Advances in Autism – 8-4
1. Chester V, Tromans S. Editorial. Advances in Autism. 2022; 8(4): 273-4.
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2. Hatton VA, Lee MX. An evaluation of the online post-diagnostic groups facilitated by the autism spectrum condition service at Gloucestershire Health and Care NHS. Advances in Autism. 2022; 8(4): 319-31.
Purpose Autism spectrum condition (ASC) is a lifelong developmental condition. According to research, it is recommended that those diagnosed with ASC should be offered post-diagnosis support to explore their diagnosis (Punshow, Skirrow and Murphy, 2009). The ASC Diagnostic Assessment Service at Gloucestershire Health Care (GHC) NHS Foundation Trust offers an assessment service to adults (18+) located within Gloucestershire. All those who receive a diagnosis are then invited to a 7-week post-diagnostic group facilitated by the multidisciplinary team. This service evaluation aimed to evaluate the aforementioned group so that it can be improved upon and thus provide a better service for future clients. Design/methodology/approach In total, 14 participants (6 males, 8 females) were interviewed for the purpose of this evaluation following their attendance at these groups. Findings The interview transcripts then underwent thematic analysis with four themes identified; “Autistic Community”, “Experience of Being Part of an Online Group”, “Opportunity for Consolidation”, and “Design Considerations and Improvements”. Further sub-themes were also identified. Overall, the service evaluation identified that the group provided a platform for sharing experiences and gaining a sense of belonging. It also highlighted that individuals have different preferences for whether groups should be facilitated online or face-to-face, and also different preferences for the duration of sessions. Further analysis also revealed the suggestion that the final session, for family and friends, should be optional so that those without a support network, do not need to attend as this caused unease in some. Further findings were also identified. Originality/value To the authors’ knowledge, existing articles have only focused on the evaluation of the availability of post-diagnostic provision and autistic individuals’ general impression of it rather than an in-depth evaluation of a specific type of support.
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3. Jean FAM, Jouni A, Bouvard MP, Camelot G, Beggiato A, Scheid I, Gaman A, Bouquet C, Ly-Le Moal M, Houenou J, Delorme R, Leboyer M, Amestoy A. Overlap of anxiety, depression, irritability and aggressiveness in autism spectrum disorder: an exploratory study using cluster analysis. Advances in Autism. 2022; 8(4): 275-93.
Purpose This study aims to explore the overlap between symptoms of depression, anxiety, irritability and aggressiveness in autism spectrum disorder (ASD), to measure specific and idiosyncratic emotional responses. Design/methodology/approach A total of 42 high functioning adolescents and adults, between 12 and 39 years old, meeting the diagnostic and statistical manual of mental disorders – 5 criteria for ASD were selected from the InFoR Autism cohort. Data were analyzed in an exploratory way using Hill and Smith and K-medoids cluster analysis. Findings The authors found an aggregation of anxiety, depression, aggressive behaviors and irritability. Cluster analysis was maximized for two groups with 17 and 25 participants, respectively. The first group was characterized by high levels of symptoms of irritability, aggressiveness, hyperactivity and intermediate levels of anxiety and depression. In the first group, participants had significantly higher levels of autistic symptoms considering the social responsiveness scale and repetitive behavior scale-revised scales (relatives’ reports) suggesting that a particular group of subjects with a high level of ASD specific symptoms may express anxiety and depression in a specific way based on externalizing behaviors in addition to the common mood and anxiety symptoms. Research limitations/implications Improved understanding of the aggregation of externalized symptoms with symptoms of anxiety and mood disorders in ASD should lead to a better understanding of the underlying mechanisms related to emotion dysregulation in ASD. Practical implications Improved knowledge of the symptoms could lead to enhanced detection of psychiatric comorbidities in ASD. Originality/value The study was based on a transdiagnostic approach of psychiatric symptoms in individuals with ASD. Aggregation and clustering analysis was used to explore naive patterns of these psychiatric symptoms.
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4. Ng MB, Klag M, Mazoff C, Sacks S, Czerednikow C, Borbridge K, Broda T, Lai J. The creation of a specializedmedical-dental clinic for adults with developmental disabilities in Montreal, Canada. Advances in Autism. 2022; 8(4): 294-305.
Purpose There is inadequate health care for patients with developmental disabilities (DD), due to a number of systemic issues. This case study describes the establishment of a medical-dental clinic in Montréal, Québec for adults with DD. The purpose of this paper is to describe the model of interdisciplinary care based on best practices, as an example to encourage a growing community of trained health professionals to serve this population. Design/methodology/approach Interviews with all the clinic staff and leadership were conducted on-site at the clinic, followed by document review and discussions with an embedded researcher in the organization. Findings The clinic was established through a series of events that led to public and government interest to act, the timely emergence of major donors, and bringing together several dedicated individuals and organizations. The core team engaged in consultation with clinics, followed by extensive billing analyses and iterative process mapping as a learning organization. Prior to patient visits, the clinic conducted detailed intake processes to adequately plan for each patient interaction. Desensitization visits were undertaken to improve patient tolerance for examination and treatment. The continual collection of data fed into an evaluation framework to facilitate continuous improvement and articulate a model for replication. Originality/value To the best of the authors knowledge, there is not a clinic of this nature serving this population in Canada. This work can serve to inform the efforts of other care providers looking to create a medical – dental home for this population.
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5. Perihan C, Burke MD, Bowman-Perrott L, Bocanegra J. Assessment and treatment of anxiety in children and adolescents with ASD: a systematic review. Advances in Autism. 2022; 8(4): 354-72.
Purpose The purpose of this study was to investigate the quality of current studies that assess and treat anxiety symptoms in children with autism spectrum disorder (ASD). More specifically the study aimed to answer the following questions: What are the qualities of the current studies using cognitive behavioral therapies (CBTs) to treat anxiety symptoms in children with ASD? Did studies make necessary modifications and adaptations to CBTs according to the evidence-based strategies and implement these versions of CBTs with precise fidelity? Were the selected measurements appropriate for assessing the anxiety symptoms in children with ASD? Design/methodology/approach A systematic review protocol was developed from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2009). A rubric was adapted based on the CEC (Council for Exceptional Children; Cook, 2014) group comparison studies standards and the Evaluative Method for Determining EBP in Autism (Reichow et al., 2007). The 3-point Likert Scale (Chard et al., 2009) was adapted to score each study based on the rubric. Findings CBT is a first-line treatment with significant mixed results. Current studies use adapted versions of existing CBTs for children with ASD without reporting empirical evidence to these adaptations and changes. Reporting of the implementation fidelity is still an issue in the treatment of anxiety. Anxiety measurements that were designed for typically developing children failure to detect unusual anxiety symptoms in children with ASD. Research limitations/implications The first limitation of this study was including a variety of studies across CBT programs and types of anxiety symptoms. Types of anxiety and CBT treatments may require separate analyses with specific indicators. Due to the limited studies, reviews could not be analyzed across types of CBT programs. The second limitation was the types of studies. Most of the studies were pilot studies. Pilot studies might use various instruments and CBTs components for making selections to produce the best effects and results. The final limitation was the lack of examination of the data analysis process. Originality/value These findings are important because due to the variety of changes or adaptation to CBTs, inappropriate implementations and failure to detect unusual anxiety symptoms of children with ASD may cause significant differences in treatment responses and outcomes. The study demonstrated that the majority of the studies used adapted versions of existing CBTs without reporting empirical evidence for these adaptations and changes. The findings have shown that reporting of the implementation fidelity is still an issue. Moreover, the majority of studies had used anxiety measurements that were designed for typically developing children, not for children with ASD.
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6. Proskurnina E, Portnova G, Ivanova M, Sokolova S. Chemiluminescence analysis of saliva for the assessment of emotional stress in autistic children undergoing a medical examination. Advances in Autism. 2022; 8(4): 332-42.
Purpose An electroencephalography (EEG) examination may cause psychological stress in children with autism that can interfere with the examination results. The objective information on the presence or absence of psycho-emotional stress in patients can help interpret electroencephalograms. This paper aimed to demonstrate the potential of noninvasive objective diagnostics of emotional stress in autistic children undergoing an EEG examination based on analysis of saliva. Design/methodology/approach This study involved 19 children with autism spectrum disorder (ASD) (ICD-10 F84.0); the mean age was seven years. During EEG examination of the children, behavioral parameters were assessed. The activity of cytochrome P450 reductase (CYPOR) in saliva was measured before and after the EEG procedure using lucigenin-enhanced nicotinamide adenine dinucleotide phosphate-stimulated chemiluminescence assay. Findings Significant differences in CYPOR activity were found between the children who were distressed during an EEG examination and the children without behavioral disturbances (Mann–Whitney test, p = 0.002). Thus, the EEG examination resulted in an increase in CYPOR activity in saliva cells, which may prove the stressful effect of this procedure on autistic children. Originality/value The chemiluminescent indices reflecting the activity of microsomal CYPOR in cells presenting in saliva correlate with the absence or presence of psychological stress in children; this phenomenon can be explained by an increased metabolism of the stress hormone, cortisol, by the cytochrome P450 microsomal system. Furthermore, the proposed method is completely safe, noninvasive, rapid (recording time is 20 min), inexpensive and promising for an objective assessment of psycho-emotional stress in autistic children undergoing medical examinations.
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7. Riese B, Mukherjee RAS. The experiences of autistic adults during the COVID-19 pandemic in the UK and implications for autism services development. Advances in Autism. 2022; 8(4): 343-53.
Purpose COVID-19 has been challenging for many in the UK. This is no different to many with autism spectrum disorder. Based on the experiences and issues raised by a small group of autistic women in an ongoing support group, consideration if this holds true for the wider adult autistic community across further lockdowns and restrictions to public life was explored. Design/methodology/approach An online questionnaire was created based on the issues raised. Participants indicated the degree to which they agreed or disagreed with each statement. Findings Autistic adults experienced an increase in anxiety and poor mental health, which in turn has exacerbated autistic features, such as rigidity. The data indicates that autistic adults can adapt to change provided there is support in maintaining routines. Research limitations/implications The research is limited due to the small number of participants (N = 120), as well as national variations in service provision. Practical implications Our data raises wider questions about the nature of support for autistic adults without cognitive impairments during times of crises and how services can respond and may even be shaped in the future to provide support that is cost-effective and relevant to autistic adults. Social implications To ensure that services have an awareness of how crises impact on autistic adults and how relatively simple changes may avert poor mental health. Originality/value That the creation of local support networks, and the ability to access these, is a key feature of autism-specific support.
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8. Roy RG, Kumar A. The mediating role of parental playfulness on parent–child relationship and competence among parents of children with ASD. Advances in Autism. 2022; 8(4): 306-18.
Purpose The difficulties of a child diagnosed with autism spectrum disorder (ASD) can lead to behaviours that are quite challenging for parents to understand and address. Most of the parental studies of ASD focus on the challenges faced by the parents. This study aims to adopt a strength-based model that investigates the mediating role of parental playfulness in the association between parent–child relationship and parental competence. Design/methodology/approach This study is a quantitative study that adopts a correlational research design. The mediation analysis explores the role of parental playfulness as a mediator in the association between parent–child relationship and parental competence. The sample consisted of 120 parents of children diagnosed with ASD from India, selected using a purposive sampling technique. Findings The mediation analysis results indicate that playfulness among parents of children with ASD was found to function as a partial mediator in the relationship between parent–child relationship and parental competence. This could suggest that more playful parents have better parent–child relationships and are competent in parenting. Research limitations/implications These findings have importance in understanding the role of playful interaction on parent–child relationships and parenting competence, having implications for further research. Enabling playfulness in parenting will enhance children and parents to promote their relationship and thus feel competent to bring positive light in their lives. Practical implications Most often, the clinicians are concerned with addressing only the autistic symptoms; it is also essential to look into parental well-being. Practical playful interaction training should help parents establish a rapport, understand, adjust and adapt with their child. Social implications Practical intervention and training plans can be suggested to all family members to improve the condition of the child and the family’s general well-being. As the study focused on the clinical population, the findings could provide useful inputs for mental health professionals and counsellors. Originality/value There are some theoretical and empirical evidence that support positive outcomes of playfulness on personal well-being (Atzaba Poria, in press; Yue et al., 2016; Proyer, 2014). Although there has been some interest in the impact of children’s playfulness on their development (Bundy, 1997), little is known about the influence of parental playfulness on parents and children. Therefore, addressing these gaps, this empirical study focusses on investigating the role of parental playfulness in parent–child relationship and parental competence, rather than considering external challenges of parents based on the ASD child’s behavioural challenges and autistic features.