A Systemic Treatment of Families with a Child Diagnosed with Autism Spectrum Disorder Using a Narrative Lens

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder that now affects one in 59 children, a 15% increase from the 2012 report. Although there have been numerous studies on the treatment of ASD, interventions focus primarily on the individual diagnosed with ASD. Marriage and family therapists’ (MFT) are in a unique position to handle the systemic dynamics of ASD. As a result, many MFTs find it difficult and outside their scope of practice to work with these families. We will explore aspects of narrative family therapy, conceptualization, and interventions, giving the reader a base understanding of how to implement narrative therapy while working with this population.     

Resilience in Families Adapting to Autism Spectrum Disorder

This study explored adjustment and adaptation in families living with Autism Spectrum Disorder (ASD). Data on family resilience were collected from 19 biological mothers of children with ADS. The data were analysed qualitatively and quantitatively to yield information on factors that enable these families to bounce back from the diagnosis and accompanying challenges with regard to ADS. The findings from the qualitative analysis indicate that social support, the spousal relationship, and family time, togetherness and routines are the most important resilience-promoting factors with ASD. Family hardiness, family problem-solving communication, and family time and routines were significant resilience resources.     

Behavioral Telehealth Consultation with Families of Children with Autism Spectrum Disorder

In this study, desktop video teleconferencing was used to facilitate behavioral consultation at a distance with three parents of school‐age children with autism spectrum disorders. Parents were supported via desktop video teleconferencing as they conducted functional analyses and learned to implement an antecedent manipulation strategy, functional communication training, and a consequence‐based strategy. Parents then conducted a brief multi‐element treatment comparison to evaluate the preliminary effectiveness of each intervention strategy on their child's challenging behavior. The results of this study provide additional support to previous research suggesting that a telehealth model of behavioral consultation may be an effective way to assist parents of children with autism spectrum disorders address challenging behavior that disrupts family routines. Suggestions for future research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Family Experience of Safe: A New Intervention for Families of Children with a Diagnosis of Autism Spectrum Disorder

Systemic Autism-related Family Enabling (SAFE) is a new intervention for families of children with a diagnosis of Autism Spectrum Disorder (ASD). SAFE responds to international and national recommendations for improved care and the reported needs of families. SAFE draws from Family Therapy techniques, Attachment Narrative Therapy and known preferences of individuals with autism. Twenty two families of a child with a diagnosis of ASD severity level 1 or 2 were recruited. The families attended five 3-hour sessions. Family members completed the Helpful Aspects of Therapy Questionnaire (HAT) after each session. Analysis of the HAT data revealed that adults and children experienced SAFE to be helpful which was elaborated in terms of the following themes: therapist as helping reflection, increased understanding, feeling closer, more confident to reflect and problem solve, improved communication and feeling less alone and isolated. The findings are discussed to consider how SAFE can be improved and implemented to offer support for families. SAFE is a good candidate to fill a gap in autism related care.

     

Comparing Attention to Socially-Relevant Stimuli in Autism Spectrum Disorder and Developmental Coordination Disorder

Difficulties with social interaction have been reported in both children with an autism spectrum disorder (ASD) and children with developmental coordination disorder (DCD), although these disorders have very different diagnostic characteristics. To date, assessment of social skills in a DCD population has been limited to paper-based assessment or parent report. The present study employed eye tracking methodology to examine how children attend to socially-relevant stimuli, comparing 28 children with DCD, 28 children with ASD and 26 typically-developing (TD) age-matched controls (aged 7–10). Eye movements were recorded while children viewed 30 images, half of which were classed as ‘Individual’ (one person in the scene, direct gaze) and the other half were ‘Social’ (more naturalistic scenes showing an interaction). Children with ASD spent significantly less time looking at the face/eye regions in the images than TD children, but children with DCD performed between the ASD and TD groups in this respect. Children with DCD demonstrated a reduced tendency to follow gaze, in comparison to the ASD group. Our findings confirm that social atypicalities are present in both ASD and to a lesser extent DCD, but follow a different pattern. Future research would benefit from considering the developmental nature of the observed findings and their implications for support.     

A Novel Approach to Enhancing Upper Extremity Coordination in Children with Autism Spectrum Disorder

Abstract

Recent studies examining children diagnosed with Autism Spectrum Disorder (ASD) have revealed kinematic markers highlighting deficits in the preparatory and online phases of upper extremity movements. In the following study, 12 children with high functioning ASD were first assessed (pre-test) on 15 trials of a reciprocal upper extremity Fitts Law target task by flexing and extending their right arm in the horizontal plane between two targets as fast and accurately as possible. Following the initial assessment, the children either continued with 30 additional trials of the target task (control) or were asked to track a sine wave template (experimental). All participants were then assessed on 15 trials of the target test (post-test). Results reveal that tracking the sine wave template during training not only produced faster movements compared to the control but also produced these movements in a more harmonic way.     

The Cultural Adaptation of a Transition Program for Latino Families of Youth with Autism Spectrum Disorder

During the transition to adulthood, effective and culturally relevant supports are critical for families of youth with autism spectrum disorder (ASD). There is a dearth of documented program development and research on supports for Spanish-speaking Latino families during this life stage. The present work describes the cultural adaptation process of an evidence-based transition program for Latino families of youth with ASD. A model of the actions necessary to meaningfully conduct a cultural adaptation in this context is described. After implementing the culturally adapted program titled Juntos en la Transición with five Spanish-speaking families, parents reported high social validity of the program through surveys and interviews. The cultural adaptation process followed in this work is important for the further development of programs that address the transition needs of Latino youth with ASD and their families. Our impressions may also be useful to those who aim to develop culturally sensitive and ecologically valid multifamily group intervention programs for families from cultural and linguistic minority groups.     

The Experience of Crisis in Families of Individuals with Autism Spectrum Disorder Across the Lifespan

It is well-established that parents of individuals with autism spectrum disorder (ASD) experience significant stress in their caregiving role, and research findings indicate that chronic stressors can act as a precipitant to crisis. In the present study, we examined the experience of crisis in families of individuals with ASD from early childhood to adulthood. One hundred and fifty-seven comments provided by family members in response to an online survey were coded using grounded theory methods. We explored three components of crisis drawn from the comments: antecedents (precipitating events and the context of crisis), behaviors (the nature of crisis), and consequences (outcomes and reactions to crisis). Similarities and differences in the crisis experiences among varying age groups are discussed, as well as implications for practice and future research.     

A Child With Autism Spectrum Disorder Teaches Siblings to Skateboard: Effects on Sibling Skills and Family Social Behavior

Abstract

Children with autism spectrum disorder (ASD) may have few common activities with their siblings who do not have ASD, and this can limit their opportunities for social play. In this study, we used a multiple-baseline across skills design to assess the effects of a boy with ASD following an activity schedule to teach his favorite activity of skateboarding to his two siblings who do not have ASD. Family social behavior was also measured before and after sibling training. After training by the boy with ASD, both of the siblings’ skateboarding skills improved, and measures of family social behavior also increased. Results suggest that sibling relationships may benefit when a child with ASD teaches siblings to play.     

On Associative Stigma: Implicit and Explicit Evaluations of a Mother of a Child with Autism Spectrum Disorder

Individuals with psychiatric problems are subjected to highly damaging stigma. Some research suggests that this stigma may extend to associates (e.g., family, friends), who themselves report being devalued, avoided, and rejected. The research literature on associative stigma is largely qualitative, and extant quantitative research has utilized only explicit measures which are notably weakened by self-presentational motives. In the current study, 95 undergraduates were randomized to hear one of two audio recorded vignettes pertaining to a fictional mother of a child with either autism spectrum disorder (ASD) or severe asthma. Participants then completed an Implicit Association Test capturing implicit evaluations of the fictional mother and two separate measures of explicit stigma. No group differences for either explicit measure emerged. However, the predicted group difference in implicit stigma emerged, such that the mother of the child with ASD was evaluated less positively than the mother of the child with severe asthma. Implicit-explicit correlations were not statistically significant but in the small to medium range according to effect size conventions. This study offers evidence of implicit associative stigma in the psychiatric domain. It also points to a variety of interesting avenues for further illumination of this potentially important phenomenon.     

Structural Family Therapy and Autism Spectrum Disorder: Bridging the Disciplinary Divide

ABSTRACT

Applied Behavior Analysis (ABA) is an evidence-based practice approach for the treatment of individuals with autism. The systemic effects of autism suggest that family therapy would considerably enhance the treatment of individuals with autism. Marriage and family therapy (MFT) training does not routinely include exposure to autism beyond the associated diagnostic criteria. Structural Family Therapy (SFT) is a systemic model that is familiar to those trained in family therapy and appropriate for the needs of families affected by autism. Therefore, the authors have used SFT as a foundation for supervising MFT trainees working in an autism treatment setting.     

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.     

自闭症谱系障碍者的视运动知觉

视运动知觉是人脑对外界物体的运动特性的知觉。视运动知觉异常是自闭症谱系障碍者的一种常见表现, 其检测光流、二阶运动、协同性运动、生物运动及运动速度的能力异于健康控制组, 且过度迷恋重复性运动物体。该群体视运动知觉异常的原因探析集中于背侧/M细胞通路特定假设、复杂性假设、神经噪声假设、经验缺失假设、时空加工异常假设、极端男性脑理论和社会脑假设。但到目前为止, 尚缺乏一个统一准确的、可验证的解释。未来研究应注重考察自闭症者视运动知觉异常的个体差异和神经生理机制, 进一步整合和验证解释理论, 并着眼开发有效的视运动知觉测评工具和干预策略     

Assessing Family Coordination in Divorced Families

Posttraumatic stress disorder (PTSD) and partner relationship difficulties commonly co-occur among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF). This study reports upon results for six male OEF-OIF Veterans with PTSD and their female relationship partners who completed cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD), which is a treatment that targets reductions in PTSD and couple distress. Case- and group-level data supported reductions in Veterans' PTSD symptoms and female partners' relationship distress. These findings suggest that CBCT for PTSD may be a promising intervention for OEF-OIF Veterans' PTSD and their partners.     

Mathematical Abilities in Elementary School Children with Autism Spectrum Disorder

Although clinical practitioners often express concerns about the mathematical functioning of children with autism spectrum disorder (ASD), the field of mathematics remains a relatively unexplored topic in individuals with ASD. Moreover, research findings are fragmentary and hold inconclusive results. The present study aimed to examine whether grade 1 (aged 6–7 years) to 4 (aged 9–10 years) elementary school children with ASD scored significantly different from age‐adequate norms on mathematics. To this end, a multi‐componential approach of mathematics was used. Four domains of mathematics were assessed in 121 children with ASD: procedural calculation, number fact retrieval, word/language problems, and time‐related competences. All children attended general education classrooms, following the standard curriculum, and were coached by integrated educational services. Children with ASD showed a strength in word/language problems in second and fourth grade. There was evidence of a weakness for procedural calculation in first grade and for time‐related competences in first and third grade. In all other cases, average scores were shown. As such, results revealed a profile of strengths, average abilities, and weaknesses in mathematics and highlighted the importance of focusing on different domains of mathematics. Because a high variability in mathematical performance could be observed, we recommend an individual assessment when considering the mathematical trajectory of children with ASD. Copyright © 2015 John Wiley & Sons, Ltd.     

Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, Clinical Child and Family Psychology Review 2:71–90, 1999; Sanders, Journal of Consulting and Clinical Psychology 68:624–640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, Journal of Clinical Child and Adolescent Psychology, 35(2):180–193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.     

Three Dimensions of Oppositionality in Autism Spectrum Disorder

In autism spectrum disorder (ASD), symptoms of oppositional defiant disorder (ODD) are common but poorly understood. DSM-5 has adopted a tripartite model of ODD, parsing its features into ‘angry and irritable symptoms’ (AIS), ‘argumentative and defiant behavior’ (ADB) and ‘vindictiveness’. This was based on findings in non-autistic populations that each of these dimensions of oppositionality has a distinct constellation of associations with internalising and externalising psychopathology. We applied the tripartite DSM-5 ODD model to ASD to test its generalisability beyond non-ASD populations; and to elucidate the nature of ODD symptoms in ASD. Participants were 216 verbally-fluent young people (mean age?=?9.6 years, range 3.0 to 16.2 years, 82 % male) with ASD. Cross-sectional parent-and teacher-report data were analysed using bootstrap multiple regression to test the following predictions, derived from studies of non-ASD young people: (1) AIS will be the main predictor of internalising problems; (2) ADB will be the main predictor of ADHD symptoms; (3) all ODD traits will independently predict conduct disorder symptoms; (4) vindictiveness will be the main predictor of aggressive conduct problems. Our findings using both parent and teacher data were consistent with the non-ASD ODD literature. AIS were associated with internalising but not externalising problems; ADB and vindictiveness were associated with externalising but not internalising problems; and vindictiveness was the main predictor of aggression. The DSM-5 tripartite model of ODD appears to be generalisable to ASD: for people with an autistic disorder, AIS, ADB and vindictive dimensions of oppositionality have distinct associations with concurrent psychopathology, suggesting the need to assess them as separate constructs.     

Enrichment and Stress in Families Caring for a Child with a Serious Emotional Disorder

We examined enrichment and stress in 214 families who had children with severe emotional disorders. Caregivers' ratings of enrichment and stress were obtained through a newly developed instrument, the Effects of the Situation Questionnaire, which used parallel items covering 17 life areas. While ratings of stress were generally higher than enrichment, caregivers reported some enrichment in areas encompassing self concept and family relationships, Bivariate and multivariate analyses using various child, family, and service-system variables revealed that stress was notably associated with severity of the child's disorder, low empowerment, and a lack of coordination among service providers. Enrichment was unrelated to severity but associated with high empowerment and spiritual support. Our findings suggest that families' experiences of caregiving can have both positive and negative aspects and that a comprehensive approach to serving and studying families should take both into account.     

Matrix Training for Generative Spelling in Children with Autism Spectrum Disorder

Children with autism often have difficulty in generative learning. Effective training program for generative learning in these children is needed. In this study, we examined the effectiveness of matrix training for generative spelling in two children with autism spectrum disorder (ASD). Matrix training is a procedure in which stimuli used in teaching are arranged with overlapping within‐syllable units. After training with a Constructed‐Response Matching to Sample (CRMTS) with matrix training, both participants' generative spelling was assessed by CRMTS test using untrained combinations of characters. In this study, spoken syllables (auditory stimuli) are presented as the sample stimulus, and written characters (visual stimuli) are presented as comparison stimuli in CRMTS task. As a result, both participants showed generative spelling by matrix training, however, one of the two participants needed additional matrix training. The results discussed the effectiveness of matrix training as a procedure for teaching generative spelling and some issues to be conducted in applying this procedure for Japanese reading and spelling in children with ASD. Copyright © 2011 John Wiley & Sons, Ltd.