SPAN Website for Remote Intervention with Autistic Adolescents and Young Adults: Feasibility and Usability.

Adolescents and young adults (AYA) with autism spectrum disorders (ASD) report less functional independence and social participation than their neurotypical peers. Remotely delivered interventions may allow autistic AYA to promote their independence, social participation, and wellbeing as they transition to adulthood. Social Participation and Navigation (SPAN) is a technology-based remotely delivered intervention initially developed for AYA with acquired brain injuries. The SPAN (website, application, and intervention manual) was modified to address the needs of AYA with autism (SPAN-ASD). This study examined the SPAN-ASD website and web application's feasibility and usability. Participants comprised 12 autistic AYA and 18 practitioners (all occupational therapists) with more than 1 year of experience in working with autistic AYA. All navigated the SPAN-ASD website and goal-management application. Practitioners completed the SPAN-ASD components and the Usefulness, Satisfaction, and Ease of Use questionnaires; AYA completed the System Usability Scale. The practitioners' average feasibility scores ranged from 4.30 to 4.68 (high); the overall usability score was 5.77 (good). The autistic AYA rated SPAN-ASD as a good, acceptable, and useful tool. Content analysis and item-level ratings indicated some needed improvements. Practitioners and autistic AYA perceived the SPAN-ASD website and application as highly feasible and usable, with excellent potential for technology-supported interventions.

The Relations between Repetitive Behaviors and Family Accommodation among Children with Autism: A Mixed-Methods Study.

Restricted and repetitive behaviors and interests (RRBI) are a significant component in diagnosing autism spectrum disorder (ASD). They often pose the main challenge in day-to-day functions for children with ASD and their families. Research addressing family accommodation behaviors (FAB) in the ASD population is scarce, and associations with the characteristics of the children's behaviors are unclear. This sequential mixed-methods study assessed the correlation between RRBI and FAB within the ASD group to deepen the understanding of parents' subjective experiences regarding their children's RRBI. It included a quantitative phase with a follow-up qualitative study. A total of 29 parents of children with autism (5-13 yr) completed the study questionnaires; a total of 15 also were interviewed regarding their children's RRBI and related FAB. We used the Repetitive Behavior Scale-Revised (RBS-R) to assess RRBI, and the Family Accommodation Scale (FAS-RRB) to assess FAS. In-depth interviews from phenomenological methodology were used in the qualitative phase. We found significant positive correlations between the RRBI and FAB overall and their subscores. Qualitative research supports these findings, adding descriptive examples of the accommodations families make to address the RRBI-related challenges. The results indicate relations between RRBI and FAB and the importance of practically addressing children with autism's RRBI and their parents' experiences. Both affect and are affected by the children's behaviors.

Indifference or hypersensitivity? Solving the riddle of the pain profile in individuals with autism.

ABSTRACT: Excitatory-inhibitory (E/I) imbalance is a mechanism that underlies autism spectrum disorder, but it is not systematically tested for pain processing. We hypothesized that the pain modulation profile (PMP) in autistic individuals is characterized by less efficient inhibitory processes together with a facilitative state, indicative of a pronociceptive PMP. Fifty-two adults diagnosed with autism and 52 healthy subjects, age matched and sex matched, underwent quantitative sensory testing to assess the function of the (1) pain facilitatory responses to phasic, repetitive, and tonic heat pain stimuli and (2) pain inhibitory processes of habituation and conditioned pain modulation. Anxiety, pain catastrophizing, sensory, and pain sensitivity were self-reported. The autistic group reported significantly higher pain ratings of suprathreshold single ( P = 0.001), repetitive (46°C- P = 0.018; 49°C- P = 0.003; 52°C- P < 0.001), and tonic ( P = 0.013) heat stimuli that were cross correlated ( r = 0.48-0.83; P < 0.001) and associated with sensitivity to daily life pain situations ( r = 0.39-0.45; P < 0.005) but not with psychological distress levels. Hypersensitivity to experimental pain was attributed to greater autism severity and sensory hypersensitivity to daily stimuli. Subjects with autism efficiently inhibited phasic but not tonic heat stimuli during conditioned pain modulation. In conclusion, in line with the E/I imbalance mechanism, autism is associated with a pronociceptive PMP expressed by hypersensitivity to daily stimuli and experimental pain and less-efficient inhibition of tonic pain. The latter is an experimental pain model resembling clinical pain. These results challenge the widely held belief that individuals with autism are indifferent to pain and should raise caregivers' awareness of pain sensitivity in autism.

Social Participation and Navigation: Formative Evaluation of a Remote Intervention for Autistic Adolescents and Young Adults.

Remote interventions can uniquely benefit and significantly increase the motivation/engagement of autistic adolescents and young adults (AYA) in intervention processes. The evidence-based, technology-based Social Participation and Navigation (SPAN), originally a remote intervention for AYA with traumatic brain injuries, shows great promise for autistic AYA. This formative evaluation aimed to inform SPAN adaptations for autistic AYA. Fifteen researcher and clinician stakeholders provided feedback and modification recommendations via a semistructured interview. Stakeholders described potential participants who might benefit, intervention goals, intervention delivery procedures, and additional program-content and technology suggestions, including original components to preserve or adjust. Findings provided a basis for developing a new SPAN-ASD website and intervention manual. The next steps include assessing website usability and feasibility and a pilot implementation study of SPAN-ASD with autistic AYA.

A Self-Determination Theory Approach to Work Motivation of Autistic Adults: A Qualitative Exploratory Study.

The study explores work motivation of autistic adults through the lens of Self-Determination Theory (SDT). Twelve autistic employees (ages 28-47; 3 females) participated in semi-structured qualitative interviews about their work experience. Analysis combined inductive and deductive approaches, identifying motivational themes emerging from the interviews, and analyzing them according to SDT concepts. Two major themes emerged: (1) work motivation factors positioned on the self-determination continuum: income and self-reliance; a daily routine; social/familial internalized norms; meaning and contribution; and job interest; and (2) satisfaction of psychological needs at work, postulated by SDT: competence, social-relatedness, and autonomy and structure. Findings are discussed in relation to current literature, and practical applications are suggested for meeting the motivational needs of autistic employees and promoting employment stability.

Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements particularly in social symptoms: an open label study.

In recent years there has been growing interest in the potential benefits of CBD-rich cannabis treatment for children with ASD. Several open label studies and one double-blind placebo-controlled study have reported that CBD-rich cannabis is safe and potentially effective in reducing disruptive behaviors and improving social communication. However, previous studies have mostly based their conclusions on parental reports without the use of standardized clinical assessments. Here, we conducted an open label study to examine the efficacy of 6 months of CBD-rich cannabis treatment in children and adolescents with ASD. Longitudinal changes in social communication abilities and restricted and repetitive behaviors (RRB) were quantified using parent report with the Social Responsiveness Scale and clinical assessment with the Autism Diagnostic Observation Schedule (ADOS). We also quantified changes in adaptive behaviors using the Vineland, and cognitive abilities using an age-appropriate Wechsler test. Eighty-two of the 110 recruited participants completed the 6-month treatment protocol. While some participants did not exhibit any improvement in symptoms, there were overall significant improvements in social communication abilities as quantified by the ADOS, SRS, and Vineland with larger improvements in participants who had more severe initial symptoms. Significant improvements in RRB were noted only with parent-reported SRS scores and there were no significant changes in cognitive scores. These findings suggest that treatment with CBD-rich cannabis can yield improvements, particularly in social communication abilities, which were visible even when using standardized clinical assessments. Additional double-blind placebo-controlled studies utilizing standardized assessments are highly warranted for substantiating these findings.

"When I'm in Pain, Everything Is Overwhelming": Implications of Pain in Adults With Autism on Their Daily Living and Participation.

Pain sensation in autism spectrum disorder (ASD) has been a growing research field in the last two decades. Existing pain research has focused on pain sensitivity, suggesting either hyposensitivity or hypersensitivity to pain in individuals with ASD. However, research about other aspects of pain experience is scarce. Moreover, most pain-related research in ASD focused on quantitative measures, such as neuroimaging or parental reports. Instead, this paper aimed to illuminate the various aspects of pain experience as perceived by adults with ASD. Its descriptive qualitative research design incorporated semi-structured interviews and deductive thematic analysis. This phenomenological approach captured the subjective pain experience through the lens of people with ASD. Four primary themes emerged from the data: (a) physical pain experience, including the sequence of pain sensitivity, pain awareness, pain-related emotional aspects, and pain communication; (b) direct and indirect coping strategies; (c) function and participation outcomes; and (d) suggestions for Healthcare Providers. The findings echo the crucial role of pain awareness and communication in the pain experience of people with ASD. These two factors have been reported as profoundly influencing coping strategies, function, and participation. The results emphasize the need to expand the exploration of pain in this population, calling for greater understanding, and listening to this population's unique pain profiles and experiences to promote better-suited evaluation, diagnosis, and intervention in pain conditions.

Association Between Sensory Features and High-Order Repetitive and Restricted Behaviors and Interests Among Children With Autism Spectrum Disorder.

IMPORTANCE: Children diagnosed with autism spectrum disorder (ASD) are often referred to occupational therapy practitioners so their sensory features and their repetitive and restricted behaviors and interests (RRBIs) can be addressed. RRBIs include an insistence on sameness, narrow interests, rigid routines, and rituals. However, there is a paucity of knowledge concerning the association between sensory features-across patterns, modalities, and contexts-and high-order RRBIs among children with ASD who are cognitively able. OBJECTIVE: To examine the association between sensory features across sensory patterns, modalities, and contexts and high-order RRBIs in children with ASD. DESIGN: Correlational clinical study based on parent questionnaire responses. SETTING: General education system in Israel. PARTICIPANTS: Parents of 39 cognitively able school-age children with ASD (ages 6-10 yr; 34 boys and 5 girls), recruited by means of convenience sampling. OUTCOMES: High-order RRBIs were assessed with relevant subscales from the Repetitive Behavior Scale-Revised (RBS-R), and sensory features across patterns, modalities, and contexts were examined with the Sensory Experiences Questionnaire, Version 2.1. The study hypotheses were formulated before data were collected. RESULTS: Significant correlations were observed between the high-order RRBIs of children with ASD and their sensory features across patterns, sensory modalities, and contexts. Fifty-one percent of the total RBS-R scores were predicted by sensory hyperresponsiveness, and an additional 11% were predicted by sensory-seeking behaviors. CONCLUSIONS AND RELEVANCE: The hypotheses concerning the association between sensory features and high-order RRBIs were confirmed. The findings enhance occupational therapy practitioners' understanding of this association and may assist in the planning of more efficient interventions. What This Article Adds: The findings enhance clinical knowledge concerning the association between sensory features and high-order RRBIs and may lay a better foundation for occupational therapy interventions for children with ASD and their families.

EASI Praxis Tests: Age Trends and Internal Consistency.

IMPORTANCE: Ayres Sensory Integration® is an evidence-based practice that requires a comprehensive assessment before intervention. The Evaluation in Ayres Sensory Integration (EASI) is intended for this purpose, and psychometric data are needed to determine its validity and reliability. OBJECTIVE: To evaluate the internal consistency of four EASI Praxis tests and their validity as developmental measures. DESIGN: Cross-sectional developmental design. SETTING: Participants' homes. PARTICIPANTS: Typically developing children and young adolescents, ages 6 to 12 yr (N = 234). Outcomes and Measures: We analyzed four EASI Praxis tests using Cronbach's α, Pearson correlation coefficients, and one-way analysis of variance to explore internal consistency and developmental trends. RESULTS: The findings indicate moderate to high internal consistency for all tests. Significant correlations between age and praxis scores indicate that the EASI Praxis tests are sensitive to developmental changes. CONCLUSIONS AND RELEVANCE: Occupational therapists can have confidence in the internal consistency and sensitivity to developmental changes of these praxis scores through early adolescence. What This Article Adds: Occupational therapists administering EASI Praxis tests can have confidence that they consistently measure praxis ability and are sensitive to developmental changes across ages 6 to 12 yr. The results suggest that praxis continues to develop into early adolescence, and adolescents may benefit from assessment and intervention targeting praxis ability.

Implications of Employment Changes Caused by COVID-19 on Mental Health and Work-Related Psychological Need Satisfaction of Autistic Employees: A Mixed-Methods Longitudinal Study.

This mixed-methods study examined longitudinal data, assessing Israeli autistic adults' employment-related changes, resulting from the COVID-19 pandemic. In the quantitative phase, 23 participants answered a survey before and during COVID-19, assessing work-status, mental health, and work-related psychological need satisfaction. The qualitative phase included interviews with ten employed participants. Results indicate a significant decrease in mental health of participants who lost their jobs during COVID-19, while participants who continued to physically attend work, maintained pre-COVID-19 levels on all assessed variables. Participants who transitioned to remote-work from home, showed a marginally significant deterioration in mental health and a significant decrease in satisfaction of work-related psychological needs for competence and autonomy. Qualitative accounts supplement these findings and portray advantages and disadvantages of remote-work.

Eating Challenges in Children with Autism Spectrum Disorder: Development and Validation of the "Aut-Eat" Questionnaire (AEQ).

The Aut-Eat Questionnaire (AEQ) provides a novel and comprehensive assessment of eating problems and patterns in children with ASD. To establish the internal consistency and discriminant validity of the AEQ, parents of children with ASD (n = 105, Mage = 40.85, SD = 15.67 months) or typical development (TD; n = 98, Mage = 50.33, SD = 16.50 months) completed the AEQ. Questionnaire construction, content validity, factor analysis, internal consistency and discriminant validity are reported. The AEQ was reliable with high internal consistency in most domains. Significant differences were found between groups in all domains. The AEQ is a reliable and valid tool and may help to characterize eating difficulties in this population.

Video modelling as a tool to evaluate self-perception of strategies used by adolescents during daily tasks.

INTRODUCTION: Metacognition is defined as the process of regulating behavior and having self-perception of own performance. An application of video modeling (VM) was used as a technological solution for assessing self-perception in daily situations among typical adolescents, compared to parental reports and to an objective performance-based assessment. METHOD: One hundred and three adolescents (30 boys, 73 girls, mean age =15.1, SD = 1.9), viewed five clusters of videotaped scenarios of teen actors performing daily activities entailing strategy use. Half of the scenarios were classified as "Type A" indicating a more organized approach to accomplishing a task, the other half were "Type B" scenarios indicated a less organized approach to accomplishing the same tasks. Participants were asked to choose the scenarios that best represent their own daily performance using the VM application. The participants then completed the WCPA, an executive function (EF) performance-based assessment. Their parents completed the BRIEF as an indication of EF behaviors in the home environment. RESULTS: 46% of the adolescents associated their performance with a less organized approach yet parental reports indicated adaptive daily performance and their ability to complete the WCPA was as correct as it was for the 56% of participants who associated their performance with a more organized approach. CONCLUSIONS: Unexpectedly, the participants who associated their ability as less organized presented successful behaviors in the home environment and successfully performed the WCPA. Therapists should be aware that clients may achieve success in daily tasks even though they may cope with cognitive challenges in unexpected ways.Implication for rehabilitationTherapists may expect adolescent clients to approach tasks in a variety of ways, using different strategies for coping with everyday cognitive challenge.Therapists need to acknowledge that there is no ideal strategy that provides a solution for all individuals.Mediating a guided discovery of strategies through use of VM technology may customize intervention for each client's needs, assuring a client-centered approach and may encourage a collaboration of therapists and clients in search for the strategies that work best for them.

Visual Detection and Decoding Skills of Aerial Photography by Adults with Autism Spectrum Disorder (ASD).

Despite challenges in social communication skills people with ASD often display strengths in visual processing. Aerial photography analysis is an occupation reliant on strong visual processing skills that matches this unique profile. We investigated basic-vision and "real-life" visual tasks in 20 cognitively-able young adults with ASD and 20 typically-developed (TD) "gamers". Basic-vision tests included Visual-Search, Embedded-Figures, and Vigilance; "real-life" tests included aerial-photograph detection and identification. Groups performed equally well, and did not differ significantly on any tasks. The study demonstrates strong visual skills in people with ASD in basic and "real-life" settings, and supports the idea that they may be well suited for employment in occupations that demand high visual perception skills such as aerial photography analysis.

"It's like a ramp for a person in a wheelchair": Workplace accessibility for employees with autism.

BACKGROUND, AIMS AND METHODS: Participation in employment by individuals with autism spectrum disorders (ASD) remains restricted despite their high motivation and evident abilities. Challenges to employment result from personal characteristics and environmental barriers. This phenomenological research explores the accessibility of a competitive work environment according to the perceptions of adults with ASD. PROCEDURES AND OUTCOMES: We conducted in-depth interviews with 19 employees with ASD, followed by a thematic content analysis. Three themes emerged: (a) the employees' motivation for employment, (b) challenges and abilities at work, and (c) workplace accessibility (types of accommodations, implementation process). RESULTS AND CONCLUSIONS: The findings contribute a classification of accommodations that addresses the core characteristics of autism-challenges as well as abilities and motivations for employment. Four types of accommodations were identified: job-performance communication, attitudes and interpersonal communication, daily workplace routines, and physical and sensory environments. Hence, this study supports the centrality of environmental factors in successful employment of individuals with ASD. IMPLICATIONS: This study presents an evidence-based foundation for autism-related workplace accessibility. It offers an approach to enhance employees' abilities, strengths, and motivation for employment, as well as to decrease barriers and challenges. The findings may expand organizational policies regarding accessibility and thereby anchor workplace accommodations within organizations' corporate cultures.

Autistic adults' subjective experiences of hoarding and self-injurious behaviors.

LAY ABSTRACT: Hoarding and self-injurious behaviors are relatively common in autism, but knowledge about their expressions in adulthood is scarce. Through interviews collecting subjective experiences of autistic adults, these behaviors were explored, and categorized to their underlying purposes. Findings portray the occurrence of these behaviors in the lives of autistic adults, their self-regulatory purposes, and their relationship to other behaviors in the domain of Restrictive and Repetitive Behaviors and Interests.

The autism advantage at work: A critical and systematic review of current evidence.

BACKGROUND: Despite difficulties entering the workforce, people on the autism spectrum are often successful. Furthermore, they are suggested to bring unique abilities (e.g., attention to detail, tolerance for repetitive tasks) related to the repetitive and restrictive behaviours and interests (RRBI) diagnostic domain, that may be advantageous in employment. AIMS: This critical and systematic review examined evidence supporting the superior workplace performance of employees on the autism spectrum, particularly regarding the RRBI domain. METHOD AND PROCEDURES: A systematic review (PRISMA guidelines) evaluated empirical peer-reviewed studies that assess employees on the autism spectrum's performance in the workplace or on work-specific tasks. Nine databases were searched, with additional papers identified from reference lists and consultation. OUTCOMES AND RESULTS: Two quantitative and four qualitative papers met criteria. Results reflect themes; attention to detail, tolerance of repetitive tasks, special/circumscribed interests, other RRBI related advantages/concerns. CONCLUSIONS AND IMPLICATIONS: Due to the nature and quality of the identified studies there is currently no strong evidence supporting or negating a workplace autism advantage. This review highlights the need for more research and urges constraint in utilising stereotypes that may not apply to all on the autism spectrum, arguing an individual differences approach to supporting autism strengths at work.

Quality of life: A universal or a disability specific concept?

BACKGROUND.: Quality of life (QoL) is an important outcome of occupational therapy practice. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts the individual throughout their lifespan and may substantially affect QoL. Measuring QoL of people with ASD presents a challenge and a debate whether to use general versus disability-specific adapted measures. PURPOSE.: This paper aims to (a) revisit the construct of QoL and discuss specific dilemmas pertaining to its measurement, and (b) discuss implications to the assessment of QoL in individuals with ASD while highlighting the potential contribution of occupational therapy to the development of measures. KEY ISSUES.: We suggest adding the domain of accessibility into QoL assessments, including, physical, sensory, social, and cognitive aspects, and to use disability-specific QoL measures. IMPLICATIONS.: The paper presents a call for occupational therapists to be involved in developing specific ASD disability-oriented measures that consider the unique characteristics of the disorder and environmental supports.

Somatosensory Discrimination in People With Autism Spectrum Disorder: A Scoping Review.

IMPORTANCE: Sensory symptoms in people with autism spectrum disorder (ASD) are commonly reported by researchers. However, an often overlooked sensory aspect of ASD is sensory discrimination in general, and somatosensory discrimination in particular. OBJECTIVE: To examine what has and what has not yet been learned concerning the somatosensory discrimination abilities of people with ASD and to reveal gaps warranting further research. DESIGN: Scoping review of clinical studies published 1995-2017 located through searches of PsycNET, PubMed, ERIC, and Google Scholar. Inclusion criteria were English-language peer-reviewed studies with (1) participants diagnosed with ASD, (2) a specific somatosensory discrimination measure, and (3) a comparison group. No age or intellectual exclusion criteria were established; studies were excluded if they were theoretical or descriptive, did not incorporate a control group, focused only on neurology or genetics, or used simple threshold detection measures or somatosensory measures integrated with other measures. The final search yielded 12 comparative articles discussing tactile and proprioceptive discrimination in people with ASD. RESULTS: Overall, most results showed atypical somatosensory discrimination in people with ASD, especially among young children. The relationship between sensory discrimination abilities and other sensory symptoms and ASD symptoms is briefly discussed. CONCLUSIONS AND RELEVANCE: Heterogeneous findings concerning somatosensory discrimination in people with ASD shed light on underlying mechanisms of these disorders and can contribute to improvement of occupational therapy intervention for this population. WHAT THIS ARTICLE ADDS: The occupational therapy evaluation of people with ASD can benefit from addressing somatosensory discrimination and its contribution to other clinical symptoms. This type of assessment can help improve intervention strategies for people with ASD by promoting a focus on the effect of discrimination deficits on daily function.

Update of a Meta-analysis of Sensory Symptoms in ASD: A New Decade of Research.

This meta-analysis updated evidence regarding sensory over-responsivity (SOR), under-responsivity (SUR) and seeking symptoms in individuals with autism spectrum disorders (ASDs) relative to typical controls and those with other conditions. Fifty-five questionnaire studies included 4606 individuals with ASD. Moderators tested were age, IQ, male ratio, matching group, and self-report. Compared to typical controls, effect size was large and significant for SOR, SUR, and Seeking but heterogeneous. For Seeking, age, IQ and self-report were significant moderators. Compared with developmental disorders (DDs) groups, effect size was significantly positive for SOR and Seeking; whereas compared with other clinical groups, only SOR was significant. These findings highlight the core nature of sensory symptoms in ASD and particularly SOR. Explanatory factors are yet to be revealed.