A Systematic Review of Psychosocial Interventions for Adults with Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASD) spend the majority of their lives as adults, and psychosocial interventions show promise for improving outcomes in this population. This research conducted a systematic review of all peer-review studies evaluating psychosocial interventions for adults with ASD. A total of 1,217 studies were reviewed, only 13 met inclusion criteria. The majority of studies were single case studies or non-randomized controlled trials, and most focused on applied behavior analysis or social cognition training. Effects of psychosocial treatment in adults with ASD were largely positive ranging from d = 0.14–3.59, although the quantity and quality of studies is limited. There is substantial need for the rigorous development and evaluation of psychosocial treatments for adults with ASD.     

Effective strategies for the inclusion of children with autism in general education classrooms

Successful inclusion of students with autism spectrum disorder (ASD) in general education classrooms can be challenging and may require additional supports. This article provides information on recent trends in autism intervention research and a review of research that has addressed individualized and systemic interventions for promoting inclusion. Response to intervention and schoolwide positive behavior support are reviewed as organizational/ systems strategies relevant to preventing problems and improving social and academic outcomes for students with ASD. Additional individualized strategies that can be implemented within these models are described. A discussion of future research directions is provided.     

A review of treatments for deficits in social skills and self-help skills in autism spectrum disorder

Deficits in social skills and self-help skills present significant challenges for individuals diagnosed with autism spectrum disorders (ASD). Much research in Applied Behavior Analysis (ABA) has been devoted to treatments for deficits in social skills and there exist a number of extensive reviews on the research in this area. Some research has also been conducted in the treatment of self-help skills although no comprehensive reviews of this research have been conducted. A combined acquisition of social and self-help kills is required by individuals diagnosed with ASD for successful independent living in society. The current literature review provides a comprehensive investigation and examination of studies focused on interventions for deficits in social skills or self-help skills in those with ASD. Twenty-two studies that met the inclusion criteria were chosen. Studies were categorised based on intervention. Key studies were defined as studies that added something novel to the literature, rather than replicating previous research. Each study was then evaluated on a number of aspects. All studies showed positive outcomes. Strengths, limitations and future recommendations are discussed.     

Use of school recess time in the education and treatment of children with autism spectrum disorders: A systematic review

School recess is an opportunity to include students with autism spectrum disorders (ASD) with their typically developing peers and is a setting in which instruction can occur. However, the educational opportunities for children with ASD within recess are often overlooked and recess time is being reduced or eliminated in the United States. This review involved a systematic search and analysis of 15 studies that utilized recess to implement academic, social, or behavioral interventions for students with ASD. Each identified study that met pre-determined inclusion criteria was analyzed and summarized in terms of: (a) participant characteristics, (b) intervention procedures, (c) dependent variables, and (d) intervention outcomes. This review has three main aims: (a) to evaluate and synthesize the evidence-base, (b) to inform and guide teachers interested in utilizing recess time for educational purposes, and (c) to stimulate and guide future research in this area. Results demonstrate that recess time can indeed be used to teach target behaviors to students with ASD.     

Overlap of autism and conditions associated with atypical sex hormone levels or response: A systematic review and meta-analysis

BackgroundThis review explored any altered risk of Autism Spectrum Disorder (ASD) associated with conditions with a known or postulated atypical exposure to androgens and oestrogens in early fetal development, and conditions associated with atypical hormone levels and responses within an individual.MethodSearches of Ovid Medline, PsychInfo and PubMed were completed until November 2019 with inclusion criteria of cohort, case control or clinical studies exploring the overlap of ASD with hormone-related conditions.ResultsOf 2640 studies, 49 met inclusion criteria exploring: Polycystic ovarian syndrome (PCOS), Klinefelter Syndrome, Turner Syndrome, Congenital Adrenal Hyperplasia (CAH), cryptorchidism, hypospadias, hirsutism; ovarian, uterine, testicular, cervical cancer; hypergonadotropic hypogonadism. Half had low risk of bias, with confidence in findings ranging from Very Low to Moderate, with all studies observational. Meta-analyses indicated 5 of 23 analyses had significant associations; with significantly increased odds of ASD in women with PCOS 1.48 [95 % CI 1.21–1.80], ASD in offspring of mothers with PCOS 1.53 [95 % CI 1.37–1.72]; but no increased odds of ASD in women with CAH, hirsutism or cancer. In conditions associated with reduced androgens, meta-analyses found an unexpected increased odds of ASD in hypospadias 1.38 [95 % CI 1.07–1.77], cryptorchidism 1.38 [95 % CI 1.11–1.71], and Klinefelter syndrome 6.39 [95 % CI 4.21–9.71].ConclusionThe androgen hypothesis was supported by 2 of 25 outcomes with 4 outcomes having opposite findings. Other complex factors are likely involved including genetic influences which may override simple sex hormone associations, as well as confounding pregnancy and birth factors inflating associations in some conditions.     

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.     

Systematic Review of Articles Describing Experience and Supports of Individuals with Autism Enrolled in College and University Programs

The increase in the number of higher-functioning individuals with autism spectrum disorders (ASD) is likely to lead to an increased interest in postsecondary opportunities including degree-granting college and university programs. To provide an understanding of the current evidence-base for supporting individuals with ASD in higher education, this article reports the results of a systematic review of the literature concerning college students with ASD. Overall, 20 articles describing 69 individuals met the inclusion criteria. This small number of articles and participants indicates the scarcity of research on this topic and only two of these studies were experimental in nature. These studies described a video-self modeling intervention and a counseling intervention respectively. Eighteen “case studies” were also present in the literature that described difficulties ranging from anxiety to housing concerns. This review deliniates the limitation of our understanding of effective college programming for individuals with ASD.     

Congenital idiopathic microcephaly in an infant: Congruence of head size with developmental motor delay

Objective: To review intervention studies on the use of video-based instruction for teaching adaptive behaviours to children with autism spectrum disorders (ASD).

Review process: Electronic and hand searches were conducted to identify intervention studies that focus on using video-based instruction to teach adaptive behaviours to children with ASD. Studies that met the inclusion criteria were summarized in terms of: (a) participants, (b) setting, (c) model type, (d) target skills, (e) intervention type, (f) design and (g) outcomes.

Outcomes: Forty-four studies encompassing 49 experiments met the inclusion criteria. The studies targeted a range of adaptive behaviours and academic skills. Most studies reported positive results, but the certainty of evidence was not strong for all of the studies due to reliance on pre-experimental designs.

Conclusion: The results from this review support the use of video-based instruction in the rehabilitation of children with ASD.     

The non-fitness-related benefits of exergames for young individuals diagnosed with autism spectrum disorder: A systematic review

BackgroundAutism Spectrum Disorder (ASD) is a common neurodevelopmental condition characterized by social-communication deficits and is often accompanied by an array of autism-specific traits, including cognitive and motor differences. Research has begun to investigate the utility of exergames (virtual exercise games) for combating some of the functionally impairing facets of ASD. However, no review to date has investigated the positive effects of exergaming for young autistic individuals, exclusive of their effects on fitness-related/health-related outcomes.MethodsWe systematically reviewed the literature for articles published between 1990 and 2020, which aimed to examine the effectiveness of exergames for targeting some of the facets observed in autistic children, exclusive of physical fitness-related outcomes.ResultsOut of 193 relevant articles, 10 met the inclusion criteria. Some studies showed initial beneficial effects of exergaming for executive function and motor skills, however more work is needed to examine the beneficial effects of exergaming for social development in young autistic individuals.ConclusionThe present review suggests the potential use of exergaming for enhancing some functions in ASD and future research is needed to expand the use of exergames for supporting social-communication skills. Furthermore, additional studies using rigorous research designs are needed to draw stronger conclusions about the effects of exergames for the young autistic population.     

The perspectives of students with Autism Spectrum Disorder on the transition from primary to secondary school: A systematic literature review

BackgroundThe transition from primary to secondary school is a period of intense sociocultural and environmental change, which can present specific challenges for children with Autism Spectrum Disorder (ASD). Children’s perspectives are often lacking in research on ASD, and this is also the case for research on children with ASD at the primary to secondary school transition.MethodThis systematic literature review serves an important purpose by comprehensively identifying and synthesising the empirical research on the first-hand accounts of children with ASD in relation to their transition from primary to secondary school.ResultsAcross the results of nine studies that met inclusion criteria, four core themes emerged: relationships, feelings and expectations regarding transition, facilitators and barriers of a successful transition, and heterogeneity of needs relating to ASD.ConclusionThe results emphasise the importance of reducing the concerns of children with ASD through transition planning as well as the adoption of a less negative narrative around the primary-secondary transition. Similar to their typically developing peers, children with ASD can have a positive experience of the primary-secondary transition.     

Teaching individuals with autism spectrum disorder to ask questions: A systematic review

This review involved a systematic search and analysis of studies aimed at teaching individuals with autism spectrum disorder (ASD) to ask questions (i.e., teaching mands for information). A systematic search of databases, reference lists, and journals identified 21 studies that met predetermined inclusion criteria. Included studies were then summarized in terms of (a) participant characteristics, (b) dependent variables (e.g., types of question-asking skills that were taught), (c) intervention procedures, (d) research designs, and (e) outcomes. All 21 studies reported that participants acquired or improved in the targeted question-asking skills. The most common intervention components included (a) echoic prompts and systematic fading procedures (e.g., time delay), (b) positive reinforcement via provision of requested information and/or access to preferred items or activities, and (c) contriving situations to motivate specific questions (i.e., creating establishing operations). Implications for practitioners and directions for future research are discussed.     

A systematic review of weighted vests with individuals with autism spectrum disorder

The purpose of the study was to evaluate the current literature on the use of weighted vests (WV) with individuals with autism spectrum disorder (ASD). A literature review using the standards recommended by the What Works Clearinghouse was conducted. The studies included in the review met the following criteria: (a) use of a single case research design; (b) inclusion of at least one individual with ASD; (c) examination of the effects of WV on a particular dependent variable; and (d) publication in English in a peer-refereed journal in the past 25 years. The results of the review show that the use of WV with individuals with ASD is not an evidence-based practice.     

Training paraprofessionals to implement interventions for people autism spectrum disorders: A systematic review

Objective: This review summarizes studies in which paraprofessionals were trained to implement interventions for people with autism spectrum disorders (ASD) in school and rehabilitation settings.

Methods: Systematic searches identified 12 studies meeting inclusion criteria. These studies were evaluated in terms of: (a) participant characteristics, (b) intervention implemented, (c) training procedures, (d) outcomes and (e) certainty of evidence.

Results: Across the 12 studies intervention was provided to a total of 39 paraprofessionals including teacher aides and rehabilitation staff. Paraprofessionals were trained to implement: social stories, prompting, Picture Exchange Communication System (PECS), Discrete Trial Training (DTT), Pivotal Response Training (PRT), incidental teaching or activity schedules. Training procedures included written and verbal explanations, modelling, video demonstrations, role playing and feedback. Positive outcomes were reported in 92% of the included studies.

Conclusion: Although the literature base is limited, this review highlights promising training procedures and areas in need of further research.     

Mechanisms of facial emotion recognition in autism spectrum disorders: Insights from eye tracking and electroencephalography

While behavioural difficulties in facial emotion recognition (FER) have been observed in individuals with Autism Spectrum Disorder (ASD), behavioural studies alone are not suited to elucidate the specific nature of FER challenges in ASD. Eye tracking (ET) and electroencephalography (EEG) provide insights in to the attentional and neurological correlates of performance, and may therefore provide insight in to the mechanisms underpinning FER in ASD. Given that these processes develop over the course of the developmental trajectory, there is a need to synthesise findings in regard to the developmental stages to determine how the maturation of these systems may impact FER in ASD. We conducted a systematic review of fifty-four studies investigating ET or EEG meeting inclusion criteria. Findings indicate divergence of visual processing pathways in individuals with ASD. Altered function of the social brain in ASD impacts the processing of facial emotion across the developmental trajectory, resulting in observable differences in ET and EEG outcomes.     

Self-harm: a transdiagnostic marker of psychopathology and suicide risk during the COVID-19 pandemic?

There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive–behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive–behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.

     

Resting state EEG abnormalities in autism spectrum disorders

Autism spectrum disorders (ASD) are a group of complex and heterogeneous developmental disorders involving multiple neural system dysfunctions. In an effort to understand neurophysiological substrates, identify etiopathophysiologically distinct subgroups of patients, and track outcomes of novel treatments with translational biomarkers, EEG (electroencephalography) studies offer a promising research strategy in ASD. Resting-state EEG studies of ASD suggest a U-shaped profile of electrophysiological power alterations, with excessive power in low-frequency and high-frequency bands, abnormal functional connectivity, and enhanced power in the left hemisphere of the brain. In this review, we provide a summary of recent findings, discuss limitations in available research that may contribute to inconsistencies in the literature, and offer suggestions for future research in this area for advancing the understanding of ASD.     

Friendship interventions and measurements in children with ASD: A systematic review

BackgroundFriendships are vital to children's social well-being and overall development, and they can also serve as a protector factor from peer victimization and bullying. For children with ASD, friendship development can be an area of challenge. Friendship interventions may help children and adolescents with ASD in developing the skills for making and keeping friends.MethodThis systematic review examined friendship interventions for children and adolescents with autism spectrum disorder (ASD). It also explored measures of friendship skills in children with ASD. Twenty-seven studies met the inclusion criteria: (a) experimental intervention studies focused on improving friendships of individuals with ASD, (b) the measurement of friendship outcomes, and (c) strong or acceptable methodological ratings.ResultsFifteen unique interventions were tested across the 27 studies. Thirteen interventions included strategies specifically focused on improving (making and maintaining) friendships in the participants with ASD. Friendship interventions were primarily focused on behaviorally based social skills building and varied in implementation settings. Friendship measures included the use of parent reports, child and adolescent surveys and questionnaires, peer nominations, and sociometric ratings.ConclusionThe results highlighted the benefit of including targeted friendship-building strategies in social and friendship interventions and the value of multiple perspectives when measuring friendship. The findings of the study can influence how families and practitioners collaborate to support children and adolescents with ASD in the development and maintenance of their friendships.     

A Systematic Review of People with Autism Spectrum Disorder and the Criminal Justice System

This paper provides a systemic review of the available literature on people with autism spectrum disorder (ASD) in the criminal justice system (CJS). The review considers two main types of study: those that examined the prevalence of people with ASD in the CJS and those that examined the prevalence of offending in populations with ASD. In addition, types of offences in people with ASD, co-morbid psychiatric diagnoses, and characteristics of people with ASD who commit offences (including predisposing factors) are considered. A combination of search terms was used in a variety of databases in order to find all of the available literature on this topic, and research studies were included based on specified inclusion and exclusion criteria. It was found that whilst there is an emerging literature base on this topic, there are a wide variety of methodologies used, making direct comparison difficult. Nevertheless it can be concluded so far that people with ASD do not seem to be disproportionately over-represented in the CJS, though they commit a range of crimes and seem to have a number of predisposing features. There is poor evidence of the presence of comorbid psychiatric diagnoses (except in mental health settings) amongst offenders with ASD, and little evidence of the oft-asserted over-representation of certain kinds of crimes. It is recommended that further research of good quality is required in this area, rather than studies that examine populations that are not representative of all those with ASD.     

Aging in Autism Spectrum Disorder

Most research on autism spectrum disorder (ASD) has focused on younger individuals, but there is increasing awareness that more must be known about the clinical needs and outcomes of older adults with ASD. This article reviews what is known about barriers to recognition in the elderly, the prevalence of ASD over the lifespan, outcomes in adulthood in comparison to the general population, co-occurring psychiatric diagnoses, and healthcare needs in this population.     

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.