Positive and negative gaze perception in autism spectrum conditions

Abstract

Eyes are key social features providing a wealth of information about the attention, interest, emotion, and intention of others. Humans are typically very adept at detecting gaze direction, but there is a large decrement in gaze discrimination ability when eye images change from positive to negative polarity. This is thought to show an expert system for gaze perception that applies a contrast-specific heuristic to determine where someone else is looking. Autism spectrum conditions (ASC) are characterized by social deficits including difficulties in face-processing and in the social use of gaze. People with ASC are thought to have less expertise for gaze processing compared to typical controls, though little research has tested this. We investigated gaze direction perception in typical males and females, and males with ASC using facial stimuli with positive or negative polarity of the eyes. Results showed that the ASC group was worse at judging gaze direction with positive stimuli, and showed less of a decrement in performance when eye stimuli changed from positive to negative polarity. The differences in gaze perception for the ASC group were most evident when information from the eyes was more difficult and ambiguous. Typical females performed better at gaze direction detection with positive polarity than typical males, who in turn performed better than males with ASC. This latter finding is consistent with the extreme male brain theory of autism, and with the idea that people with ASC have less gaze expertise.     

Using applied behavior analysis and smart technology for meeting the health needs of individuals with intellectual disabilities

Abstract

Objective: Individuals with intellectual disabilities often have special healthcare concerns such as diabetes, kidney disease, severe allergies, progressive illnesses, respiratory weaknesses, and obesity. Smart technology can be an asset for individuals with intellectual disabilities for better managing their healthcare needs.

Methods: A critical review of the literature related to applied behavior analysis, smart technology, and health needs of individuals with intellectual disabilities was conducted.

Results: This discussion paper describes factors that contribute to the successful use of smart technology for the health issues of individuals with intellectual disabilities.

Conclusions: We see key components in developing appropriate access and use of smart technology for the health of people with intellectual disabilities being: (a) systematic instructional methods for consistent and accurate use of the technology, (b) modifying the current technology for people with intellectual disabilities, (c) guidelines for implementation, and (d) resources for getting the technology.     

The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis

Background

A core component of treatment provided by early intervention for psychosis (EI) services is ensuring individuals remain successfully engaged with the service. This ensures they can receive the care they may need at this critical early stage of illness. Unfortunately, rates of disengagement are high in individuals with a first episode of psychosis (FEP), representing a major barrier to effective treatment. This study aimed to ascertain the rates and determinants of disengagement and subsequent re-engagement of young people with FEP in a well-established EI service in Melbourne, Australia.

Method

This cohort study involved all young people, aged 15–24, who presented to the Early Psychosis Prevention and Intervention Centre (EPPIC) service with FEP between 1st January 2011 and 1st September 2014. Data were collected retrospectively from clinical files and electronic records. Cox regression analysis was used to identify determinants of disengagement and re-engagement.

Results

A total of 707 young people presented with FEP during the study period, of which complete data were available for 700. Over half of the cohort (56.3%, N = 394) disengaged at least once during their treatment period, however, the majority of these individuals (85.5%, N = 337) subsequently re-engaged following the initial episode of disengagement. Of those who disengaged from the service, 54 never re-engaged, representing 7.6% of the total cohort. Not being in employment, education or training, not having a family history of psychosis in second degree relatives and using cannabis were found to be significant predictors of disengagement. No significant predictors of re-engagement were identified.

Conclusion

In this study, the rate of disengagement in young people with first-episode psychosis was higher than found previously. Encouragingly, rates of re-engagement were also high. The concept of disengagement from services might be more complex than previously thought with individuals disengaging and re-engaging a number of times during their episode of care. What prompts individuals to re-engage with services needs to be better understood.

     

Brief Report: Which Came First? Exploring Crossmodal Temporal Order Judgements and Their Relationship with Sensory Reactivity in Autism and Neurotypicals

Previous studies have indicated that visual-auditory temporal acuity is reduced in children with autism spectrum conditions (ASC) in comparison to neurotypicals. In the present study we investigated temporal acuity for all possible bimodal pairings of visual, tactile and auditory information in adults with ASC (n?=?18) and a matched control group (n?=?18). No group differences in temporal acuity for crossmodal stimuli were observed, suggesting that this may be typical in adults with ASC. However, visual-tactile temporal acuity and bias towards vision when presented with visual-auditory information were both predictors of self-reported sensory reactivity. This suggests that reduced multisensory temporal acuity and/or attention towards vision may contribute to atypical sensory reactivity.     

The design and implementation of a CBT-based intervention for sensory processing difficulties in adolescents on the autism spectrum

BackgroundUnusual reactions to sensory input now form part of the diagnostic criteria for autism. These features are common and can have an often-devastating impact on autistic individuals and their families. Yet there are few validated interventions that help to remediate or support autistic individuals’ adverse sensory experiences. To date, both measurement of sensory experiences and the resulting interventions have been based on assumptions of neurological sensitivities and largely ignored the role of cognition. This study therefore sought to assess the feasibility of a new 8-week CBT-based group intervention for self-regulation of sensory processing difficulties.MethodSeven cognitively able adolescents diagnosed with autism aged 11–16 years from one mainstream secondary school received the 8-week intervention. Measures of sensory reactivity, anxiety and repetitive behaviours were taken at baseline, post-intervention and follow-up, 8 weeks after the intervention had ceased. Semi-structured interviews and focus groups were also conducted with adolescents and their parents to examine further the acceptability of the intervention.ResultsThe results showed that the intervention itself was feasible – both in its implementation and its acceptability to participants. Qualitative analysis clearly showed that the intervention was effective in raising meta-conscious awareness and self-regulation in these autistic adolescents. Analysis of outcome variables showed no significant change over the intervention period, although effect sizes were moderate-to-large.ConclusionsThese preliminary results are encouraging and should inform the design of a future pilot randomized controlled trial to test its efficacy with a larger group of participants.     

Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings

Abstract

Objective: Misophonia is a neurophysiological disorder, phenotypically characterized by heightened autonomic nervous system arousal which is accompanied by a high magnitude of emotional reactivity to repetitive and pattern-based auditory stimuli. This study identifies the prevalence of psychiatric symptoms in misophonia sufferers, the association between severity of misophonia and psychiatric symptoms, and the association between misophonia severity and gender.

Methods: Fifty-two misophonia sufferers, 30 females (mean age?=?40.93 ± 15.29) and 22 males (mean age?=?51.18 ± 15.91) were recruited in our study and they were diagnosed according the criteria proposed by Schröder et al. The participants were evaluated by the A-MISO-S for the severity of misophonia and the MINI to assess the presence of psychiatric symptoms.

Results: The most common comorbid symptoms reported by the misophonia patients were respectively PTSD (N?=?8, 15.38%), OCD (N?=?6, 11.53%), MDD (N?=?5, 9.61%), and anorexia (N?=?5, 9.61%). Misophonia severity was associated with the symptoms of MDD, OCD, and PTSD as well as anorexia. There was an indication of a significant difference between men and women in the severity of misophonic symptoms.

Conclusion: Our findings highlight the importance of recognizing psychiatric comorbidity among misophonia sufferers. The presence of these varying psychiatric disorders’ features in individuals with misophonia suggests that while misophonia has unique clinical characteristics with an underlying neurophysiological mechanism, may be associated with psychiatric symptoms. Therefore, when assessing individuals with misophonia symptoms, it is important to screen for psychiatric symptoms. This will assist researchers and clinicians to better understand the nature of the symptoms and how they may be interacting and ultimately allocating the most effective therapeutic strategies.     

Social reward and rejection sensitivity in eating disorders: An investigation of attentional bias and early experiences

Abstract

Objectives. People with eating disorders (EDs) have difficulties with social functioning. One explanatory mechanism is a problem with over-sensitivity to rejection and/or low sensitivity to social reward. The aim of this study is to investigate attentional bias to facial stimuli in people with a lifetime diagnosis of EDs and healthy controls (HCs) and to test whether these attentional biases are linked to adverse early experiences. Methods. Forty-six participants with a current diagnosis of EDs (29 with anorexia nervosa (AN) and 17 with bulimia nervosa (BN)), 22 participants recovered from an eating disorder (13 with past AN and nine with past BN) and 50 HCs completed a dot-probe task with faces expressing rejection and acceptance. Participants reported on parental style and adverse early experiences. Results. People with a lifetime diagnosis of EDs show an attentional bias to rejecting faces and a difficulty disengaging attention from these stimuli. Also, they had a sustained attentional avoidance of accepting faces. HCs demonstrated the opposite attentional pattern. The attentional bias to rejection was correlated with adverse childhood experiences. Conclusions. People with an EDs show vigilance to rejection and avoidance of social reward. This may contribute to the causation or maintenance of the illness.     

“I'm in their shoes”: Experiences of peer educators in sexuality and relationship education

Abstract

Background Sexuality and relationship education for adults with an intellectual disability has failed to include them in roles other than as learners. This paper reports findings from a study of the experiences of peer educators with an intellectual disability who co-facilitated a respectful relationships education program.

Method Qualitative data were collected about the experiences of 16 peer educators through in-depth interviews and observations of their work in delivering the program. These data were thematically analysed.

Findings Peer educators reported that peer education gave them a sense of empowerment, positioned them as credible sources of information about relationships, enabled them to help others, and gave them an opportunity to learn new knowledge about respectful relationships, community resources and supports, and new skills.

Conclusions This study presents an alternative approach to relationship education that involves people with an intellectual disability as peer educators and that benefits these people.     

A systematic review of physiological reactivity to stimuli in autism

Objective: The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism. Methods: Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied. Results: Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not. Conclusions: Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.     

Sexual health services and support: The views of younger adults with intellectual disability

Abstract

Background?The sexual health needs of younger adults with intellectual disability (ID) are not currently being met by mainstream sexual health services. Little research has been conducted into improving these services’ accessibility.

Method?Thirty-four people with ID aged 16–35, who attended ID services in Lothian, Scotland, completed a questionnaire at a face-to-face interview about whom they could go to for advice and information about sex and relationships, which information sources they used, their experiences of sexual health services, and their preferences regarding these services.

Results?Most participants wanted to attend mainstream services and felt staff from these services should be able to meet their special needs. Preferences on services varied between individuals.

Conclusions?It is important that there continues to be a variety of sexual health services available and that staff are appropriately trained in working with people with ID. Further research is needed to identify and resolve unmet needs in this area.     

Emotional states and informational brain processing in drug addicts free of drugs: An ERPs study

Objective

To analyze brain event-related responses in heroin-dependent patients under different emotional conditions, in order to determine the influence of specific emotional loading on information processing in drug addicts.

Methods

Fifteen male heroin-dependent patients, matched to 11 male healthy individuals, were exposed to emotion-triggering slides designed to elicit neutral, pleasant or unpleasant emotions, while ERPs were obtained by means of an auditory oddball paradigm. Evoked potential analysis consisted of measuring the amplitude, latency, and topographic distribution (mapped from 19 scalp sites) of the early and late latency component waveforms.

Results

Both groups showed large-amplitude, long-latency, and positive-polarity responses to odd stimuli under all emotional conditions. A within-group comparison between the three emotional conditions showed that the control group had smaller P300 amplitudes under pleasant stimulation; drug addicts showed no differences between all three emotional conditions. Between-group analysis revealed smaller P300 amplitudes in drug addicts than in controls, both for unpleasant and neutral emotional conditions, but this was only significant for some electrode sites. Brain electrical activity mapping at P300 showed that high activation is less spread in the brain areas of drug addicts than in controls for unpleasant and neutral emotional conditions.

Conclusion

Drug addicts have deficits in extracting relevant information from sensory stimuli under different emotional conditions, particularly under unpleasant and neutral stimulation. Decreased P300 in controls under pleasant stimulation is interpreted as a result of an attentional bias mechanism that directs attentional resources to environmental stimuli of positive emotional valence, in contrast to drug addicts where there is no such effect.     

Clinical and functional characteristics of a subsample of young people presenting for primary mental healthcare at headspace services across Australia

Purpose

Headspace services provide treatment options to young people seeking mental healthcare. To obtain a better understanding of needs and characteristics of this population, and effectively evaluate services, we require novel youth-specific outcome measures. As part of our broad research program to establish such measures, a sample of young people were recruited and assessed. The study describes (i) methodology used to obtain clinical, functioning, and substance use characteristics of young people presenting to headspace services; and (ii) an overview of these characteristics.

Methods

Young people presenting to headspace centres were recruited. Multidimensional information was obtained relating to clinical and functional outcomes, demographic information, and lifestyle factors.

Results

1107 young help-seeking individuals were recruited. Participants were most likely young adults aged M = 18.1 years, SD = 3.3, with diagnoses of depression and/or anxiety (76.6%, n = 801), engaged in work and study (84.9%, n = 890), and living with parent(s) (68.9%, n = 736). Impairments in functioning were moderate as indicated by the Social and Occupational Functioning Assessment Scale (M = 65.2, SD = 9.5), substance use was common (alcohol 62.7%, n = 665; illicit substances 30.5%, n = 324), and current suicidal ideation was reported by a third (33.6%, n = 358).

Conclusions

A broad dataset was obtained providing an insight into key clinical, functional and quality of life characteristics of these individuals. We observed that young people present with complex problems, comorbid diagnoses, moderate levels of symptomatology, impairments in functioning, substance use, and suicidal ideation. This work provides the foundation for our broader research program aiming to develop novel, relevant and youth-specific, change and outcome measures.

     

Experiences of living with mental health problems during the COVID-19 pandemic in the UK: a coproduced,participatory qualitative interview study

Purpose

Research is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time.

Methods

We used qualitative interviews (N = 49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team.

Results

Existing mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to the community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health.

Conclusion

There is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.

     

Living positively with dementia: a systematic review and synthesis of the qualitative literature

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.     

Atypical symptom presentations in children and adolescents with obsessive compulsive disorder

BackgroundCommon symptom presentations in youth with Obsessive Compulsive Disorder (OCD) are easily recognized and are included in the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) symptom checklist. However, some youth may occasionally present with atypical or unusual symptoms that are less readily recognized as OCD and may be confused with other disorders that sometimes overlap, such as autism spectrum disorder or even psychosis.MethodsCase synopses which are thematically linked and exemplify and illustrate two distinct types of unusual or atypical symptom presentations are described. These symptoms are embedded in the subjects' broader clinical picture, that more correctly identifies the atypical symptoms as a variant feature of OCD rather than some other diagnostic condition.ResultsWe describe twenty-four children with OCD. Twelve children had obsessions related to adverse experiences of places, times or other people that were felt as horrific, abhorrent or disgusting. These obsessions led to contamination fears of any thoughts or actions associated with those places, events or people. In those whose OCD was a reaction to another person, the contamination obsession often took the form of fear of acquiring an unwanted trait or characteristic by association, which was then avoided. Twelve other youth had obsessions driven by a primary sensory experience that was intolerable, including tactile, olfactory, and auditory stimuli. These sensory experiences were sometimes linked to specific objects or people, driving time-consuming repetitive behaviors to avoid or alleviate the sensory discomfort.ConclusionRecognition of atypical presentations of OCD, such as fear of contamination by association with adverse experiences and primary sensory intolerance leading to OCD will help clinicians to better identify and treat these unique symptoms.     

Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors

Purpose

Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors.

Methods

We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders.

Results

Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36–31.11), even after adjusting for the full set of variables.

Conclusions

Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide.

     

No cross-sectional evidence for an increased relation of cognitive and sensory abilities in old age1

Objectives: A key question in gerontological research concerns whether good functioning can be maintained in some cognitive abilities in old age, even if deficits occur in other cognitive or sensory abilities. Our goals were to investigate relations of cognitive and sensory abilities in old age, whether these relations differed in size across old age, and whether this was affected by general cognitive ability (processing speed), educational level, and/or general health status.

Methods: Two thousand eight hundred and twelve older adults (aged 65–101, M = 77.9 years) from the Vivre–Leben–Vivere survey served as cross-sectional sample for the present study. We administered psychometric tests on processing speed (the speed of cognitive processing), cognitive flexibility (the ability to alternate between cognitive operations), and verbal abilities (vocabulary). In addition, we interviewed individuals on their hearing, eyesight, educational level, and general health status. We regressed sizes of relations between abilities (calculated within each 1-year age tranche) on mean age within the corresponding age tranche, with the number of participants within the corresponding age tranche as case weights.

Results: We observed a decrease in relations between processing speed and cognitive flexibility in old age that was particularly pronounced in individuals with high educational level (r = ?.41). In contrast, we did not find differences in relations between other cognitive and sensory abilities across old age, which held for different levels of general cognitive ability, education, and general health status.

Conclusion: Present data do not support the view of a generally increased relation of cognitive and sensory abilities in old age.     

Experience of mindfulness in people with bipolar disorder: A qualitative study

Abstract

The aim of the study was to explore experiences of practising mindfulness and how this related to living with, and managing, bipolar disorder. Qualitative methodology was used to explore the experiences of 12 people with bipolar disorder who had been practising mindfulness for at least 18 weeks. Semi-structured interviews exploring how mindfulness practice related to living with bipolar disorder were recorded verbatim, transcribed and analysed using thematic analysis. Seven themes emerged: Focusing on what is present; clearer awareness of mood state/change; acceptance; mindfulness practice in different mood states; reducing/stabilizing negative affect; relating differently to negative thoughts; reducing impact of mood state. All participants reported subjective benefits and challenges of mindfulness practice, and gave insights into processes of change.