Although higher-order restricted and repetitive behaviors (H-RRBs) are associated with social, emotional, and behavioral difficulties in individuals with Autism Spectrum Disorder (ASD), there is a paucity of literature on behavioral interventions to treat this core symptom. Through a systematic search, 29 intervention studies that target H-RRBs were identified and analyzed in terms of (a) participant characteristics, (b) setting, (c) targeted behaviors, (d) intervention procedures, (e) experimental design, (f) outcomes and certainty of evidence, and (g) generalization and maintenance of outcomes. Overall, 41% of studies (n = 12) yielded large effect sizes, 34% yielded medium effects (n = 10), and 17% yielded small effects (n = 5). Results suggest that studies yielding large effect sizes were more likely to be rooted in applied behavior analysis (ABA) than cognitive behavioral therapy (CBT), more likely to use function-based than non-function-based interventions, more likely to use both antecedent- and consequence-based interventions versus either one alone, more likely to use single-subject designs than group designs, and were more likely to be classified as focused intervention practices than comprehensive treatment models or manualized treatment programs. Overall, results suggest that ABA and CBT approaches to treating H-RRBs show promise. Directions for future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for youth with anxiety and related disorders, with a 59% remission rate at post-treatment. Results of reviews and meta-analyses indicate that treatment gains are maintained across long-term follow-up, at least in terms of symptom improvement. Less is known about relapse, defined as patients who initially achieve remission status but then experience a return of symptoms after a follow-up period.
METHOD: The current study used meta-analysis to determine the overall rate of relapse in CBT for children and adolescents (age 18 years or younger) with anxiety and related disorders. Potential moderating factors of relapse rates, including demographic, methodological, and clinical/intervention characteristics, were also examined. Out of a pool of 78 abstracts, 13 full-text articles were retained for meta-analysis. An additional two articles were identified from other sources (total N = 535 patients).
RESULTS: Results showed an overall relapse rate of 10.5% (including comorbid autism spectrum disorder) and 8% (excluding comorbid autism spectrum disorder) across studies. Moderator analyses demonstrated that relapse rates were higher among younger and more racially diverse samples, as well as among patients with comorbid externalizing disorders and those taking psychiatric medications. There were no differences in relapse rates as a function of primary diagnosis.
CONCLUSIONS: Taken together, the findings indicate that relapse rates in CBT for anxious youth are relatively low, suggesting that treatment development and refinement efforts should focus on improving treatment response and remission rates for this population.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (N = 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.
Autism is a type of neurodegenerative disorder, caused by genetic and environmental factors. Children with autism spectrum disorder (ASD) have symptoms of attention deficit and behavioral problems. Child's sleep pattern has a significant effect on mood. Sleep problems are more common in children with ASD. The current study aimed to investigate the effect of non-pharmacological approaches on the improvement of sleep disturbances in patients with ASD. Materials & Methods We systematically searched PubMed, EMBASE, Web of Science, Scopus, and Science Direct to identify relevant articles published from January 2009 to May 2019. All original articles from observational and interventional studies were reviewed. The CONSORT Statement and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were used to assess the quality of selected papers. Results Reviewing 18 eligible articles according to the CONSORT checklist (for interventional studies) and STROBE (for descriptive studies) demonstrated that behavioral interventions, such as cognitivebehavioral therapy, bedtime fading with response cost, and functional behavioral assessment, physical activity such as aerobic exercise, swimming, and aquatic exercise and weighted blankets can improve sleep disturbances. Conclusion Restlessness, tantrums, increased stereotypic activities, and reduced learning level and speaking power in children with autism were caused by poor sleep quality and sleep deficiency, which may affect other dimensions of life. Non- pharmacological approaches to sleep disturbances could improve both sleep quality and quality of life of children with ASD with no adverse effect.
BACKGROUND: Autistic spectrum disorder (ASD) is an increasingly recognised neurodevelopmental condition; that is, a neurologically-based condition which interferes with the acquisition, retention or application of specific skills. ASD is characterised by challenges with socialisation and communication, and by stereotyped and repetitive behaviours. A stereotyped behaviour is one which is repeated over and over again and which seems not to have any useful function. ASD often co-occurs with mental health disorders, including obsessive compulsive disorder (OCD). People with ASD may show certain cognitive differences (i.e. differences in ways of thinking) which influence their response to therapies. Thus, there is a need for evidence-based guidelines to treat mental health issues in this group. OCD, a common condition characterised by repeated obsessional thoughts and compulsive acts, occurs with greater frequency in persons with ASD than in the general population. Genetic, anatomic, neurobiological and psychological factors have been proposed to explain this co-occurrence. However, care should be taken to distinguish stereotyped and repetitive behaviours characteristic of ASD from obsessive compulsive acts in OCD. Cognitive behavioural therapy (CBT) is the recommended treatment for OCD, but studies have suggested that this treatment may be less effective in those with OCD co-occurring with ASD. Hence, modifications to CBT treatment may be helpful when treating OCD co-occurring with ASD to optimise outcomes.
OBJECTIVES: To assess the effectiveness of behavioural and cognitive behavioural therapy for obsessive compulsive disorder (OCD) in children and adults with autism spectrum disorder (ASD).
SEARCH METHODS: We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, five other bibliographic databases, international trial registries and other sources of grey literature (to 24 August 2020). We checked the reference lists of included studies and relevant systematic reviews to identify additional studies missed from the original electronic searches. We contacted subject experts for further information when needed.
SELECTION CRITERIA: We included randomised controlled trials (RCTs), cross-over, cluster- and quasi-randomised controlled trials involving both adults and children with diagnoses of OCD and ASD. We included studies of participants with co-occurring conditions (i.e. those experiencing other mental illnesses or neurodevelopmental conditions at the same time), but we did not include individuals who had a co-occurring global learning difficulty. Treatment could be in any setting or format and include behavioural therapy (BT) and cognitive behavioural therapy (CBT), which may have been adapted for those with ASD. Comparator interventions included no treatment, waiting list, attention placebo (where the control group receives non-specific aspects of therapy, but not the active ingredient) and treatment as usual (TAU, where the control group receives the usual treatment, according to accepted standards).
DATA COLLECTION AND ANALYSIS: Three review authors independently screened studies for inclusion. The authors extracted relevant data from the one eligible study, assessed the risk of bias and certainty of evidence (GRADE). Outcomes of interest were changes in OCD symptoms and treatment completion (primary outcome), and severity of depressive symptoms, anxiety symptoms and behavioural difficulties, as well as degree of family accommodation (secondary outcomes). We did not conduct meta-analyses as only one study met the selection criteria.
MAIN RESULTS: We included only one RCT of 46 participants in our analysis. This study compared CBT for OCD in persons with high-functioning ASD with a control group who received anxiety management only. There were no differences in rates of treatment completion between the CBT (87%) and anxiety management (87%) groups (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.80 to 1.25; low-certainty evidence). Behavioural difficulties were not included as an outcome measure in the study. This study showed that there may be a benefit at the end of treatment favouring CBT compared with anxiety management in OCD symptoms (mean difference (MD) -3.00, 95% CI -8.02 to 2.02), depression symptoms (MD -1.80, 95% CI -11.50 to 7.90), anxiety symptoms (MD -3.20, 95% CI -11.38 to 4.98), and quality of life (MD 5.20, 95% CI -1.41 to 11.81), but the evidence was of low certainty. AUTHORS' CONCLUSIONS: Evidence is limited regarding the efficacy of CBT for treatment of OCD in ASD. There is much scope for future study, not only examining the efficacy of CBT for OCD in ASD, but also the particular ways that OCD manifests in and affects people with ASD and the role of the family in treatment response.
CONTEXT: In several studies, authors have reported on cognitive behavioral therapy (CBT) for children and adolescents with autism spectrum disorders (ASDs), but inconsistent treatment effectiveness was revealed from these studies. OBJECTIVE: To evaluate the effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD by using a meta-analytic approach. Data sources: Data sources included PubMed, Embase, and the Cochrane Library. Study selection: We selected randomized controlled trials (RCTs) in which authors reported effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD from database inception to May 2019. Data extraction: For each study, 2 authors extracted data on the first author's surname, publication year, country, sample size, mean age, CBT target, intervention, outcome measurement, follow-up duration, and investigated outcomes. RESULTS: Forty-five RCTs and 6 quasi RCTs of 2485 children and adolescents with ASDs were selected for the final meta-analysis. There was no significant difference between CBT and control for symptoms related to ASD based on self-reported outcomes (standard mean difference: -0.09; 95% confidence interval: -0.42 to 0.24; <i>P</i> = .593), whereas CBT significantly improved the symptoms related to ASD based on informant-reported outcomes, clinician-rated outcomes, and task-based outcomes. Moreover, the pooled standard mean differences indicated that CBT has no significant effect on symptoms of social-emotional problems based on self-reported outcomes. Limitations: The quality of included studies was low to modest, significant heterogeneity among the included studies for all investigated outcomes was detected, and publication bias was inevitable. CONCLUSIONS: These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
