Editorial: Special Issue on Mental Health Issues in Autism Spectrum Disorder

Autism Spectrum Disorder and Specific Phobia: the Role of Sensory Sensitivity: Brief Review Abstract Autism spectrum disorder (ASD) is a common neurodevelopmental disorder affecting approximately 1 in 59 children (Baio et al. MMWR Surveillance Summaries, 67(6), 1, 2018). A commonly experienced psychiatric comorbidity in ASD is anxiety. Although this is known, little research has been done on the specific issues concerning specific phobia in ASD, even though specific phobias (SPs) are present in up to 40% of children with ASD. As one of the leading treatments for anxiety, cognitive behavioral therapy (CBT) has been adapted for many different populations, including children with ASD. However, the work that has been done on treatment of SP in ASD has been mostly case studies from an operant perspective. These case studies have not, to our knowledge, utilized CBT; however, they suggest that behaviorally based treatments may be effective. Still, they do not explore potential mechanisms associated with the co-occurrence of these disorders, such as sensory sensitivity, that may be responsible for these differences. Within the context of ASD, Green and Ben-Sasson (Journal of autism and developmental disorders, 40(12), 1495-1504, 2010) suggest a model of SP based on classical fear conditioning theory, which suggests sensory sensitivities cause anxieties by conditioning children to associate aversive sensations with certain objects that consequently come to elicit fear and anxiety. Here, we suggest three potential modifications of CBT to address sensory sensitivity in youth with ASD. In offering these modifications, we attempt to address explicitly the potential mechanisms underlying the development of SP in youth with ASD.

A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders Abstract Individual differences are known to influence the risk of trauma exposure and development of posttraumatic stress disorder (PTSD). It has been suggested that features of autism spectrum disorder (ASD) may confer such risk. This article provides a systematic review of the assessment and treatment of PTSD in individuals with ASD, in addition to summarising the rates and presentation of PTSD within this population. Twenty-four studies met eligibility criteria. PTSD in children and adolescents was found to co-occur at a similar or greater rate compared to general population estimates, although current estimates come predominantly from treatment-seeking samples. Preliminary findings from case reports suggest traditional assessments and treatments for PTSD can be effective, although there is a shortage of well-controlled research.

Integrating Applied Behavior Analysis and Infant/Early Childhood Mental Health: Implications for Early Intensive Intervention in Autism Abstract Identification of autism spectrum disorder (ASD) has been occurring at earlier ages, leading to a need for interventions that suit this age range. Because young children’s development is highly dependent on adults and positive adult relationships, fields that traditionally have success in treating ASD, such as Applied Behavior Analysis (ABA), must explicitly consider relationships. At the same time, Infant/Early Childhood Mental Health (I/ECMH) specialists that have traditionally focused on the parent and child relationship must recognize the importance of addressing atypical or difficult child behavior as major motivating factor or port of entry with families. This paper discusses two seemingly different approaches to the treatment of young children, the Applied Behavior Analysis (ABA) informed Early Start Denver Model (ESDM) and Infant/Early Childhood Mental Health (I/ECMH) and proposes that they are complementary therapies that can be used simultaneously within the context of an interdisciplinary team to treat the “whole” child and his/her relationships. As demonstrated by the case example, combining the strengths of ABA and mental health services when working with very young children and families has the potential for many benefits.

Equine-Assisted Interventions for Psychosocial Functioning in Children and Adolescents with Autism Spectrum Disorder: a Literature Review Abstract Equine-Assisted Activities and Therapies (EAAT), in its various forms, is an innovative approach emerging in the treatment of symptoms and difficulties associated with autism spectrum disorder (ASD). This literature review presents an overview of the current research on psychosocial outcomes of EAAT for children and adolescents with ASD. Sixteen studies published in peer-reviewed journals between 2007 and 2017 were selected for inclusion. The research reports outcomes which include improvements in multiple areas of functioning relating to core features of ASD, such as greater social interaction and decreased problematic behaviors. Yet, there is much variability in the presentation of EAAT across the studies, with the majority concerned with therapeutic riding. EAAT may be relevant and powerful for client populations where there has been limited success with traditional clinic- or room-based forms of treatment.

Mood as a Dependent Variable in Behavioral Interventions for Individuals with ASD: a Systematic Review Abstract The current review provides an original examination of the literature involving mood as a dependent variable in behavioral interventions designed for individuals with autism spectrum disorder (ASD). Twenty-nine single-subject experimental design studies were identified through systematic searches and evaluated in relation to the following variables: (a) participant and setting characteristics, (b) experimental design, (c) approach to mood assessment, (d) intervention procedures, and (e) intervention effects on mood. The experimental rigor of the included studies was evaluated on the National Autism Center’s Scientific Merit Rating Scale (2009). Results suggest that behavioral interventions can be successfully used to improve the mood of individuals with ASD and that observable indices of mood can be operationally defined and measured among these individuals. These observable indices of mood could be more often measured in behavioral intervention research, particularly when improved quality of life (QoL) is a stated goal of intervention. Limitations of the current research base are discussed and suggestions for future studies incorporating measures of mood in ASD populations are offered.

Anxiety in Children with Autism at School: a Systematic Review Abstract Anxiety in autism is commonly reported by parents, but teacher reports of anxiety in their students with autism have received little attention. This paper presents the results from the first systematic review on anxiety in children with autism at school. Six intervention studies (five of which were based upon cognitive–behavioural therapy) and 26 descriptive/non-experimental studies met inclusion criteria. Sample populations from included studies were frequently drawn from psychiatric clinics, with females and children attending special schools underrepresented, making generalisability of results difficult. Few studies used anxiety-specific measures, with most reporting anxiety-related subscale means from broader emotional/behavioural questionnaires. While 19 studies included multiple informants, which is recommended practice, only seven studies combined parent, teacher and child reports of anxiety. Comparison between informants proved difficult, with varying sample sizes and few studies using the same measure across participant groups. To further our understanding of the presentation of anxiety in children with autism attending school, studies need to include multiple informants and, where possible, extend beyond reporting average scores from broad anxiety subscales to provide descriptions of presentation and symptomatology.

Missing Components in Current Management of Autism Spectrum Disorder (ASD): Nutrition, Dental Care, and House-Call Programs Abstract Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder and systemic disease with multiple comorbidities and largely fragmented clinical care. In this article, we discuss three important components frequently missing from the current ASD standard care routine: oral health, nutrition, and house-call programs. Both ASD centers associated with tertiary-care hospitals and community ASD providers do not regularly offer these services. In this review, we address the benefits of and rationale behind incorporating dental care, nutrition, and house-call programs into ASD management. We also explain why these three services are closely intertwined, with potentially synergistic effects to improve health care outcomes for patients with ASD. Finally, we discuss strategies for service implementation and envision ways in which these three branches of ASD care can be best integrated into a primary care routine.

Effects of Pivotal Response Treatment (PRT) for Children with Autism Spectrum Disorders (ASD): a Systematic Review Abstract Background Pivotal response treatment (PRT) is suggested to be an effective treatment for children with autism spectrum disorder (ASD). Objectives We aimed to compile evidence examining the effectiveness of PRT on social communication, social interaction, and repetitive behavior for children with ASD. Methods We performed a systematic and comprehensive search for relevant trials about PRT. The results are summarized quantitatively and qualitatively. Results We included five randomized controlled trials suggesting that PRT may have positive effects on expressive language (SMD = 0.48; 95% CI 0.04 to 0.93), social interaction (SMD = 1.12; 95% CI 0.50 to 1.74), and repetitive behavior (SMD = 15.97; 95% CI 11.57 to 20.36). The effect on other outcomes, receptive language, and early learning skills is more uncertain. The quality of the evidence was found to be low. Author’s Conclusions PRT may be associated with advantageous effects, but more high-quality research is needed before we can draw firm conclusions.

Schema Development in Individuals with Autism: A Review of the Literature Abstract The purpose of this article was to synthesize the available research regarding the development of complex schemata in individuals with autism across its entire developmental process beginning with prototype formation, followed by categorization, and finally the development of schema. Specific research questions addressed the quality of research across all available studies, characteristics of participants, and whether a difference exists in the ability of individuals with autism to form schema as it relates to all three steps of the developmental process. Through a search of articles published between 1980 and 2018, 23 articles were identified, and results indicated a difference in individuals with autism as compared to typically developing controls, with the most mixed results occurring in prototype research. Implications for future research are discussed.