The short- and longer-term effects of brief behavioral parent training versus care as usual in children with behavioral difficulties: study protocol for a randomized controlled trial.

BACKGROUND: The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties. METHODS: Parents of children aged 2-12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent-child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents' and therapists' satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1. DISCUSSION: The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible. TRIAL REGISTRATION: The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.

The clinical relevance of subgroups of autistic adults: Stability and predictive value.

Autism in adulthood is characterized by heterogeneity, complicating the provision of tailored support. In previous work, we aimed to capture this heterogeneity by determining subgroups of autistic adults that differed in clinical outcomes: cognitive failures, psychological difficulties, and quality of life (QoL). Two subgroups were identified: a "Feelings of Low Grip" subgroup characterized by experiencing a lower sense of mastery and a higher susceptibility to difficulties in daily life, and a "Feelings of High Grip" subgroup characterized by a higher sense of mastery and lower susceptibility to difficulties in daily life. The current pre-registered study involves a longitudinal extension to determine (a) stability and (b) predictive value of the previously identified two subgroups. Subgroups were identified using community detection based on 14 self-report measures related to demographic, psychological, and lifestyle characteristics in two samples (aged 31-86 years) that were analyzed separately: Sample 1 (NAutism = 80) measured 5 years after baseline and Sample 2 (NAutism = 241, NComparison = 211) measured 2 years after baseline. The stability over time was assessed based on (a) the number of subgroups, (b) subgroup profiles, and (c) subgroup membership. Predictive validity was assessed for cognitive failures, psychological difficulties, and QoL. Results indicated that autistic and non-autistic adults formed distinct subgroups. Within both autism samples, the two previously identified autism subgroups were replicated at follow-up. Subgroup profiles were similar for >50% of the variables at two-year follow-up, and 21% at five-year follow-up. Moreover, ≥76% remained in the same subgroup at two-year follow-up, and ≥ 57% after 5 years. Subgroup membership was predictive of external clinical outcomes up to 5 years. Thus, this study demonstrated the stability and predictive value of the autism subgroups, especially for the two-year follow-up. A further focus on their clinical utility might increase the aptness of support, and may provide more insight into the aging process when being autistic.

Effectiveness, working mechanisms, and implementation of youth-initiated mentoring for juvenile delinquents: a multiple-methods study protocol.

BACKGROUND: The societal costs associated with juvenile delinquency and reoffending are high, emphasising the need for effective prevention strategies. A promising approach is Youth-Initiated Mentoring (YIM). In YIM, professionals support youths in selecting a non-parental adult from within their social network as their mentor. However, until now, little (quasi-)experimental research has been conducted on YIM in the field of juvenile delinquency. We will examine the effectiveness, working mechanisms, and implementation of YIM as a selective prevention strategy for juvenile delinquents. METHODS: This multiple-methods study consists of a quasi-experimental trial and a qualitative study. In the quasi-experimental trial, we aim to include 300 juvenile offenders referred to Halt, a Dutch juvenile justice system organisation which offers youths a diversion program. In the Netherlands, all juvenile offenders between 12 and 18 years old are referred to Halt, where they must complete the Halt intervention. Youths will be non-randomly assigned to region-matched non-YIM-trained and YIM-trained Halt professionals implementing Care as Usual (CAU, i.e., the Halt intervention) or CAU plus YIM, respectively. Despite non-random allocation, this approach may yield comparable conditions regarding (1) the characteristics of professionals delivering the intervention and (2) case type and severity. Youth and caregiver(s) self-report data will be collected at pre-and post-test and a 6-month follow-up and complemented with official Halt records data. Multilevel analyses will test whether youths following CAU plus YIM show a stronger increase in resilience factors and a stronger decline in the need for formal support and delinquency than youths following CAU. In the qualitative study, we will organise focus group interviews with YIM-trained professionals to explore boosters and barriers experienced by professionals during the implementation of YIM. DISCUSSION: The proposed study will help identify the effectiveness of YIM in strengthening resilience factors and possibly decreasing juvenile delinquency. In addition, it may offer insights into how and for whom YIM works. Finally, this study can help strengthen the implementation of YIM in the future. TRIAL REGISTRATION: ClinicalTrials.Gov (# NCT05555472). Registered 7 September 2022. https://www. CLINICALTRIALS: gov/ct2/show/NCT05555472?cond=Youth+Initiated+Mentoring&draw=2&rank=1 .

When mind and measurement diverge; the interplay between subjective cognitive complaints (SCCs), objective cognition, age, and depression in autistic adults.

While the increased incidence of dementia and subjective cognitive complaints (SCCs) suggests that autistic adults may face cognitive challenges at older age, the extent to which SCCs predict (future) cognitive functioning remains uncertain. This uncertainty is complicated by associations with variables like depression. The current study aims to unravel the interplay of age, depression, cognitive performance, and SCCs in autism. Using a large cross-sectional cohort of autistic (n=202) and non-autistic adults (n=247), we analyzed associations of SCCs with age, depression, and cognitive performance across three domains (visual memory, verbal memory, and fluency). Results showed a strong significant association between depression and SCCs in both autistic and non-autistic adults. Cognitive performance was not significantly associated with SCCs, except for a (modest) association between visual memory performance and SCCs in autistic adults only. Follow-up regression tree analysis indicated that depression and being autistic were considerably more predictive of SCCs than objective cognitive performance. Age nor sex was significantly associated with SCCs. These findings indicate that self-reported cognitive functioning does not equal cognitive performance, and should be interpreted with care, especially in individuals with high rates of depression. Longitudinal investigations are needed to understand SCCs' role in dementia and cognitive health in autism.

Remembering the future; prospective memory across the autistic adult's life span.

LAY ABSTRACT: What is already known: Prospective memory is an important function for daily living. It is the cognitive function that helps you remember that you are meeting your friend for coffee at 2 pm tomorrow, or that you need to take your vitamins after breakfast. This cognitive function is particularly important in autistic adults, but how prospective memory is associated with increasing age, we currently do not know.What this paper adds: Although performance on experimental tasks that measure prospective memory decreases with age, this pattern is similar in autistic and non-autistic adults. No age effects were found for tasks that were performed outside the lab. Autistic adults and non-autistic adults perform similarly on prospective memory, and this performance remains similar when autistic and non-autistic adults age.Implications for practice, research, or policy: While our results show that prospective memory decreased with increasing age, our results do point to parallel development of prospective memory in autistic and non-autistic adults. This finding serves as a reassurance for those individuals concerned that older autistic individuals might show quicker cognitive decline.

Navigating adolescence: pubertal development in autism spectrum conditions and its relation to mental health.

Adolescence is a period of social, psychological, and physiological change, including the onset of puberty. Differential pubertal onset has been linked to a myriad of problems, including mental health problems. Therefore, we aim to investigate deviating pubertal development in autism, and whether this is more pronounced in girls than in boys. A total of 68 individuals (nASC = 34, nCOM (comparisons) = 34) aged 12 to 16 years were administered test concerning pubertal development and mental health (i.e., sensory sensitivity, autistic traits, depression, anxiety, and externalizing problems). Frequentist and Bayesian ANOVA was used to examine deviations in pubertal development in ASC and possible sex effects. Regression analyses was used to test whether this asynchronicity was linked to mental health problems. Our (frequentist and Bayesian) analyses revealed earlier onset and slower development of pubertal development in ASC but we did not find any sex differences. Maturation disparity was linked to higher mental health problems in ASC, but not in COM. No sex differences in the relation with mental health outcomes was found. We found evidence for a slower development of "true" puberty in those with ASC compared to those without. Moreover, we show that disparities in pubertal development are related to mental health in ASC, suggesting a greater impact on mental health in autistic than in non-autistic teens. Longitudinal studies are necessary to elucidate important developmental trajectories in puberty in neurodiverse populations.