Journal of Autism and Developmental Disorders最新文献

This comprehensive meta-analysis aimed to assess the effectiveness of digital interventions in improving developmental skills for children and adolescents with autism spectrum disorder (ASD). We conducted a systematic literature search based on three databases. A pre-test adjusted between-group standardized effect size was computed for effect size synthesis. We utilized a robust variance estimation model to analyze overall treatment effect. Moderator analyses and publication bias were also addressed. Twenty-eight studies (150 effect sizes) using randomized control trials (RCT; n = 22) or quasi-experimental designs (QED; n = 6) were included. Most studies (n = 22) included social-emotional skills as primary outcomes. The meta-analysis revealed a medium to large overall effect size, with Hedges' g = 0.62, 95% CI [0.36, 0.88], p < 0.001. We found that digital interventions have a statistically significantly large effect on enhancing social-emotional skills compared with language and communication skills, cognitive skills, daily living skills, and physical skills. The results of moderator analyses indicated that computer-based interventions have larger effect sizes in comparison to tablet/smartphone-based interventions. No statistically significant differences were observed between studies utilizing RCT and those using QED. We recommended the integration of digital interventions as supplemental resources in behavioral and educational interventions. Further research needs to focus on more females, young children, and adolescents with ASD in digital intervention research.

About half of autistic youth present with clinically interfering anxiety. Psychotherapies with exposure-focused elements are effective in academic clinical settings and controlled trials. However, there is relatively less research examining the implementation of modified interventions for autistic youth with anxiety in community mental health settings. The current study explores community members' perceptions of barriers and facilitators that impact autistic youth with anxiety's receipt of quality mental health services in their community. Semi-structured interviews were conducted with 15 autistic youth, 15 caregivers of autistic youth, 11 community mental health clinicians, and 8 community mental health clinic leaders. Interviews were analyzed thematically. Participants shared their experiences with facilitators and barriers to autistic youth with anxiety receiving quality mental healthcare. Themes that emerged include (1) characteristics of the autistic youth, (2) engagement of autistic youth and caregivers, (3) building rapport between providers, autistic youth, and caregivers, (4) access to mental health services, (5) intervention fit, and (6) provider characteristics. Based on participants' perspectives and suggestions, future directions for anxiety treatment programs tailored for autistic youth include building more time into the intervention sessions to build rapport, incorporating autistic youth's preferences into provider matches, and providing families with more psychoeducation.

Purpose: Research questions included: (1) What are rates of on- versus off-label prescribing among transition age youth and young adults on the autism spectrum (with and without intellectual disability [ID]) compared to similar-aged youth with ID and a comparison group? (2) What types of antipsychotics are prescribed to transition-age youth, and what factors are associated with prescribing ?

Methods: We conducted a cross-sectional analysis of 2019 U.S. Medicaid data from all states, DC, and Puerto Rico to evaluate antipsychotic prescribing in four transition-age groups aged 14-29y: autistic youth with ID (n = 108,892) and without ID (n = 218,484), an ID-only group (n = 193,733), and a comparison group without autism or ID (n = 269,819).

Results: Almost half of autistic youth with ID were prescribed an antipsychotic (45%), compared to 22% of autistic youth, 19% of youth with ID, and 3% of youth with no autism or ID. Among youth taking any antipsychotic, off-label prescribing was highest for autistic youth with ID. Autistic youth with ID were more likely to be prescribed both typical and atypical antipsychotics compared to youth without autism or ID. Young adults 18-29y were significantly more likely to be prescribed atypical and typical antipsychotics compared to youth 14-17y.

Conclusion: Prescribing of antipsychotics for individuals with developmental disabilities is high, particularly for those with ID. Additional research on prescribing reasons and prescriber characteristics is needed. Well-controlled longitudinal studies evaluating the short-term and long-term consequences of antipsychotic prescribing on autistic people across the lifespan is required.

Purpose: This study evaluated the effectiveness of the Program for the Education and Enrichment of Relational Skills (PEERS^®) for young autistic adults in Iran and explored participant and caregiver experiences.

Methods: Twenty-one autistic males aged 18-30 were randomly assigned to either a 16-week program or a waitlist control group. Weekly group sessions were held for participants and their parents. Quantitative assessments were conducted at baseline, post-intervention, and 12-month follow-up using Farsi versions of validated scales measuring social functioning, empathy, loneliness, and social skills knowledge.

Results: While no significant between-group differences were found in most outcome measures using repeated measures analyses, participants in the intervention group showed a statistically significant decrease in conflict scores reported by young adults (p = 0.026) and an increase in Test of Young Adult Social Skills Knowledge (TYASSK) (p = 0.008) after 16 weeks, which remained significant at 12 months (p = 0.046) based on paired t-tests. Focus groups identified several challenges in program implementation, including limited awareness of autism, resistance to homework, dense session content, and cultural barriers such as indirect communication norms and limited opportunities for social practice. However, participants reported meaningful improvements in confidence and social engagement. Families and therapists also expressed high satisfaction and a desire for follow-up sessions.

Conclusion: The findings suggest that PEERS^® is a culturally adaptable and positively received intervention for autistic young adults in Iran. The study emphasizes the importance of contextualizing interventions to local cultures and addressing the needs of underrepresented populations in autism research.

Purpose: Sleep problems and behavioural challenges are examined rarely in very young autistic children. We investigated sleep in 173 autistic children, close to their autism diagnosis (M_age = 2.49 years at diagnosis), focussing on sleep's relationship with daytime behaviour and vice versa, and examining if there were specific sleep problem-behaviour relationships in this very young cohort.

Methods: Caregivers of 173 autistic children (M_age = 2.58 years at data collection) provided information on their children's sleep (CSHQ; written descriptions) and behaviour (BASC-3, VABS-3). Demographic, ADOS-2 and developmental (MSEL) information were also available. Using parents' written descriptions and normative sleep data, children were categorized as severe (SSP) or typical (TSP) problems sleepers, or good sleepers (NSP) (Roussis et al., 2021). Kruskal-Wallis, correlation and regression analyses examined sleep and behavioural relationships among these three sleep groups.

Results: Most children (71.9%) had two or more sleep problems. The TSP and NSP groups did not differ on behaviour, showing significantly less hyperactivity, aggression, attention, and atypicality than the SSP group. Night waking/parasomnias, daytime alertness, and sleep initiation/duration for both sleep problem groups strongly correlated with increased hyperactivity, attention, anxiety, depression, and aggression. Sleep explained 38.4% of variance and 61.8% variance in behaviour, and behaviour explained 22.4% of variance and 32.1% of variance in sleep, for the TSP and SSP groups respectively.

Conclusion: Reciprocal relationships between sleep and behaviour in autism emphasise the importance of addressing sleep problems in young autistic children, at the time of diagnosis, as they can negatively impact behaviour and well-being.

Purpose: Social difficulties are fundamental aspects of autism spectrum disorder (ASD). However, behavioral issues such as attention difficulties, thought problems, externalizing behaviors, and internalizing behaviors can further hinder children's ability to develop social skills. We aimed to explore how co-occurring behavioral challenges may intensify social difficulties in autistic children and adolescents by assessing whether a higher prevalence of behavioral problems is associated with poorer social functioning in real-world scenarios.

Methods: We surveyed parents of 225 children diagnosed with ASD. Parents completed two questionnaires-the Child Behavior Checklist (CBCL) measuring psychiatric symptoms, and the Social Skills Improvement System (SSIS) assessing observable social abilities. We statistically analyzed the connection between behavioral scores and social scores.

Results: The results showed that more severe behavioral issues on the CBCL tied to weaker social skills overall on the SSIS. Among all behavioral domains, attention problems showed the strongest negative associations with total social skills and all subdomains. Thought problems also demonstrated significant negative association with several aspects of social functioning. Externalizing behaviors and internalizing behaviors were also negatively associated with social skills, though their effects were less pronounced than those of attention and thought problems.

Conclusion: Our findings provide real-world evidence that common co-occurring behavioral problems especially attention problems and thought problems showed strong negative associations with social skill difficulties in autistic children and adolescents. Screening for and adjusting conditions like attention problems, thought problems, and disruptive behaviors may be an important piece of helping autistic children build social competence.

Purpose: Autistic adults often face co-occurring depressive symptoms. While previous studies have focused primarily on depression in children with autism, this study aims to investigate the factors associated with depressive syptoms in autistic adults. By examining a broader range of variables including sociodemographic factors and autistic traits like sensory sensitivity and restricted and repetitive behaviors, we seek to gain a more comprehensive understanding of the elevated levels of depression within this population.

Methods: This quantitative study utilized a cross-sectional design. Two hierarchical regression analyses were conducted. The first analysis included all participants (N=438), focusing on demographic factors such as age, gender, income, in the first model and autistic traits such as repetitive behaviors, and depressive symptoms in the second model. The second analysis included a reduced sample (N=305) that additionally incorporated sensory sensitivity data.

Results: Older age, lower income, and a greater number of co-occurring psychosocial problems were significantly associated with higher levels of depressive symptoms.

Conclusions: Our research, unique by its large sample of adults with autism and innovative exploration of potential factors of influence, offers valuable insights into the unique challenges faced by autistic adults. Our findings highlight the difficulty older autistic individuals may encounter in accessing support services primarily designed for younger populations. Moreover, co-occurring problems and lower income can exacerbate these challenges, leading to instability and limited access to resources. These results underscore the urgent need for societal inclusion and tailored support systems to promote the mental well-being of autistic adults.

Purpose: The aim of the study is to examine (i) if young children with a family history of autism and/or ADHD differ on executive functions and deferred gratification in comparison to peers with no family history of autism or ADHD, (ii) the specificity of these domains in relation to early-life autistic and ADHD symptoms and adaptive functioning, and (iii) if deferred gratification and strong EF skills may function as protective factors in the association between symptoms and adaptive behaviour.

Methods: A total of 77 infant siblings at 3 years of age with a family history of autism only, autism and co-occurring ADHD, or no family history of these conditions (FH-TL) were assessed on behavioural lab-tasks (EF and deferred gratification), parent-rated adaptive behaviour using Vineland, and clinician ratings using ADOS-2 (autistic symptoms) and ADHD DSM-5 symptom rating scale (ADHD RS).

Results: Group comparisons showed that FH-autism and FH-autism + ADHD groups received lower scores on common EF, but not on deferred gratification in comparison to the FH-TL group. Lower levels of deferred gratification related to autistic symptoms, while lower level on EF was specific to ADHD symptoms. Finally, deferred gratification moderated the association between autistic symptoms and adaptive behaviour, in that stronger ability to defer gratification attenuated the association between autistic symptoms and adaptive functions.

Conclusions: These results are in line with the idea that strong ability to inhibit and defer gratification may act as a protective factor for children with a family history of autism and/or ADHD pointing to affective aspects of EF as particularly important.