How to behave ethically in a world of fads

Although applied behavior analysis (ABA) has significant scientific support for treating people with autism spectrum disorders (ASDs), the field of autism treatment has been plagued with rapidly proliferating fad treatments subjecting people with ASD to various ineffective, pseudoscientific, and antiscientific treatments. To combat this, professionals must learn to make ethical treatment decisions, sometimes before research is conducted or published. Even when research is available negating fads, behavioral professionals must also overcome misperceptions about ABA. The purposes of this paper are to provide behavioral professionals with (a) a mechanism for making ethical treatment decisions (using sensory integration as an example) and (b) a method for responding to potential misperceptions and obstacles to using ABA. Copyright © 2010 John Wiley & Sons, Ltd.     

Some actions for behavior analyst licensing bodies to consider in response to the COVID‐19 pandemic

The COVID‐19 global pandemic has had a significant impact on the practice of applied behavior analysis (ABA). Practitioners and caregivers have had to adapt quickly as physical distancing, stay‐at‐home orders, and shelter‐in‐place directives have become commonplace. As the field copes with the changes produced by the COVID‐19 outbreak, many behavior analytic practitioners are seeking guidance from regulatory bodies to ensure they are practicing legally and ethically. This article outlines some actions that the regulatory bodies that manage state behavior analyst licensure programs may consider to assist ABA practitioners and consumers during this unprecedented time. Additionally, suggestions are offered as to how state licensing bodies might prepare to support the practice of licensees during future events that present challenges similar to the current pandemic.     

APPLIED BEHAVIOR ANALYSIS: AUTISM AND BEYOND

Over the past 60 years, applied behavior analysis (ABA) has made notable contributions to the literature involving populations with developmental disabilities. Practitioners and researchers have made impressive advances in addressing challenges posed by autism spectrum disorder (ASD), in particular. The focus on autism has resulted in an improved public image of ABA and, in turn, has helped highlight the need for increased awareness surrounding ASD. A summary of relevant research contributions is provided, and although the advances in autism are impressive, individuals with ASD constitute a minority portion of the educational system. A review of the existing literature, as well as a novel literature search, supports the suggestion that ABA has narrowed its focus to issues affecting populations with ASD, while concurrently being less attentive to problems faced by society as a whole, particularly general education. Copyright © 2012 John Wiley & Sons, Ltd.     

Sleep disorders, epilepsy, and autism

The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum disorders. Epilepsy and sleep have reciprocal relationships, with sleep facilitating seizures and seizures adversely affecting sleep architecture. The hypothesis put forth is that identifying and treating sleep disorders, which are potentially caused by or contributed to by autism, may impact favorably on seizure control and on daytime behavior. The article concludes with some practical suggestions for the evaluation and treatment of sleep disorders in this population of children with autism.     

Development and Content Validity of the Participation and Sensory Environment Questionnaire

Qualitative methodology was used to develop items for a questionnaire designed to examine the perspectives of parents regarding the impact of the sensory environment on participation for children aged 3 to 5 who have autism spectrum disorders. A total of 34 parents/caregivers of children with autism spectrum disorders and 8 experts in autism spectrum disorders and/or measurement completed qualitative interviews for concept, content review, and cognitive interviewing. The result was a pool of 35 items for home/community domains for 3 scales. The outcome of this study was the development and content validation of the Participation and Sensory Environment Questionnaire.     

PERSONAL CONSTRUCT PSYCHOLOGY AND AUTISM

There has been no significant writing within personal construct psychology about autistic spectrum disorders, despite the fact that this approach provides promising models in a number of other specific areas of human difficulty. This article outlines a PCP model of autism, based on a wide variety of recent research findings and writings, including those of autism sufferers themselves. Autism is considered in the light of Kelly's fundamental postulate and 11 corollaries as well as Procter's (1978) group and family corollaries. It is argued that Kelly's theory provides an integrative framework for considering this complex set of disorders with implications for further research in autism and the early development of social cognition as well as for therapeutic and educational intervention in helping people struggling with autistic spectrum disorders.     

AUTISM TREATMENTS IN PRINT: MEDIA'S COVERAGE OF SCIENTIFICALLY SUPPORTED AND ALTERNATIVE TREATMENTS

Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and non‐scientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non‐scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non‐scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media. Copyright © 2013 John Wiley & Sons, Ltd.     

自闭症谱系障碍个体的焦虑：发生机制、评估与治疗

自闭症谱系障碍是一种神经发育性障碍, 主要表现为社会交往互动障碍和重复刻板性行为。焦虑或焦虑障碍常被认为是自闭症个体最普遍的共病之一。焦虑与自闭症之间的关系尚不明确, 自闭症个体的焦虑与无法忍受不确定性、杏仁核功能和体积、情绪调节策略、消极思维存在一定关联; 目前已经开发出专门用于自闭症个体焦虑的评估工具; 修订版认知行为疗法对自闭症个体焦虑的治疗取得了良好效果。未来的研究应着重探索自闭症个体焦虑的认知与神经机制, 检验专用评估工具的有效性, 继续关注现代技术(如虚拟现实技术)对自闭症个体焦虑的治疗效果。     

Theory of Mind in Infants and Young Children: A Review

Theory of mind, or mindreading, refers to our uniquely human capacity to infer what is in other people's minds. Recent research suggests that “implicit” elements of this ability can be seen as early as the second year of life, in infants’ spontaneous helping, communicative, and eye‐gaze behaviours. More “explicit” verbally mediated mindreading skills emerge in the preschool period, and these are positively linked to social competence. Research with typically developing children as well as those with autism spectrum disorders suggests that exposure to conversation about mental states promotes theory of mind development.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Autismus oder „Psychopathy“?

According to the concept of Hare autism spectrum disorders and psychopathy are associated with a strong deficit in empathy. However, empathy deficits in patients suffering from autism spectrum disorders and empathy deficits in individuals with psychopathic personality traits appear to be different. Some authors described the comorbid occurrence of psychopathic personality traits/psychopathy in individuals with autism spectrum disorders. The following article aims to approach this differential diagnostic problem by a brief review of the literature on a casuistic basis. This article reports the case of a highly remarkable 17-year-old adolescent. The case will be discussed according to the construct of psychopathy with reference to the concept of Hare.     

A systems neuroscience approach to autism: biological,cognitive, and clinical perspectives

Autism is a behaviorally defined disorder characterized by a broad constellation of symptoms. Numerous studies directed to the biological substrate demonstrate clear effects of neurodevelopmental differences that will likely point to the etiology, course, and long-term outcomes of the disorder. Consistently replicated research on the neural underpinnings of autism is reviewed. In general, results suggest several main conclusions: First, autism is a heterogeneous disorder and is likely to have multiple possible etiologies; second, structural brain studies have indicated a variety of diffuse anatomical differences, reflective of an early developmental change in the growth or pruning of neural tissue, rather than localized lesions; similarly, neurochemical studies suggest early, neuromodulatory discrepancies rather than gross or localized abnormalities; and finally, there are a number of limitations on studies of brain activity that to date preclude definitive answers to questions of how the brain functions differently in autism. The large number of active research programs investigating the cognitive neuroscience of autism spectrum disorders, in combination with the exciting development of new methodologies and tools in this area, indicates the drama and excitement of work in this area.     

Behavioral treatments for sleep problems in autism: empirically supported or just universally accepted?

With health maintenance organizations and insurance companies requiring proof of treatment efficacy, clinicians must determine whether research supports commonly used treatment methods. To determine the effectiveness of applied behavior analysis (ABA) for treating sleep problems in children with autism, a computer search of all relevant literature was conducted. The resulting articles revealed four basic themes of behavioral techniques for treating sleep disorders for children with autism: bedtime routines, extinction, stimulus fading, and faded bedtimes. Research on each technique was evaluated based on the Chambless criteria of treatment efficacy (Chambless and Hollon, 1998 ; Lonigan, Elbert, and Johnson, 1998 ). Of the ABA methods, only research on extinction provided sufficient evidence for a possibly efficacious intervention for sleep problems in children with autism. However, the lack of available research indicates significantly more research must be conducted before endorsing other ABA methods. Copyright © 2001 John Wiley & Sons, Ltd.     

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.     

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.     

The felt presence of other minds: Predictive processing,counterfactual predictions,and mentalising in autism

The mental states of other people are components of the external world that modulate the activity of our sensory epithelia. Recent probabilistic frameworks that cast perception as unconscious inference on the external causes of sensory input can thus be expanded to enfold the brain’s representation of others’ mental states. This paper examines this subject in the context of the debate concerning the extent to which we have perceptual awareness of other minds. In particular, we suggest that the notion of perceptual presence helps to refine this debate: are others’ mental states experienced as veridical qualities of the perceptual world around us? This experiential aspect of social cognition may be central to conditions such as autism spectrum disorder, where representations of others’ mental states seem to be selectively compromised. Importantly, recent work ties perceptual presence to the counterfactual predictions of hierarchical generative models that are suggested to perform unconscious inference in the brain. This enables a characterisation of mental state representations in terms of their associated counterfactual predictions, allowing a distinction between spontaneous and explicit forms of mentalising within the framework of predictive processing. This leads to a hypothesis that social cognition in autism spectrum disorder is characterised by a diminished set of counterfactual predictions and the reduced perceptual presence of others’ mental states.     

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.     

An Evolutionary Life History Framework for Psychopathology

In this article, I outline a general framework for the evolutionary analysis of mental disorders based on the concepts of life history theory. I synthesize and extend a large body of work showing that individual differences in life history strategy set the stage for the development of psychopathology. My analysis centers on the novel distinction between fast spectrum and slow spectrum disorders. I describe four main causal pathways from life history strategies to psychopathology, argue that psychopathology can arise at both ends of the fast–slow continuum of life history variation, and provide heuristic criteria for classifying disorders as fast or slow spectrum pathologies. I then apply the fast–slow distinction to a diverse sample of common mental disorders: externalizing disorders, schizophrenia and autism spectrum disorders, obsessive-compulsive disorders, eating disorders, and depression. The framework integrates previously disconnected models of psychopathology within a common frame of reference and has far-reaching implications for the classification of mental disorders.     

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.