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Sommers L, Papadopoulos N, Fuller-Tyszkiewicz M, Sciberras E, McGillivray J, Howlin P, Rinehart N. The Connection Between Sleep Problems and Emotional and Behavioural Difficulties in Autistic Children: A Network Analysis. J Autism Dev Disord 2024:10.1007/s10803-024-06298-2. [PMID: 38526802 DOI: 10.1007/s10803-024-06298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/27/2024]
Abstract
The interactions between sleep problems, autism symptoms and emotional and behavioural difficulties were explored using network analysis in 240 autistic children (mean age: 8.8 years, range 5-13 years) with moderate to severe sleep problems. Findings revealed a highly connected and interpretable network, with three separate clusters identified of the modelled variables. Depression, anxiety and behavioural difficulties were the most central variables of the network. Depression, anxiety and restricted repetitive and stereotyped patterns behaviours (RRBs) were the strongest bridging variables in the network model, transmitting activation both within and between other symptom clusters. The results highlight that depression and anxiety were highly connected symptoms within the network, suggesting support in these areas could be helpful, as well as future research.
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Affiliation(s)
- Lucy Sommers
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
- School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Nicole Papadopoulos
- Monash Krongold Clinic, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicole Rinehart
- Monash Krongold Clinic, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
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Carruthers S, Pickles A, Charman T, McConachie H, Le Couteur A, Slonims V, Howlin P, Collum R, Salomone E, Tobin H, Gammer I, Maxwell J, Aldred C, Parr J, Leadbitter K, Green J. Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial. J Child Psychol Psychiatry 2024; 65:233-244. [PMID: 37095645 PMCID: PMC10953331 DOI: 10.1111/jcpp.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There are very few mechanistic studies of the long-term impact of psychosocial interventions in childhood. The parent-mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre-school to mid-childhood. We investigated the mechanism by which the PACT intervention achieved these effects. METHODS Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5-6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non-verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. RESULTS Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow-up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow-up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near-significant total effect on follow-up TVABS. No moderation of this mediation was found for AE, CSBS or IS. CONCLUSIONS Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long-term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long-term generalised outcome effects.
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Affiliation(s)
- Sophie Carruthers
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Helen McConachie
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ann Le Couteur
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Vicky Slonims
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Patricia Howlin
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rachel Collum
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Erica Salomone
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Department of PsychologyUniversity of Milano‐BicoccaMilanItaly
| | | | - Isobel Gammer
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jessica Maxwell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jeremy Parr
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jonathan Green
- Manchester Academic Health Sciences Centre, Royal Manchester Children's HospitalUniversity of ManchesterManchesterUK
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Pattison E, Papadopoulos N, Fuller-Tyszkiewicz M, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Bellows ST, Marks D, Howlin P, Rinehart N. Randomised Controlled Trial of a Behavioural Sleep Intervention, 'Sleeping Sound', for Autistic Children: 12-Month Outcomes and Moderators of Treatment. J Autism Dev Disord 2024; 54:442-457. [PMID: 36414853 PMCID: PMC9684935 DOI: 10.1007/s10803-022-05809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5-13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p < .001, effect size: - 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support.
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Affiliation(s)
- Emily Pattison
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Susannah T Bellows
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Deborah Marks
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
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4
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Clark T, Jung JY, Roberts J, Robinson A, Howlin P. The identification of exceptional skills in school-age autistic children: Prevalence, misconceptions and the alignment of informant perspectives. J Appl Res Intellect Disabil 2023; 36:1034-1045. [PMID: 37157995 DOI: 10.1111/jar.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/30/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although autism is commonly described in terms of deficits, many autistic individuals have been found to demonstrate exceptional skills. The shift to a strengths-based approach in the field of autism necessitates increased understanding of these skills. AIMS This study examined (1) rates of exceptional skills in autistic school-age children as reported by parents and teachers, (2) associations between exceptional skills, autism severity and intellectual disability and (3) correlations between parent and teacher reports of exceptional skills. METHOD Parents and teachers of 76 children attending autism-specific schools in Australia completed online questionnaires. Thereafter, 35 parents and teachers who identified their child as having one or more exceptional skills were interviewed by a clinical psychologist. RESULTS Forty parents (53%) and 16 (21%) teachers reported that their child had at least one exceptional skill (agreement between the parent and teacher reports was low; κ = .03, p = .74). In comparison, clinical psychologist assessments identified 22 children (29%) as having at least one such skill. No statistically significant relationships were identified between exceptional skills, autism severity and intellectual disability. CONCLUSION While different exceptional skills were identified, regardless of children's intellectual functioning or autism severity, parents and teachers varied substantially in their evaluations of these skills. Furthermore, the identified prevalence rates of exceptional skills did not always align with the rates identified in previous studies. The study findings highlight the need for definitional consensus on different types of exceptional skills, and the importance of multiple criteria/multi-instrument approaches in the identification of exceptional skills in autistic children.
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Affiliation(s)
- Trevor Clark
- Aspect Research Centre for Autism Practice, Sydney, Australia
- Griffith Institute for Educational Research, Brisbane, Australia
| | - Jae Yup Jung
- School of Education, The University of New South Wales, Sydney, Australia
| | - Jacqueline Roberts
- Autism Centre of Excellence (ACE), Griffith Institute for Educational Research, Brisbane, Australia
| | | | - Patricia Howlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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5
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Howlin P. Increased risk of physical health problems among older autistic adults. Lancet Healthy Longev 2023; 4:e293-e294. [PMID: 37295449 DOI: 10.1016/s2666-7568(23)00087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
- Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
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Papadopoulos N, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Engel L, Fuller‐Tyszkiewicz M, Bellows ST, Marks D, Howlin P, Rinehart N. Sleeping Sound Autism Spectrum Disorder (ASD): a randomised controlled trial of a brief behavioural sleep intervention in primary school-aged autistic children. J Child Psychol Psychiatry 2022; 63:1423-1433. [PMID: 35285017 PMCID: PMC9790415 DOI: 10.1111/jcpp.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. This study examined the efficacy of a brief behavioural sleep intervention in autistic children. It was hypothesised that the intervention would reduce overall child sleep problems (primary outcome), in addition to improvements in children's social, emotional, cognitive, academic functioning, and quality of life, and parent/caregivers' stress, quality of life, and mental health (secondary outcomes). METHODS A randomised controlled trial was conducted with participants randomised via a computer-generated sequence to the sleeping sound intervention (n = 123) or treatment as usual (n = 122) group. Participants comprised 245 children with an ASD diagnosis. Inclusion criteria were as follows: confirmation of DSM IV or DSM-5 diagnosis of ASD, participants aged between 5 and 13 years and parent/caregiver report of moderate-severe sleep problems. Exclusion criteria were as follows: parent/caregiver intellectual disability or lacking sufficient English to complete questionnaires; and child participant with co-occurring medical conditions known to impact sleep. The intervention group received the sleeping sound intervention (2 × 50-min face-to-face sessions plus follow-up phone call) by a trained clinician. RESULTS Change in children's sleep problems was measured by the Children's Sleep Habits Questionnaire (CSHQ) at 3 months post randomisation. Parents/caregivers of children in the intervention group reported a reduction in child sleep problems at 3 months post randomisation (effect size: E.S -0.7). There were also small effects in a number of child (internalising symptoms, emotional behavioural disturbance and quality of life) and parent/caregiver (mental health, parenting stress and quality of life) outcomes; however, these did not remain significant when controlling for multiple comparisons. CONCLUSIONS The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children. This brief behavioural intervention has the potential to be embedded easily into the Australian healthcare system.
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Affiliation(s)
- Nicole Papadopoulos
- Deakin Child Study CentreDeakin UniversityBurwoodVICAustralia,School of Educational Psychology and CounsellingFaculty of EducationMonash UniversityClaytonVICAustralia
| | - Emma Sciberras
- Deakin Child Study CentreDeakin UniversityBurwoodVICAustralia,Murdoch Children’s Research InstituteParkvilleVICAustralia,Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia
| | - Harriet Hiscock
- Murdoch Children’s Research InstituteParkvilleVICAustralia,Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia,Royal Children’s HospitalParkvilleVICAustralia
| | - Katrina Williams
- Murdoch Children’s Research InstituteParkvilleVICAustralia,Department of PaediatricsUniversity of MelbourneParkvilleVICAustralia,Department of PaediatricsMonash Children’s HospitalMonash UniversityClaytonVICAustralia
| | | | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health TransformationDeakin UniversityBurwoodVICAustralia
| | - Lidia Engel
- Deakin Health Economics, Institute for Health TransformationDeakin UniversityBurwoodVICAustralia
| | | | | | | | - Patricia Howlin
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Nicole Rinehart
- Deakin Child Study CentreDeakin UniversityBurwoodVICAustralia,School of Educational Psychology and CounsellingFaculty of EducationMonash UniversityClaytonVICAustralia
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7
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Carruthers S, Mleczko N, Page S, Ahuja S, Ellis C, Howlin P, Leadbitter K, Taylor L, Slonims V, Charman T. Using implementation science frameworks to explore barriers and facilitators for parents' use of therapeutic strategies following a parent-mediated autism intervention. Autism 2022; 27:1011-1025. [PMID: 36314780 PMCID: PMC10115939 DOI: 10.1177/13623613221125630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Many early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy-Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2 years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy-Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy-Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child's behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vicky Slonims
- King's College London, UK
- Guy's and St Thomas' NHS Foundation Trust, UK
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8
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Roestorf A, Howlin P, Bowler DM. Ageing and autism: A longitudinal follow-up study of mental health and quality of life in autistic adults. Front Psychol 2022; 13:741213. [PMID: 36081725 PMCID: PMC9447441 DOI: 10.3389/fpsyg.2022.741213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
Background Poor mental health is known to adversely affect functional abilities, social isolation, and quality of life (QoL). It is, therefore, crucial to consider the long-term impacts of mental health conditions as autistic adults grow older. Objectives To explore, in a group of community-based autistic adults, the extent of: (i) autistic traits, co-occurring physical and mental health conditions; (ii) age-related differences in those conditions, and changes over time; and (iii) their impact on everyday living and QoL. Method About Sixty-eight autistic adults (aged 19–80 years) participated in the first study (T1); 49 participants from T1 took part in a follow-up at T2 (mean retest interval 2.4 years). Standardised self-report measures of autistic traits, mental health, and QoL were completed at both time points. Results Over two-thirds (71%) of autistic adult participants experienced at least one co-occurring condition, and over a third (37%) met the criteria for three or more co-occurring conditions. Mental and physical health difficulties were related to autistic traits and difficulties in everyday life and were consistent predictors of poor QoL at T1 and T2. Conclusion Mental health difficulties in autism persisted into older age and did not improve over time. These findings have important implications for mental health provision for autistic adults in older age.
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Affiliation(s)
- Amanda Roestorf
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
- *Correspondence: Amanda Roestorf,
| | - Patricia Howlin
- Department of Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dermot M. Bowler
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
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9
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Scheeren AM, Howlin P, Pellicano L, Magiati I, Begeer S. Continuity and change in loneliness and stress during the COVID-19 pandemic: A longitudinal study of autistic and non-autistic adults. Autism Res 2022; 15:1621-1635. [PMID: 35930166 PMCID: PMC9538450 DOI: 10.1002/aur.2787] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/15/2022] [Indexed: 12/02/2022]
Abstract
Previous studies have suggested that autistic adults may be negatively affected by the COVID‐19 pandemic and its associated restrictions. In this study, we examined continuity and change in loneliness and stress, and their predictors, in 448 autistic and 70 non‐autistic adults living in the Netherlands. Autistic participants were assessed on three occasions using the de Jong Gierveld Loneliness Scale and Perceived Stress Scale (pre‐lockdown (T0), first lockdown (T1), and second lockdown (T2)); non‐autistic participants were assessed twice (T1 and T2). Autistic adults' loneliness and stress levels remained stable across all three time points over 8 months, but were consistently higher than those of non‐autistic adults. Other predictors of higher loneliness and stress levels at the first lockdown (T1) included low perceived social support and high levels of COVID‐19 related worries. Although loneliness and stress were stable at the group level, the wellbeing of some autistic adults worsened over the course of the pandemic, while others improved. For instance, adults with a mental health diagnosis (other than autism) prior to the pandemic were more likely to increase in stress over time, whereas adults with higher perceived social support were more likely to decrease in stress over time (from T1 to T2). Factors contributing to variability in outcome require further examination. Moreover, the relatively high loneliness and stress levels in autistic adults call for attention from clinicians and service providers.
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Affiliation(s)
- Anke M Scheeren
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Liz Pellicano
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Iliana Magiati
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Sander Begeer
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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10
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Yarar EZ, Roestorf A, Spain D, Howlin P, Bowler D, Charlton R, Happé F. Aging and autism: Do measures of autism symptoms, co-occurring mental health conditions, or quality of life differ between younger and older autistic adults? Autism Res 2022; 15:1482-1494. [PMID: 35790084 DOI: 10.1002/aur.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
Previous research has indicated that autistic adults experience higher rates of co-occurring mental health difficulties and poorer quality of life (QoL) than their non-autistic peers. Little is known, however, about these aspects in older age or whether younger and older autistic adults experience similar patterns This cross-sectional study investigated potential age-related effects on autism symptoms, self-reported mental health, and QoL in younger and older autistic adults (n = 79, aged 19-71 years) compared to a non-autistic control group (n = 57) matched for gender, age and IQ. Results showed that autistic adults had higher levels of self-reported autism symptoms and poorer QoL than controls. There were no significant age effects on autism symptoms or on most self-rated mental health symptoms. However, significantly more autistic adults in the younger versus older group scored above the clinical threshold for anxiety, somatoform disorders and eating disorders. Older autistic adults rated social QoL as significantly better than younger autistic adults; there was no significant age difference in the control group. Self-reported QoL was best predicted by self-ratings of severity of depressive symptoms in both groups. Further research is needed to track autism and co-occurring mental health symptomatology across the lifespan, so that service provision can be tailored accordingly. LAY SUMMARY: Young autistic adults have reported more psychological difficulties and poorer quality of life (QoL) than the general population. We investigated whether these difficulties continue into older age. Autism symptoms and mental health problems were common in autistic adults, with no difference between age groups, except for anxiety, physical and eating problems. Although QoL was poorer in both younger and older autistic compared to non-autistic adults, older autistic adults reported better social QoL than those who were younger.
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Affiliation(s)
- Esra Zıvralı Yarar
- Department of Psychology, Social Sciences University of Ankara, Ankara, Turkey
| | | | - Debbie Spain
- Visiting Postdoctoral Clinical Researcher, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
| | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
| | - Dermot Bowler
- Department of Psychology, City, University of London, London, England
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, London, England
| | - Francesca Happé
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
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11
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Cameron LA, Tonge BJ, Howlin P, Einfeld SL, Stancliffe RJ, Gray KM. Social and community inclusion outcomes for adults with autism with and without intellectual disability in Australia. J Intellect Disabil Res 2022; 66:655-666. [PMID: 35677963 PMCID: PMC9328353 DOI: 10.1111/jir.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/12/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research suggests that adults with autism tend to have poor outcomes. Outcomes have mostly been defined using summary outcome ratings, with less focus on specific outcomes such as employment, living situation, social satisfaction, loneliness, and friendships. This study aimed to explore social and community outcomes, including employment, education, living arrangements, friendships, and social satisfaction, for autistic adults with and without intellectual disability. METHOD Eighty-four adults with autism (mean age 34.2 years, SD = 4.5; 67% with co-occurring intellectual disability), recruited as children and adolescents, participated in the current study. Adult social and community inclusion outcomes were explored through interview and questionnaire, both parent/carer-report and self-report. RESULTS Participants predominantly lived with family or in supported accommodation, did not pursue higher education, and mostly participated in day activity programmes. Most had limited friendships as reported by parents/carers; however, self-report data (n = 28) indicated that adults were largely satisfied with their social relationships. Overall outcome was poor for 57%, and good/very good for 34%. Adults with intellectual disability generally had poorer outcomes. CONCLUSION Autistic adults encountered numerous difficulties in leading an independent life. Adults with co-occurring intellectual disability were most likely to experience difficulties; however, outcomes ranged from poor to very good for adults without intellectual disability. Discrepancies in parent/carer-report and self-reported experiences of friendships highlight the need to ensure individual experiences are captured in addition to parent/carer-report. Appropriate resources and programmes are crucial for adults with autism to support them to have the choice to live independently.
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Affiliation(s)
- L. A. Cameron
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | - B. J. Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | - P. Howlin
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - S. L. Einfeld
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - R. J. Stancliffe
- Centre for Disability Research and PolicyUniversity of SydneySydneyNew South WalesAustralia
| | - K. M. Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
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12
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Green J, Leadbitter K, Ellis C, Taylor L, Moore HL, Carruthers S, James K, Taylor C, Balabanovska M, Langhorne S, Aldred C, Slonims V, Grahame V, Parr J, Humphrey N, Howlin P, McConachie H, Couteur AL, Charman T, Emsley R, Pickles A. Combined social communication therapy at home and in education for young autistic children in England (PACT-G): a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2022; 9:307-320. [PMID: 35305746 PMCID: PMC9630149 DOI: 10.1016/s2215-0366(22)00029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autistic children can have difficulty generalising treatment effects beyond the immediate treatment context. Paediatric Autism Communication Therapy (PACT) has been successful when delivered in the clinic. Here we tested the Paediatric Autism Communication Therapy-Generalised (PACT-G) intervention combined between home and education settings for its overall effect and mechanistic transmission of effect across contexts. METHODS In this parallel, single-blind, randomised, controlled trial, we recruited autistic children aged 2-11 years in urban or semi-urban areas in Manchester, Newcastle, and London, England. Children needed to meet core autism criteria on Autism Diagnostic Observation Schedule-second edition (ADOS-2) and parent-rated Social Communication Questionnaire (SCQ-lifetime), and children older than 5 years were included if they had intentional communication but expressive language equivalent of age 4 years or younger. Eligible children were randomly assigned (1:1), using block randomisation (random block sizes of 2 and 4) and stratified for site, age (2-4 years vs 5-11 years), and gender, to either PACT-G plus treatment as usual or treatment as usual alone. Research assessors were masked to treatment allocation. The PACT-G intervention was delivered by a therapist in parallel to the child's parents at home and to learning-support assistants (LSA) at their place of education, using both in-person and remote sessions over a 6 month period, to optimise adult-child social interaction. Treatment as usual included any health support or intervention from education or local community services. The primary outcome was autism symptom severity using the ADOS-2, as measured by researchers, at 12 months versus baseline. Secondary outcomes were Brief Observation of Social Communication Change (BOSCC) and dyadic social interaction between child and adult across contexts, both at 12 months. Other secondary outcome measures were assessed using the following composites: language, anxiety, repetitive behaviour, adaptive behaviour, parental wellbeing, child health-related quality of life, and disruptive behaviour. Assessments were done at baseline, 7 months, and 12 months. We used an intention-to-treat (ITT) analysis of covariance for the efficacy outcome measures. Adverse events were assessed by researchers for all trial families at each contact and by therapists in the PACT-G group at each visit. This study is registered with the ISRCTN Registry, ISRCTN 25378536. FINDINGS Between Jan 18, 2017, and April 19, 2018, 555 children were referred and 249 were eligible, agreed to participate, and were randomly assigned to either PACT-G (n=122) or treatment as usual (n=127). One child in the PACT-G group withdrew and requested their data be removed from the study, giving an ITT population of 248 children. 51 (21%) of 248 children were female, 197 (79%) were male, 149 (60%) were White, and the mean age was 4·0 years (SD 0·6). The groups were well balanced for demographic and clinical characteristics. In the PACT-G group, parents of children received a median of 10 (IQR 8-12) home sessions and LSAs received a median of 8 (IQR 5-10) education sessions over 6 months. We found no treatment effect on the ADOS-2 primary outcome compared with treatment as usual (effect size 0·04 [95% CI -0·19 to 0·26]; p=0·74), or researcher-assessed BOSCC (0·03 [-0·25 to 0·31]), language composite (-0·03 [-0·15 to 0·10]), repetitive behaviour composite (0·00 [-0·35 to 0·35]), adaptive behaviour composite (0·01 [-0·15 to 0·18]), or child wellbeing (0·09 [-0·15 to 0·34]). PACT-G treatment improved synchronous response in both parent (0·50 [0·36 to 0·65]) and LSA (0·33 [0·16 to 0·50]), mediating increased child communication with parent (0·26 [0·12 to 0·40]) and LSA (0·20 [0·06 to 0·34]). Child dyadic communication change mediated outcome symptom alteration on BOSCC at home (indirect effect -0·78 [SE 0·34; 95% CI -1·44 to -0·11]; p=0·022) although not in education (indirect effect -0·67 [SE 0·37; 95% CI -1·40 to 0·06]; p=0·073); such an effect was not seen on ADOS-2. Treatment with PACT-G also improved the parental wellbeing composite (0·44 [0·08 to 0·79]) and the child disruptive behaviour composite in home and education (0·29 [0·01 to 0·57]). Adverse events on child behaviour and wellbeing were recorded in 13 (10%) of 127 children in the treatment as usual group (of whom four [31%] were girls) and 11 (9%) of 122 in the PACT-G group (of whom three [33%] were girls). One serious adverse event on parental mental health was recorded in the PACT-G group and was possibly study related. INTERPRETATION Although we found no effect on the primary outcome compared with treatment as usual, adaptation of the 12-month PACT intervention into briefer multicomponent delivery across home and education preserved the positive proximal outcomes, although smaller in effect size, and the original pattern of treatment mediation seen in clinic-delivered therapy, as well as improving parental wellbeing and child disruptive behaviours across home and school. Reasons for this reduced efficacy might be the reduced dose of each component, the effect of remote delivery, and the challenges of the delivery contexts. Caution is needed in assuming that changing delivery methods and context will preserve an original intervention efficacy for autistic children. FUNDING National Institute for Health Research and Medical Research Council Efficacy and Mechanism Evaluation Award.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester Royal Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Lauren Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Heather L Moore
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Matea Balabanovska
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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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: 227] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Scheeren AM, Howlin P, Bartels M, Krabbendam L, Begeer S. The importance of home: Satisfaction with accommodation, neighborhood, and life in adults with autism. Autism Res 2021; 15:519-530. [PMID: 34910374 PMCID: PMC9299856 DOI: 10.1002/aur.2653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
Although good quality housing and a socially cohesive neighborhood are associated with a higher well‐being in the general population, housing is a rarely studied topic in autism research. In the present study, we describe the housing situation of a large sample of adults with autism and mostly (above) average intellectual abilities (n = 1429; 17 to 84 years), and examine predictors of independent living, accommodation satisfaction, neighborhood satisfaction, and satisfaction with life based on an online survey. The outcomes of independently living adults were compared with those from a Dutch community sample (n = 929). Nearly 80% of the autistic adults lived independently. Older participants, women, and those with higher self‐reported IQ's were more likely to live independently. Autistic adults living independently were equally satisfied with their accommodation and neighborhood as the comparison group, but were less satisfied with their life in general. In both groups, higher satisfaction with accommodation and neighborhood was associated with higher life satisfaction. We advocate further research to better understand and anticipate the housing needs of the growing group of adults with autism.
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Affiliation(s)
- Anke M Scheeren
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience King's College, London, UK
| | - Meike Bartels
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sander Begeer
- Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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15
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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16
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Kildahl AN, Helverschou SB, Rysstad AL, Wigaard E, Hellerud JM, Ludvigsen LB, Howlin P. Pathological demand avoidance in children and adolescents: A systematic review. Autism 2021; 25:2162-2176. [PMID: 34320869 DOI: 10.1177/13623613211034382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue. The concept of pathological demand avoidance has been criticised for undermining the self-advocacy of autistic people and neglecting the potential role of anxiety as a possible underlying or contributing cause. The current study was undertaken to summarise and review the methodological quality and findings from current research into pathological demand avoidance in children and adolescents. Further aims were to describe how pathological demand avoidance has been identified and to explore the relationships with autism and other developmental and psychiatric disorders. After a comprehensive search, 13 relevant studies using a wide range of methods were identified and systematic quality assessments were undertaken. All the studies had based the identification of pathological demand avoidance, directly or indirectly, on descriptions from the original study by Newson and colleagues. However, the methods used to develop these criteria were not clearly described. Most studies relied exclusively on parental report for data, and there was a general failure to take account of alternative explanations for the behaviours under study. No studies explored the views of individuals with pathological demand avoidance themselves. Problems concerning definition and measurement in the reviewed studies currently limit any conclusions regarding the uniformity or stability of the behaviours described, or the characteristics of individuals displaying them. Relationships between pathological demand avoidance and other emotional and behavioural difficulties should be explored in future research, as should the perspectives of individuals with pathological demand avoidance themselves.
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17
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Bakke KA, Howlin P, Helverschou SB. Hyperactive behaviour in Angelman syndrome: the association with sleep problems and age of epilepsy onset. J Intellect Disabil Res 2021; 65:666-674. [PMID: 33951249 DOI: 10.1111/jir.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sleep problems are common in many neurodevelopmental disorders, but little is known about how sleep is related to behavioural symptoms in Angelman syndrome (AS) or other genetic disorders. Hyperactive behaviour, sleep problems and epilepsy seem to be more common in AS than in other genetic conditions associated with severe intellectual disability. We hypothesised that both more sleep problems and earlier onset of epileptic seizures would predict more symptoms of hyperactivity. Hence, the aim of the project was to explore the association between hyperactive behaviour, sleep problems and age of epilepsy onset in individuals with AS. METHOD All known parents/guardians (n = 115) of individuals with AS in Norway were invited to participate in this descriptive correlational study. Fifty-six individuals (49%) responded, and 42 people (25 male and 17 female; mean age 18.5 years, range 2-57 years) with genetically verified AS were included. Scores for 'hyperactivity' and 'sleep problems' were derived from questionnaire data. Information on epilepsy was obtained from medical records. RESULTS 'Hyperactivity' was positively correlated with 'total sleep problems' (r = 0.46, P = 0.002) and negatively correlated with 'age of epilepsy onset' (r = -0.47, P = 0.01). 'Age of epilepsy onset' was not correlated with 'total sleep problems'. An overall multiple regression model with 'hyperactivity' as the dependent variable and 'age of epilepsy onset' and 'total sleep problems' as covariates was significant (R2 = 0.39, F = 8.16, P = 0.002). Hence, hyperactivity in AS could be predicted from both age of epilepsy onset and current sleep problems. CONCLUSIONS Sleep problems may increase hyperactivity symptoms in individuals with AS. The association between hyperactivity and sleep problems in AS indicates that both should be investigated together as part of routine clinical assessment and intervention for either area of difficulty. Younger age of epilepsy onset was associated with more hyperactivity in AS, which may be related to encephalopathic effects of seizures and epilepsy.
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Affiliation(s)
- K A Bakke
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - P Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S B Helverschou
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
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18
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Scheeren AM, Buil JM, Howlin P, Bartels M, Begeer S. Objective and subjective psychosocial outcomes in adults with autism spectrum disorder: A 6-year longitudinal study. Autism 2021; 26:243-255. [PMID: 34169776 PMCID: PMC8750151 DOI: 10.1177/13623613211027673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research has shown lower rates of employment and independent living in
adults with autism. Many of these findings are based on
cross-sectional studies, predominantly involving male participants. In
a 6-year longitudinal study, we examined determinants of psychosocial
outcomes in 917 adults with autism spectrum disorder (425 men, 492
women, mean age 43.5 years). Most were diagnosed in adulthood and had
(above) average intellectual abilities. Via a yearly online survey,
participants’ objective psychosocial functioning (based on employment,
independent living and friendship) and subjective well-being were
assessed. Averaged across the five waves of the study, 86% of the
sample showed a fair to very good level of objective psychosocial
functioning. Objective psychosocial functioning and subjective
well-being were positively correlated, and both improved over time.
Lower intellectual ability, more autism traits, co-occurring
psychiatric conditions and younger age predicted poorer objective
outcomes. More autism traits and co-occurring psychiatric conditions
predicted lower subjective well-being. There were no gender
differences in initial levels of, or changes in, objective and
subjective outcomes over time. This study has identified important
risk/protective factors for psychosocial outcomes across early and
middle adulthood. In general, the findings offer a more positive
outlook for adults with autism and average to high intellectual
abilities.
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19
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de Veld DMJ, Scheeren AM, Howlin P, Hoddenbach E, Mulder F, Wolf I, Begeer S. Sibling Configuration as a Moderator of the Effectiveness of a Theory of Mind Training in Children with Autism: a Randomized Controlled Trial. J Autism Dev Disord 2021; 51:1719-1728. [PMID: 32808151 PMCID: PMC8084814 DOI: 10.1007/s10803-020-04649-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This RCT investigated whether participants’ sibling configuration moderated the effect of a Theory of Mind (ToM) intervention for children with autism. Children with autism aged 8–13 years (n = 141) were randomized over a waitlist control or treatment condition. Both having more siblings, as well as having an older sibling were related to better outcomes on measures of ToM-related behavior and social cognition, but not ToM knowledge or autistic features in general. The finding that these associations were limited to practical skills addressed in the intervention, seems to indicate that having more siblings and having an older sibling provides enhanced opportunities for children with autism to practice taught skills in the home environment.
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Affiliation(s)
- Danielle M J de Veld
- Netherlands Youth Institute, Utrecht, The Netherlands.,Section Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Anke M Scheeren
- Section Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience King's College, London, UK.,Faculty of Health Sciences & Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, Australia
| | | | - Fleur Mulder
- Section Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,De Bascule, Duivendrecht, The Netherlands
| | - Imke Wolf
- Section Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,De Bascule, Duivendrecht, The Netherlands
| | - Sander Begeer
- Section Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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20
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Fuentes J, Hervás A, Howlin P. ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. Eur Child Adolesc Psychiatry 2021; 30:961-984. [PMID: 32666205 PMCID: PMC8140956 DOI: 10.1007/s00787-020-01587-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
Across Europe, there is increased awareness of the frequency and importance of autism spectrum disorder (ASD), which is now recognised not only as a childhood disorder but as a heterogeneous, neurodevelopmental condition that persists throughout life. Services for individuals with autism and their families vary widely, but in most European countries, provision is limited. In 2018, European Society of Child and Adolescent Psychiatry (ESCAP) identified the need for a Practice Guidance document that would help to improve knowledge and practice, especially for individuals in underserviced areas. The present document, prepared by the ASD Working Party and endorsed by the ESCAP Board on October 3, 2019, summarises current information on autism and focuses on ways of detecting, diagnosing, and treating this condition.
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Affiliation(s)
- Joaquin Fuentes
- Child and Adolescent Psychiatrists, Policlínica Gipuzkoa Research Consultant, GAUTENA Autism Society, Paseo de Miramón 174, 20016, San Sebastián, Spain.
| | - Amaia Hervás
- Child and Adolescent Psychiatrists, University Hospital MutuaTerrassa, AGAUR Clinical and Genetic Research Group IGAIN, Barcelona, Spain
| | - Patricia Howlin
- Emeritus Professor of Clinical Child Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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21
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Royston R, Oliver C, Howlin P, Waite J. Anxiety characteristics in individuals with Williams syndrome. J Appl Res Intellect Disabil 2021; 34:1098-1107. [PMID: 33561900 DOI: 10.1111/jar.12864] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Williams syndrome anxiety research predominantly focuses on disorder prevalence and symptomatology, categorised using standardised mental health classifications. However, the use of these assessments may not fully capture the phenotypic features of anxiety in Williams syndrome. In this study, we examined characteristics of anxiety using a formulation framework. METHOD A semi-structured interview was conducted with thirteen parents of individuals with Williams syndrome (median age: 19, age range: 12-45, 8 females). RESULTS Various anxiety triggers were reported, including anxiety triggered by phobias, uncertainty and negative emotions in others. The range of described behaviours was diverse with both avoidant and active coping strategies for anxiety management reported. CONCLUSIONS Many of the characteristics described were consistent with findings in the intellectual disability and typically developing literature, although novel information was identified. The study demonstrates the utility of a formulation framework to explore anxiety characteristics in atypical populations and has outlined new avenues for research.
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Affiliation(s)
| | | | | | - Jane Waite
- University of Birmingham, Birmingham, UK
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22
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Helverschou SB, Bakken TL, Berge H, Bjørgen TG, Botheim H, Hellerud JA, Helseth I, Hove O, Johansen PA, Kildahl AN, Ludvigsen LB, Nygaard S, Rysstad A, Wigaard E, Howlin P. Preliminary Findings From a Nationwide, Multicenter Mental Health Service for Adults and Older Adolescents With Autism Spectrum Disorder and ID. Journal of Policy and Practice in Intellectual Disabilities 2020. [DOI: 10.1111/jppi.12366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sissel Berge Helverschou
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Trine Lise Bakken
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Heidi Berge
- Specialized Habilitation Service, Nordmøre and Romsdal, Møre and Romsdal Hospital Trust Norway
| | | | - Henrik Botheim
- Specialized Habilitation Service, Sunnmøre, Møre and Romsdal Hospital Trust Norway
| | - Jane Askeland Hellerud
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Ingunn Helseth
- Department of Mental Health, Regional Section Autism and Intellectual Disability Mental Health Helse Fonna Hospital Trust Norway
| | - Oddbjørn Hove
- Department of Research and Innovation/Department of Mental Health, Regional Section Autism and Intellectual Disability Mental Health Helse Fonna Hospital Trust Norway
| | | | - Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism and NevSom—Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnia Oslo University Hospital Norway
| | - Linn Beate Ludvigsen
- Department of Psychiatry, Section Intellectual Disability and Autism Vestre Viken Hospital Trust Norway
| | - Sissel Nygaard
- Department of Psychiatry, Section Specialized Habilitation Nord‐Trøndelag Hospital Trust Norway
| | - Anne Rysstad
- Department of Psychiatry, Section Intellectual Disability and Autism Vestre Viken Hospital Trust Norway
| | - Elisabeth Wigaard
- Department of Psychiatry Section Intellectual Disability and Autism, Vestre Viken Hospital Trust Norway
| | - Patricia Howlin
- Department of Psychology King's College LondonInstitute of Psychiatry, Psychology and Neuroscience London UK
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23
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Mason D, Capp SJ, Stewart GR, Kempton MJ, Glaser K, Howlin P, Happé F. A Meta-analysis of Outcome Studies of Autistic Adults: Quantifying Effect Size, Quality, and Meta-regression. J Autism Dev Disord 2020; 51:3165-3179. [PMID: 33200352 PMCID: PMC8349337 DOI: 10.1007/s10803-020-04763-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Longitudinal studies have generally reported poor outcomes in adulthood for the majority of individuals (c.50–60%) with autism. Several factors putatively predict outcome (e.g. IQ), but findings remain mixed. This paper presents an updated meta-analysis of autism outcome studies and extends previous findings with additional analyses (including meta-regression). A total of 4088 records was screened and 18 studies, involving 1199 individuals, were included in the quantitative analysis. Estimated percentages indicated that 20.0% of participants were rated as having a good outcome, 26.6% a fair outcome, and 49.3% a poor outcome. Meta-regression indicated that lower IQ in adulthood was predictive of poor outcome; other meta-regression models did not survive correction for multiple comparisons. Overall, outcomes for autistic people are on average poor, and higher IQ appears to be protective against having a poor outcome. The limitations of current constructs of outcome are discussed.
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Affiliation(s)
- David Mason
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Simone J Capp
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Gavin R Stewart
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Karen Glaser
- Department of Global Health & Science Medicine, King's College London, Bush House North East Wing, 30 Aldwych, London, WC2B 4BG, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Francesca Happé
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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24
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Zıvralı Yarar E, Howlin P, Charlton R, Happé F. Age-Related Effects on Social Cognition in Adults with Autism Spectrum Disorder: A Possible Protective Effect on Theory of Mind. Autism Res 2020; 14:911-920. [PMID: 33067894 DOI: 10.1002/aur.2410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/13/2020] [Accepted: 09/29/2020] [Indexed: 11/06/2022]
Abstract
Impaired social cognition has been suggested to underlie the social communication difficulties that define autism spectrum disorder (ASD). In typical development, social cognition may deteriorate in older age, but age effects in ASD adults have been little explored. In the present study, we compared groups of younger and older adults with and without ASD (n = 97), who completed a set of social cognition tasks assessing theory of mind (ToM), and self-report measures of empathy and alexithymia. While typically developing (TD) younger adults outperformed elderly TD and younger ASD participants, younger and older ASD adults did not differ in their ToM performance, and the elderly ASD and TD groups performed equivalently. By contrast, ASD adults reported lower empathy scores and higher levels of alexithymia symptoms compared to TD adults regardless of age. The difference between ASD and TD groups in self-reported empathy scores was no longer significant when alexithymia was covaried (with the exception of the Perspective Taking subscore). Results suggest a possible age-protective effect on ToM in the ASD group. In addition, empathy difficulties appear to be associated with alexithymia rather than ASD per se. Possible interpretations are discussed, and future directions for autism aging research are proposed. LAY SUMMARY: People with autism spectrum disorder (ASD) have difficulties with social understanding. Some age-related studies in typical development have shown a decline in social understanding in older age. We investigated whether a similar pattern is present in adults with ASD. We found that understanding what someone is thinking was not worse in older versus younger autistic adults. Also, we reported further evidence suggesting that emotional empathy difficulties were related to difficulties with understanding one's own emotions rather than with autism itself. Autism Res 2021, 14: 911-920. © 2020 International Society for Autism Research and Wiley Periodicals LLC.
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Affiliation(s)
- Esra Zıvralı Yarar
- Department of Psychology, Social Sciences University of Ankara, Ankara, Turkey
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, London, UK
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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Royston R, Oliver C, Howlin P, Dosse A, Armitage P, Moss J, Waite J. The Profiles and Correlates of Psychopathology in Adolescents and Adults with Williams, Fragile X and Prader-Willi Syndromes. J Autism Dev Disord 2020; 50:893-903. [PMID: 31802317 PMCID: PMC7010621 DOI: 10.1007/s10803-019-04317-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychopathology is prevalent in Williams (WS), fragile X (FXS) and Prader–Willi (PWS) syndromes. However, little is known about the potential correlates of psychopathology in these groups. A questionnaire study was completed by 111 caregivers of individuals with WS (n = 35); FXS (n = 50) and PWS (n = 26). Mean age was 26 years (range 12–57 years); 74 (67%) were male. Multiple regression analyses indicated that higher rates of health problems and sensory impairments predicted higher psychopathology in WS (p < .0001). In PWS, poorer adaptive ability predicted higher overall psychiatric disturbance (p = .001), generalised anxiety (p = .006) and hyperactivity (p = .003). There were no significant predictors in FXS. This study highlights dissociations in the potential risk markers of psychopathology between genetic syndromes. Implications for intervention are discussed.
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Affiliation(s)
- R Royston
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Division of Psychiatry, University College London, London, W1T 7NF, UK.
| | - C Oliver
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - P Howlin
- Department of Psychology, King's College London, Strand, London, WC2R 2LS, UK
| | - A Dosse
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - P Armitage
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - J Moss
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Institute of Cognitive Neuroscience, University College London, Alexandra House, 17 Queen Square, London, WC1N 3AZ, UK
| | - J Waite
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK
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26
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Carruthers S, Pickles A, Slonims V, Howlin P, Charman T. Beyond intervention into daily life: A systematic review of generalisation following social communication interventions for young children with autism. Autism Res 2020; 13:506-522. [PMID: 31943828 PMCID: PMC7187421 DOI: 10.1002/aur.2264] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 01/07/2023]
Abstract
Researchers have generally considered autistic individuals to have difficulties generalising learned skills across novel contexts. Successful generalisation is necessary for an intervention to have benefits in everyday life beyond the original learning environment. We conducted a systematic review of randomised controlled trials of early social communication interventions for children with autism in order to explore generalisation and its measurement. We identified nine RCTs that provided evidence of initial target learning and measured generalisation, of which eight demonstrated at least some successful generalisation across people, settings, and/or activities. The findings did not support the widely reported generalisation 'difficulties' associated with autism. However, generalisation was not consistent across all skills within studies, and one study found no generalisation despite evidence for initial target learning within the intervention context. In general, there are few methodologically sound social communication intervention studies exploring generalisation in autism and no consensus on how it should be measured. In particular, failure to demonstrate initial learning of target skills within the intervention setting and an absence of formal mediation analyses of the hypothesised mechanisms limit current research. We outline a framework within which measurement of generalisation can be considered for use in future trials. To maximise the effectiveness of interventions, the field needs to gain a better understanding of the nature of generalisation among autistic individuals and what additional strategies may further enhance learning. Autism Res 2020, 13: 506-522. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: It is generally considered that autistic individuals experience difficulties applying things they have learned in one context into different settings (e.g. from school to home). This is important to consider for intervention studies. Our review does not support a complete lack of generalisation but instead suggests that after early social communication intervention, autistic children can transfer some skills to new contexts. Overall, there is limited research in this area and further work is needed.
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Affiliation(s)
- Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Vicky Slonims
- Guy's and St Thomas' NHS Foundation Trust (Evelina Children's Hospital)LondonUnited Kingdom
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
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27
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Howlin P. Editorial: What Constitutes "Evidence-Based" Educational Practice? J Am Acad Child Adolesc Psychiatry 2020; 59:344-345. [PMID: 31128269 DOI: 10.1016/j.jaac.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022]
Abstract
The requirement for educational provision for all children to be evidence based has been highlighted in many government policies.1 The significant additional costs of educating children with autism, and difficulties in recruiting adequately trained teachers, have placed increasing pressure on education authorities to provide more cost-effective instruction methods for pupils with autism. Computer-assisted interventions (CAI) have been suggested as a possible means of meeting the educational needs of this group, and findings from mostly small, uncontrolled studies have indicated positive improvements in areas such as academic ability, social and communication skills, and adaptive behavior.2 The present study by Pellecchia et al.3 describes an evaluation of one such program: TeachTown: Basics. This is a computer-assisted intervention that aims to increase students' vocabulary, listening skills, socio-emotional development, and academic and cognitive abilities. It is designed for children with autism or other developmental disabilities with a nonverbal mental age equivalent of 2 to 7 years. A brief (20 minutes per day for 3 months), small-scale (n = 22, children 3-6-years of age), randomized control trial (RCT) of TeachTown: Basics, previously conducted in the Los Angeles Unified School District,4 produced some positive but generally nonsignificant changes in language and cognitive measures compared with a control group. Although the authors themselves were cautious about the results, this very limited evidence from a single RCT was enough for the School District of Philadelphia (the eighth largest district in the country) to decide to roll out the program to students in all of its kindergarten to second grade autism support classrooms.
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Affiliation(s)
- Patricia Howlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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28
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Papadopoulos N, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Engel L, Fuller-Tyszkiewicz M, Bellows ST, Marks D, Howlin P, Rinehart N. Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD. BMJ Open 2019; 9:e029767. [PMID: 31748288 PMCID: PMC6887021 DOI: 10.1136/bmjopen-2019-029767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child's socio-emotional functioning, as well as on parents' psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children's sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed. METHODS AND ANALYSIS The RCT aims to recruit 234 children with a diagnosis of ASD, aged 5-13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child's sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children's sleep problems as measured by the Children's Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated. ETHICS AND DISSEMINATION Findings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online. TRIAL REGISTRATION NUMBER ISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Affiliation(s)
| | - Emma Sciberras
- Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | | | - Lidia Engel
- Deakin University, Geelong, Victoria, Australia
| | | | | | - Deborah Marks
- Deakin University, Geelong, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Patricia Howlin
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Roestorf A, Bowler D, Deserno M, Howlin P, Klinger L, McConachie H, Parr J, Powell P, Van Heijst B, Geurts H. "Older Adults with ASD: The Consequences of Aging." Insights from a series of special interest group meetings held at the International Society for Autism Research 2016-2017. Res Autism Spectr Disord 2019; 63:3-12. [PMID: 31275429 PMCID: PMC6559228 DOI: 10.1016/j.rasd.2018.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/18/2018] [Accepted: 08/25/2018] [Indexed: 05/21/2023]
Abstract
A special interest group (SIG) entitled "Older Adults with ASD: The Consequences of Aging" was held at the International Society for Autism Research (INSAR) annual meetings in 2016 and 2017. The SIG and subsequent meetings brought together, for the first time, international delegates who were members of the autistic community, researchers, practitioners and service providers. Based on aging autism research that is already underway in UK, Europe, Australia and North America, discussions focussed on conceptualising the parameters of aging when referring to autism, and the measures that are appropriate to use with older adults when considering diagnostic assessment, cognitive factors and quality of life in older age. Thus, the aim of this SIG was to progress the research agenda on current and future directions for autism research in the context of aging. A global issue on how to define 'aging' when referring to ASD was at the forefront of discussions. The 'aging' concept can in principle refer to all developmental transitions. However, in this paper we focus on the cognitive and physical changes that take place from mid-life onwards. Accordingly, it was agreed that aging and ASD research should focus on adults over the age of 50 years, given the high rates of co-occurring physical and mental health concerns and increased risk of premature death in some individuals. Moreover, very little is known about the cognitive change, care needs and outcomes of autistic adults beyond this age. Discussions on the topics of diagnostic and cognitive assessments, and of quality of life and well-being were explored through shared knowledge about which measures are currently being used and which background questions should be asked to obtain comprehensive and informative developmental and medical histories. Accordingly, a survey was completed by SIG delegates who were representatives of international research groups across four continents, and who are currently conducting studies with older autistic adults. Considerable overlap was identified across different research groups in measures of both autism and quality of life, which pointed to combining data and shared learnings as the logical next step. Regarding the background questions that were asked, the different research groups covered similar topics but the groups differed in the way these questions were formulated when working with autistic adults across a range of cognitive abilities. It became clear that continued input from individuals on the autism spectrum is important to ensure that questionnaires used in ongoing and future are accessible and understandable for people across the whole autistic spectrum, including those with limited verbal abilities.
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Affiliation(s)
- A. Roestorf
- The Ageing with Autism Project, Autism Research Group, Department of Psychology, City, University of London, United Kingdom
| | - D.M. Bowler
- The Ageing with Autism Project, Autism Research Group, Department of Psychology, City, University of London, United Kingdom
| | - M.K. Deserno
- Dutch Autism Research Center (d’Arc), Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Dr. Leo Kannerhuis, Doorwerth, The Netherlands
| | - P. Howlin
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Brain and Mind Centre, The University of Sydney, Australia
| | - L. Klinger
- University of North Carolina at Chapel Hill, TEACCH Autism Program, Department of Psychiatry, USA
| | - H. McConachie
- Institute of Health and Society, Newcastle University, United Kingdom
| | - J.R. Parr
- Institute of Neuroscience, Newcastle University, United Kingdom
| | - P. Powell
- Georgia Institute of Technology, School of Psychology, Atlanta, GA, USA
| | - B.F.C. Van Heijst
- Dutch Autism Research Center (d’Arc), Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Dr. Leo Kannerhuis, Doorwerth, The Netherlands
| | - H.M. Geurts
- Dutch Autism Research Center (d’Arc), Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Dr. Leo Kannerhuis, Doorwerth, The Netherlands
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30
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Palmer M, San José Cáceres A, Tarver J, Howlin P, Slonims V, Pellicano E, Charman T. Feasibility study of the National Autistic Society EarlyBird parent support programme. Autism 2019; 24:147-159. [DOI: 10.1177/1362361319851422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The EarlyBird programme is a group-based psychoeducation intervention for parents of young children with autism. Although it is widely used in the United Kingdom, the evidence base for the programme is very limited. Using a mixed method, non-randomised research design, we aimed to test (1) the acceptability of the research procedures (recruitment, retention, suitability of measures), (2) the parental acceptability of EarlyBird (attendance, views of the programme, perceived changes) and (3) the facilitator acceptability of EarlyBird (fidelity, views of the programme, perceived changes). Seventeen families with a 2- to 5-year-old autistic child and 10 EarlyBird facilitators took part. Pre- and post-intervention assessment included measures of the child’s autism characteristics, cognitive ability, adaptive behaviour, emotional and behavioural problems and parent-reported autism knowledge, parenting competence, stress and wellbeing. Semi-structured interviews were completed at post-intervention with parents and facilitators. For those involved in the study, the research procedures were generally acceptable, retention rates were high and the research protocol was administered as planned. Generally, positive views of the intervention were expressed by parents and facilitators. Although the uncontrolled, within-participant design does not allow us to test for efficacy, change in several outcome measures from pre- to post-intervention was in the expected direction. Difficulties were encountered with recruitment (opt-in to the groups was ~56% and opt-in to the research was 63%), and strategies to enhance recruitment need to be built into any future trial. These findings should be used to inform protocols for pragmatic, controlled trials of EarlyBird and other group-based interventions for parents with young autistic children.
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31
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Salomone E, Leadbitter K, Aldred C, Barrett B, Byford S, Charman T, Howlin P, Green J, Le Couteur A, McConachie H, Parr JR, Pickles A, Slonims V. The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood. J Autism Dev Disord 2019; 48:1189-1198. [PMID: 29177606 PMCID: PMC5861164 DOI: 10.1007/s10803-017-3392-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We examined predictors of mental health difficulties and wellbeing in caregivers of children with autism in the Pre-school Autism Communication Trial cohort in middle childhood (N = 104). Child’s intellectual disability, daily living skills impairment, elevated emotional and behavioural difficulties, high educational level of caregiver and household income below the median significantly predicted caregivers’ mental health difficulties, but autism severity, child communication skills and family circumstances did not. Lower caregiver mental wellbeing was predicted by elevated child emotional and behavioural difficulties. The need to support the mental health and wellbeing of caregivers of children with autism is discussed in light of the results.
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Affiliation(s)
- Erica Salomone
- University of Turin, Via Po, 14, 10123, Turin, Italy. .,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | | | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Green
- University of Manchester, Manchester, UK.,UK Royal Manchester Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vicky Slonims
- Evelina London Children's Hospital, Guys and St Thomas University NHS Trust, London, UK
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Royston R, Oliver C, Moss J, Adams D, Berg K, Burbidge C, Howlin P, Nelson L, Stinton C, Waite J. Brief Report: Repetitive Behaviour Profiles in Williams syndrome: Cross Syndrome Comparisons with Prader-Willi and Down syndromes. J Autism Dev Disord 2019; 48:326-331. [PMID: 28980100 DOI: 10.1007/s10803-017-3319-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study describes the profile of repetitive behaviour in individuals with Williams syndrome, utilising cross-syndrome comparisons with people with Prader-Willi and Down syndromes. The Repetitive Behaviour Questionnaire was administered to caregivers of adults with Williams (n = 96), Prader-Willi (n = 103) and Down (n = 78) syndromes. There were few group differences, although participants with Williams syndrome were more likely to show body stereotypies. Individuals with Williams syndrome also showed more hoarding and less tidying behaviours than those with Down syndrome. IQ and adaptive ability were negatively associated with repetitive questioning in people with Williams syndrome. The profile of repetitive behaviour amongst individuals with Williams syndrome was similar to the comparison syndromes. The cognitive mechanisms underlying these behaviours in genetic syndromes warrant further investigation.
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Affiliation(s)
- R Royston
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - C Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - J Moss
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Adams
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Griffith University, PO Box 3370, South Brisbane Qld 4101, Sidon Street, South Bank, QLD, Australia
| | - K Berg
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,School of Psychology, University of East London, AE 1.10, Stratford Campus, London, E15 4LZ, UK
| | - C Burbidge
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Coventry and Warwickshire Partnership NHS Trust, Wayside House, Wilsons Lane, Coventry, CV6 6NY, UK
| | - P Howlin
- Department of Psychology, King's College London, Strand, London, WC2R 2L, UK.,University of Sydney, Sydney, Australia
| | - L Nelson
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C Stinton
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,University of Warwick, Coventry, CV4 7AL, UK
| | - J Waite
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Green J, Aldred C, Charman T, Le Couteur A, Emsley RA, Grahame V, Howlin P, Humphrey N, Leadbitter K, McConachie H, Parr JR, Pickles A, Slonims V, Taylor C. Paediatric Autism Communication Therapy-Generalised (PACT-G) against treatment as usual for reducing symptom severity in young children with autism spectrum disorder: study protocol for a randomised controlled trial. Trials 2018; 19:514. [PMID: 30241574 PMCID: PMC6150959 DOI: 10.1186/s13063-018-2881-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Prior evidence shows that behaviours closely related to the intervention delivered for autism are amenable to change, but it is more difficult to generalise treatment effects beyond the intervention context. We test an early autism intervention designed to promote generalisation of therapy-acquired skills into home and school contexts to improve adaptive function and reduce symptoms. A detailed mechanism study will address the process of such generalisation. Objective 1 will be to test if the PACT-G intervention improves autism symptom outcome in the home and school context of the intervention as well as in the primary outcome research setting. Objective 2 will use the mechanism analysis to test for evidence of acquired skills from intervention generalizing across contexts and producing additive effects on primary outcome. Methods/design This is a three-site, two-parallel-group, randomised controlled trial of the experimental treatment plus treatment as usual (TAU) versus TAU alone. Children aged 2–11 years (n = 244 (122 intervention/122 TAU; ~ 82/site) meeting criteria for core autism will be eligible. The experimental intervention builds on a clinic-based Pre-school Autism Communication Treatment model (PACT), delivered with the primary caregiver, combined with additional theory- and evidence-based strategies designed to enhance the generalisation of effects into naturalistic home and education contexts. The control intervention will be TAU. Primary outcome: autism symptom outcome, researcher-assessed using a standardised protocol. Secondary outcomes: autism symptoms, child interaction with parent or teacher, language and reported functional outcomes in home and school settings. Outcomes measured at baseline and 12-month endpoint in all settings with interim interaction measurements (7 months) to test treatment effect mechanisms. Primary analysis will estimate between-group difference in primary outcome using analysis of covariance with test of homogeneity of effect across age group. Mechanism analysis will use regression models to test for mediation on primary outcome by parent-child and teaching staff-child social interaction. Discussion This is an efficacy and mechanism trial of generalising evidence-based autism treatment into home and school settings. It will provide data on whether extending treatment across naturalistic contexts enhances overall effect and data on the mechanism in autism development of the generalisation of acquired developmental skills across contexts. Trial registration ISRCTN, ID: 25378536. Prospectively registered on 9 March 2016: Electronic supplementary material The online version of this article (10.1186/s13063-018-2881-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. .,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.,Children's and Young People's Disability Partnership, Kingsgate House, Wellington Road North, Stockport, SK4 1LW, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Box PO77, Henry Wellcome Building, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Ann Le Couteur
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Richard A Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Room S 2.03, De Crespigny Park, London, SE5 8AF, UK
| | - Victoria Grahame
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park, Benfield Rd, Newcastle upon Tyne, NE6 4QD, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Box PO77, Henry Wellcome Building, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Helen McConachie
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Framlington Place, Newcastle upon Tyne, NE1 9DU, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Room S 2.10, De Crespigny Park, London, SE5 8AF, UK
| | - Vicky Slonims
- Guy's and St Thomas' NHS Foundation Trust (Evelina Children's Hospital), Newcomen Centre at St Thomas' 2nd Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, PACT-G Trial Office, Room 3.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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White SW, Elias R, Capriola-Hall NN, Smith IC, Conner CM, Asselin SB, Howlin P, Getzel EE, Mazefsky CA. Development of a College Transition and Support Program for Students with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3072-3078. [PMID: 28685409 DOI: 10.1007/s10803-017-3236-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Empirically based, consumer-informed programming to support students with Autism Spectrum Disorder (ASD) transitioning to college is needed. Informed by theory and research, the Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address this need. The first level (Step 1) supports high school students and the second level (Step 2) is for postsecondary students with ASD. Herein, we review the extant research on transition supports for emerging adults with ASD and describe the development of STEPS, including its theoretical basis and how it was informed by consumer input. The impact of STEPS on promotion of successful transition into college and positive outcomes for students during higher education is currently being evaluated in a randomized controlled trial.
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Affiliation(s)
- Susan W White
- Department of Psychology, Child Study Center, Virginia Tech, 460 Turner St., Blacksburg, VA, 24060, USA.
| | - Rebecca Elias
- Department of Psychology, Child Study Center, Virginia Tech, 460 Turner St., Blacksburg, VA, 24060, USA
| | - Nicole N Capriola-Hall
- Department of Psychology, Child Study Center, Virginia Tech, 460 Turner St., Blacksburg, VA, 24060, USA
| | - Isaac C Smith
- Department of Psychology, Child Study Center, Virginia Tech, 460 Turner St., Blacksburg, VA, 24060, USA
| | - Caitlin M Conner
- Department of Psychology, Child Study Center, Virginia Tech, 460 Turner St., Blacksburg, VA, 24060, USA
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Elizabeth E Getzel
- Center on Transition Innovations, Virginia Commonwealth University, Richmond, VA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Rice LJ, Emerson E, Gray KM, Howlin P, Tonge BJ, Warner GL, Einfeld SL. Concurrence of the strengths and difficulties questionnaire and developmental behaviour checklist among children with an intellectual disability. J Intellect Disabil Res 2018; 62:150-155. [PMID: 28980362 DOI: 10.1111/jir.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. METHOD Parents of 83 young people with ID aged 4-17 years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. RESULTS The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. CONCLUSION The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.
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Affiliation(s)
- L J Rice
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - E Emerson
- Centre for Disability Research and Policy, University of Sydney, Lidcombe, New South Wales, Australia
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - P Howlin
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - B J Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - G L Warner
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - S L Einfeld
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
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36
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Bakke KA, Howlin P, Retterstøl L, Kanavin ØJ, Heiberg A, Nærland T. Effect of epilepsy on autism symptoms in Angelman syndrome. Mol Autism 2018; 9:2. [PMID: 29340132 PMCID: PMC5759870 DOI: 10.1186/s13229-017-0185-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/25/2017] [Indexed: 12/02/2022] Open
Abstract
Background Autism spectrum disorder and epilepsy often co-occur; however, the extent to which the association between autism symptoms and epilepsy is due to shared aetiology or to the direct effects of seizures is a topic of ongoing debate. Angelman syndrome (AS) is presented as a suitable disease model to explore this association. Methods Data from medical records and questionnaires were used to examine the association between age of epilepsy onset, autism symptoms, genetic aberration and communication level. Forty-eight participants had genetically verified AS (median age 14.5 years; range 1–57 years). A measure of autism symptoms (the Social Communication Questionnaire; SCQ) was completed for 38 individuals aged ≥ 4 years. Genetic cause was subgrouped into deletion and other genetic aberrations of the 15q11-q13 area. The number of signs used to communicate (< 20 sign and ≥ 20 signs) was used as a measure of nonverbal communication. Results Mean age of epilepsy onset was 3.0 years (range 3 months–7.8 years). Mean SCQ score for individuals without epilepsy was 13.6 (SD = 6.7) and with epilepsy 17.0 (SD = 5.6; p = 0.17); 58% used fewer than 20 signs to communicate. There were no age differences between groups according to presence of epilepsy, level of nonverbal communication or type of genetic aberration. SCQ scores were higher in individuals with the deletion than in those with other genetic aberrations (18.7 vs 10.8 p = 0.008) and higher in the group who used < 20 signs to communicate (19.4 vs 14.1 p = 0.007). Age of epilepsy onset was correlated with SCQ (r = − 0.61, p < 0.001). Multiple regression showed that age of seizure onset was significantly related to SCQ score (β = − 0.90; p = 0.006), even when the type of genetic abnormality was controlled (R2 = 0.53; F = 10.7; p = 0.001). Conclusions The study provides support for the notion that seizures themselves contribute more to autism symptoms than expected from the underlying genetic pathology alone. The study demonstrates how a rare genetic syndrome such as Angelman syndrome may be used to study the relation between epilepsy and autism symptomatology.
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Affiliation(s)
- Kristin A Bakke
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health Sciences, University of Sydney, Sydney, NSW Australia
| | - Lars Retterstøl
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Øivind J Kanavin
- Frambu National Resource Center for Rare Disorders, Siggerud, Norway
| | - Arvid Heiberg
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Terje Nærland
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
SummaryThe internet abounds with promises of ‘miracle cures’ for autism and within the published research literature there are numerous claims and counter-claims for the effectiveness of specific therapies. Systematic evaluations, however, indicate that few treatment programmes have a sound evidence base, and even those interventions that do produce positive findings are not successful for all children. To date, the best researched programmes are those involving intensive, early, home-based intervention, and those with a focus on communication and parent–child interaction. This article assesses the evidence base for some of the better evaluated therapies. There is, as yet, no evidence that any one programme is superior to all others. Indeed, large individual differences in response to intervention suggest that the focus of research now needs to shift to the study of which components of therapy work best for which children and under which conditions.
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Abstract
Autism is a pervasive and life-long disorder that is characterised by profound deficits in communication and social understanding, together with ritualistic and obsessional behaviours and a general resistance to change. Although usually associated with additional cognitive impairments (approximately 50% of those affected have an IQ below 50) the condition can occur in individuals of all levels of ability, and around 20% of cases have an IQ within the normal range. Estimates of prevalence vary from 3.3 to 16.0 per 10 000 and rates may be even higher if children within the autistic wider spectrum are included (Wing, 1993, 1996). Understanding of causation is still limited, although genetic factors are now known to play a major role (Lord & Rutter, 1994).
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Royston R, Howlin P, Waite J, Oliver C. Anxiety Disorders in Williams Syndrome Contrasted with Intellectual Disability and the General Population: A Systematic Review and Meta-Analysis. J Autism Dev Disord 2017; 47:3765-3777. [PMID: 27696186 PMCID: PMC5676825 DOI: 10.1007/s10803-016-2909-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Individuals with specific genetic syndromes associated with intellectual disability (ID), such as Williams syndrome (WS), are at increased risk for developing anxiety disorders. A systematic literature review identified sixteen WS papers that could generate pooled prevalence estimates of anxiety disorders for WS. A meta-analysis compared these estimates with prevalence estimates for the heterogeneous ID population and the general population. Estimated rates of anxiety disorders in WS were high. WS individuals were four times more likely to experience anxiety than individuals with ID, and the risk was also heightened compared to the general population. The results provide further evidence of an unusual profile of high anxiety in WS.
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Affiliation(s)
- R Royston
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - P Howlin
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - J Waite
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - C Oliver
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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40
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Abstract
Young people with autism spectrum disorder (ASD) have a high prevalence (~40 %) of anxiety disorders compared to their non-ASD peers. It is unclear whether cognitive and biological processes associated with anxiety in ASD are analogous to anxiety in typically developing (TD) populations. In this study 55 boys with ASD (34 with a co-occurring anxiety disorder, 21 without) and 28 male controls, aged 10-16 years and with a full-scale IQ ≥ 70, completed a series of clinical, cognitive (attention bias/interpretation bias) and biological measures (salivary cortisol/HR response to social stress) associated with anxiety in TD populations. Structural equation modelling was used to reveal that that both attentional biases and physiological responsiveness were significant, but unrelated, predictors of anxiety in ASD.
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Affiliation(s)
- Matthew J Hollocks
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Neurology Unit, R3, Department of Clinical Neurosciences, University of Cambridge, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry and Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Bezzina LA, Rice LJ, Howlin P, Tonge BJ, Einfeld SL. Syndrome specific modules to enhance the Stepping Stones Triple P public health intervention. J Intellect Disabil Res 2017; 61:836-842. [PMID: 28833838 DOI: 10.1111/jir.12405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Service responses to behaviour phenotypes include care by expert clinicians, syndrome-specific clinics, disability-specific mental health services and generic mental health services. While these services contribute to care, they are often of limited accessibility. METHODS We describe a population-wide public health intervention aimed at increasing the accessibility of services to the target population. Stepping Stones Triple P (SSTP) is a public health intervention of known efficacy in reducing behaviour problems when delivered to parents of children aged 0-12 with mixed developmental disabilities. RESULTS The strategy we discuss involves enhancing SSTP with modules for specific causes of developmental disabilities including Down, Fetal Alcohol, Fragile X, Prader-Willi and Williams syndromes. CONCLUSIONS We propose that enhancing SSTP with syndrome specific modules will increase the accessibility of support to families who have a child with a specific behaviour phenotype. We suggest that future research should confirm the public health impact of the modified SSTP programme using the RE-AIM framework.
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Affiliation(s)
- L A Bezzina
- Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - L J Rice
- Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - P Howlin
- Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - B J Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University
| | - S L Einfeld
- Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Naerland T, Bakke KA, Storvik S, Warner G, Howlin P. Age and gender-related differences in emotional and behavioural problems and autistic features in children and adolescents with Down syndrome: a survey-based study of 674 individuals. J Intellect Disabil Res 2017; 61:594-603. [PMID: 27862512 DOI: 10.1111/jir.12342] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 08/16/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recent studies have indicated an increased risk of autism, behavioural and emotional problems and attention-deficit/hyperactivity disorder in individuals with Down syndrome. METHOD In a large-scale survey-based study, we examined the rates of these problems and their relationship to age and gender, in a sample of 674 individuals (4-18 years) with Down syndrome. The relationship with IQ level was also explored in a subsample (n = 175). The Strengths and Difficulties Questionnaire and the Social Communication Questionnaire were used to assess behavioural and emotional problems and autism traits. RESULTS On the Strengths and Difficulties Questionnaire, peer problems were the most frequently reported difficulty (48% > cut-off), followed by hyperactivity/inattention (34% > cut-off). On the Social Communication Questionnaire, 37% scored at or above cut-off (≥15) for autism spectrum disorder; 17% were at or above the suggested cut-off (≥22) for autism. Little association between age and behavioural or emotional problems or with severity of autistic symptomatology was found. However, peer problems were more common in adolescents than in junior school children (P < 0.001); Hyperactivity/inattention was less prevalent among adolescents (P < 0.001). CONCLUSIONS High rates of autistic features, emotional and behavioural problems are documented. These problems are related to age, gender and degree of intellectual disability.
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Affiliation(s)
- T Naerland
- NevSom Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - K A Bakke
- NevSom Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - S Storvik
- NevSom Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - G Warner
- Psychology, Institue of Psychiatry, London, UK
| | - P Howlin
- Psychology, Institue of Psychiatry, London, UK
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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43
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Helverschou SB, Steindal K, Nøttestad JA, Howlin P. Personal experiences of the Criminal Justice System by individuals with autism spectrum disorders. Autism 2017; 22:460-468. [DOI: 10.1177/1362361316685554] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The processes of arrest, investigation, trial and imprisonment are often extremely difficult for individuals with autism spectrum disorders. In this study, nine offenders with autism spectrum disorders were interviewed about the circumstance surrounding the criminal acts, their views of the arrest, the police interrogation, the trial and the defence and their experiences of being in prison and/or life following the offence. The nine individuals described a range of different and often negative experiences with the Criminal Justice System. However, the majority of those given a custodial sentence coped well in prison, probably due to the high levels of structure and firm frameworks in that environment. Explanation factors associated with the offences indicated that autism spectrum disorder characteristics such as misunderstandings, obsessions and idiosyncratic beliefs and/or behaviours were frequently involved, but stress was the most common explanation provided by the participants. The findings suggest limited understanding of autism spectrum disorders within the Criminal Justice System which needs to be significantly improved in order to secure their legal protection.
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Affiliation(s)
| | | | - Jim Aage Nøttestad
- St. Olavs Hospital, Norway
- Norwegian University of Science and Technology (NTNU), Norway
| | - Patricia Howlin
- King’s College London, UK
- The University of Sydney, Australia
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45
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Warner G, Howlin P, Salomone E, Moss J, Charman T. Profiles of children with Down syndrome who meet screening criteria for autism spectrum disorder (ASD): a comparison with children diagnosed with ASD attending specialist schools. J Intellect Disabil Res 2017; 61:75-82. [PMID: 27868264 DOI: 10.1111/jir.12344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recent research suggests that around 16% to 18% of children with Down syndrome (DS) also meet diagnostic criteria for autism spectrum disorder (ASD). However, there are indications that profiles of autism symptoms in this group may vary from those typically described in children with ASD. METHOD Rates of autism symptoms and emotional and behavioural problems among children with DS who screened positive for ASD on the Social Communication Questionnaire (SCQ) (n = 183) were compared with a group of children with clinical diagnoses of ASD (n = 189) attending specialist schools in the UK. Groups were matched for age and approximate language level (use of phrase speech). RESULTS Profiles of autistic symptoms in the two groups were generally similar, but children with DS meeting ASD cut-off on the SCQ tended to show fewer problems in reciprocal social interaction than those in the ASD group. They also showed slightly lower rates of emotional and peer-related problems. The results mostly confirm findings from a previous study in which the original validation sample for the SCQ was used as a comparison group. CONCLUSION Findings suggest that children with DS who meet screening criteria for ASD show similar profiles of communication and repetitive behaviours to those typically described in autism. However, they tend to have relatively milder social difficulties. It is important that clinicians are aware of this difference if children with DS and ASD are to be correctly diagnosed and eligible for specialist intervention and education services.
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Affiliation(s)
- G Warner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Faculty of Health Sciences, University of Sydney, BMRI, Sydney, New South Wales, Australia
| | - E Salomone
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Dipartimento di Psicologia, Università di Torino, Torino, Italy
| | - J Moss
- Cerebra Centre, University of Birmingham, Birmingham, UK
- Department of Psychology, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK
| | - T Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Romhus S, Herder GA, Grindheim E, Schjølberg S, Howlin P. Changes in the frequency and characteristics of children diagnosed with autistic disorder in two Norwegian cohorts: 1992 and 2009. Scand J Child Adolesc Psychiatr Psychol 2017. [DOI: 10.21307/sjcapp-2017-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
Is the increasing prevalence of autistic disorder (AD) a well-documented trend or merely a reflection of the wider recognition of AD among both the public at large and health care professionals? Data from relevant studies are frequently compromised by comparisons of different sites and different diagnostic methods.
Objectives:
To explore changes over time, we reviewed the following: 1) the frequency of AD diagnoses; 2) the characteristics of the diagnosed children; and 3) the ages of the children when initial concerns were addressed and AD diagnoses made.
Method:
We compared the case records of children between the ages of 1 and 17 years who were residing in Nordland County, Norway, and who were diagnosed with AD during two different data collection periods: 1992 (Cohort 1) and 2009 (Cohort 2).
Results:
In Cohort 1, 28 children were diagnosed with AD; 71 children in Cohort 2 received AD diagnoses. The increase was greatest among children with intelligence quotient (IQ) values of at least 70. The proportion of children with genetic syndromes was around 20% in both cohorts. Median age at AD diagnosis did not differ between the two cohorts (4.5 vs. 5.0 years, respectively). When the two cohorts were combined, children with IQ values of 70 or more without a genetic syndrome and those with IQ values of less than 50 with genetic syndromes were diagnosed at approximately the same age (5.5 and 5.3 years, respectively). Both groups were significantly older at diagnosis as compared with children with IQ values of less than 50 without genetic syndromes (3.5 years).
Conclusions:
The increase in the number of children diagnosed with AD is consistent with findings from international studies. Contrary to predictions, the age at diagnosis was not reduced over time. A higher proportion of children with IQ values in the average range in the latter cohort may have contributed to this. A delayed diagnosis of AD among children with genetic syndromes may indicate that early autism symptoms are attributed to the genetic condition. Clinical implications are discussed.
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Pickles A, Le Couteur A, Leadbitter K, Salomone E, Cole-Fletcher R, Tobin H, Gammer I, Lowry J, Vamvakas G, Byford S, Aldred C, Slonims V, McConachie H, Howlin P, Parr JR, Charman T, Green J. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet 2016; 388:2501-2509. [PMID: 27793431 PMCID: PMC5121131 DOI: 10.1016/s0140-6736(16)31229-6] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is not known whether early intervention can improve long-term autism symptom outcomes. We aimed to follow-up the Preschool Autism Communication Trial (PACT), to investigate whether the PACT intervention had a long-term effect on autism symptoms and continued effects on parent and child social interaction. METHODS PACT was a randomised controlled trial of a parent-mediated social communication intervention for children aged 2-4 years with core autism. Follow-up ascertainment was done at three specialised clinical services centres in the UK (London, Manchester, and Newcastle) at a median of 5·75 years (IQR 5·42-5·92) from the original trial endpoint. The main blinded outcomes were the comparative severity score (CSS) from the Autism Diagnostic Observation Schedule (ADOS), the Dyadic Communication Assessment Measure (DCMA) of the proportion of child initiatiations when interacting with the parent, and an expressive-receptive language composite. All analyses followed the intention-to-treat principle. PACT is registered with the ISRCTN registry, number ISRCTN58133827. FINDINGS 121 (80%) of the 152 trial participants (59 [77%] of 77 assigned to PACT intervention vs 62 [83%] of 75 assigned to treatment as usual) were traced and consented to be assessed between July, 2013, and September, 2014. Mean age at follow-up was 10·5 years (SD 0·8). Group difference in favour of the PACT intervention based on ADOS CSS of log-odds effect size (ES) was 0·64 (95% CI 0·07 to 1·20) at treatment endpoint and ES 0·70 (95% CI -0·05 to 1·47) at follow-up, giving an overall reduction in symptom severity over the course of the whole trial and follow-up period (ES 0·55, 95% CI 0·14 to 0·91, p=0·004). Group difference in DCMA child initiations at follow-up showed a Cohen's d ES of 0·29 (95% CI -0.02 to 0.57) and was significant over the course of the study (ES 0·33, 95% CI 0·11 to 0·57, p=0·004). There were no group differences in the language composite at follow-up (ES 0·15, 95% CI -0·23 to 0·53). INTERPRETATION The results are the first to show long-term symptom reduction after a randomised controlled trial of early intervention in autism spectrum disorder. They support the clinical value of the PACT intervention and have implications for developmental theory. FUNDING Medical Research Council.
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Affiliation(s)
- Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle, UK; Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK
| | | | - Erica Salomone
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | | | - Isobel Gammer
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - George Vamvakas
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Vicky Slonims
- Evelina London Children's Hospital, Guys and St Thomas University NHS Trust, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Jonathan Green
- University of Manchester, Manchester, UK; Royal Manchester Children's Hospital and Manchester Academic Health Sciences Centre, Manchester, UK.
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48
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White SW, Elias R, Salinas CE, Capriola N, Conner CM, Asselin SB, Miyazaki Y, Mazefsky CA, Howlin P, Getzel EE. Students with autism spectrum disorder in college: Results from a preliminary mixed methods needs analysis. Res Dev Disabil 2016; 56:29-40. [PMID: 27262124 PMCID: PMC4927339 DOI: 10.1016/j.ridd.2016.05.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a growing call for empirically based programming to support the success of students with autism spectrum disorder (ASD) as they transition to college. AIMS The purpose of this study was to identify the needs and challenges faced by adolescents and young adults with ASD in postsecondary education. METHODS A mixed methods approach was taken to explore the needs of college-bound and college-enrolled students with ASD. Primary stakeholders (i.e., parents, educators/support staff from secondary and postsecondary institutions, and students) participated in an online survey (n=67) and focus groups (n=15). RESULTS Across the stakeholder groups, commonly identified areas of difficulty included limited interpersonal competence, managing competing demands in postsecondary education, and poor emotional regulation. There was a high degree of agreement across stakeholders in the identified needs and challenges. IMPLICATIONS Findings from this preliminary needs analysis will inform the development of programming to support students with ASD.
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Affiliation(s)
- Susan W White
- Department of Psychology, Virginia Tech, United States.
| | - Rebecca Elias
- Department of Psychology, Virginia Tech, United States
| | | | | | | | - Susan B Asselin
- School of Education, Faculty of Teaching & Learning, Virginia Tech, United States
| | - Yasuo Miyazaki
- School of Education, Faculty of Leadership, Counseling, & Research, Virginia Tech, United States
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London and BMRI, Faculty of Health Sciences, University of Sydney, Australia
| | - Elizabeth E Getzel
- School of Education Rehabilitation Research and Training Center, Virginia Commonwealth University, United States
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49
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Robinson S, Howlin P, Russell A. Personality traits, autobiographical memory and knowledge of self and others: A comparative study in young people with autism spectrum disorder. Autism 2016; 21:357-367. [PMID: 27197697 DOI: 10.1177/1362361316645429] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between dissociable components of autobiographical memory (e.g. semantic personality traits and episodic memory retrieval) and other cognitive skills that are proposed to enable one to develop a sense of self (e.g. introspection) have not previously been explored for children with autism spectrum disorder. This study compared autobiographical memory (semantic and episodic) and knowledge of self (internal/external self-knowledge and introspection/mentalising abilities) in children (aged 11-18 years) with high-functioning autism spectrum disorder and typically developing controls (total N = 48). Novel and standard tasks were employed. Compared to typically developing controls, young people with autism spectrum disorder had autobiographical memory difficulties that were characterised by a reduction in the retrieval of semantic personality traits, with more initial prompts required to facilitate episodic memory retrieval and fewer episodic memories containing emotional and sensory information. Knowledge of the self and others was also impaired, with reduced introspection and poorer mentalising abilities. Young people with autism spectrum disorder were also identified as presenting with an atypical relationship between autobiographical memory and self-knowledge, which was significantly different from typically developing controls. Test performance is discussed in relation to the functions of autobiographical memory, with consideration of how these cognitive difficulties may contribute to clinical practices and the social and behavioural characteristics of autism spectrum disorder.
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50
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Chandler S, Howlin P, Simonoff E, Kennedy J, Baird G. Comparison of parental estimate of developmental age with measured IQ in children with neurodevelopmental disorders. Child Care Health Dev 2016; 42:486-93. [PMID: 27126521 DOI: 10.1111/cch.12346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/11/2016] [Accepted: 03/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Formal IQ tests are an important part of the diagnostic and needs-based assessment process for children with neurodevelopmental disorders. However, resources for such assessments are not always available. It has been suggested that parental estimates of their child's developmental age could serve as a proxy IQ when formal measures are unavailable. METHOD Parental estimates of their child's developmental age were converted to a developmental quotient (DQ) in 197 children with Autism Spectrum Disorder (ASD) aged 4-9 years, and 108 children with ADHD and intellectual disability (ADHD + ID) aged 7-15 years. Formal IQ assessments were then conducted. Parents completed the Social Communication Questionnaire ((SCQ), a measure of autism symptomatology) and a demographic questionnaire. RESULTS In the ASD sample, 58% of parent estimates were within 15 points (i.e. one standard deviation) of the child's measured IQ score. Lower measured IQ and lower SCQ total score predicted higher parental accuracy. In the ADHD + ID sample, 74% of parental estimates were within 15 points of measured IQ. In this group, higher child IQ predicted greater parental accuracy. Parents in the ADHD + ID group were more likely to overestimate children's ability level than parents in the ASD group. CONCLUSIONS In this study, the majority of parents of children with ADHD and ID were able to estimate their child's intellectual ability level with some accuracy. Parents of children with ASD were less accurate, but this may be because these parents were focussing more on children's level of adaptive functioning, which is known to be typically lower than cognitive ability in ASD.
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Affiliation(s)
- S Chandler
- Paediatric Neurosciences, Newcomen Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - P Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Faculty of Health Sciences, University of Sydney, Australia
| | - E Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - J Kennedy
- The Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - G Baird
- Paediatric Neurosciences, Newcomen Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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