New and Familiar Roles for Clinical Psychologists in the Effective Treatment for Children With an Autism Spectrum Disorder

Alongside the increased prevalence of autism spectrum disorders (ASD), there is a greater likelihood of clinical psychologists having a role in the treatment of children with these disorders. Population heterogeneity with respect to ASD-specific symptomatology, comorbid medical and psychiatric issues, level of cognitive functioning, and presence of adaptive behaviors, all add to the complexity of providing treatment to this population. Consequently, psychologists often find themselves in multiple roles in order to effectively manage treatment for children with ASD and their families. The purpose of this article is to increase awareness of three major roles for clinical psychologists working with this population: assisting families with treatment coordination, identifying and treating comorbid psychopathology, and addressing parental stress.     

Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” (highest client autonomy) to “disclosure without the client’s knowledge or consent” (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.     

Effectiveness of Child-Directed Interaction Training for Young Japanese Children With Autism Spectrum Disorders

Abstract

This study examined the efficacy of Child-Directed Interaction Training (CDIT), the first phase of Parent-Child Interaction Therapy (PCIT), for Japanese children with autism spectrum disorders. The participants were 21 mother-child dyads with children aged 4–7 years; participants were assigned to an Immediate Treatment (IT) group or to a Waitlist (WL) control group. Across eight training sessions, mothers learned positive attention skills that were adapted from traditional PCIT training. Results showed CDIT not only improved social cognition skills and decreased disruptive behavior in Japanese children, but also reduced stress/distress among their mothers, particularly in relation to their own parenting skills and their child’s problem behaviors.     

A Brief Group Intervention Using Video Games to Teach Sportsmanship Skills to Children With Autism Spectrum Disorders

Impaired social skills represent a fundamental deficit for children with Autism Spectrum Disorders (ASD). Despite the potential importance of “good sportsmanship,” this social skill has received relatively little attention in the literature. The current study utilized a Behavioral Skills Training (BST) approach to teach three sportsmanship skills (i.e., complimenting, turn taking, and being a good sport) during video game play (Wii Sports). Six children with ASD completed this study. Findings suggest BST can be used effectively to teach sportsmanship skills to children with ASD. The use of video-game technology as part of social skills intervention programs is also discussed.     

Keeping a Sound Marriage: How Couples with Children with Autism Spectrum Disorders Maintain Their Marriages

This study focused on strengths and variables that contribute to marital successes for couples with children with autism spectrum disorders (in this article, referred to as “autism”). Particularly, the purpose of this study was to examine what husbands and wives with children with autism in contrast to couples with children who are typically developing identify as helpful to maintaining their marriages. Concept mapping methodology was used for this research study. Couples with children with autism and couples with children who are typically developing participated in telephone interviews and then grouped and rated the statements generated from their interviews. Groupings were translated into pictorial maps showing relationships and patterns. Couples with children with autism shared common perceptions about factors that help to keep their marriages strong: communication and shared foundational ideas about marriage. Communication was a cluster for all groups of husbands and wives. Only mothers of children with autism identified time for self-care as a distinct cluster.     

The Spectrum of Autism Spectrum Disorder: A Spectrum of Needs,Services, and Challenges

The dramatic rise in the diagnosis of autism spectrum disorders (ASDs) has resulted in a significant explosion in visibility and a substantial increase in the understanding of this complex group of disorders. Over the last decade, what was once defined only as “autism” has become a spectrum of neurodevelopmental disorders, with variable presentations and levels of impairment that requires an equally broad continuum of care. A wealth of research has not discovered a single “cause” for ASDs, but rather has found a range of genetic/genomic variations that likely play a significant role in the etiology of these disorders. Routine screening for autism is becoming more common, allowing for more timely diagnosis, and hopefully for earlier entry into appropriate and effective treatment. Although there remains no single ‘‘cure’’, there are treatments available that can improve overall functioning and decrease problematic or interfering symptoms across the full spectrum of this disorder. The wide spectrum of ASD presentations complicates treatment planning, with overall ASD severity a factor in determining type, intensity, and duration of interventions and services. This article presents a two-dimensional model of “ASD severity” that considers both the level of specific ASD symptoms/deficits and the level of cognitive resources/limitations as a framework for understanding needs, challenges, and potentially effective interventions for individuals across the ASD spectrum.     

Managing Child Behavior Problems in Children With Autism Spectrum Disorders: Utilizing Structural and Solution Focused Therapy With Primary Caregivers

Previous therapeutic models for modifying and managing problem behaviors in children with an Autism Spectrum Disorder have, typically, focused on working directly with the diagnosed child. The exclusion of other family member involvement in treatment displayed a need for creating a systemic model for managing children's problem behaviors. This model proposes Solution Focused Brief Therapy (SFBT) and Structural Family Therapy (SFT) with a focus on the caregivers of children with ASDs to reduce parental stress, increase parental self-efficacy, and ultimately begin to manage child behavior problems.     

Benefits of Including Siblings in the Treatment of Autism Spectrum Disorders

Having a brother or sister with an autism spectrum disorder (ASD) can significantly impact the life of a typically developing sibling. These relationships are generally characterized by less frequent and nurturing interactions than are evident in sibling constellations with neurotypical children or children with other developmental disabilities. One way to address this issue is to teach typically developing siblings skills to participate in a brother or sister's treatment. Including siblings in behavioral interventions is documented to be beneficial to both children, and is associated with generalization of skills for the sibling with ASD. Here we review this body of literature, present case examples from clinical practice, and make treatment recommendations for utilizing sibling-mediated behavioral approaches.     

Parent and Teacher Agreement of Behavior Problems in Youth Diagnosed With and Without Autism Spectrum Disorders

The prevalence and severity of behavioral problems in youth with autism spectrum disorders (ASD) may be context dependent leading to discrepant informants’ reports and complicating case conceptualizations and treatment goals. This study examines the inter-rater agreement of parents and teachers on behavioral problems of 58 youth with ASD and 42 youth without an ASD diagnosis. Parents and teachers of 26 youth with ASD (M?=?4.08, SD?=?1.02) and 21 youth with non-ASD diagnoses (M?=?4.38, SD?=?0.80), ages 2–5 years, and 32 youth with ASD (M?=?7.47, SD?=?1.44), and 21 youth with non-ASD diagnoses (M?=?7.71, SD?=?1.23), ages 6–10, completed the Child Behavior Checklist and Teacher Report Form. Compared to youth with a non-ASD diagnosis (ages 2–5 years), youth with ASD also had poor to moderate agreement across subscales with the exception of comparable substantial agreement on Externalizing Behavior (ICC?=?0.73 and ICC?=?0.63, respectively) and Aggressive Behavior subscales (ICC?=?0.72 and ICC?=?0.69, respectively). Compared to youth with a non-ASD diagnosis (ages 6–10 years), youth with ASD similarly had poor agreement across subscales with the exception of moderate agreement on Anxious/Depressed subscale (ICC?=?0.41 and ICC?=?0.06, respectively). These results suggest that the severity and prevalence of behavior problems in youth may depend on the context and reporter of the symptoms.     

Social Participation During Transition to Adult Life Among Young Adults With High-Functioning Autism Spectrum Disorders: Experiences From an Exploratory Multiple Case Study

This study aimed to explore the social participation of young adults with high-functioning autism spectrum disorders (HFASD) during their transition to adult life. A multiple case study was conducted using semi-structured interviews with a purposive sample of 10 participants (n = 10) composed of three adults with HFASD, their caregivers, and two representatives of community organizations. Four themes emerged: (1) access to services, (2) orientation to integrated life goals, (3) engagement in meaningful activities, and (4) gap in services before reaching independent living. Properly preparing and orienting the families could help them have a more satisfying social participation.     

Diagnostic and Assessment Findings: A Bridge to Academic Planning for Children with Autism Spectrum Disorders

Increasing numbers of children diagnosed and treated for autism spectrum disorders (ASDs) has impacted both neuropsychologists and educators. Though both play key evaluative and treatment roles, there is no available method or process in place enabling the translation of the neuropsychological report recommendations into a format educational teams can easily use, leading to a gap between neuropsychological recommendations and educational planning. In the following, we review the areas evaluated by a neuropsychologist when assessing a child with an ASD, discuss the domains targeted by educational teams when designing an educational plan, and then present a process that has met with some success creating a "bridge" between the diagnostic/assessment process and the subsequent academic planning. Though presented in the context of ASD, the process described can be used by neuropsychologists for various populations to facilitate partnerships with educators that result in improved care for the child.     

Use of Computer-Based Interventions to Teach Communication Skills to Children with Autism Spectrum Disorders: A Systematic Review

The purpose of this review is to provide a systematic analysis of studies involving the use of computer-based interventions (CBI) to teach communication skills to children with autism spectrum disorders (ASD). This review evaluates intervention outcomes, appraises the certainty of evidence, and describes software and system requirements for each included study. This review has three main aims: (a) to evaluate the evidence-base regarding CBI, (b) to inform and guide practitioners interested in using CBI, and (c) to stimulate and guide future research aimed at improving the efficiency and effectiveness of CBI in communication for individuals with ASD. Results suggest that CBI should not yet be considered a researched-based approach to teaching communication skills to individuals with ASD. However, CBI does seem a promising practice that warrants future research.     

Preparing Counselors to Meet the Needs of the Handicapped

The Education for All Handicapped Children Act (PL 94–142) mandates a number of counseling and allied services for the handicapped and their parents. In many cases counselors will need to acquire additional information and training to meet the needs of this special population. This article outlines many competencies that need to be considered in developing pre-service and in-service programs for counselors serving the handicapped. Hosie discusses several professional development areas relating to these competencies, and provides resources and training materials.     

Anger Can Help: Clinical Representation of Three Pathways of Anger

Anger is a powerful emotion prevalent in therapy. An integrative model situating varied manifestations of anger within a purposive context of healing and repair following relationship trauma is needed. A first paper (Butler, Meloy-Miller, Seedall, & Dicus, 2017) approached anger as a psychological and relational construction of diffuse physiological arousal and provided a conceptual model of how the experience of offense interacts with a person's view of self in relation to other (VSIRO) in the formation of anger. Three resulting trajectories and pathways of anger were outlined. Here we provide clinical representations of these pathways—two pathways of hostile anger arising from pathogenic VSIROs (inflated, with accompanying externalizing anger, and collapsed, with accompanying internalizing anger), and a third pathway of benevolent anger, arising from a balanced VSIRO. Clinical application of the model through several vignettes illuminates its use in discriminating helpful from harmful pathways of anger and developing interventions for reshaping pathogenic anger to beneficent anger.     

The Internal Structure of the Aberrant Behavior Checklist Irritability Subscale: Implications for Studies of Irritability in Treatment-Seeking Youth With Autism Spectrum Disorders

Given the prominence of the Aberrant Behavior Checklist (ABC), Irritability Subscale (ABC-I), in treatment outcome studies, we conducted a critical examination of its internal consistency and relationship to other measures of irritability in 758 psychiatrically hospitalized youth with autism spectrum disorder. In exploratory and confirmation samples, we conducted factor and bifactor analyses to describe the internal structure of the ABC-I. Our results suggest that the ABC-I roughly represents a unidimensional construct of irritability, as indicated by a general factor in bifactor analysis. In addition to irritability, subordinate factors are presented that represent tantrums, verbal outbursts, self-harm, and negative affect. Notably, self-harm items explain a large proportion of variance independent of irritability. Therefore, their contribution in analyses of treatment effects should be considered. Further study or revision of the ABC-I may improve convergent validity with transdiagnostic formulations of irritability as well as prevent confound from self-harm in treatment studies for irritability in ASD     

Peer and Teacher-Selected Peer Buddies for Adolescents With Autism Spectrum Disorders: The Role of Social,Emotional, and Mentalizing Abilities

This study examined mentalizing abilities, social behavior, and social impact of adolescents who expressed the willingness to become peer buddies for adolescents with Autism Spectrum Disorders, and adolescents selected by their teachers and peers. Twenty-seven teachers and 395 adolescents from public high schools completed mentalizing abilities, social status, behavioral, and peer buddy nomination measures. Findings suggest that social status and preference play a significant role in the selection of peer buddies by both teachers and classmates. Furthermore, more advanced Theory of Mind (ToM) abilities and the engagement in prosocial behaviors differentiated peers selected as buddies from other classmates. When compared with nonparticipating students, adolescents who expressed willingness to participate were more often girls, and were more prosocial. Agreement between teacher and peer nominations of best peer was moderate.     

Effects of Self-Monitoring Intervention on Independent Completion of a Daily Living Skill for Children With Autism Spectrum Disorders in China

Abstract

The purpose of this study was to investigate the effect of a self-monitoring intervention on the independent completion of dishwashing for three boys with autism (ages 6, 7, and 8) in China. The self-monitoring intervention included visual task analysis, in vivo modeling, self-recording, video self-feedback, and reinforcement. A multiple probe across subjects design was used. Prior to the study, the children had limited or no dishwashing skills, nor did they receive any training on self-monitoring. All three children acquired dishwashing and performed the task independently without supervision one week after the intervention. Their parents were very satisfied with this intervention.