Search results
Found 12785 matches for
A review of instruments developed to measure outcomes for carers of people with mental health problems.
OBJECTIVE: Community-based care for mental disorders places considerable burden on families and carers. Measuring their experiences has become a priority, but there is no consensus on appropriate instruments. We aimed to review instruments carers consider relevant to their needs and assess evidence for their use. METHOD: A literature search was conducted for outcome measures used with mental health carers. Identified instruments were assessed for their relevance to the outcomes identified by carers and their psychometric properties. RESULTS: Three hundred and ninety two published articles referring to 241 outcome measures were identified, 64 of which were eligible for review (used in three or more studies). Twenty-six instruments had good psychometric properties; they measured (i) carers' well-being, (ii) the experience of caregiving and (iii) carers' needs for professional support. CONCLUSION: Measures exist which have been used to assess the most salient aspects of carers outcome in mental health. All require further work to establish their psychometric properties fully.
Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan.
BACKGROUND: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. OBJECTIVE: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. METHODS: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety-related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants' feedback about their experience with the iCT-SAD. RESULTS: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P
Exploring an e-learning community's response to the language and terminology use in autism from two massive open online courses on autism education and technology use.
Within the neurodiversity movement, one recent divergence is in the semantic choice of language when describing autism, as members of the autism and autistic community preferred to use identity-first language (autistic person), whereas professionals were more likely to use person-first language (person with autism). This study explored 803 e-learners' responses from their comments across two massive open online courses on autism education held between 2017 and 2019. Learners agreed that autistic individuals should guide others on which terminology to use when describing autism, and although identity-first language acknowledges autism as part of an individual's identity, it can also conjure up negative stereotypes and be stigmatising. Although family, friends and professionals highlighted that the diagnostic label is a way to facilitate understanding across stakeholder groups and help autistic individuals gain access to support, autistic self-advocates found the process of disclosing autism as a form of disability to conflict with their sense of identity, and broader terms such as 'autism spectrum' failed to capture individual strengths and weaknesses. Semantic language choices may matter less as long as the person's difficulties are clearly acknowledged, with adaptations made to meet their specific needs. Adding to a growing body of literature on terminology use in autism research and practice, we highlight that language used when describing autism should follow the autistic individual's lead, with the primary focus on communicating an individual's strengths and difficulties, to foster a sense of positive autism identity and inclusivity, and enable access to appropriate support.
Understanding the role of self-determination in shaping university experiences for autistic and typically developing students in the United Kingdom.
Prior research suggests that autistic students in higher education might struggle with developing autonomy, competence and establish relatedness due to their executive functioning and social communication difficulties. We interviewed 18 autistic and 18 typically developing students to explore how students perceived themselves to be in control of their university experience. Both groups provided anecdotal examples that supported similar perceptions of self-determination in shaping the academic, daily living and socialisation aspects of university life. Autistic students reflected on their cognitive strengths such as attention to detail, persistence and ability to tailor their academic studies towards their interest. Varying degrees of sociability were noted, with some autistic students preferring to focus their self-determination efforts on academic success, while others treasured the novel social experiences including peer support and friendship at university. Compared to greater flexibility endorsed by typically developing students, autistic students perceived establishing a routine at university to be a necessity and were self-determined in maintaining stability amid a sea of change. Recognising strengths and self-determination efforts in autistic students can help stakeholders support their personal development towards independent living and self-sufficiency in adulthood and to successfully transition into, through and out of university.
I Have a Fear of Negative Evaluation, Get Me Out of Here! Examining Latent Constructs of Social Anxiety and Autistic Traits in Neurotypical and Autistic Young People.
Understanding shared and unique constructs underlying social communication difficulties in autism spectrum disorder (ASD) and social anxiety disorder (SAD) can address potential diagnostic overshadowing when evaluating SAD in the context of autism. Using self-report measures, factor analyses examined constructs underlying autistic traits, social anxiety, internalising symptoms and wellbeing amongst 267 neurotypical (17-19 years) and 145 autistic (15-22 years) students in the UK. Shared constructs across measures assessed general social communication competency (e.g., social distress in new situations and peer relationships). Fear of Negative Evaluation (FNE) was identified in both samples as a stable construct unique to social anxiety. Adapting interventions targeting SAD in autism should target FNE during adolescence which marks a period of heightened peer interaction and social vulnerability.
Evaluating the Role of Autistic Traits, Social Anxiety, and Social Network Changes During Transition to First Year of University in Typically Developing Students and Students on the Autism Spectrum.
This is the first longitudinal study to quantitatively evaluate changes in social network structure (SNS) and perceived social support (PSS) amongst first-year students on the autism spectrum (n = 21) and typically developing (TD; n = 182) students transitioning to university. The relative impact of changes in SNS/PSS, students' social anxiety and autistic traits, on first-year university transition outcomes were also examined. Both groups gained friends over time who provided better support quantity and quality during first year of university. Social anxiety showed long-term differential negative impact on students on the autism spectrum and TD students' academic, social and personal/emotional adjustments, and institutional attachment, suggesting stakeholders should focus on delivering interventions to reduce social anxiety to improve university transition outcomes.
Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder.
Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16-19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students' quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.
Differences in anxieties and social networks in a group-matched sample of autistic and typically developing students transitioning to university.
Transitioning to university can be anxiety-provoking for all students. The relationship between social anxiety, autistic traits and students' social network structure, and perceived support is poorly understood. This study used a group-matched design where autistic students (n = 28) and typically developing students (n = 28) were matched on sex, age (17-19 years), ethnicity, pre-university academic performance and degree subject at university. Autistic students reported greater transition to university worries, and a smaller social network size compared to typically developing students, though perceived similar levels of support from their social networks. Autistic and typically developing students showed differential patterns of association with both autistic traits and social anxiety. Broader clinical and practical implications of findings are discussed.
Altered Neural Connectivity in Females, But Not Males with Autism: Preliminary Evidence for the Female Protective Effect from a Quality-Controlled Diffusion Tensor Imaging Study.
Previous studies using diffusion tensor imaging (DTI) to investigate white matter (WM) structural connectivity have suggested widespread, although inconsistent WM alterations in autism spectrum disorder (ASD), such as greater reductions in fractional anisotropy (FA). However, findings may lack generalizability because: (a) most have focused solely on the ASD male brain phenotype, and not sex-differences in WM integrity; (b) many lack stringent and transparent data quality control such as controlling for head motion in analysis. This study addressed both issues by using Tract-Based Spatial Statistics (TBSS) to separately compare WM differences in 81 ASD (56 male, 25 female; 4-21 years old) and 39 typically developing (TD; 23 males, 16 females; 5-18 years old) children and young people, carefully group-matched on sex, age, cognitive abilities, and head motion. ASD males and females were also matched on autism symptom severity. Two independent-raters completed a multistep scan quality assurance to remove images that were significantly distorted by motion artifacts before analysis. ASD females exhibited significant widespread reductions in FA compared to TD females, suggesting altered WM integrity. In contrast, no significant localized or widespread WM differences were found between ASD and TD males. This study highlights the importance of data quality control in DTI, and outlines important sex-differences in WM alterations in ASD females. Future studies can explore the extent to which neural structural differences might underlie sex-differences in ASD behavioral phenotype, and guide clinical interventions to be tailored toward the unique needs of ASD females and males. Autism Res 2019, 12: 1472-1483. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: Previous Diffusion Tensor Imaging (DTI) studies have found atypical brain structural connectivity in males with autism, although findings are inconclusive in females with autism. To investigate potential sex-differences, we studied males and females with and without autism who showed a similar level of head movement during their brain scan. We found that females with autism had widespread atypical neural connectivity than females without autism, although not in males, highlighting sex-differences.
Developing an Online Tool to Measure Social Network Structure and Perceived Social Support Amongst Autistic Students in Higher Education: A Feasibility Study.
The academic, daily-living, and social challenges all students face during university transition can become magnified for many autistic students, who might struggle to adapt to changes in their social network structure (SNS) and perceived social support (PSS). This study assessed the development, feasibility, and convergent validity of a novel online tool (Social Network and Perceived Social Support-SNaPSS) designed to quantitatively and qualitatively evaluate SNS and PSS during university transition. SNaPSS demonstrated good feasibility for completion amongst autistic students (Study 1, n = 10, 17-19 years), and adequate convergent validity against other PSS, autism symptom severity, and social anxiety measures amongst autistic (n = 28) and typically developing students (Study 2, n = 112, 17-19 years). Broader implications of SNaPSS to measure SNS/PSS are discussed.
Characterising the relationship between theory of mind and anxiety in children with Autism Spectrum Disorder and typically developing children
Background: Social communication impairments associated with Autism Spectrum Disorder (ASD) is a multi-faceted phenomenon that encapsulates a broad range of skills with Theory of Mind (ToM) as a key component. Early Theory of Mind (ToM) skills, such as joint attention, typically develop during infancy and provide a foundation for the co-emergence of affect regulation via social referencing. Children with Autism Spectrum Disorder (ASD) demonstrate delays and impairments in the development of ToM, and up to 40% of children with ASD also experience co-occurring symptoms of anxiety and poor affect regulation. Method: Using parent report, this cross-sectional study aimed to characterise the relationship between ToM competency and anxiety, and explore how specific ToM deficits may confer vulnerability to anxiety in children (4–8 years old) with ASD. Results: Early ToM skills, such as joint attention and social referencing, mediated the relationship between broader social communication impairments and anxiety symptom severity in children with ASD. Conclusions: Increasing competency of early ToM skills might provide additional therapeutic benefits for clinical interventions targeting anxiety in children with ASD.
Pivotal response treatment for autism spectrum disorder: current perspectives.
Pivotal response treatment (PRT) is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD). PRT adopts a more naturalistic approach and focuses on using a number of strategies to help increase children's motivation during intervention. Since its conceptualization, PRT has received much empirical support for eliciting therapeutic gains in greater use of functional social communication skills in individuals with ASD. Building upon the empirical evidence supporting PRT, recent advancements have increasingly turned to using interdisciplinary research integrating neuroimaging techniques and behavioral measures to help identify objective biomarkers of treatment, which have two primary purposes. First, neuroimaging results can help characterize how PRT may elicit change, and facilitate partitioning of the heterogeneous profiles of neural mechanisms underlying similar profile of behavioral changes observed over PRT. Second, neuroimaging provides an objective means to both map and track how biomarkers may serve as reliable and sensitive predictors of responder profiles to PRT, assisting clinicians to identify who will most likely benefit from PRT. Together, a better understanding of both mechanisms of change and predictors of responder profile will help PRT to serve as a more precise and targeted intervention for individuals with ASD, thus moving towards the goal of precision medicine and improving quality of care. This review focuses on the recent emerging neuroimaging evidences supporting PRT, offering current perspectives on the importance of interdisciplinary research to help clinicians better understand how PRT works and predict who will respond to PRT.
Distinct neural bases of disruptive behavior and autism symptom severity in boys with autism spectrum disorder.
BACKGROUND: Disruptive behavior in autism spectrum disorder (ASD) is an important clinical problem, but its neural basis remains poorly understood. The current research aims to better understand the neural underpinnings of disruptive behavior in ASD, while addressing whether the neural basis is shared with or separable from that of core ASD symptoms. METHODS: Participants consisted of 48 male children and adolescents: 31 ASD (7 had high disruptive behavior) and 17 typically developing (TD) controls, well-matched on sex, age, and IQ. For ASD participants, autism symptom severity, disruptive behavior, anxiety symptoms, and ADHD symptoms were measured. All participants were scanned while viewing biological motion (BIO) and scrambled motion (SCR). Two fMRI contrasts were analyzed: social perception (BIO > SCR) and Default Mode Network (DMN) deactivation (fixation > BIO). Age and IQ were included as covariates of no interest in all analyses. RESULTS: First, the between-group analyses on BIO > SCR showed that ASD is characterized by hypoactivation in the social perception circuitry, and ASD with high or low disruptive behavior exhibited similar patterns of hypoactivation. Second, the between-group analyses on fixation > BIO showed that ASD with high disruptive behavior exhibited more restricted and less DMN deactivation, when compared to ASD with low disruptive behavior or TD. Third, the within-ASD analyses showed that (a) autism symptom severity (but not disruptive behavior) was uniquely associated with less activation in the social perception regions including the posterior superior temporal sulcus and inferior frontal gyrus; (b) disruptive behavior (but not autism symptom severity) was uniquely associated with less DMN deactivation in the medial prefrontal cortex (MPFC) and lateral parietal cortex; and (c) anxiety symptoms mediated the link between disruptive behavior and less DMN deactivation in both anterior cingulate cortex (ACC) and MPFC, while ADHD symptoms mediated the link primarily in ACC. CONCLUSIONS: In boys with ASD, disruptive behavior has a neural basis in reduced DMN deactivation, which is distinct and separable from that of core ASD symptoms, with the latter characterized by hypoactivation in the social perception circuitry. These differential neurobiological markers may potentially serve as neural targets or predictors for interventions when treating disruptive behavior vs. core symptoms in ASD.
Brief report: Reduced anxiety following Pivotal Response Treatment in young children with Autism Spectrum Disorder.
Up to 40% of children with Autism Spectrum Disorder (ASD) exhibit co-occurring anxiety symptoms. Despite recent success in mitigating anxiety symptoms in school-aged children with ASD (mean age >9 years) using adapted versions of Cognitive Behavioural Therapy, little is known about potential treatment outcomes for younger children. To address the gap in the literature, this open-label study evaluated change in anxiety following a 16-week open-label trial of Pivotal Response Treatment (PRT) in children with ASD aged 4-8 years. PRT is a behavioural treatment based on the principles of Applied Behaviour Analysis and has a primary aim of increasing social communication skills in children with ASD through natural reinforcements. To minimise conflation of anxiety and other co-occurring symptoms such as disruptive behaviour and attention-deficit hyperactivity disorder, we measured anxiety using the autism anxiety subscale of the Child and Adolescent Symptom Inventory (CASI) devised by Sukhodolsky et al. (2008). We observed significant anxiety reduction over 16-weeks of PRT. Furthermore, anxiety reduction was independent of changes in autism symptom severity. This study shows promising results for PRT as an intervention for reducing anxiety in young children with ASD.
Parenting a Child with ASD: Comparison of Parenting Style Between ASD, Anxiety, and Typical Development.
Parenting children with ASD has a complex history. Given parents' increasingly pivotal role in children's treatment, it is critical to consider parental style and behaviours. This study (1) compares parenting style of parents of children with ASD, parents of children with anxiety disorders, and parents of typically developing (TD) children and (2) investigates contributors to parenting style within and between groups. Parents of children with anxiety had a distinct parenting style compared to ASD and TD parents. Unique relationships between child symptoms and parenting behaviours emerged across the three groups. Understanding factors that impact parenting between and within clinical groups can guide the development of interventions better tailored to support the needs of parents, particularly parents of children with ASD.
Exploring the suitability of the Clark and Wells (1995) model of social anxiety in autistic adults: The role of mental imagery and fear of negative evaluation.
Around 50% of autistic adults meet diagnostic criteria for social anxiety disorder based on self-report questionnaires. Among non-autistic adults with social anxiety, distorted negative self-imagery in social situations stemming from fear of negative evaluation from observers can be corrected in cognitive therapy via video feedback. However, the role of social imagery in the maintenance of social anxiety has not been explored in autistic adults. This study examined in 62 autistic adults: (1) quality of social imagery elicited during social situations; (2) how image qualities were related to self-reported levels of social anxiety and fear of negative evaluation when accounting for co-occurring generalised anxiety. Many autistic adults reported social imagery from a field (i.e., looking through one's own eyes) rather than observer perspective. Using response surface analysis (RSA), autistic adults wanted to escape from/avoid social imagery and found them more upsetting when social anxiety was greater than fear of negative evaluation from others. Social imagery may be linked to autistic adults' somatic and sensory responses related to social anxiety rather than cognitive worries associated with fear of negative evaluation from others in social situations. Future studies can explore how qualitative differences in social imagery may influence maintenance of social anxiety and treatment efficacy in autistic and non-autistic adults over time.Lay abstractMany autistic adults experience social anxiety, which can negatively impact on one's quality of life and increase risk for developing other mental health difficulties if left untreated. Current treatment for social anxiety involves supporting individuals to identify their worries in social situations and explore how focusing on one's worries about being judged by others might generate an unhelpful and inaccurate negative image of oneself in social situations. In treatment, individuals use video feedback to look for differences between how they think they might come across to others, versus how they actually come across to others in conversation. Correcting any overly negative and unhelpful images of oneself in social situations is a key step in treatment for social anxiety. To date, little is known about whether autistic adults also generate negative images of oneself in social situations, and whether these images are related to one's worries about being judged by others. In this study, we interviewed 62 autistic adults and asked them to generate images about relaxed and social situations. Autistic adults found images generated about being in a social situation to be more upsetting and anxiety inducing, less controllable and wanted to escape from/avoid such images. Negative aspects of social images were more related to general feelings of social anxiety rather than specific worries about being perceived negatively by others. We propose that autistic adults may draw on bodily sensations and sensory experiences related to general distress or feelings of discomfort to generate images in social situations. This is different to non-autistic adults where images may be generated based on one's belief of how others might negative perceive oneself in social situations. Understanding such differences and the role images play in social anxiety for autistic and non-autistic adults can help clinicians better adapt treatment for social anxiety to suit autistic adults' needs.
Social Network Structure in Autistic Individuals: A Systematic Review
Background: While many studies aim to address social communication differences between autistic and non-autistic individuals, little is known about the real-world impact on the quantity and quality of social relationships that develop across their lifespan. Social network analysis captures the size and connectedness of one’s social network and offers insight into one’s social connectivity with other people either within one (e.g., school, workplace) or multiple social settings. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched across PubMed, PsycINFO, and Web of Science to identify articles that examined how the social network structure is measured among autistic individuals and the characteristics of social network structure across the lifespan. Results: After removing 308 duplicates from 4177 identified studies, we screened titles and abstracts for 3869 articles and full texts for 70 articles. Twenty-five studies met the eligibility and led to 4 additional relevant studies identified from reference lists, with a total of 29 studies included for narrative synthesis. Most studies were U.S.-based (n = 19) and included children and young people (n = 21) recruited from local schools (n = 20). Many studies (n = 17) used the Friendship Survey to assess peer relationships within classroom settings, with social networks that reflect peer acceptance, rejection, and reciprocal friendships. Results indicate that autistic children experience greater isolation with more peripheral status and lower peer acceptance compared with their neurotypical peers. Other social network mapping tools in adults captured both social network structure (e.g., number of network members and their connections with each other), and some captured support provided by network members, with family members often cited as providing the most frequent and best quality support across a range of life domains. Conclusion: There is limited knowledge about social network structure for autistic individuals beyond childhood in classroom settings. Social network analysis may provide a valuable snapshot into the types of social connections an autistic individual may have in one or more settings. However, we emphasize the need to work together with autistic individuals to understand how they perceive their social network structure to be meeting their social need.