Sluggish Cognitive Tempo in Autism Spectrum Disorder, ADHD, and Their Comorbidity: Implications for Impairment.

Objective: Sluggish Cognitive Tempo (SCT), characterized by lethargy and daydreaming, has most commonly been studied in community samples and in youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Despite shared neurodevelopmental symptoms with ADHD, few studies have investigated SCT in Autism Spectrum Disorders (ASD). The current study investigated SCT symptoms in youth with ASD, ADHD, and comorbid ASD+ADHD to explore the relations between SCT and global and social impairment.Method: Caregivers of children and adolescents (n = 98; ages 6-17) diagnosed with ADHD (n = 46), ASD (n = 28), or ASD+ADHD (n = 24) completed measures of social impairment, SCT, and demographic variables.Results: All three clinical groups demonstrated comparable levels of SCT. Diagnosis and SCT independently contributed to parent-rated social impairment, while SCT and IQ, but not diagnosis, contributed to clinician-rated global functioning. Specifically, having comorbid ASD+ADHD, but not an ASD or ADHD diagnosis alone, significantly predicted greater social impairment.Conclusion: These results extend previous literature investigating SCT in ASD and provide evidence to suggest that SCT is associated with social and global impairment above and beyond the impairment associated with ADHD and/or ASD. These results may have implications for clinical assessment and treatment of ASD and ADHD.

Pivotal response treatment for autism: A brief report on training for rural communities.

Many providers from rural communities feel ill-prepared to treat children with autism spectrum disorder (ASD). Cost-effective training in Pivotal Response Treatment (PRT), an evidence-based ASD treatment, can address unmet needs for rural communities. The current study examined a 1-day general PRT workshop for parents and professionals followed by a 3-day small, intensive training for professionals. Fifty-two parents and providers completed surveys before and after Day 1, indicating improvements in perceived stress and confidence. Three providers were trained during Days 2-4, and submitted four 10-min videos (i.e., baseline, 1-week, 1-month, and 2-months post-training) working with a target child discussed in the training and another child. Videos were coded for correct PRT implementation and analyzed using a single-subject A-B design with generalization and maintenance probes. All providers learned to apply PRT techniques with the target child and generalized skills to another child within 1-week post-training, with partial maintenance. Implications for rural mental health training in evidence-based practices are discussed.

Examining the Psychological Effect of Rape Acknowledgment: The Interaction of Acknowledgment Status and Ambivalent Sexism.

OBJECTIVE: Although the majority of rape survivors do not label their experiences as rape (i.e., unacknowledged rape), the literature is mixed in terms of how this affects survivors' psychological functioning. To elucidate the discrepancies, the present study examined the interaction between rape acknowledgement and ambivalent sexism in relation to depression and posttraumatic stress disorder (PTSD) symptoms. METHOD: The analyzed sample included 128 female rape survivors who were drawn from a larger college sample of 1,595 participants. The participants completed measures of sexual assault experiences, ambivalent sexism, and depression and PTSD symptoms. RESULTS: The results supported a significant interaction between acknowledgement status and benevolent sexism in relation to both depression and PTSD symptoms. Conversely, the present study failed to find support for an interaction between acknowledgment status and hostile sexism. CONCLUSION: The clinical implications suggest that rather than seeing acknowledging rape as essential to the recovery process, clinicians should assess for and take into account other factors that may contribute to psychological functioning. Additionally, the findings support that more complex models of trauma recovery should be investigated with the goal of working toward a more comprehensive understanding of the longitudinal process of rape acknowledgment.

Broad implications for respiratory sinus arrhythmia development: associations with childhood symptoms of psychopathology in a community sample.

Replicating the group-based developmental trajectory methodology from our prior study (Patriquin, Lorenzi, Scarpa, & Bell. 2014. Developmental Psychobiology, 56, 317-326), the current study examines the development of baseline respiratory sinus arrhythmia (RSA) across a new, larger cohort of typically developing children at 5, 10, 24, 36, and 48 months of age and examines the trajectory relationship with symptoms of childhood psychopathology. Group-based developmental trajectory modeling replicated our prior findings of a two-group model fit: a "High RSA" and "Low RSA" group. The "Low RSA" group, which demonstrated lower baseline RSA across all time points, had significantly more childhood problems at 48 months, namely increased withdrawal, aggressive behavior, pervasive developmental problems, and oppositional defiant problems. All participants for whom there were developmental or autism spectrum concerns (n = 6; based on maternal report at 48 months) were allocated to the Low RSA trajectory group. These results suggest that consistent developmental trajectories of RSA may point to protective factors (i.e., high RSA) against developing symptoms of childhood psychopathology.

Interpersonal difficulties mediate the relationship between child sexual abuse and depression symptoms.

This study examined the influence of interpersonal functioning as a mediator in the relationship between child sexual abuse and depression symptoms, after accounting for the influence of child physical abuse. The research questions build on the existing knowledge base by examining mechanisms of adult adjustment among child sexual abuse survivors. In the current study, 2,892 young adult women (18-29 years old; M = 19.06) reported on child sexual and physical abuse, 5 domains of interpersonal functioning, and depression symptoms. The results supported aggression, sensitivity, ambivalence, and lack of sociability as mediators in the relationship between child sexual abuse and depression symptoms. These results suggest that interpersonal difficulties related to hostility, emotional reactivity, inability to collaborate, and isolation may be of particular interest when understanding depression in child sexual abuse survivors. The findings support interpersonal problems as a key mechanism of depression symptoms following child sexual abuse and is even demonstrated when examining long-term outcomes and controlling for child physical abuse. The hypotheses and findings are discussed in the context of interpersonal psychotherapy for depression.

Unacknowledged Rape: The Influences of Child Sexual Abuse and Personality Traits.

Evidence supports that the majority of young women who experience sexual victimization that meets the legal definition of rape do not label their experiences as rape--this has been termed unacknowledged rape. In a sample of 77 young adult women, the odds of unacknowledged rape significantly increased as a function of less severe child sexual abuse histories and greater levels of dysfunctional personality traits. Potential explanations for these findings as well as clinical implications are discussed. Because of the potential psychological and societal consequences of unacknowledged rape, it is vital that researchers continue to examine this phenomenon.

Developmental trajectories of respiratory sinus arrhythmia: associations with social responsiveness.

The present longitudinal study examined relations between respiratory sinus arrhythmia (RSA) development and social responsiveness characteristics associated with autism spectrum disorders. Group-based developmental trajectory modeling was used to characterize RSA development patterns in 106 typically developing children across 5, 10, 24, 36, and 48 months of age. A two-group model fit of RSA development was found: a "typically" and "atypically" developing group. The typical group gradually increased in RSA across 5-48 months of age. The atypical group, however, increased in RSA from 5 to 24 months and demonstrated a plateau or "delay" in RSA development from 24 to 48 months. The atypical RSA development group also demonstrated more difficulties in parent-reported social responsiveness at 48 months. The results support current literature that identifies RSA as a marker of social functioning level.

Aggressive behavior: an alternative model of resting heart rate and sensation seeking.

Low resting heart rate is a well-replicated biological correlate of aggression, and sensation seeking is frequently cited as the underlying causal explanation. However, little empirical evidence supports this mediating relationship. Furthermore, the biosocial model of violence and social push theory suggest sensation seeking may moderate the relationship between heart rate and aggression. In a sample of 128 college students (82.0% White; 73.4% female), the current study tested a moderation model as an alternative relationship between resting heart rate and sensation seeking in regard to aggression. Overall, the findings partially supported an interaction effect, whereby the relationship between heart rate and aggression was moderated by sensation seeking. Specifically, the oft-noted relationship between low resting heart rate and increased aggression was found, but only for individuals with low levels of sensation seeking. If replication supports this finding, the results may better inform prevention and intervention work.

Service Acquisition for Children with Autism Spectrum Disorder in Rural Southwest Virginia: The Role of Caregiver Psychoeducation.

PURPOSE: Evidence-based intervention can significantly improve the trajectory of symptoms and overall outcomes for children with autism spectrum disorder (ASD), especially when implemented at an early age. However, families residing in rural communities experience barriers to accessing ASD-related services. The purpose of this pilot study was to assess how the provision of accessible caregiver psychoeducation related to new service acquisition for children recently diagnosed with ASD in rural Southwest Virginia. METHODS: Psychoeducation was delivered either live by a clinician (Live PE, n = 13 caregivers) or via paper materials (Paper PE, n = 10 caregivers) and included content on ASD epidemiology and symptoms, risk factors, evidence-based interventions, and navigating service systems. Survey data were collected from caregivers of 20 children to measure new service acquisition within six months following psychoeducation. RESULTS: Results indicated that 81.8% of children whose caregivers received Live PE obtained at least one new service within six months, compared to 55.6% of those whose caregivers received Paper PE. An independent samples t-test showed a significant difference in the number of new services obtained between groups, such that the Live PE group received over 2.5 times as many services as the Paper PE group. CONCLUSION: Results suggest that psychoeducation, particularly delivered by a clinician, positively impacted service acquisition, and emphasize the clinical importance of personalized, accessible ASD psychoeducation for rural families. Future implications are discussed, including recommendations to evaluate the role of psychoeducation on service acquisition in larger samples.

Respiratory sinus arrhythmia: a marker for positive social functioning and receptive language skills in children with autism spectrum disorders.

The current study builds on the emerging autism spectrum disorder (ASD) literature that associates autonomic nervous system activity with social function, and examines the link between respiratory sinus arrhythmia (RSA) and both social behavior and cognitive function. The RSA response pattern was assessed in 23 4- to 7-year-old children diagnosed with an ASD. Higher baseline RSA amplitudes were associated with better social behavior (i.e., more conventional gestures, more instances of joint attention) and receptive language abilities. Similar to reports of typically developing children, ASD children with higher RSA amplitude at baseline showed greater RSA and HP reactivity during an attention-demanding task. These results highlight the importance of studying RSA as a marker of positive function in children with ASD.

Baseline heart rate, sensation seeking, and aggression in young adult women: a two-sample examination.

Although substantial literature discusses sensation seeking as playing a role in the relationship between baseline heart rate and aggression, few published studies have tested the relationships among these variables. Furthermore, most prior studies have focused on risk factors of aggression in men and have largely ignored this issue in women. Two samples (n = 104; n = 99) of young adult women completed measures of resting heart rate, sensation seeking, and aggression. Across the two samples of females there was no evidence for the relationships of baseline heart rate with sensation seeking or with aggression that has been consistently shown in males. Boredom susceptibility and disinhibition subscales of sensation seeking were consistently significantly correlated with aggression. The lack of significance and the small effect sizes indicate that other mechanisms are also at work in affecting aggression in young adult women. Finally, it is important to consider the type of sensation seeking in relation to aggression, as only boredom susceptibility and disinhibition were consistently replicated across samples.

Relationship between respiratory sinus arrhythmia, heart period, and caregiver-reported language and cognitive delays in children with autism spectrum disorders.

The present study examines the relationship between autonomic activity and cognitive/language delays in children with autism spectrum disorder (ASD). Baseline levels of respiratory sinus arrhythmia (RSA) and heart period (HP) were assessed in 23 4-7-year old children diagnosed with ASD. The relationship between RSA, HP, and ASD behavioral symptoms was examined. Similar to prior studies on typically developing children, lower basal RSA was related to more caregiver-reported language and cognitive delays, and to the lack of language.

A Qualitative Examination of the Impact of COVID-19 on Transition Services for Autistic Youth.

The coronavirus (COVID-19) pandemic has caused widespread disturbances in many human and social service programs. Several studies have examined special education programming adaptations since the onset of the pandemic; however, there has yet to be documentation of pandemic-related changes to transition programming and the impact of these changes for autistic youth. The purpose of this qualitative study was to examine changes in transition programming for autistic youth amid the changing educational landscape. We conducted 12 interviews with caregivers (n = 5) and school providers (n = 7) about transition programming for autistic youth and the COVID-19 impact to these services. The pandemic had positive and negative effects on many aspects of transition programming, including student-focused planning, student development, interagency and interdisciplinary collaboration, family involvement, and program structure and attributes. Elucidation of the ways that the COVID-19 pandemic impacted transition programming from the perspectives of multiple stakeholders has important implications for school personnel and can help to inform the future directions for the field of transition programming research.

Examining Feasibility and Outcomes of the PEERS® for Preschoolers Program.

Social impairments characteristic of autism spectrum disorder (ASD) are evident in early childhood and often worsen. There is a paucity of evidence-based interventions explicitly targeting social skill development for young children with ASD and few actively integrate caregivers. The PEERS® program, an evidence-based caregiver-assisted social skills program, was extended for young children with ASD (i.e., PEERS® for Preschoolers (P4P)). This pilot study expands upon initial results by examining the feasibility of a briefer intervention period and the effectiveness in improving child social skills among 15 children with ASD. Results suggest P4P recruitment, participant retention, and implementation are feasible across clinicians and sites. Further, P4P appears to improve social skills, maintained post-intervention. Future research might examine mechanisms that lead to results.

PEERS® for Preschoolers preliminary outcomes and predictors of treatment response.

PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.

Perceived Driving Difficulty, Negative Affect, and Emotion Dysregulation in Self-Identified Autistic Emerging Drivers.

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver's licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty (DD), emotion dysregulation, and negative affect in emerging drivers with and without autistic traits (AT), and investigated how emotion dysregulation and negative affect relate to perceived DD. We expected (1) greater perceived DD, emotion dysregulation, and negative affect in participants with AT and (2) a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults (15 AT) self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale (DERS) and the Depression, Anxiety, and Stress Scale (DASS). Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed.

Frequency and correlates of augmentative and alternative communication use in an autistic inpatient sample.

Although augmentative and alternative communication (AAC) strategies are often used by autistic youth, little is known about the use of AAC in inpatient psychiatric settings. This study evaluated how demographic and clinical factors (e.g., language level, IQ) related to AAC use in a well-characterized sample of 527 autistic youth (78.7% male, mean age 12.94) who participated in the Autism Inpatient Collection. AAC use was common, with 42.5% of caregivers reporting at least one form of AAC. White children were more likely to use AAC than non-white children at the bivariate level. In regression analyses, young children were more likely to use AAC than older children. These results suggest the importance of provider training and improved equitable access to AAC.

An Initial Pilot Study Examining Child Social Skills, Caregiver Styles, and Family Functioning in the PEERS® for Preschoolers Program for Young Autistic Children and their Caregivers.

BACKGROUND: Social impairments characteristic of autism spectrum disorder (ASD) are evident in early childhood and worsen as the child matures. Though many interventions for young children exist, few specifically target social skills and involve caregivers. AIMS: This pilot study examined PEERS® for Preschoolers, focusing on temporal change in child social skills, caregiver style, and family functioning in the context of a caregiver-assisted social skills intervention. This extension of the PEERS® program builds on the success of the intervention for older children, presenting skills in a developmentally appropriate manner to young autistic children and their caregivers. METHODS AND PROCEDURES: The present pilot study used a non-concurrent multiple baseline design to examine the above variables with 15 autistic children (Mage = 4.87, SD = 1.25; 11 boys). Children and caregivers participated in PEERS® for Preschoolers groups, with each group randomly assigned three different baseline periods (1.5, 2, or 2.5 weeks) before beginning. OUTCOMES AND RESULTS: Simulation Modeling Analysis (SMA) revealed concurrent improvements in social and caregiving skills, with subsequent changes in family functioning occurring over the course of this 16-session intervention. CONCLUSIONS AND IMPLICATIONS: Future research will need to examine mechanisms of change in PEERS® for Preschoolers for children and caregivers. WHAT THIS PAPER ADDS: There is a dearth of research that specifically examines social skills interventions for young autistic children that incorporates caregivers and examines family functioning as well. This paper is one of the first to evaluate the PEERS® for Preschoolers (P4P) intervention by: 1) exploring changes in child social skills, caregiver efficacy, and family functioning, and 2) analyzing the sequence of improvements in the aforementioned variables to measure systematic change. This pilot study presents results using appropriate methodology for a small sample size of children and caregivers. Results suggested concurrent improvements in social and caregiving skills and subsequent changes in family functioning. These can be built upon for further research on the PEERS® for Preschoolers intervention. This study supports PEERS® for Preschoolers as a feasible intervention that likely contributes to improvements for the child, caregiver in their relationship with their child and parenting styles in general, as well as functioning of the entire family. In sum, this work is essential to furthering the provision of a much needed service of social skills interventions for young autistic children.

The link between sensation seeking and aggression: a meta-analytic review.

Substantial empirical evidence supports low resting heart rate (HR) as the best replicated psychophysiological correlate of aggression [Ortiz and Raine, 2004]; however, researchers continue to debate the explanatory mechanisms of the phenomenon. Sensation seeking has been proposed as a possible outcome of low resting HR that may lead to aggressive tendencies but findings have been inconsistent in terms of showing a relationship between sensation seeking and aggression. A meta-analysis was conducted on 43 independent effect sizes, from studies with a total of 32,217 participants, to test the hypothesis that sensation seeking would be positively related to aggression across studies. A significant overall effect size was found (d = .1935, P<.001), supporting the hypothesis. Moderator analyses revealed that the relationship differed based on participant and methodological characteristics, such as participant age and the nature of the aggression measurement; however, these conclusions are limited by the uneven number of studies in many of the moderator classes. Overall, the findings provide support for higher levels of aggression in high sensation seekers and have theoretical implications for arousal theory. Further research on the links between arousal, sensation seeking and aggression can inform clinicians about potential interventions.

Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: a pilot study.

BACKGROUND AND AIMS: This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders (ASD) to teach emotion regulation strategies for reducing anger and anxiety, commonly noted problems in this population. METHOD: Eleven 5-7 year-old children participated in a CBT-group while parents participated in psychoeducation. Children were randomly assigned to an experimental or delayed-treatment control group. RESULTS: From pre- to post-treatment, all children had less parent reported negativity/lability, better parent reported emotion regulation, and shorter outbursts, and also generated more coping strategies in response to vignettes. Parents also reported increases in their own confidence and their child's ability to deal with anger and anxiety. CONCLUSIONS: This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety, and parent training may improve parental self-efficacy. Future studies are needed to make conclusions about its efficacy.