1. Afsharnejad B, Falkmer M, Black MH, Alach T, Lenhard F, Fridell A, Coco C, Milne K, Chen NTM, Bolte S, Girdler S. {{KONTAKT(c) for Australian adolescents on the autism spectrum: protocol of a randomized control trial}}. {Trials}. 2019; 20(1): 687.
BACKGROUND: Individuals diagnosed with autism spectrum disorder (ASD) experience impairing challenges in social communication and interaction across multiple contexts. While social skills group training (SSGT) has shown moderate effects on various sociability outcomes in ASD, there is a need for (1) replication of effects in additional clinical and cultural contexts, (2) designs that employ active control groups, (3) calculation of health economic benefits, (4) identification of the optimal training duration, and (5) measurement of individual goals and quality of life outcomes. METHOD/DESIGN: With the aim of investigating the efficacy and cost-effectiveness of a SSGT, KONTAKT(c), a two-armed randomized control trial with adolescents aged 12-17 years (N = 90) with ASD and an intelligence quotient (IQ) of over 70 will be undertaken. Following stratification for centre and gender, participants will be randomly assigned to either KONTAKT(c) or to an active control group, a group-based cooking programme. Participants will attend both programmes in groups of 6-8 adolescents, over 16 one-and-a-half-hour sessions. The primary outcome examined is adolescent self-rated achievement of personally meaningful social goals as assessed via the Goal Attainment Scaling during an interview with a blinded clinician. Secondary outcomes include adolescent self-reported interpersonal efficacy, quality of life, social anxiety, loneliness, face emotion recognition performance and associated gaze behaviour, and parent proxy reports of autistic traits, quality of life, social functioning, and emotion recognition and expression. Cost-effectiveness will be investigated in relation to direct and indirect societal and healthcare costs. DISCUSSION: The primary outcomes of this study will be evidenced in the anticipated achievement of adolescents’ personally meaningful social goals following participation in KONTAKT(c) as compared to the active control group. This design will enable rigorous evaluation of the efficacy of KONTAKT(c), exercising control over the possibly confounding effect of exposure to a social context of peers with a diagnosis of ASD. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12617001117303. Registered on 31 July 2017. anzctr.org.au ClinicalTrials.gov, NCT03294668. Registered on 22 September 2017. https://clinicaltrials.gov.
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2. Cassidy SA, Gould K, Townsend E, Pelton M, Robertson AE, Rodgers J. {{Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample}}. {J Autism Dev Disord}. 2019.
The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18-23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.
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3. Chlebowski C, Hurwich-Reiss E, Wright B, Brookman-Frazee L. {{Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study}}. {Journal of community psychology}. 2019.
Embedded within a Hybrid Type 1 randomized effectiveness-implementation trial in publicly funded mental health services, the current study identified stakeholder recommendations to inform cultural adaptations to An Individualized Mental Health Intervention for Autism Spectrum Disorder (AIM HI) for Latinx and Spanish-speaking families. Recommendations were collected through focus groups with therapists (n = 17) and semi-structured interviews with Latinx parents (n = 29). Relevant themes were identified through a rapid assessment analysis process and thematic coding of interviews. Adaptations were classified according to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to facilitate fit, acceptability, and sustained implementation of AIM HI and classify the content, nature, and goals of the adaptations. Recommended adaptations were classified through FRAME as tailoring training and intervention materials, changing packaging or materials, extending intervention pacing, and integrating supplemental training strategies. Goals for adaptations included improving fit for stakeholders, increasing parent engagement, and enhancing intervention effectiveness. The current study illustrates the process of embedding an iterative process of intervention adaptation within a hybrid effectiveness-implementation trial. The next steps in this study are to integrate findings with implementation process data from the parent trial to develop a cultural enhancement to AIM HI and test the enhancement in a Hybrid Type 3 implementation-effectiveness trial.
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4. Epstein S, Elefant C, Thompson G. {{Music Therapists’ Perceptions of the Therapeutic Potentials Using Music When Working With Verbal Children on the Autism Spectrum: A Qualitative Analysis}}. {Journal of music therapy}. 2019.
While there are numerous descriptions of the use of music and its therapeutic potential by music therapists working with nonverbal children on the autism spectrum, only limited literature focuses on exploring how music therapists use music and perceive its therapeutic potential when working with children on the spectrum who have verbal skills. This qualitative study aimed to explore music therapists’ descriptions of the use of music and its therapeutic potential in their work with children on the autism spectrum who have verbal skills. Semi-structured interviews were conducted with six qualified music therapists from Israel and then analyzed according to the principles of interpretative phenomenological analysis (IPA). Three main themes were identified: (a) musical infrastructure, which describes how the music therapists facilitated musical experiences to support the children’s ability to regulate their arousal, attention and emotions; (b) the meeting point between musical and verbal playfulness, which reflects the music therapists’ beliefs about how musical experiences add vitality and support the development of both verbal and nonverbal imaginative play; and (c) musical responses, which describes the different ways music therapists use their voice and songs to interact musically with verbal children. The experiences described by the participants emphasize the importance of the therapist musically attuning to the child’s emotional, physiological, creative, and playful qualities, even when the child has verbal skills. These musical interactions help to create a shared experience between the child and therapist that are perceived to help the child’s different forms of regulation, continuity, and vitality within the play.
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5. McDonnell CG, DeLucia EA, Hayden EP, Anagnostou E, Nicolson R, Kelley E, Georgiades S, Liu X, Stevenson RA. {{An Exploratory Analysis of Predictors of Youth Suicide-Related Behaviors in Autism Spectrum Disorder: Implications for Prevention Science}}. {J Autism Dev Disord}. 2019.
Although autism spectrum disorder (ASD) is associated with significant mental health concerns, little is known about suicidality, particularly among youth. To address this critical gap in the literature, the current study examined the predictive validity of (1) demographics, (2) core autism symptoms, (3) cognitive abilities and adaptive behavior, (4) comorbid psychopathology, and (5) medical problems, for suicide-related behaviors among autistic youth (N = 481; Mage = 11.56 years). As indices of suicide-related behaviors, parents reported on whether the child had ever (1) talked about killing themselves, and (2) engaged in deliberate self-harm or attempted suicide. These two suicide-related outcomes had distinct clinical correlates, including child age, parental education, restricted and repetitive behaviors, IQ and adaptive behavior, affective and conduct problems, and medical concerns.
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6. Mizuno Y, Kagitani-Shimono K, Jung M, Makita K, Takiguchi S, Fujisawa TX, Tachibana M, Nakanishi M, Mohri I, Taniike M, Tomoda A. {{Structural brain abnormalities in children and adolescents with comorbid autism spectrum disorder and attention-deficit/hyperactivity disorder}}. {Translational psychiatry}. 2019; 9(1): 332.
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) share high rates of comorbidity, with the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition now acknowledging the comorbid diagnosis of ASD and ADHD. Although structural abnormalities in the prefrontal cortex, cerebellum, and basal ganglia occur in both ASD and ADHD, no structural studies have focused exclusively on patients with comorbid ASD and ADHD. We thus aimed to clarify the structural features and developmental changes in patients with comorbid ASD and ADHD in a relatively large sample from two sites. Ninety-two patients were age-matched to 141 typically developing (TD) controls (age range: 5-16 years) and assessed for volumetric characteristics using structural magnetic resonance imaging (i.e. surface-based morphometry). While there were no significant differences in prefrontal cortex, cerebellum, and basal ganglia volumes, patients with ASD and ADHD exhibited significantly lower left postcentral gyrus volumes than TD controls. We observed significantly lower postcentral gyrus volumes exclusively in children and preadolescents, and not in adolescents. Our findings suggest that abnormal somatosensory, attributed to delayed maturation of the left postcentral gyrus, leads to the core symptoms experienced by patients with comorbid ASD and ADHD.
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7. South M, Beck JS, Lundwall R, Christensen M, Cutrer EA, Gabrielsen TP, Cox JC, Lundwall RA. {{Unrelenting Depression and Suicidality in Women with Autistic Traits}}. {J Autism Dev Disord}. 2019.
Understanding the cognitive and emotional mechanisms that link autistic traits and risk for suicide is a vital next step for research and clinical practice. This study included a broad sample of adult women (n = 74) who report finding social situations confusing and/or exhausting, and who score high on measures of autistic traits. Regardless of autism diagnostic status, these women reported high rates of suicidal thoughts and behaviors. Depression symptoms were more associated with suicidality than were autistic trait measures of social communication. Measures of neurotypical « imagination » and of repetitive behavior likewise were associated with suicidality risk. Simultaneously feeling sad and feeling stuck or unable to imagine alternate strategies, may uniquely increase suicide risk in autism.
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8. Takeguchi R, Takahashi S, Kuroda M, Tanaka R, Suzuki N, Tomonoh Y, Ihara Y, Sugiyama N, Itoh M. {{MeCP2_e2 partially compensates for lack of MeCP2_e1: A male case of Rett syndrome}}. {Molecular genetics & genomic medicine}. 2019: e1088.
BACKGROUND: Rett syndrome (RTT) is a neurodevelopmental disorder that predominantly affects girls. Its causative gene is the X-linked MECP2 encoding the methyl-CpG-binding protein 2 (MeCP2). The gene comprises four exons and generates two isoforms, namely MECP2_e1 and MECP2_e2. However, it remains unclear whether both MeCP2 isoforms have similar function in the brain. METHODS: We report a case of a boy with typical RTT. Male cases with MECP2 variants have been considered inviable, but somatic mosaicism of the variants can cause RTT in males. Whole-exome sequencing was performed to search for the genetic background. RESULTS: A novel nonsense and mosaic variant was identified in exon 1 of MECP2, and the variant allele fraction (VAF) was 28%. Our patient had the same level of VAF as that in reported male cases with mosaic variants in MECP2 exon 3 or 4, but manifested RTT symptoms that were milder in severity compared to those in these patients. CONCLUSION: This is probably because the variants in MECP2 exon 3 or 4 disrupt both isoforms of MeCP2, whereas the variant in exon 1, as presented in this study, disrupts only MeCP2_e1 but not MeCP2_e2. Therefore, our findings indicate that MeCP2_e2 may partially compensate for a deficiency in MeCP2_e1.
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9. van Kessel R, Roman-Urrestarazu A, Ruigrok A, Holt R, Commers M, Hoekstra RA, Czabanowska K, Brayne C, Baron-Cohen S. {{Autism and family involvement in the right to education in the EU: policy mapping in the Netherlands, Belgium and Germany}}. {Mol Autism}. 2019; 10: 43.
Introduction: In recent years, the universal right to education has been emphasised by the Universal Declaration on Human Rights and the Convention on the Rights of Persons with Disabilities. In this paper, we mapped policies relevant to special education needs and parental involvement of children with autism at an international level and in the Netherlands, Germany and Belgium. Methods: A policy path analysis was performed using a scoping review as an underlying methodological framework. This allowed for a rapid gathering of available data from which a timeline of adopted policies was derived. Results and discussion: Internationally, the universal right to education has been reinforced repeatedly and the values of the Universal Declaration of Human Rights have been reiterated with every reinforcement. Also, the additional support that a child with special education needs requires is acknowledged and measures are taken to facilitate access to any education for all children. There are slight cross-country differences between the countries under study, attributable to differences in national regulation of education. However, all countries have progressed to a state where the right to education for all children is integrated on a policy level and measures are taken to enable children with special needs to participate in education. Recently, an attempt to implement a form of inclusive education was made as a form of special needs provision. Nevertheless, nowhere has this been implemented successfully yet. Conclusion: The Universal Declaration of Human Rights was a critical juncture in international policy and created an environment where the universal right to education has been implemented for all children in the countries under study.
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10. van Leeuwen TM, van Petersen E, Burghoorn F, Dingemanse M, van Lier R. {{Autistic traits in synaesthesia: atypical sensory sensitivity and enhanced perception of details}}. {Philosophical transactions of the Royal Society of London Series B, Biological sciences}. 2019; 374(1787): 20190024.
In synaesthetes, specific sensory stimuli (e.g. black letters) elicit additional experiences (e.g. colour). Synaesthesia is highly prevalent among individuals with autism spectrum disorder (ASD), but the mechanisms of this co-occurrence are not clear. We hypothesized autism and synaesthesia share atypical sensory sensitivity and perception. We assessed autistic traits, sensory sensitivity and visual perception in two synaesthete populations. In Study 1, synaesthetes (N = 79, of different types) scored higher than non-synaesthetes (N = 76) on the Attention-to-detail and Social skills subscales of the autism spectrum quotient indexing autistic traits, and on the Glasgow Sensory Questionnaire indexing sensory hypersensitivity and hyposensitivity which frequently occur in autism. Synaesthetes performed two local/global visual tasks because individuals with autism typically show a bias towards detail processing. In synaesthetes, elevated motion coherence thresholds (MCTs) suggested reduced global motion perception, and higher accuracy on an embedded figures task suggested enhanced local perception. In Study 2, sequence-space synaesthetes (N = 18) completed the same tasks. Questionnaire and embedded figures results qualitatively resembled Study 1 results, but no significant group differences with non-synaesthetes (N = 20) were obtained. Unexpectedly, sequence-space synaesthetes had reduced MCTs. Altogether, our studies suggest atypical sensory sensitivity and a bias towards detail processing are shared features of synaesthesia and ASD. This article is part of the discussion meeting issue ‘Bridging senses: novel insights from synaesthesia’.
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11. Zilli C, Parsons S, Kovshoff H. {{Keys to engagement: A case study exploring the participation of autistic pupils in educational decision-making at school}}. {The British journal of educational psychology}. 2019.
BACKGROUND: The UNCRC (1989) established the importance of listening to children’s views globally. In England, seeking the views of pupils with special educational needs and disability about their education, and involving them in decision-making, has been mandatory since 2015. Autistic children’s views and experiences are particularly underrepresented in this context. AIMS: To provide a detailed exploratory analysis of practices that enable autistic pupils to participate in educational decision-making, and to generate new knowledge about pupil participation in a school context, using the Framework for Participation (Black-Hawkins, 2010) as an analytical frame. SAMPLE: Four male pupils aged 11-15, with autism spectrum diagnoses, and 11 staff members from a specialist, independent school took part in this case study. METHODS: Observations were made of pupils in lessons, and pupils completed a photo-voice activity focusing on where they felt ‘most listened to’ in the school. Staff members participated in semi-structured interviews. RESULTS: A range of practices supported pupils’ participation in everyday decision-making, underpinned by a respectful and positive culture led by the senior management team. The focus was on what learners can do and how they make decisions to facilitate achievement. Pupils and staff developed mutually respectful relationships, within which boundaries were negotiated and compromises offered. Flexibility through decision-making was provided within the timetabling and content of the curriculum. Pupils’ special interests and expertise were valued as ‘keys’ to supporting their engagement. CONCLUSIONS: These insights provide a tool for reflection by educators and educational psychologists for considering how they might promote the participation of autistic pupils in different educational contexts.
