A video parent-training program for families of children with autism spectrum disorder in Albania

BackgroundBehavioral intervention with parent participation is effective in reducing symptoms of Autism Spectrum Disorder (ASD), but access to intervention is limited. The current study explored whether a video-enriched parent-training program would (a) be comprehensible and acceptable to parents in the Republic of Albania, (b) increase parental knowledge of behavioral strategies, and (c) increase parental self-efficacy.MethodsTwenty-nine parents of children with ASD aged 18–70 months completed the Early Intervention Parenting Self-Efficacy Scale (EIPSES, Guimond et al., 2008) and a quiz to assess their knowledge of behavioral strategies. Parents in the Treatment Group then received access to a parent-training (PT) program on evidence-based teaching and behavior management techniques. The program was based on empirical research, but considered Albanian cultural norms and included topics Albanian parents requested. Parents in the Treatment Group rated the program using the Treatment Evaluation Inventory Short Form (TEI-SF; Kelley et al., 1989). Change in parents’ quiz scores and EIPSES ratings from baseline to post-treatment were compared by group.ResultsParents rated this video training program as comprehensible and valuable. The program modestly increased aspects of self-efficacy as well as parents’ knowledge of effective teaching strategies.ConclusionRemote PT may be useful in low-resource settings to help parents develop techniques for teaching skills and forestalling problem behavior in children with ASD. Additional research, with a larger sample size, that observes the effect of the program on child behavior is warranted.     

The inclusion of fathers in investigations of autistic spectrum disorders

Recent reviews indicate an underrepresentation of fathers in empirical investigations of child development and psychopathology (Cassano et al., 2006, Phares et al., 2005). The purpose of the current study was to examine the nature of parental involvement in research on children with autistic spectrum disorders (ASD). Articles published over the last decade from journals with the highest impact factors in disciplines relevant to the study of ASD were reviewed, including areas of psychiatry, developmental psychopathology, and developmental disabilities. A total of 404 articles were included in the review and were coded to determine if parental inclusion and method of statistical analysis varied as a function of child age, journal type, year of publication, and parent gender. Results were consistent with findings from recent reviews and indicated that fathers are widely underrepresented in the literature on ASD, even more so than rates of inclusion in investigations of developmental and child clinical psychology. In contrast to findings from broad reviews of parental inclusion in studies of child psychopathology, fathers’ involvement was not higher in older versus younger age of child participant. Clinical implications and recommendations to improve inclusion rates of fathers in research on children with ASDs are discussed.     

Problem behavior interventions for young children with autism: a research synthesis

This paper provides a summary of research on behavioral interventions for children with autism 8 years of age or younger published between 1996 and 2000. The analysis is divided into four sections: (1) emerging themes in the technology of behavior support, (2) a review of existing research syntheses focusing on behavioral interventions, (3) a new literature review of current pertinent research, and (4) an evaluative discussion of the synthesis results and the field's future needs to develop effective behavioral interventions for young children with autism. The authors offer recommendations for strengthening the existing research base and advancing behavioral technology to meet the needs of the defined target population.     

Treatment of autistic children: Relative effectiveness of residential,out-patient and home-based interventions

This study investigates the relative effectiveness of three different treatment approaches on three groups of autistic children. Only theHome-based group showed significant improvements on the behavioral observation measure. Further, the nonresidential groups (Home-based andOutpatient) were the only groups who demonstrated consistent improvements as measured by the Functional Behavior Checklist. Overall, few differences existed, indicating that the effects of the different interventions were comparable. Therefore, for both clinical and economic reasons, nonresidential approaches should be implemented initially with autistic children.The authors wish to extend their appreciation to the Hospital for Sick Children Foundation, without whom this study would not have been possible. The authors would also like to thank the following people who helped in this study: Dr. Jalal Shamsie, Dr. Steven Stein, Mary McMillan, Dr. Greg Mazuryk, Dr. Tony LePage, Dr. David Hung, Dr. Leslie Gardner, Heather McPherson, Heather McKiernan, Richard Darjes, Nancy Freeman, Angie Hussein, Dr. Julie Malvesuto, and Chris Gibbons. Finally, we would like to thank all the children, families and staff of House 17 for their cooperation and participation in this study.     

85例儿童孤独症临床分析

目的 探讨儿童孤独症的临床特征以及相应的干预措施。方法 调查患儿首诊主诉、发病与就诊时间间隔、个人史以及家庭史。采用PPVT、DDST智力量表,CARS、ABC孤独症量表以及ADQ儿童适应行为评定量表进行测试。结果 85例患儿临床症状完全符合DSM-Ⅳ儿童孤独症诊断标准。临床特征以社会交往障碍、言语障碍、智力迟滞以及主动回避与他人眼对视为主。患儿从发病到就诊时间平均延迟22个月。45例(占53％)患儿系由剖宫产或产钳助产而娩出。结论 作者提出早期发现,早期干预以及综合性行为、语言等训练对孤独症来说至关重要。     

Parent inclusion in Early Intensive Behavioral Intervention: the influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes

Although early intensive behavior interventions have been efficient in producing positive behavior outcome in young children with Autism Spectrum Disorder, there is a considerable variety in the children's progress. Research has suggested that parental and treatment factors are likely to affect children's response to treatment. The purpose of the current study was to examine the interrelating factors that impact children's progress, highlighting the influence of parent inclusion in treatment provision captured by parental stress, how faithfully the parents followed the treatment protocols and the intensity of treatment provided at home. Twenty-four children received cross-setting staff- and parent-mediated EIBI, including continuous parent training and supervision. A comparison group of 20 children received eclectic intervention. Standardized tests were carried out by independent examiners at intake and after six months. The intervention group outperformed the eclectic group in measures of autism severity, developmental and language skills. Parent training and constant parent-mediated treatment provision led to reduced challenging behaviors from the children, increased treatment fidelity and child direct behavior change as measured by performance in correct responding on behavior targets. Variables of treatment progress and potential predictors of child outcome were analyzed in detail and mapped with regard to their relationships drawn from multiple regression analysis. Particularly, the study highlights an association between parental stress and staff treatment fidelity that interferes with decision making in treatment planning and consequently with positive behavior outcome. Such results provide important scientific and clinical information on parental and treatment factors likely to affect a child's response to treatment.     

Sleep quantity and quality as predictors of behavior and mental health issues for children and adolescents with autism

BackgroundResearch has supported a relationship between sleep problems and day-time behavior and mental health for young children with autism. Fewer studies have investigated these relationships across young children to adolescents.MethodThis study analyzed data retrieved from a sleep and behavior data base constructed from information obtained from patient charts and psychological assessments at a developmental pediatric clinic. The study evaluated the relationships among sleep quality and quantity (measured by the Behavioral Evaluation of Disorders of Sleep), age, and mental health and behavior problems (measured by the Child Behavior Checklist) for children and adolescents with autism (N = 446) from 16 months to 18 years old.ResultsResults indicated that despite age, children and adolescents with autism who experienced sleep quantity and quality problems were more likely to experience internalizing (e.g., anxiety/depression), and externalizing (aggression, destructiveness, delinquency) behavior problems. Internalizing and externalizing behavior problems were associated with sleep behavior, such as sensitivity to environmental stimuli, waking during the night, disoriented waking, and fewer hours of sleep (last 24 h for externalizing and total).ConclusionsThe results of this study replicate and extend previous research on daytime behavior, mental health, and sleep quality and quantity relationships. Indications of sensitivity to the environment to these daytime issues indicates the need for subsequent research delineating the influence of variables within the biopsychosocial model (e.g., sensory hyperarousal) of the inter-relatedness of sleep, daytime behaviors, and mental health for individuals with autism across the lifespan.     

A review of behavioral interventions for the treatment of aggression in individuals with developmental disabilities

Aggression can present as a significant problem behavior in individuals with a diagnosis of developmental disability. Much research has focused on the prevalence of aggression in individuals with varying degrees of severity of intellectual disability (AD), autism spectrum disorders (ASD) and co-morbidity of ID and ASD. Research has also focused on the impact of aggressive behavior on individuals’ development including cognitive, adaptive and social functioning. The literature on Applied Behavior Analysis provides abundant examples of various interventions that are effective in reducing or eliminating aggressive behavior across a range of ages and degrees of developmental disabilities. Many interventions report success using antecedent alterations, reinforcement-based strategies and consequence manipulations. The current review provides a focused, comprehensive examination of aggressive behavior intervention research for individuals with developmental disabilities aged 3-18 years published between 1980 and 2009.     

Low-level lead exposure and autistic behaviors in school-age children

IntroductionThe association between lead exposure and autism spectrum disorder is inconclusive. We hypothesized an association between higher blood lead concentrations and more autistic behaviors, including impaired social interactions and communication, stereotypical behaviors, and restricted interests, among school-age children.MethodsData from 2473 Korean children aged 7–8 years who had no prior history of developmental disorders were analyzed. Two follow-up surveys were conducted biennially until the children reached 11–12 years of age. Blood lead concentrations were measured at every survey, and autistic behaviors were evaluated at 11–12 years of age using the Autism Spectrum Screening Questionnaire (ASSQ) and Social Responsiveness Scale (SRS). The associations of blood lead concentration with ASSQ and SRS scores were analyzed using negative binomial, logistic, and linear regression models.ResultsBlood lead concentrations at 7–8 years of age (geometric mean: 1.64 μg/dL), but not at 9–10 and 11–12 years of age, were associated with more autistic behaviors at 11–12 years of age, according to the ASSQ (β = 0.151; 95% confidence interval [CI]: 0.061, 0.242) and SRS (β = 2.489; 95% CI: 1.378, 3.600). SRS subscale analysis also revealed associations between blood lead concentrations and social awareness, cognition, communication, motivation, and mannerisms.ConclusionEven low blood lead concentrations at 7–8 years of age are associated with more autistic behaviors at 11–12 years of age, underscoring the need for continued efforts to reduce lead exposure.     

A multisite trial of atomoxetine and parent training in children with autism spectrum disorders: Rationale and design challenges

Several randomized controlled trials (RCTs) involving children with autism spectrum disorder (ASD) have examined effectiveness of mono-therapies for problem behavior. However, results have not been as encouraging as in typically developing children. For example, when prescribed stimulants, children with ASD and hyperactivity/inattentiveness, show only moderately reduced symptoms, with frequent side effects. Therefore, alternative treatments or combinations of treatments are needed. The Children's Hyperactivity and Autism Research Treatment Study (CHARTS) is a randomized clinical trial comparing the individual and combined effects of atomoxetine and parent training to treat hyperactivity, inattentiveness, and noncompliance in children with ASD. Design challenges included the overall study design, targeting of different outcomes by different treatments, and data analysis. This article details options for addressing a number of these methodological issues in the context of conducting a large multicenter RCT with an ASD population.     

Psychosocial interventions for reducing vocal challenging behavior in persons with autistic disorder: A multilevel meta-analysis of single-case experiments

Vocal challenging behavior (VCB) forms a common problem in individuals with autistic disorder. Since VCB is associated with negative outcomes for the individual and his or her environment, it is important to know how to manage this type of CB. To evaluate the effectiveness of several psychosocial interventions applied to decrease VCB in individuals with autistic disorder, we conducted a meta-analysis of single-case experiments (SCEs). Fifty-two SCEs, including 74 participants, were combined using a multilevel meta-analysis. The overall treatment effect was large and statistically significant. However, the effect varied significantly over the included studies and participants. Examining this variance, evidence was found for a moderator effect of VCB type and intervention type, with, on average, the largest effects for interventions used to reduce VCB including stereotypical VCB and for interventions containing both antecedent and consequence components. Age, gender, primary treatment setting, publication year, and study quality did not significantly moderate the intervention effect.     

Factors influencing treatment decisions by parents for their children with autism spectrum disorder

Studies examining the treatment choices of parents of children with autism spectrum disorder (ASD) have mostly addressed questions about the prevalence of certain treatments. Fewer studies have examined the factors that influence their treatment decisions. In this study, 18 parents of children with ASD rated treatments according to their knowledge about them and how effective they believed them to be. They then distributed tokens representing resources (i.e., money, time, and energy) amongst the treatments they were currently using, or would use were there fewer constraints. Finally, they distributed tokens amongst hypothetical treatments about which they were only given information regarding empirical support and immediacy of outcome. Without the constraints of cost and availability participants distributed resources broadly. However, participants showed a preference for empirical support over immediacy of treatment outcome.     

Use of peer-mediated interventions in the treatment of autism spectrum disorders: A systematic review

This review involved a systematic analysis of studies that focused on the use of peer-mediated interventions (PMI) in the treatment of individuals with autism spectrum disorders (ASD). Forty-two studies that met pre-determined inclusion criteria were analyzed and summarized in terms of: (a) participants receiving intervention, (b) peers implementing, (c) method of training peers, (d) intervention procedures, and (e) desired outcomes. Further, we critically appraised each study's design and related methodological details in order to determine certainty of evidence. Collectively, the 42 studies involved a total of 172 participants who received intervention from a total of 396 trained peers. The reported outcomes were mostly positive (91%), but the studies are limited because treatment fidelity was only rarely assessed. Overall, the reviewed studies suggest that PMI is a versatile and potentially effective intervention approach for individuals with ASD.     

Role of hedgehog protein family members in autistic children

BackgroundThe neurological basis for autism is still not fully understood, and the role of the interaction between hedgehog (hh) protein family members, Sonic hedgehog (Shh), Indian (Ihh), and Desert (Dhh) biological activities have not been previously undertaken in autism spectrum disorder (ASD).MethodsSerum levels of Shh, Ihh and Dhh were determined in the plasma of 57 Saudi patients, categorized as mild-moderate and severe as indicated by their Childhood Autism Rating Scale (CARS) and compared to 27 age- and gender-matched control samples.ResultsThe data indicated that autistic children had higher serum levels of Shh (P = 0.001), Ihh (P = 0.001) and lower level of Dhh (P = 0.003) than those of normal controls. Moreover, serum levels of Shh had significant positive correlations with Dhh (P < 0.002).ConclusionsThis study suggests that higher levels of Shh, Ihh and lower Dhh levels may play a role in the pathophysiology of autism.     

孤独症与精神分裂症患者异常淋巴细胞的对照研究

目的了解孤独症患者免疫功能状况以及孤独症和精神分裂症在免疫指标上是否存在联系。方法采用随机、双盲法检测２４例孤独症和１５例精神分裂症患者外周血中的异常淋巴细胞。患者均未服过抗精神病药，精神分裂症为首次发作。结果孤独症和精神分裂症患者外周血中Ｐ型异常淋巴细胞分别为１２．７％±９．２％、１７．６％±８．７％，均较各自正常对照组（分别为３．２％±２．３％、５．１％±４．３％）显著增多（Ｐ＜０．０１），而孤独症组与精神分裂症组之间差异无显著性（Ｐ＞０．０５）。结论孤独症存在免疫功能异常，且在免疫指标上与精神分裂症存在某些相似的异常表现     

Predictors of self-reported resilience in parents of autistic children

BackgroundThough an emerging evidence base has documented the elevated stress and unique challenges among parents of autistic children, less is known about resilience. Based on the resilience-stress model (Fletcher & Sarkar, 2013; Masten, 2011), resilience may be a promising area of investigation given its inverse relationship with stress.MethodFifty parents of autistic children (4:0–10:11 years) self-reported resilience on the Connor-Davidson Resilience Scale (CD-RISC) and completed additional questionnaires, which were categorized into three classes of predictors: psychological functioning, child factors and parenting stress, and positive mental health practices. Regression analyses were conducted to identify the amount of variance in CD-RISC scores explained by the overall model and each class of predictors. The relative strength of individual predictors was investigated.ResultsThe overall model accounted for 66% of the variance in self-reported resilience scores. Two classes of predictors were significant – psychological functioning and positive mental health practices – while child factors and parenting stress were not. Specifically, the class of psychological functioning variables accounted for 45% of the variance in resilience scores and positive mental health practices accounted for an additional 19%. The individual predictors of anxiety, stress, optimism, and self-compassion were the most robust.ConclusionsFindings indicate that certain factors – anxiety, stress, optimism, and self-compassion – are important in understanding self-reported resilience among some parents of autistic children. This may suggest treatment targets for resilience interventions. Continued investigations with larger, more representative samples are needed to expand the present findings.     

Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample

Aggressive behavior problems (ABP) are frequent yet poorly understood in children with autism spectrum disorders (ASD) and are likely to co-vary significantly with comorbid problems. We examined the prevalence and sociodemographic correlates of ABP in a clinical sample of children with ASD (N = 400; 2–16.9 years). We also investigated whether children with ABP experience more intensive medical interventions, greater impairments in behavioral functioning, and more severe comorbid problems than children with ASD who do not have ABP. One in four children with ASD had Child Behavior Checklist scores on the Aggressive Behavior scale in the clinical range (T-scores ≥ 70). Sociodemographic factors (age, gender, parent education, race, ethnicity) were unrelated to ABP status. The presence of ABP was significantly associated with increased use of psychotropic drugs and melatonin, lower cognitive functioning, lower ASD severity, and greater comorbid sleep, internalizing, and attention problems. In multivariate models, sleep, internalizing, and attention problems were most strongly associated with ABP. These comorbid problems may hold promise as targets for treatment to decrease aggressive behavior and proactively identify high-risk profiles for prevention.