Psychiatric Symptom Impairment in Children with Autism Spectrum Disorders

The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6–12 year old children with ASD (N?=?115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents’ and teachers’ ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Treating Couples Raising Children on the Autism Spectrum: A Marriage-Friendly Approach

Available research demonstrates that autism spectrum disorders (ASDs) affect couples in a variety of different ways. Some partners draw closer to one another through the experience of caring for a child on the autism spectrum while others experience relationship dissatisfaction, separation, and divorce. Yet other research reveals that many couples raising children with ASDs may experience an initial dip in relationship satisfaction but, after adjusting to a new way of life and developing new expectations for their children, are later able to bond in novel ways. Thus, a marriage-friendly approach to therapy, which focuses on helping partners remain committed to each other through the trials and tribulations of life, may allow these couples to work through the difficulties of raising children on the autism spectrum without resorting to separation or divorce. Ethical implications of a marriage-friendly approach to therapy with couples raising children with ASDs are also considered.     

Experiences Delivering a Marital Intervention for Couples With Children With Autism Spectrum Disorder

Previous researchers have indicated that parents of children with autism spectrum disorder (ASD) are vulnerable to relationship stress, lower marital satisfaction, and potential relationship dissolution. We describe the experiences of three couples who participated in a 10-week, in-home couples therapy intervention using Emotionally Focused Therapy (EFT). Each couple and their progress through the intervention are described using therapist and supervisor reflections, and qualitative evaluation interviews with the participants after termination. Based on the experiences of the couples, we conclude that couples would benefit from an in-home couples therapy intervention aimed to strengthen their relationships.     

Story Recall and Narrative Coherence of High-Functioning Children with Autism Spectrum Disorders

Previous research has found few quantitative differences between children with high-functioning autism spectrum disorders (ASDs) and well-matched controls in the length, complexity, and structure of their narratives. Researchers have noted, however, that narratives of children with ASDs have an unusual and idiosyncratic nature. This study provides an analysis of narratives in 17 children with high-functioning ASDs and 17 typically developing children matched on age, gender, language abilities, and cognitive abilities. We examined story recall and narrative coherence. The study revealed no group differences in story length or syntactic complexity. Children with ASDs also did not differ from controls in their use of the gist of a story to aid recall, or in their sensitivity to the importance of story events. Children with ASDs did, however, produce narratives that were significantly less coherent than the narratives of controls. Children with ASDs appeared less likely to use the gist of the story to organize their narratives coherently. These findings are discussed with regard to their relationship to other cognitive and linguistic difficulties of children with ASDs.     

Autonomic Responses to Head-Up Tilt Test in Children with Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) is a group of neurodevelopmental disorders often manifested by social and behavioral deficiencies. Autonomic dysfunction is frequently reported in the autistic population but the mechanisms remain largely unknown. We aimed to characterize the cardiac autonomic profile of children with autism during a head-up tilt test. Thirty-nine male children were recruited: 19 controls (9.9 ± 1.6 years) and 20 children with ASD without intellectual disability (10.7 ± 1.2 years). Each child underwent a head-up tilt test on a motorized tilt table. After a 10 min resting period in the supine position, subjects were tilted head-up to 70° on the table for 10 min. Heart rate and blood pressure variabilities were continuously recorded using non-invasive Nexfin monitoring. The head-up tilt test significantly altered heart rate variability (p < 0.001 for both groups) and greater parasympathetic responses were found in the ASD group compared to controls (p < 0.05). In the supine position baroreflex sensitivity was higher in children with ASD than in the controls (p < 0.05) and significantly decreased during the tilt test in the ASD group, but not in controls. Our results showed that children with ASD did not have clinical signs of dysautonomia in response to a head-up tilt test. However, in children with ASD higher parasympathetic responses with the same sympathetic modulations during orthostatic stress suggest parasympathetic dominance in this population.     

Children with Autism and Their Friends: A Multidimensional Study of Friendship in High-Functioning Autism Spectrum Disorder

This study of Israeli and American preadolescent children examined characteristics of friendship in 44 children with high-functioning autism spectrum disorder (HFASD) compared to 38 typically developing children (TYP), as they interacted with a close friend Participants were 8-12 years of age (HFASD: Israel, n = 24; USA, n = 20; TYP: Israel, n = 23; USA, n = 15), and were matched on SES, receptive language vocabulary, child age, and gender (each study group included one girl). Multidimensional assessments included: individual behaviors of target children and observed child-friend interactions during construction and drawing scenarios; target child's and friend's self-perceived mutual friendship qualities; and mother-reported characteristics (friendship's duration/frequency; friend's age/gender/disability status). Overall, children with HFASD displayed a number of differences on individual and dyadic friendship measures. Both age and verbal abilities affected friendship behaviors. Children with HFASD and their friends perceived friendship qualities similarly, suggesting that preadolescents with HFASD have capacities for interpersonal awareness. Between-group similarities also emerged on several complex social behaviors, suggesting that friendship follows a developmental trajectory in autism and may enhance social interaction skills in autism.     

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

Patterns of Growth in Adaptive Social Abilities Among Children with Autism Spectrum Disorders

Adaptive social skills were assessed longitudinally at approximately ages 2, 3, 5, 9, and 13 years in a sample of 192 children with a clinical diagnosis of autism (n = 93), PDD-NOS (n = 51), or nonspectrum developmental disabilities (n = 46) at age 2. Growth curve analyses with SAS proc mixed were used to analyze social trajectories over time. Both individual characteristics and environmental resources emerged as key predictors of adaptive social behavior outcome. The gap between children with autism and the other two diagnostic groups widened with time as the social skills of the latter groups improved at a higher rate. However, within diagnostic groups, improvement ranged from minimal to very dramatic. Children with autism most at risk for problems with social adaptive abilities later in life can be identified with considerable accuracy at a very young age so they can be targeted for appropriate early intervention services.     

Parenting Interventions for Children with Autism Spectrum and Disruptive Behavior Disorders: Opportunities for Cross-Fertilization

Empirical support exists for parent training/education (PT/PE) interventions for children with disruptive behavior disorders (DBD) and autism spectrum disorders (ASD). While the models share common roots, current approaches have largely developed independently and the research findings have been disseminated in two different literature traditions: mental health and developmental disabilities. Given that these populations often have overlapping clinical needs and are likely to receive services in similar settings, efforts to integrate the knowledge gained in the disparate literature may be beneficial. This article provides a systematic overview of the current (1995–2005) empirical research on PT/PE for children with DBD and ASD; attending to factors for cross-fertilization. Twenty-two ASD and 38 DBD studies were coded for review. Literature was compared in three main areas: (1) research methodology, (2) focus of PT/PE intervention, and (3) PT/PE procedures. There was no overlap in publication outlets between the studies for the two populations. Results indicate that there are opportunities for cross-fertilization in the areas of (1) research methodology, (2) intervention targets, and (3) format of parenting interventions. The practical implications of integrating these two highly related areas of research are identified and discussed.     

孤独症个体的公平决策：心理理论和自我/他人情绪识别的作用

研究通过最后通牒任务,考查孤独症儿童在公平任务中的决策,以及心理理论和识别自我/他人情绪对决策的影响。29名孤独症儿童和三组对照组儿童参加实验结果发现,孤独症儿童在任务中面对不同分配比例的接受率（2:8、3:7）与对照组之间存在显著差异。心理理论能力和自我情绪识别都与决策存在相关：当处于不公平的情况下（1:9、2:8、3:7）,通过心理理论任务的孤独症儿童才会拒绝接受不公平分配,儿童也会感觉到不高兴并且做出拒绝的决定。     

Reduction of Pain Sensitivity after Somatosensory Therapy in Children with Autism Spectrum Disorders

Children with autism spectrum disorders (ASD) often present with somatosensory dysfunction including an abnormal reactivity to tactile stimuli and altered pain perception. A therapy based on somatosensory stimuli has shown effectiveness in reducing pain sensitivity among adults with cerebral palsy. The present study aims at exploring the influence of somatosensory therapy on somatosensory parameters in children with ASD. Children with high-functioning ASD were randomly assigned to either the intervention (n?=?29) or the control group (n?=?30). The intervention group received a somatosensory therapy consisting of four types of exercises (touch, proprioception, vibration, stereognosis). Somatosensory function (pressure pain thresholds, tactile thresholds, stereognosis, proprioception) was assessed before and immediately after the therapy. Children in the intervention group showed a significant reduction of pain sensitivity and increase of tactile sensitivity after treatment, whereas children in the control group displayed increased pain sensitivity in the absence of changes of tactile sensitivity. No changes were observed for proprioception or stereognosis. The repetitive somatosensory stimulation therapy led to a decrease of pain sensitivity and an increase of tactile sensitivity. These findings may have important research and clinical implications, as promoting early tactile interventions in children with ASD may lead to a more adequate development of somatosensory processing and less somatosensory abnormalities upon adult life.     

Psychotherapy for Individuals with Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASDs) present unique challenges for psychotherapists. Those with autism, Asperger’s Disorder and pervasive developmental disorder-not otherwise specified (PDD-NOS) show impairments in social communication and social relationships as well as unusual behavioral features that set them apart from peers. Further, individuals affected with autism spectrum disorders may experience anxiety, depression, obsessive–compulsive disorder and other psychiatric symptoms that can be distressing and, at times, disabling. At present, there is limited information regarding evidence-based approaches for addressing either core impairments of ASDs or associated conditions in a psychotherapy setting. Nevertheless, information about how persons with ASD experience their world and learn can provide clues about what interventions might be useful to assist them such that they can reach their fullest potential. From this standpoint, new or modified approaches to therapy can be tested and further refined to provide a more comprehensive understanding of the psychotherapeutic challenges and the most efficacious therapeutic approach to maximize functioning in this population.     

Interventions for Children With Autism Spectrum Disorders in Inclusive School Settings

Students with ASD present unique challenges to school systems. Despite these challenges, federal laws require that schools implement research-based practices in the least restrictive environment (LRE). The LRE is often deemed to be the general education classroom and the primary intervention agent is often the classroom teacher. Ensuring students with ASD receive effective intervention in these least restrictive and inclusive school settings will depend, in part, on the extent to which teachers and school personnel are prepared to implement research-based interventions. The purpose of this article is to provide a summary of research-based interventions for students with ASD. Our focus in this summary is on interventions that can be implemented in inclusive school settings by teachers and classroom support personnel. We first provide a general overview of interventions designed to reduce challenging behavior, teach communication skills, and improve social relationships. This is followed by a discussion of the obstacles to intervention implementation that may be present in school settings. Finally, we conclude by offering a list of intervention guidelines.     

Using a Behavioral Treatment Package for Sleep Problems in Children With Autism Spectrum Disorders

This study investigated the effectiveness of a behavioral treatment package for sleep problems in children diagnosed with Autism Spectrum Disorders. Treatment consisted of four behaviorally based components: circadian rhythm management, positive bedtime routines, white noise, and graduated extinction. A multiple-baseline design across three participants was used. Families completed a baseline of various lengths followed by 1 month of intervention. Results indicated the treatment package was effective in decreasing sleep onset latency and the frequency of night awakenings. A week of follow-up data showed continued improvement. Parents reported their children slept better and satisfaction with the four intervention components.     

Anxiety, Sensory Over-Responsivity, and Gastrointestinal Problems in Children with Autism Spectrum Disorders

Children with autism spectrum disorders (ASD) experience high rates of anxiety, sensory processing problems, and gastrointestinal (GI) problems; however, the associations among these symptoms in children with ASD have not been previously examined. The current study examined bivariate and multivariate relations among anxiety, sensory over-responsivity, and chronic GI problems in a sample of 2,973 children with ASD enrolled in the Autism Treatment Network (ages 2–17 years, 81.6 % male). Twenty-four percent of the sample experienced at least one type of chronic GI problem (constipation, abdominal pain, bloating, diarrhea, and/or nausea lasting three or more months). Children with each type of GI problem had significantly higher rates of both anxiety and sensory over-responsivity. Sensory over-responsivity and anxiety were highly associated, and each provided unique contributions to the prediction of chronic GI problems in logistic regression analyses. The results indicate that anxiety, sensory over-responsivity and GI problems are possibly interrelated phenomenon for children with ASD, and may have common underlying mechanisms.     

Subjective Quality of Life for Parents of Children with Autism Spectrum Disorders in Croatia

The purpose of this study was to investigate the subjective quality of life (SQoL) of parents of children with autism spectrum disorders (ASD) who are primary carers. The study included 346 parents: 177 parents of children with ASD and 169 parents of non-disabled children comprised the control group. The Personal Wellbeing Index (PWI) was used to assess SQoL. Parents’ general health perception was assessed with a single question scored on a scale from 1 (poor health) to 5 (excellent health). Parents of children with ASD reported a significantly lower SQoL and general health perception with more physiological symptoms as compared to parents of non-disabled children. In Croatia parents of children with ASD, as primary caregivers, is an especially vulnerable part of the population and need increased social support and assistance in order to achieve and maintain the well-being of the whole family.