Therapist Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

This mixed methods study examined therapist perspectives on serving children with autism spectrum disorders (ASD) in community mental health (CMH) clinics. One hundred therapists completed a survey about their experiences with this population and 17 participated in subsequent focus groups to clarify and expand survey results. Results indicate that CMH therapists serve many children with ASD for behavior or other psychiatric problems and perceive serving this population as challenging and frustrating due to their limited training. Therapists are highly motivated for comprehensive ASD training on ASD characteristics and intervention strategies. These data were used to tailor and package evidence-based intervention strategies for delivery in CMH services.     

A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior

Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders (ASDs) is limited. We present feasibility and initial efficacy data on a structured parent training program for 16 children (ages 3–6) with ASD and disruptive behavior. The 6-month intervention included 11 Core and up to 2 Optional sessions. The program was acceptable to parents as evidenced by an attendance rate of 84 % for Core sessions. Fourteen of 16 families completed the treatment. An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24. Using last observation carried forward, the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 (SD = 9.21) to 7.38 (SD = 6.15).     

Community-Based Treatment for Youth with Co- and Multimorbid Disruptive Behavior Disorders

Little is known about the types of psychotherapeutic practices delivered to youth with comorbid and multimorbid diagnoses in community settings. The present study, based on therapists’ self-reported practices with 569 youth diagnosed with a disruptive behavior disorder (ODD or CD), examined whether specific therapeutic practice applications varied as a function of the number and type of comorbid disorders. While type of comorbid disorder (AD/HD or internalizing) did not predict therapists’ practices, youth with more than two diagnoses (multimorbid) received treatment characterized by a more diverse set and a higher dosage of practices.     

Preparation of Mental Health Clinicians to Work With Children With Co-Occurring Autism Spectrum Disorders and Mental Health Needs

ABSTRACT

Up to 70% of children with autism spectrum disorders (ASD) have a co-occurring mental health disorder; however, many clinicians feel unprepared to serve children with complex co-occurring conditions. This study surveyed 64 mental health clinicians working in 21 publically-funded mental health agencies in a large urban setting to explore their preparation and supports for providing mental health services to children with ASD and other developmental disabilities. Results indicated that only half of clinicians received training in ASD/DD in their professional education, with social workers least likely to have had such training. Only half of clinicians felt confident to diagnose mental health problems or provide interventions to children with ASD/DD; those with training on ASD/DD during their professional education were more likely to report confidence. Agency supports were lacking, with just 16% of therapists having supervisors with expertise in ASD/DD, and only 23% receiving training in ASD/DD at their agency. Participants from county agencies were less likely to have agency supports for their work in ASD/DD compared to participants from private non-profit agencies. Implications are discussed for enhancing education and training to meet the mental health needs of children with ASD/DD.     

Deaf Children with Autism Spectrum Disorders

Epidemiological studies investigating the prevalence of autism have increased in recent years, within the United States and abroad. However, statistics as to how many of those children may also have a comorbid hearing loss is lacking. The prevalence of school-administrator reported diagnosis of autism spectrum disorders (clinical diagnosis [DSM-IV] and/or IDEA classification) among children with hearing loss in the US was estimated from the 2009–2010 Annual Survey of Deaf and Hard of Hearing Children and Youth conducted by the Gallaudet Research Institute. Results indicate that during the 2009–2010 school year 1 in 59 children (specifically 8-year olds) with hearing loss were also receiving services for autism; considerably higher, than reported national estimates of 1 in 91 (Kogan et al. in Pediatrics 124(4):1–8, 2009) and 1 in 110 (CDC 2007) for hearing children. Significantly more children with profound hearing loss had a comorbid diagnosis of autism than those with milder forms of hearing loss. These results are discussed, while highlighting the need for increased awareness and research in a population that has thus far received little services or attention.     

Assessing the Strengths of Children Referred for Community-Based Mental Health Services

This study investigated the relationship between child strengths and functional impairment, specifically whether youth with greater levels of functional impairment also exhibit strengths. The relationship was investigated for children (N = 1,838) of different genders, ages, race, and ethnic backgrounds and whose families were living at different income levels. A moderate relationship was found between child strengths and functional impairment. Those children with even the most severe functional impairment were rated as having average or near average strengths. With the exception of gender, the relationship between impairment and strengths did not differ as a function of demographic characteristics. These findings provide additional support for the construct validity of the Behavioral and Emotional Strengths Rating Scale (M. Epstein & J. Sharma, 1998) and they highlight the need for strength-based assessment and screening for youth entering mental health services. Child strengths as the foundation for service planning and implementation, and other implications are discussed.     

The Role of Parent Characteristics in Community-Based Medication Treatment for Children with Disruptive Behavior Problems

Studies have documented increased psychoactive medication use rates among children, but little is known about what child and/or family characteristics predict medication treatment in community-based care. This study examines the role of parent characteristics in children’s medication treatment, while accounting for other potential predictors. Participants included 213 children ages 4–13 with disruptive behavior problems. Medication treatment was assessed by parent report; potential predictors of medication treatment, including child characteristics and parent characteristics (e.g., education level, perceived strain and psychopathology) were assessed at service intake. Over 60 % of children used a psychoactive medication during the 16 month study period (most commonly stimulants). Parent education level and reported strain were significant predictors of children’s medication treatment even when accounting for other significant predictors such as child diagnosis, age, race/ethnicity, etc. Results highlight the role that parent characteristics have in accessing community-based medication treatment for children with disruptive behavior problems.     

Hyperlexia in Children with Autism Spectrum Disorders

We compared the reading-related skills of children with Autism Spectrum Disorders who have hyperlexia (ASD + HPL) with age-matched children with ASD without HPL (ASD - HPL) and with single-word reading-matched typically developing children (TYP). Children with ASD + HPL performed (1) better than did children with ASD - HPL on tasks of single-word reading and pseudoword decoding and (2) equivalently well compared to word-reading-matched TYP children on all reading-related tasks except reading comprehension. It appears that the general underlying model of single-word reading is the same in principle for "typical" and hyperlexic reading. Yet, the study revealed some dissimilarities between these two types of reading when more fine-grained cognitive and linguistic abilities were considered; these dissimilarities warrant further investigations.     

Characterizing Sleep in Adolescents and Adults with Autism Spectrum Disorders

We studied 28 adolescents/young adults with autism spectrum disorders (ASD) and 13 age/sex matched individuals of typical development (TD). Structured sleep histories, validated questionnaires, actigraphy (4 weeks), and salivary cortisol and melatonin (4 days each) were collected. Compared to those with TD, adolescents/young adults with ASD had longer sleep latencies and more difficulty going to bed and falling asleep. Morning cortisol, evening cortisol, and the morning-evening difference in cortisol did not differ by diagnosis (ASD vs. TD). Dim light melatonin onsets (DLMOs) averaged across participants were not different for the ASD and TD participants. Average participant scores indicated aspects of poor sleep hygiene in both groups. Insomnia in ASD is multifactorial and not solely related to physiological factors.     

Therapists’ Attitudes Towards Psychotherapeutic Strategies in Community-Based Psychotherapy with Children with Disruptive Behavior Problems

Little is known about what individual treatment strategies therapists providing usual care psychotherapy consider the most valuable to their practice. The Therapeutic Strategies Survey (TSS) assesses therapists’ attitudes about the value of 27 individual treatment strategies in their practice with children with disruptive behavior problems in community-based outpatient psychotherapy. Findings indicate that therapists from multiple professional disciplines highly value many individual psychotherapeutic strategies, and consider strategies common to a majority of evidence-based practices (EBPs) for this population at least as important as strategies not emphasized in EBPs. Implications for developing therapist training and implementation of EBPs are discussed. Portions of this work were presented at the 2007 NIMH Conference on Mental Health Services Research in Washington, D.C.     

Parent-Based Sleep Education for Children with Autism Spectrum Disorders

This study provided sleep education to parents of children with autism spectrum disorder (ASD) to determine whether an individual or group format was more effective in improving sleep and aspects of daytime behavior and family functioning. Eighty children, ages 2–10 years, with ASD and sleep onset delay completed the study. Actigraphy and parent questionnaires were collected at baseline and 1 month after treatment. Mode of education did not affect outcomes. Sleep latency, insomnia subscales on the Children’s Sleep Habits Questionnaire, and other outcomes related to child and family functioning improved with treatment. Parent-based sleep education, delivered in relatively few sessions, was associated with improved sleep onset delay in children with ASD. Group versus individualized education did not affect outcome.     

Autism Treatment Survey: Services Received by Children with Autism Spectrum Disorders in Public School Classrooms

The Autism Treatment Survey was developed to identify strategies used in education of children with autism spectrum disorders (ASD) in Georgia. Respondents of the web-based survey included a representative sample of 185 teachers across the state, reporting on 226 children with ASD in grades preschool-12th. The top five strategies being used in Georgia (Gentle Teaching, sensory integration, cognitive behavioral modification, assistive technology, and Social Stories^TM) are recognized as lacking a scientific basis for implementation. Analysis revealed the choice of strategies varied by grade level and classroom type (e.g., general education, special education). Results highlight clear implications for preservice and inservice educator training, and the need for continued research to document evidence-based strategy use in public schools for students with ASD.     

Depressive and Disruptive Disorders and Mental Health Service Utilization in Children and Adolescents

ObjectiveTo examine the relationship of depressive and disruptive disorders with patterns of mental health services utilization in a community sample of children and adolescents.MethodData were from the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The sample consisted of 1,285 child (ages 9–17 years) and parent/guardian pairs. Data included child psychopathology (assessed by the Diagnostic Interview Schedule for Children), Impairment, child need and use of mental health services, and family socioeconomic status.ResultsAfter adjusting for potential confounding factors, disruptive disorder was significantly associated with children's use of mental health services, but depressive disorder was not. For school-based services, no difference was found between the 2 types of disorders. Parents perceived greater need for mental health services for children with disruptive disorders than for those with depression. Conversely, depression was more related to children's perception of mental health service need than was disruptive disorder.ConclusionsThe findings highlight the need for more effective ways to identify and refer depressed children to mental health professionals, the importance of improving school-based services to meet children's needs, and the necessity to better educate parents and teachers regarding the identification of psychiatric disorders, especially depression. J. Am. Acad. Chlid Adolesc. Psychiatry, 1999, 38(9):1081–1090.     

Autism Spectrum Traits in Children with Anxiety Disorders

The aim of this study was to examine ASD traits in children with clinical anxiety in early development, as well as current manifestations. Parents of 42 children with an anxiety disorder (but no known diagnosis of ASD) and 42 typically developing children were interviewed using the Autism Diagnostic Interview (ADI-R). They also completed questionnaires that assessed child anxiety (SCARED-71) and children’s ASD symptoms. Results revealed that children with anxiety disorders had higher scores than typically developing children, for both ASD traits in early development as well as current ASD symptoms. A specific association was found between symptoms of Social Anxiety Disorder and ASD traits early in life. Findings are considered in terms of clinical implications, and limitations are discussed.     

The Association Between Mental Health, Stress, and Coping Supports in Mothers of Children with Autism Spectrum Disorders

Raising a child with an autism spectrum disorder (ASD) can be a stressful experience for parents. When left unmanaged, high stress levels can lead to the development of depressive symptomatology, highlighting the importance of coping supports. The current paper examined the stress level and psychological wellbeing of mothers with a child with ASD in a national survey. After adjusting for child, mother and family level characteristics, it was determined that mothers of children with ASDs were at greater risk for poor mental health and high stress levels compared to mothers of children without ASDs. The presence of maternal coping strategies, in the form of emotional and neighborhood social supports, as well as strong coping skills, reduced these risks between models.     

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

This study examined predictors of psychiatric hospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be hospitalized (OR = 2.54), as were youth diagnosed at a later age (OR = 1.10). Engaging in self-injurious behavior (OR = 2.14), aggressive behavior (OR = 4.83), and being diagnosed with depression (OR = 2.48) or obsessive compulsive disorder (OR = 2.35) increased the odds of hospitalization. Risk for hospitalization increased with age and over time. The results suggest early diagnosis and community-based interventions for aggressive and self-injurious behaviors may reduce hospitalizations.