Executive functioning in children with ADHD Investigating the cross-method correlations between performance tests and rating scales.

Objective: Replicated evidence shows a weak or non-significant correlation between different methods of evaluating executive functions (EF). The current study investigates the association between rating scales and cognitive tests of EF in a sample of children with ADHD and executive dysfunction. Method: The sample included 139 children (aged 6-13) diagnosed with ADHD and executive dysfunctions. The children completed subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Children's Organizational Skills Scale (COSS). Analysis: Pairwise Spearman correlations were calculated between the composite and separate subscales of cognitive tests and rating scales. In secondary analyses, pairwise Spearman correlations were conducted between all composite scales and subscales, stratified by child sex and child ADHD subtype. Results: The correlation analyses between composite scores yielded no significant correlations. The results when comparing CANTAB TO and BRIEF GE are r=-.095, p=.289, and r=.042, p=.643 when comparing CANTAB TO and COSS TO. The analyses between all composite scales and subscales found one significant negative correlation (r=-.25, p<.01). There are significant cross-method differences when stratified by the ADHD-Inattentive subtype, showing significant negative correlations (moderate) between CANTAB and BRIEF composite (r=-.355, p=.014) and subscales. Discussion: It is possible that the different methods measure different underlying constructs of EF. It may be relevant to consider the effects of responder bias and differences in ecological validity in both measurement methods. Conclusion: The results found no significant correlations. The expectation in research and clinical settings should not be to find the same results when comparing data from cognitive tests and rating scales. Future research might explore novel approaches to EF testing with a higher level of ecological validity, and designing EF rating scales that capture EF behaviors more so than EF cognition.

Neural circuit disruptions of eye gaze processing in autism spectrum disorder and schizophrenia: An activation likelihood estimation meta-analysis.

BACKGROUND: Impairment in social cognition, particularly eye gaze processing, is a shared feature common to autism spectrum disorder (ASD) and schizophrenia. However, it is unclear if a convergent neural mechanism also underlies gaze dysfunction in these conditions. The present study examined whether this shared eye gaze phenotype is reflected in a profile of convergent neurobiological dysfunction in ASD and schizophrenia. METHODS: Activation likelihood estimation (ALE) meta-analyses were conducted on peak voxel coordinates across the whole brain to identify spatial convergence. Functional coactivation with regions emerging as significant was assessed using meta-analytic connectivity modeling. Functional decoding was also conducted. RESULTS: Fifty-six experiments (n = 30 with schizophrenia and n = 26 with ASD) from 36 articles met inclusion criteria, which comprised 354 participants with ASD, 275 with schizophrenia and 613 healthy controls (1242 participants in total). In ASD, aberrant activation was found in the left amygdala relative to unaffected controls during gaze processing. In schizophrenia, aberrant activation was found in the right inferior frontal gyrus and supplementary motor area. Across ASD and schizophrenia, aberrant activation was found in the right inferior frontal gyrus and right fusiform gyrus during gaze processing. Functional decoding mapped the left amygdala to domains related to emotion processing and cognition, the right inferior frontal gyrus to cognition and perception, and the right fusiform gyrus to visual perception, spatial cognition, and emotion perception. These regions also showed meta-analytic connectivity to frontoparietal and frontotemporal circuitry. CONCLUSION: Alterations in frontoparietal and frontotemporal circuitry emerged as neural markers of gaze impairments in ASD and schizophrenia. These findings have implications for advancing transdiagnostic biomarkers to inform targeted treatments for ASD and schizophrenia.

Depressive symptoms and anger and aggression in Russian adolescents.

Research among adolescents exploring the association between depressive symptoms and aggression has produced inconsistent findings. This study investigated the prevalence of clinically significant (current major depressive episode) and subthreshold depressive symptoms in a general population sample of adolescents from Northern Russia and explored their association with aggression and anger, while controlling for comorbid mental health problems. The sample consisted of 2600 participants, aged 13-17 years (59.5% female; 95.7% ethnic Russian). Symptoms of a current major depressive episode, types of anger and aggression (anger rumination, trait anger, physical, verbal and social aggression) and comorbid problems (posttraumatic stress, alcohol use, anxiety, and hyperactivity/impulsivity) were assessed by means of self-reports. The prevalence of a clinically significant depressive episode in the past month was 3.5%, while for subthreshold depression it was 21.6%. All anger and aggression variables, as well as comorbid problems increased together with increasing levels of depression. The association between overt aggressive behavior and depression was primarily explained by comorbid mental health problems, whereas anger rumination and social aggression had more direct associations with depression, independent of comorbidity. Among adolescents with depression, boys reported higher levels of social and verbal aggression and of anger rumination than girls. The results of this study suggest that interventions aiming to reduce aggressive behavior in adolescents should consider depression and its comorbid conditions.

Protocol description for a randomized controlled trial of fMRI neurofeedback for tics in adolescents with Tourette Syndrome.

This article describes the protocol for a randomized, controlled clinical trial of a neurofeedback (NF) intervention for Tourette Syndrome (TS) and chronic tic disorder. The intervention involves using functional magnetic resonance imaging (fMRI) to provide feedback regarding activity in the supplementary motor area: participants practice controlling this brain area while using the feedback as a training signal. The previous version of this NF protocol was tested in a small study (n = 21) training adolescents with TS that yielded clinically promising results. Therefore, we plan a larger trial. Here we describe the background literature that motivated this work, the design of our original neurofeedback study protocol, and adaptations of the research study protocol for the new trial. We focus on those ideas incorporated into our protocol that may be of interest to others designing and running NF studies. For example, we highlight our approach for defining an unrelated brain region to be trained in the control group that is based on identifying a region with low functional connectivity to the target area. Consistent with a desire for transparency and open science, the new protocol is described in detail here prior to conducting the trial.

Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome.

BACKGROUND: Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome. METHODS: Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression. RESULTS: Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect. CONCLUSIONS: This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.

Bulimia symptoms and anger and aggression among adolescents.

BACKGROUND: Previous research has indicated that anger and aggression may be elevated in adolescents with a bulimia nervosa (BN) diagnosis. However, as yet, little is known about whether bulimia symptoms are linked to anger and aggression in adolescents in the general population. To address this deficit this study aimed to explore the associations between a clinical level of bulimia symptoms (CLBS) and anger, anger rumination and aggression in community-based adolescents, and determine whether gender is important in this context. METHODS: This study was conducted on a representative sample of youth from northwestern Russia (n = 2613, age 13-17 years old, 59.5% female) using self-report scales. A proxy variable for a CLBS was created using the Eating Disorder Diagnostic Scale. Aggression, anger and anger rumination were assessed by the Trait Anger Scale of the State Trait Anger Expression Inventory, the Anger Rumination Scale, and scales created to assess physically and verbally aggressive behavior. Multivariate analysis of covariance was used to examine the associations between the study variables. RESULTS: A CLBS was more prevalent in girls than in boys (13.4% vs. 3.5%). The association with anger and aggression was stronger in both genders with a CLBS, compared to those adolescents without a CLBS. In the CLBS group, boys as compared to girls scored higher on verbal and physical aggression, anger rumination and social aggression. In both the CLBS and Non-CLBS groups higher anger and aggression scores were associated with increasing age. CONCLUSIONS: Findings suggest that aggression and anger rumination are elevated in adolescents with BN symptoms, and that the associations between anger, aggression and BN symptoms may be stronger in boys. As previous research has indicated that the presence of aggressive behaviors may affect the prognosis of BN and complicate management of the disorder, clinician screening for these behaviors in adolescents with BN symptoms may facilitate the provision of more effective treatment, especially among boys.

Increased Alpha-Band Connectivity During Tic Suppression in Children With Tourette Syndrome Revealed by Source Electroencephalography Analyses.

BACKGROUND: Tourette syndrome (TS) is a neurodevelopmental disorder involving chronic motor and phonic tics. Most individuals with TS can suppress their tics for at least a short period of time. Yet, the brain correlates of tic suppression are still poorly understood. METHODS: In the current study, high-density electroencephalography was recorded during a resting-state and a tic suppression session in 72 children with TS. Functional connectivity between cortical regions was assessed in the alpha band (8-13 Hz) using an electroencephalography source connectivity method. Graph theory and network-based statistics were used to assess the global network topology and to identify brain regions showing increased connectivity during tic suppression. RESULTS: Graph theoretical analyses revealed distinctive global network topology during tic suppression, relative to rest. Using network-based statistics, we found a subnetwork of increased connectivity during tic suppression (p < .001). That subnetwork encompassed many cortical areas, including the right superior frontal gyrus and the left precuneus, which are involved in the default mode network. We also found a condition-by-age interaction, suggesting age-mediated increases in connectivity during tic suppression. CONCLUSIONS: These results suggest that children with TS suppress their tics through a brain circuit involving distributed cortical regions, many of which are part of the default mode network. Brain connectivity during tic suppression also increases as youths with TS mature. These results highlight a mechanism by which children with TS may control their tics, which could be relevant for future treatment studies.

Posttraumatic Stress and Perceived Interpersonal Provocation in Adolescents.

Objective: To examine the impact of posttraumatic stress on the choice of responses to and attribution of intentionality in peer provocation in adolescent boys and girls. Methods: A sample of 2678 adolescents from Northern Russia, aged 13-17 years (59.3% female; 95.7% ethnic Russian) completed self-reports on posttraumatic stress and rated hypothetical peer provocation scenarios that teenagers can encounter in their daily lives. Results: Adolescents with clinically significant levels of posttraumatic stress symptoms (n=184 (6.8%)) reported a different pattern of reactions to peer provocation as compared to all other adolescents. Boys and girls with high levels of posttraumatic symptoms reported that they would be less likely to discuss conflict situations and more likely to react with physical aggression. Compared to their male counterparts, girls with high levels of posttraumatic stress symptoms were more likely to endorse hostile intentions, avoid provocations, and were less likely to endorse verbally aggressive responses. In provocation scenarios that involved physical aggression, girls with high levels of posttraumatic stress symptoms were less likely to endorse verbal aggressive responses and more likely to endorse physically aggressive responses than girls without clinically significant levels of posttraumatic symptoms. Girls with high levels of posttraumatic stress symptoms were also more likely to avoid socially aggressive situations than non-traumatized girls, whereas boys had an opposite pattern. Conclusions: High levels of posttraumatic stress symptoms may play a significant role in the endorsement of aggressive reactions in conflicts with peers and patterns of reactions may be gender-specific. A history of posttraumatic stress should be carefully evaluated in children and adolescents seeking treatment for aggressive behavior.

Aggression Is Associated With Social Adaptive Functioning in Children With ASD and Anxiety.

Social adaptive functioning is notably compromised and may be further impaired by aggressive behavior in children with autism spectrum disorder (ASD). This study examined the association between aggressive behavior and social adaptive skills in children with ASD and the contribution of aggressive behavior to social adaptive skills in a combined sample of children with and without ASD. Participants consisted of children, ages 8 to 15 years, with ASD (n = 52) and who were typically developing (n = 29). Results indicate that aggressive behavior is negatively associated with social adaptive skills in children with ASD and that it contributes to reduced social adaptive functioning above and beyond ASD diagnosis. Findings underscore the importance of considering the role of aggressive behavior when evaluating and promoting social functioning in children with ASD.

Linear discriminant analysis of phenotypic data for classifying autism spectrum disorder by diagnosis and sex.

Autism Spectrum Disorder (ASD) is a developmental condition characterized by social and communication differences. Recent research suggests ASD affects 1-in-44 children in the United States. ASD is diagnosed more commonly in males, though it is unclear whether this diagnostic disparity is a result of a biological predisposition or limitations in diagnostic tools, or both. One hypothesis centers on the 'female protective effect,' which is the theory that females are biologically more resistant to the autism phenotype than males. In this examination, phenotypic data were acquired and combined from four leading research institutions and subjected to multivariate linear discriminant analysis. A linear discriminant model was trained on the training set and then deployed on the test set to predict group membership. Multivariate analyses of variance were performed to confirm the significance of the overall analysis, and individual analyses of variance were performed to confirm the significance of each of the resulting linear discriminant axes. Two discriminant dimensions were identified between the groups: a dimension separating groups by the diagnosis of ASD (LD1: 87% of variance explained); and a dimension reflective of a diagnosis-by-sex interaction (LD2: 11% of variance explained). The strongest discriminant coefficients for the first discriminant axis divided the sample in domains with known differences between ASD and comparison groups, such as social difficulties and restricted repetitive behavior. The discriminant coefficients for the second discriminant axis reveal a more nuanced disparity between boys with ASD and girls with ASD, including executive functioning and high-order behavioral domains as the dominant discriminators. These results indicate that phenotypic differences between males and females with and without ASD are identifiable using parent report measures, which could be utilized to provide additional specificity to the diagnosis of ASD in female patients, potentially leading to more targeted clinical strategies and therapeutic interventions. The study helps to isolate a phenotypic basis for future empirical work on the female protective effect using neuroimaging, EEG, and genomic methodologies.

Evaluation of EEG biomarkers of Comprehensive Behavioral Intervention for Tics in children with Tourette syndrome.

OBJECTIVE: Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment of Tourette syndrome (TS). However, the brain mechanisms involved in CBIT are poorly understood. Enhanced frontomesial EEG coherence during a Go/NoGo task has been suggested as a mechanism involved in voluntary tic control. In the current study, we conducted a randomized controlled trial to assess whether EEG coherence during a Go/NoGo task was associated with CBIT outcome. METHODS: Thirty-two children with TS were randomly assigned to CBIT or to treatment-as-usual (TAU). Treatment outcome was assessed by a blinded evaluator with the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression - Improvement Scale (CGI-I). EEG was recorded during a Go/NoGo task at baseline and endpoint. EEG coherence was computed in the alpha frequency band between a priori selected channel pairs spanning the frontal and motor areas. RESULTS: Tic severity decreased significantly in the CBIT group. However, CBIT did not impact EEG coherence and baseline EEG coherence did not predict treatment outcome. CONCLUSIONS: Although CBIT was superior to TAU on blinded clinical outcomes, EEG coherence during the Go/NoGo task was not associated with change in tic severity. SIGNIFICANCE: The brain processes involved in the inhibition of motor responses do not appear to be involved in CBIT.

Amygdala-prefrontal connectivity in children with maladaptive aggression is modulated by social impairment.

Aggressive behavior is common across childhood-onset psychiatric disorders and is associated with impairments in social cognition and communication. The present study examined whether amygdala connectivity and reactivity during face emotion processing in children with maladaptive aggression are moderated by social impairment. This cross-sectional study included a well-characterized transdiagnostic sample of 101 children of age 8-16 years old with clinically significant levels of aggressive behavior and 32 typically developing children without aggressive behavior. Children completed a face emotion perception task of fearful and calm faces during functional magnetic resonance imaging. Aggressive behavior and social functioning were measured by standardized parent ratings. Relative to controls, children with aggressive behavior showed reduced connectivity between the amygdala and the dorsolateral prefrontal cortex (PFC) during implicit emotion processing. In children with aggressive behavior, the association between reduced amygdala-ventrolateral PFC connectivity and greater severity of aggression was moderated by greater social impairment. Amygdala reactivity to fearful faces was also associated with severity of aggressive behavior for children without social deficits but not for children with social deficits. Social impairments entail difficulties in interpreting social cues and enacting socially appropriate responses to frustration or provocation, which increase the propensity for an aggressive response via diminished connectivity between the amygdala and the ventral PFC.

Electrophysiological signatures of inhibitory control in children with Tourette syndrome and attention-deficit/hyperactivity disorder.

Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, especially in children. Reduced inhibitory control abilities have been suggested as a shared phenotype across both conditions but its neural underpinnings remain unclear. Here, we tested the behavioral and electrophysiological correlates of inhibitory control in children with TS, ADHD, TS+ADHD, and typically developing controls (TDC). One hundred and thirty-eight children, aged 7-14 years, performed a Go/NoGo task during dense-array EEG recording. The sample included four groups: children with TS only (n = 47), TS+ADHD (n = 32), ADHD only (n = 22), and matched TDC (n = 35). Brain activity was assessed with the means of frontal midline theta oscillations, as well as the N200 and P300 components of the event-related potentials. Our analyses revealed that both groups with TS did not differ from other groups in terms of behavioral performance, frontal midline theta oscillations, and event-related potentials. Children with ADHD-only had worse Go/NoGo task performance, decreased NoGo frontal midline theta power, and delayed N200 and P300 latencies, compared to typically developing controls. In the current study, we found that children with TS or TS+ADHD do not show differences in EEG during a Go/NoGo task compared to typically developing children. Our findings however suggest that children with ADHD-only have a distinct electrophysiological profile during the Go/NoGo task as indexed by reduced frontal midline theta power and delayed N200 and P300 latencies.

Large-scale functional brain networks of maladaptive childhood aggression identified by connectome-based predictive modeling.

Disruptions in frontoparietal networks supporting emotion regulation have been long implicated in maladaptive childhood aggression. However, the association of connectivity between large-scale functional networks with aggressive behavior has not been tested. The present study examined whether the functional organization of the connectome predicts severity of aggression in children. This cross-sectional study included a transdiagnostic sample of 100 children with aggressive behavior (27 females) and 29 healthy controls without aggression or psychiatric disorders (13 females). Severity of aggression was indexed by the total score on the parent-rated Reactive-Proactive Aggression Questionnaire. During fMRI, participants completed a face emotion perception task of fearful and calm faces. Connectome-based predictive modeling with internal cross-validation was conducted to identify brain networks that predicted aggression severity. The replication and generalizability of the aggression predictive model was then tested in an independent sample of children from the Adolescent Brain Cognitive Development (ABCD) study. Connectivity predictive of aggression was identified within and between networks implicated in cognitive control (medial-frontal, frontoparietal), social functioning (default mode, salience), and emotion processing (subcortical, sensorimotor) (r = 0.31, RMSE = 9.05, p = 0.005). Out-of-sample replication (p < 0.002) and generalization (p = 0.007) of findings predicting aggression from the functional connectome was demonstrated in an independent sample of children from the ABCD study (n = 1791; n = 1701). Individual differences in large-scale functional networks contribute to variability in maladaptive aggression in children with psychiatric disorders. Linking these individual differences in the connectome to variation in behavioral phenotypes will advance identification of neural biomarkers of maladaptive childhood aggression to inform targeted treatments.

What are we optimizing for in autism screening? Examination of algorithmic changes in the M-CHAT.

The present study objectives were to examine the performance of the new M-CHAT-R algorithm to the original M-CHAT algorithm. The main purpose was to examine if the algorithmic changes increase identification of children later diagnosed with ASD, and to examine if there is a trade-off when changing algorithms. We included 54,463 screened cases from the Norwegian Mother and Child Cohort Study. Children were screened using the 23 items of the M-CHAT at 18 months. Further, the performance of the M-CHAT-R algorithm was compared to the M-CHAT algorithm on the 23-items. In total, 337 individuals were later diagnosed with ASD. Using M-CHAT-R algorithm decreased the number of correctly identified ASD children by 12 compared to M-CHAT, with no children with ASD screening negative on the M-CHAT criteria subsequently screening positive utilizing the M-CHAT-R algorithm. A nonparametric McNemar's test determined a statistically significant difference in identifying ASD utilizing the M-CHAT-R algorithm. The present study examined the application of 20-item MCHAT-R scoring criterion to the 23-item MCHAT. We found that this resulted in decreased sensitivity and increased specificity for identifying children with ASD, which is a trade-off that needs further investigation in terms of cost-effectiveness. However, further research is needed to optimize screening for ASD in the early developmental period to increase identification of false negatives.

Increased amygdala and decreased frontolimbic r esting- s tate functional connectivity in children with aggressive behavior.

Childhood maladaptive aggression is associated with disrupted functional connectivity within amygdala-prefrontal circuitry. In this study, neural correlates of childhood aggression were probed using the intrinsic connectivity distribution, a voxel-wise metric of global resting-state brain connectivity. This sample included 38 children with aggressive behavior (26 boys, 12 girls) ages 8-16 years and 21 healthy controls (14 boys, 6 girls) matched for age and IQ. Functional MRI data were acquired during resting state, and differential patterns of intrinsic functional connectivity were tested in a priori regions of interest implicated in the pathophysiology of aggressive behavior. Next, correlational analyses tested for associations between functional connectivity and severity of aggression measured by the Reactive-Proactive Aggression Questionnaire in children with aggression. Children with aggressive behavior showed increased global connectivity in the bilateral amygdala relative to controls. Greater severity of aggressive behavior was associated with decreasing global connectivity in the dorsal anterior cingulate and ventromedial prefrontal cortex. Follow-up seed analysis revealed that aggression was also positively correlated with left amygdala connectivity with the dorsal anterior cingulate, ventromedial and dorsolateral prefrontal cortical regions. These results highlight the potential role of connectivity of the amygdala and medial prefrontal and anterior cingulate cortices in modulating the severity of aggressive behavior in treatment-seeking children.

Organizational skills training for children with ADHD: study protocol for a randomized, controlled trial.

BACKGROUND: Problems with sustained attention, impulsivity, and hyperactivity are the most prominent symptoms of attention-deficit hyperactivity disorder (ADHD), but many children with this diagnosis also present with poor organizational skills that are important in relation to school. These problems tend to increase from childhood to adolescence and are often not well managed by medication. Organizational skills training (OST) is a range of behavioral interventions that specifically target organizational skills deficits. Evidence supports the effect of OST on improving organizational skills, inattention, and academic performance in children with ADHD. Because previous clinical trials included mostly children above the age of 8 years, this trial includes children in the age range 6-13 years to expand the knowledge on the effects of OST in younger children. Previous OST research has also shown improvement on inattention in parent ratings; we will investigate if a change in inattention can be confirmed with neurocognitive tests. Finally, little is known about predictors of treatment response in OST. OBJECTIVES: The primary objective is to investigate if OST has positive effects on organizational skills in children with ADHD. The primary outcome measurement is the parent-rated Children's Organizational Skills Scale (COSS), collected before and at the end of the 10 week intervention. Secondary and exploratory outcomes include inattention ratings, family and school functioning, and cognitive functions measured before the intervention period, immediately after, and at a 6 month follow-up. Additional objectives are to investigate both neurocognitive outcomes and age as predictors of treatment response. METHODS: This is a randomized clinical superiority trial investigating the effect of OST vs a treatment-as-usual (TAU) control group for children with ADHD in the age range of 6-13 years. All participants (n = 142) receive TAU. OST is administered in a group format of 10 weekly sessions. Adverse events are monitored by study clinicians during weekly therapy sessions and all assessments. Data analyses will be conducted using mixed linear regression models with random intercepts for patients, adjusted for the stratification variables and the baseline value. PERSPECTIVES: This study will provide important new knowledge and expand on existing research in the field of non-pharmacological treatment of children with ADHD. OST can potentially have a significant impact on the lives of children with ADHD by helping them learn how to cope with their present deficits and to become more independent and self-reliant. It is also important to investigate predictors of treatment response in order to optimize OST. TRIAL REGISTRATION: ClinicalTrials.gov NCT03160378 . Registered on May 19, 2017.

Conducting CBT for Anxiety in Children with Autism Spectrum Disorder During COVID-19 Pandemic.

This commentary describes the transition to remote delivery of cognitive-behavioral therapy (CBT) for anxiety in children with autism spectrum disorder (ASD) who participates in a clinical trial during the COVID-19 pandemic. The effects of COVID-19 on children's anxiety and on the family functioning are discussed. Modifications to CBT necessitated by telehealth delivery were aimed at maximizing engagement of children and their parents while maintaining treatment fidelity and adhering to the research protocol. Treatment targets were updated to address new sources of anxiety and CBT exposure exercises were modified to accommodate the new reality of quarantine restrictions. If the COVID-19 pandemic continues to affect treatment delivery it may require a widespread utilization of telehealth for treating anxiety in children with ASD.

Parent Emotion Socialization in Children with Autism Spectrum Disorder and Co-Occurring Anxiety.

Although parents' socialization of children's emotional experiences and expression has been widely studied in typically developing (TD) populations, these processes have been largely unexplored in families of children with autism spectrum disorder (ASD). The present study examined parent emotion socialization in a well-characterized sample of verbally fluent children with ASD and comorbid anxiety disorders. Participants included 64 children, aged 8-15 years, who had ASD and co-occurring anxiety and 24 matched TD children without psychiatric disorders. Parents completed ratings of their responses to their children's emotional experiences using the Coping with Children's Negative Emotions Scale (CCNES), and both parents and children completed ratings of child anxiety using the Multidimensional Anxiety Rating Scale (MASC). Parents of children with ASD and anxiety did not differ from parents of TD children without psychiatric disorders in their endorsement of different emotion socialization practices. However, among children with ASD and anxiety, greater anxiety was associated with more emotion-focused responses from parents, and for children with less ASD symptom severity, lower levels of anxiety were associated with more punitive responses from parents. Results suggest that certain types of more directive emotion socialization approaches may be associated with lower anxiety in children with ASD, whereas emotion socialization approaches focused on altering the child's emotional experiences may be associated with greater anxiety in this population. While it is likely that parent emotion socialization practices impact children's emotional experiences of anxiety, it is also likely that children with distinct profiles of anxiety and ASD symptomology elicit specific styles of emotion socialization from parents.

Assessing Irritability in Children with Autism Spectrum Disorder Using the Affective Reactivity Index.

Irritability is an impairing problem in children with ASD that may be associated with other behavioral and emotional concerns. The Affective Reactivity Index (ARI) is a parent-rated measure of irritability widely used in children with mood disorders, however, its utility in children with ASD remains unclear. In this study, we examined ARI parent ratings in children with ASD and contributions of parent-rated anxiety and noncompliance to irritability measured by the ARI. Participants included 81 children with ASD, aged 8-16 years. Results suggest that both anxiety and noncompliance contribute to irritability, but that anxiety only contributes to irritability in the absence of noncompliance. Further, the ARI is likely to be a useful measure of irritability in children with ASD.