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.     

Reflexive Social Orienting in Parents of Children with Autism Spectrum Disorders: Evidence from Gaze Cueing Paradigm

Twin and family studies have shown that Autism Spectrum Disorders (ASD) have a strong genetic basis and are highly heritable. First degree relatives of individuals with ASD often show mild expressions of autistic traits attributed to Broad Autism Phenotype (BAP). While numerous studies investigated different aspects of BAP, less research has been done on gaze orienting especially in parents. In the present investigation, 43 parents of children with ASD and 29 parents of typically developed children completed a modified version of gaze cueing paradigm. Results demonstrated that the control group used the eye gaze in a way that their RT was affected by congruent versus incongruent cues, while this effect was not observed in parents of individuals with ASD. Findings of the current study provide further evidence on gaze orienting deficits in parents of children with ASD, which might relate to their mild difficulties in mind-reading abilities and a common cognitive phenotype with their affected children.     

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.     

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.     

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.     

Attitudes Toward Autism Spectrum Disorders Among Students of Allied Health Professions

The prevalence of autism has increased dramatically. The objectives of this study were to explore attitudes toward prenatal diagnosis to detect autism prenatally and avoid having an affected child and to understand social acceptability of these disorders among students of allied health professions. In this study, college students of nursing and health systems management answered a structured self-report questionnaire (n?=?305). The first part addressed the respondent’s personal data. The second part targeted the respondent’s attitudes toward prenatal diagnosis of non-life-threatening disorders, including autism spectrum disorders. We found that almost two thirds of the students responded that they would not proceed with a pregnancy if the child were diagnosed with autism, and more than half thought that they would not continue with a pregnancy if the fetus were diagnosed with Asperger’s. Age, level of religiosity, and years of education were influential. This study is limited in scope; however, the positive attitude of the students toward prenatal diagnosis to avoid having an affected child might also reflect a negative view of autism spectrum disorders in future health care professionals. Further research of attitudes and the social acceptability of autism spectrum disorders, particularly among health care professionals, is required.     

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.     

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.     

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.     

Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ?70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

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.     

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.     

Parent-Implemented Early Social Communication Intervention for Young Children with Autism Spectrum Disorder

Journal of Behavioral Education - Numerous developmental difficulties differentiate children with autism from typically developing children, including delays in social communication skills. In this...     

Increasing Behavioral Variability and Social Skill Accuracy in Children with Autism Spectrum Disorder

Although social skills training for children with autism spectrum disorder (ASD) often addresses deficits in social communication, restricted and repetitive social behaviors are less frequently targeted in the literature. The present study evaluated a manualized social skills training program, modified to incorporate lag schedules of reinforcement, to promote appropriate and variable responding in three children in a school setting. Participants attended social skills once weekly, with probes of social skills taking place daily. A multiple baseline design across target skills was used to determine intervention efficacy. Results of the study indicated that the social skills curriculum incorporating lag schedules of reinforcement resulted in substantial increases in the number of appropriate and variable responses demonstrated by participants during each probe session, as well as the number of appropriate and variable responses demonstrated overall.     

A Personal Construct Approach to Understanding Stress in Mothers of Children Diagnosed with Autism Spectrum Disorders

This study explored the contribution of personal construct psychology (PCP) and the repertory grid technique to understanding stress when raising a child diagnosed with autism spectrum disorder (ASD). Associations between child level of functional impairment, parenting stress, psychological distress, and maternal construing were examined in mothers of 25 children diagnosed with ASD. Results suggest that a personal construct perspective may help delineate factors involved in parent adjustment to ASD.     

Financial Capabilities Among Youth with Autism Spectrum Disorder

Youth with Autism Spectrum Disorder (ASD) experience significant difficulties assuming adult responsibilities and achieving independence. Little is known about their desire or ability to manage their own finances. This study explored the financial circumstances, money management skills, and desires for financial independence among 27 youth with ASD. Youth took part in 30–60?min semi-structured interviews about independence. Strategies of theme analysis identified three critical themes about finances and emerging adulthood for youth with ASD. Youth (1) defined independence by being able to manage their finances, (2) worried about their lack of money management skills, and (3) cited poor financial skills as barrier to independence. Results suggest youth with ASD understand the importance of financial capability and strive for financial independence, but lack the skills and support needed to achieve their financial goals. This study provides preliminary information for clinicians, educators, and researchers to develop financial capability modules for youth with ASD.