A Meta-Analysis of Behavioral Interventions for Adolescents and Adults with Autism Spectrum Disorders

Evaluation of evidence-based treatments is important for adolescents and adults with autism spectrum disorders (ASD) given the increasing number of interventions available and the prevalence of ASD. In this study, we sought to evaluate the effectiveness of behavioral interventions for this population by conducting a meta-analysis of published single-case research studies. A new metric for calculating effect size in single-case research, nonoverlap of all pairs, was utilized. In addition, the certainty of evidence, a system to evaluate research methodology, was applied to the reviewed articles. Forty-three articles were identified in the study. Results suggested that the behavioral interventions in the areas of academic skills, adaptive skills, problem behavior, phobic avoidance, social skills, and vocational skills have medium-to-strong effect sizes. Medium-to-high confidence in findings was noted for 81 % of the studies in the meta-analysis; however, three-fourths of the reviewed studies did not include treatment integrity, which may affect the ability to draw conclusions about the effectiveness of the interventions. Overall, the evidence is promising for the use of behavioral interventions for this population; however, additional research and dissemination are needed to fill the gap between research and practice in order for practitioners to meet the increasing demand as individuals with ASD age.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis

The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.     

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.     

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.     

自闭症谱系障碍者异常的大脑功能连接

自闭症谱系障碍(Autism spectrum disorders, ASD)是一种常见的神经发育障碍, ASD在社交、语言、行为等方面的障碍与其异常的大脑功能连接存在密切关系。与正常发育者相比, ASD大脑既表现出远距离功能连接不足, 也表现出局部功能连接过度增强。ASD这种异常的脑功能连接受到结构异常、扫描状态、个体发展、分析方法等多种因素的影响。未来的ASD脑机制研究中, 要综合分析脑功能与结构, 关注年龄发展变化, 并将任务状态、被试取样、数据分析标准等因素纳入考察。     

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.     

Working Memory in Pediatric Epilepsy: A Systematic Review and Meta-Analysis

Neuropsychology Review - Working memory is a multicomponent system that is supported by overlapping specialized networks in the brain. Baddeley’s working memory model includes four...     

工作记忆容量与第二语言水平关系的元分析

运用元分析的方法,探讨在中外研究中工作记忆容量与第二语言水平的相关性和影响二者相关的潜在调节变量。通过文献搜索和筛选,共选择63项研究进行分析,时间跨度为1992-2014。结果发现,工作记忆容量与第二语言水平存在中等程度的正相关,效应值为0.358。调节效应检验发现文化背景、工作记忆测量方法、测量内容、测量语言有调节作用。结论：工作记忆容量与第二语言水平之间存在中等程度的正相关,文化背景和工作记忆测量调节二者之间的相关。     

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.     

An Abbreviated Screening Instrument for Autism Spectrum Disorders

The reliability and validity of the Parent's Observations of Social Interactions (POSI), a new, seven‐item screening instrument for autism spectrum disorders (ASD), is examined in two substudies. In Study 1, parents of 217 children (18–48 months) evaluated at a developmental clinic completed intake questionnaires that included the POSI and the Modified Checklist for Autism in Toddlers (M‐CHAT) checklist. POSI and M‐CHAT scores were compared to clinical evaluation results to assess reliability and validity. In Study 2, parents of 232 children (16–36 months) from both primary care and subspecialty settings completed the POSI, the M‐CHAT, and a report of their child's diagnoses. POSI and M‐CHAT scores were compared to reported diagnoses to assess reliability and validity. In both studies, the POSI demonstrated adequate internal reliability (Cronbach α = 0.83 and 0.86, respectively). In Study 1, POSI sensitivity (89%) was higher than that for the M‐CHAT (71%; p < .05); specificities were not significantly different (POSI: 54%, M‐CHAT: 62%). In Study 2, sensitivity (83%) compared favorably to that for the M‐CHAT (50%), although specificity was lower (75 vs. 84%). Despite its brevity, the POSI demonstrated good internal reliability and comparable sensitivity/specificity to the M‐CHAT checklist in two independent populations. If results are reproduced in larger, more diverse samples, the POSI may provide an efficient method for ASD screening in young children.     

自闭症谱系障碍者面孔识别的神经机制

自闭症谱系障碍（ASD）是一种心理状况的谱系障碍,其症状是社交及沟通上的广泛性异常、异常局限性的兴趣和高度重复性的刻板行为。包括自闭症、亚斯伯格症候群和待分类的广泛性发展障碍3类。研究主要以事件相关电位和功能性磁共振成像两种技术为线索,通过深入分析ASD患者在面孔识别认知过程中脑的异常变化,探讨其面孔识别障碍的神经机制问题。研究表明,ASD患者面孔识别能力的损伤主要与N170、N300、P400和Nc等ERPs成份异常及梭状回面孔区和杏仁核的低激活有关。研究推论ASD患者面孔识别障碍是多个异常脑区联合作用的结果,且主要受异常脑区的数量和损伤程度的影响。     

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.     

Differential Effects of Ecstasy on Short-Term and Working Memory: A Meta-Analysis

Quantitative analysis of studies examining the effect of ecstasy on short-term and working memory in the verbal and visuo-spatial domain was undertaken. Thirty verbal short-term memory, 22 verbal working memory, 12 visuospatial short-term memory and 9 visuospatial working memory studies met inclusion criteria. Ecstasy users performed significantly worse in all memory domains, both in studies using drug-naïve controls and studies using polydrug controls. These results are consistent with previous meta-analytic findings that ecstasy use is associated with impaired short-term memory function. Lifetime ecstasy consumption predicted effect size in working memory but not in short-term memory. The current meta-analysis adds to the literature by showing that ecstasy use in humans is also associated with impaired working memory, and that this impairment is related to total lifetime ecstasy consumption. These findings highlight the long-term, cumulative behavioral consequences associated with ecstasy use in humans.     

Functioning Among Typically Developing Siblings of Individuals with Autism Spectrum Disorder: A Meta-Analysis

Clinical Child and Family Psychology Review - The literature on typically developing siblings of individuals with autism spectrum disorder (ASD-Sibs) provides inconsistent results, with some...     

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.     

Facial Emotion Recognition in Autism Spectrum Disorders: A Review of Behavioral and Neuroimaging Studies

Behavioral studies of facial emotion recognition (FER) in autism spectrum disorders (ASD) have yielded mixed results. Here we address demographic and experiment-related factors that may account for these inconsistent findings. We also discuss the possibility that compensatory mechanisms might enable some individuals with ASD to perform well on certain types of FER tasks in spite of atypical processing of the stimuli, and difficulties with real-life emotion recognition. Evidence for such mechanisms comes in part from eye-tracking, electrophysiological, and brain imaging studies, which often show abnormal eye gaze patterns, delayed event-related-potential components in response to face stimuli, and anomalous activity in emotion-processing circuitry in ASD, in spite of intact behavioral performance during FER tasks. We suggest that future studies of FER in ASD: 1) incorporate longitudinal (or cross-sectional) designs to examine the developmental trajectory of (or age-related changes in) FER in ASD and 2) employ behavioral and brain imaging paradigms that can identify and characterize compensatory mechanisms or atypical processing styles in these individuals.     

Memory for emotionally arousing events over time in Autism Spectrum Disorder

Emotionally arousing events are typically better remembered and more resistant to forgetting than neutral events. Findings from word list paradigms suggest that this may not hold for individuals with Autism Spectrum Disorder (ASD), who also tend to be less accurate as eyewitnesses under some circumstances. To test whether attenuated effects of arousal on memory may be responsible for poorer eyewitness testimonies in ASD, we asked adults with and without the disorder to view either arousing or neutral versions of a narrated slide sequence (Experiment 1) or video clip (Experiment 2) before assessing their memory for the material. Both groups exhibited increases in psychophysiological arousal during the arousing compared with the neutral version of the narratives, and both groups also demonstrated a memory advantage for the arousing events. Contrary to predictions, these observations indicate that stimulus induced arousal modulates memory for naturalistic events relatively typically in ASD. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

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.     

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.