Promising social skill interventions have emerged to target socialization vulnerabilities of autistic adolescents, but there remains a critical need for effective dissemination of these programs to improve service access. The Social Tools And Rules for Teens (START) Program is a group-based intervention program for increasing social motivation while enhancing social communication skill use.
The current study aimed to evaluate START Connections, an online adaptation of the original START model. We (1) assessed the preliminary efficacy, feasibility, and acceptability of START Connections, and (2) compared its outcomes to a prior in-person START clinical trial. Participants were 41 autistic adolescents aged 11–16 and their parent. Each bi-weekly START Connections session consisted of a check-in, socialization time, group discussion and practice of social topics, group activity, and check-out.
Attendance for the program was high and teens endorsed high levels of enjoyment and skill improvement. Analysis of treatment gains yielded evidence of increased emotion regulation, social skills, and social motivation. Improvements in behaviorally coded target skills were observed for many participants during naturalistic conversations. An analytical comparison revealed a comparable trend in outcomes between START Connections and in-person START groups for social challenges, self-reported social skill use, and social motivation and competence.
Overall, these pilot outcomes are extremely promising and suggest that the START Connections model is feasible and has the potential to improve social communication and emotion regulation in autistic teens. These results warrant a follow-up, RCT investigation evaluating the unique benefits of in-person versus online START Programs.
This study aimed to explore the effects of physical activity (PA) on motor skills and stereotypical behavior in children with autism spectrum disorder (ASD).
Studies were searched in PubMed, Web of Science, Embase, the Cochrane Library, and CNKI. A total of 14 studies with 345 participants were included in this study, and a random-effects model with the standard mean difference (SMD) was used to calculate the effect size. We include 6 scales to evaluate motor skills and 2 scales to evaluate stereotyped behavior.
Compared with the baseline, the PA group showed a significantly improved Test of Gross Motor Skills (TGMD) [SMD = 1.90 (95%CI: 0.78 to 3.02), p < 0.001] and Brininx-Oresetsky Test (BOT) [SMD = 7.37 (95%CI: 1.72 to 13.02), p = 0.01], while the control group did not significantly change in TGMD. For stereotyped behavior, there was a significant reduction in GARS-2 [SMD = −0.64 (95%CI: −1.10 to −0.18), p = 0.01] in the PA group compared with the baseline, while the control group did not significantly change.
This meta-analysis confirmed the beneficial effects of PA on motor skills and stereotyped behavior in children with ASD. Engaging in activities like ball games at moderate intensity can be beneficial. Further research should examine the specific effects of various PA types and intensities to enhance PA-based interventions for ASD.
Researchers have explored long-term outcomes for those diagnosed on the autism spectrum, including how autistic individuals come to develop a diagnostic identity. Establishing an identity around a diagnostic label may lead to positive impacts, including a sense of community for those who experience stigma. The topic of autistic diagnostic identity is relatively new and, as such, a synthesized understanding of this literature has yet to be conducted. This systematic review gathered peer-reviewed literature related to autistic diagnostic identity; 20 articles were included. Data were extracted based on design, funding, location, participant age/demographics, age of diagnosis, and definition, description, and impacts of autistic diagnostic identity. Findings highlight that autistic diagnostic identity formation is a time-sensitive process influenced by factors such as age at reporting and societal considerations. Impacts of autistic diagnostic identity, gaps in the literature, and implications for clinicians and professionals working with autistic individuals are discussed.
Findings for prenatal stress, previously measured through stressful life event surveys items or biomarkers, in association with ASD are inconsistent. We prospectively examined prenatal perceived stress and prenatal urinary cortisol (PUC) in association with ASD and other non-typical developmental (Non-TD) outcomes in the child in a high familial likelihood cohort.
The Perceived Stress Scale questionnaire was used to measure perceived stress in the longitudinal Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) Study. Cortisol was measured through 24-hr urine collections. At three years of age, an algorithm consisting of scores from the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL) was used to classify children with ASD, Non-TD, or typically developing (TD) outcomes. Relative risk ratios (RRR) with TD as the reference were estimated using multinomial logistic regression.
Increased perceived stress was associated with Non-TD in trimester 1 (RRR 1.10; 95% CI: 1.00, 1.21) and ASD in trimesters 2 and 3 (RRR 1.08; 95% CI: 1.02, 1.14 and RRR 1.08; 95% CI: 1.03, 1.14, respectively). Results with PUC were non-significant but were in the direction consistent with previous findings suggesting that decreased cortisol levels are associated with higher likelihood of ASD.
Findings support the hypothesis that higher perceived stress is associated with increased likelihood of ASD and possibly Non-TD, relative to TD. This suggests that stress reduction interventions during pregnancy could serve as preventative measures that help optimize the child’s long-term health. Larger studies are needed to replicate these findings.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that may be influenced by various factors, including nutritional status. This scoping review, adhering to PRISMA-ScR guidelines, aims to systematically explore and synthesize the existing literature on micronutrient (vitamins, minerals and trace elements) deficiencies in children with ASD and how they may differ from the general population of typically developing children.
A comprehensive search strategy was employed across multiple databases, selecting studies that quantitatively assessed micronutrient levels in children with ASD and control groups. The inclusion of 34 full-text publications from 17 countries provided a geographically diverse sample, ensuring a broad overview of the field.
The findings present a complex picture of micronutrient levels in children with ASD. A recurrent observation was lower vitamin D levels in children with ASD across multiple studies, while results for other vitamins, such as vitamins A and E, and minerals like iron (ferritin), iodine, and zinc were mixed and contradictory. The heterogeneity in study methodologies, participant characteristics, and controls for confounding factors, such as supplementation, were noted as significant variables influencing outcomes.
This scoping review accentuates the crucial need for standardized methodologies in future research to explore the underlying mechanisms of altered micronutrient levels in children with ASD and determine potential therapeutic implications. Emphasis on careful consideration of external variables, such as dietary habits and supplementation, is imperative to draw valid, reproducible conclusions in subsequent studies.
Autism is a common neurodevelopmental disorder in children. Evidence suggests that autism is associated with changes in puberty onset. Precocious puberty (PP) is the early development of secondary sex characteristics. This nationwide cohort study explored PP risk in autistic children.
Using data from the Taiwan National Health Insurance Research Database, 11,104 autistic children and 11,104 age- and sex-matched non-autistic children were enrolled between 2001 and 2011. Participants were followed from enrollment until the end of 2011 to determine the incidence of PP. Cox regression models were used to account for confounding factors, such as demographic characteristics and physical and psychological comorbidities.
Autistic children were more likely than non-autistic children to experience PP (hazard ratio: 6.48, 95% confidence interval: 3.61–11.62). Subgroup analyses by sex and intellectual disability further demonstrated consistent findings that PP was more prevalent in autistic children than in non-autistic children.
Autism is an independent risk factor for subsequent PP. Autistic children may have an increased PP risk, and early detection and treatment may reduce the psychological and physical consequences.
Nearly one in two autistic individuals is involved in sibling bullying, which is linked to increased mental health difficulties. Despite its high prevalence, only a handful of studies have focused on the relationship between sibling bullying and mental health in the autistic population. Of these, a vast majority of evidence comes from Western cultures while little is known about non-western cultures. For the first time, the current study investigated the cross-cultural variability in the prevalence and demographic and mental health correlates of sibling bullying between a Western (the United Kingdom) and non-western (Turkey) country. Parents of British (N = 289) and Turkish (N = 171) autistic individuals, aged 9–20 years, completed online questionnaires. Structural equation models were fitted to test the risk factors for behavioural and mental health correlates of sibling bullying. Overall, sibling bullying was highly prevalent in the lives of both British and Turkish autistic adolescents as more than two-thirds either bullied a sibling or were bullied by a sibling every week. While some potential risk factors for sibling bullying were present in both cultures (e.g., past sibling bullying experiences), some were culture-specific (e.g., having a male sibling (British), higher parental education (Turkish)). Consistent with previous reports, higher rates of sibling bullying were significantly correlated with poorer mental health in both British and Turkish samples. Additionally, sibling bullying was indirectly linked to mental health difficulties through detrimental social behaviours (British and Turkish) and emotion regulation (British-only) in autistic children and adolescents. There were no indirect correlations between sibling bullying and mental health through social skills in either sample. Implications of these findings as well as cross-cultural similarities and differences are discussed in more detail in light of the relevant cross-cultural psychological theory.
Parenting a child with autism spectrum disorder (ASD) is a major life challenge that leads to negative emotional distress and heavy parent duties. Parent-focused interventions have recently been developed to improve parents’ psychosocial well-being in caring for their children with ASD. This study aimed to evaluate the effectiveness of parent-focused interventions on improving psychological health in parents of children with ASD, when compared with active/inactive controls, and investigate the optimal features of the effective interventions found.
Comprehensive and systematic searches of articles was conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Central Register, ProQuest, and CNKI, from their inceptions to 31 December 2022.
A total of 21 eligible randomized controlled trials (RCTs) were included. The results indicated that the parent-focused intervention group showed reduced stress (Hedge’s g=−1.26), depressive symptoms (g=−0.71), and distress (g=−0.44) in parents and problem behaviours in children (g=−0.21) and improved parentchild relationships (g=0.51) compared with the active/inactive control group post-intervention, with moderate to high certainty of evidence. Moreover, subgroup analyses revealed that mindfulness-based interventions/acceptance commitment therapy (ACT) were the optimal intervention approach for reducing parental stress and depressive symptoms. The optimal intervention duration (five to eight weeks) and target participants (involving only parents) were also identified.
As mindfulness-based interventions/ACT were identified as the potentially best approach, future well-designed RCTs are recommended to further examine their effects on both parents and their children with ASD and explore the factors and mechanisms of action influencing the effectiveness of these interventions.
As the prevalence of autism spectrum disorder (ASD) increases, the number of students with ASD receiving their education in general education settings continues to rise. Yet, teachers are often underprepared to address the behavioral needs of autistic students in inclusive settings, which often leads to negative school outcomes. Currently, no review has systematically examined the characteristics and effects of behavioral interventions specifically for autistic students in general education settings. The purpose of this systematic literature review was to identify and synthesize empirical studies of interventions aimed at reducing the challenging behavior of students with ASD in general education settings.
A literature search was conducted across three academic databases, yielding 9561 articles that were screened for eligibility against a set of inclusion criteria. Additionally, an ancestral search of included articles and a pearling search of recent systematic reviews and meta-analyses on similar topics were conducted. Finally, 12 articles were descriptively synthesized.
A lack of participant diversity in relation to disability, age, and race was found across the studies. Majority of the interventions were effective and interventions informed by functional behavioral assessments consistently yielded strong effects. Joint implementation of interventions was the most common form of researcher-practitioner collaboration, with a relative lack of studies involving practitioners in designing interventions.
Findings of this review imply a broader issue of restrictive educational placement policies for autistic students who engage in challenging behavior and a critical need to support educators to implement more inclusive educational and behavior management practices.
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