelle Hudry
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Silove
- School of Medicine, University of Sydney, NSW, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, Nedlands, WA, Australia.
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Fletcher-Watson S, Bölte S, Crompton CJ, Jones D, Lai MC, Mandy W, Pellicano L, Stahmer A, Taylor J, Mandell D. Publishing standards for promoting excellence in autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1501-1504. [PMID: 34320849 DOI: 10.1177/13623613211019830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Dawson M, Fletcher-Watson S. When autism researchers disregard harms: A commentary. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:564-566. [PMID: 34291651 PMCID: PMC8814944 DOI: 10.1177/13623613211031403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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