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Improving Transition to Adulthood for Students with Autism: A Randomized Controlled Trial of STEPS
Abstract
Emerging adulthood is a period of heightened risk for young people with autism spectrum disorder (ASD). Due in part to a lack of evidence-based services and supports during the transition to adulthood, many emerging adults fail to matriculate into postsecondary education or thrive in productive employment. The Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address the psychosocial, transition-related needs of emerging adults with ASD. Adolescents and emerging adults (n = 59) with ASD were randomly assigned to either STEPS or transition as usual (TAU). Results indicate that STEPS is acceptable to young people with ASD and their parents and that it can be implemented with high fidelity. Among secondary school students, those who completed STEPS exhibited significantly greater gains in transition readiness from high school, and these gains were largely sustained after program completion. Among students enrolled in postsecondary education, STEPS resulted in increased levels of student adaptation to college relative to those in TAU. Programming to address ASD-related challenges can promote successful educational transitions.
... Regarding CHD, a Canadian study concluded that two nurse-led information sessions held with an interval of two months between them was effective in reducing the delay to adult care and improving CHD knowledge and self-management skills (94). The remaining studies have been conducted in adolescents with hemophilia (95), spina bifida (96), type 1 diabetes (97), autism spectrum disorders (98,99), and special care needs (100). In addition to previous RCTs, these studies found positive effects on knowledge of the condition (95) disease-related distress (97), transition readiness (98), social relationships and interactions (96,99), clinic attendance (97) and satisfaction with care or perceived quality of care (97,100). ...
... The remaining studies have been conducted in adolescents with hemophilia (95), spina bifida (96), type 1 diabetes (97), autism spectrum disorders (98,99), and special care needs (100). In addition to previous RCTs, these studies found positive effects on knowledge of the condition (95) disease-related distress (97), transition readiness (98), social relationships and interactions (96,99), clinic attendance (97) and satisfaction with care or perceived quality of care (97,100). Moreover, a systematic review including 43 studies that used quasi-experimental or pre-post designs (101) showed the positive effects of transitional care interventions on participation in care, patient-reported health, quality of life, self-management skills, mortality, satisfaction with care, and more appropriate use of healthcare resources (101). ...
... For process evaluations of transition programs, there have been no published studies assessing the process of delivering the program in terms of implementation or potential mechanisms of impact. However, one study has shown that transitional care can be delivered with high participant acceptability (98). A few studies have evaluated the experiences of participation in transition programs, concluding that these programs should be tailored for the individual patient and that their needs should guide the content of the program (107). ...
Transition programs have been developed for adolescents with chronic conditions and evaluated through randomized controlled trials. However, knowledge is lacking on what barriers and facilitators to implementation exist, how change is created, and the cost-effectiveness of these programs. The overall aim of this thesis was to perform a process evaluation and health economic analysis of the STEPSTONES transition program for adolescents with congenital heart disease in transition to adulthood and transfer to adult care. The methods used in this thesis were process evaluations (Studies I – III) and a health economic evaluation (Study IV). Mixed methods were used to design, collect, and analyze data according to the methodological guidance for process evaluation of complex interventions by Moore et al (2015). The findings showed that the transition program was implemented with high fidelity, although some components were more difficult to implement. Factors affecting the implementation process were the participants’ and healthcare professionals’ responsiveness and willingness to engage in the program, organizational factors, recruitment and retention, and the parents’ process of achieving balance between becoming a support system and managing their own information and support needs. Key change mechanisms were the opportunity to meet a transition coordinator trained in person-centered care and adolescent-friendly communication, the creation of a safe space that was built on confidentiality, a learning process starting from the adolescents’ needs, and goal setting beyond the heart defect. The health economic evaluations showed that the intervention group had higher costs due to receiving the transition program. No differences in health outcomes with the EQ-5D were observed in this study. The conclusion is that the transition program was largely implemented as it was intended. Implications from these findings are that transition programs have prerequisites for implementation but tailoring to other conditions and contexts needs to be taken into consideration. Knowledge is needed on the longitudinal impact of transition programs to provide decision makers with evidence on the future benefits of transition programs for adolescents with chronic conditions.
... The use of accommodations, such as additional examination time, or a quiet testing environment, is advised (Jansen et al., 2016). Next, autistic students must learn what to expect from academic life, how lectures work (Cai & Richdale, 2016;White et al., 2019), and, we add, especially the importance of test taking and resits (Chapter 3). Furthermore, support should help them fit in socially, learn to ask for help and make friends with staff and fellow students (Accardo, Kuder, & Woodruff, 2018). ...
... In our opinion, support structures in institutions should strive for the opposite: inclusion by promoting understanding and acceptance of autistic students by peers and staff (Sarrett, 2017). The support of the academic community will help autistic students to build relationships, increase their understanding of fellow students and academic staff, and gain confidence (White et al., 2019). ...
... Our findings on prediction patterns for autistic students' success may imply that the severity of autistic students' autism plays a part in their study progression and success. Following previous findings (White et al., 2019), we assume that the more severe autistic students' autism is, the more difficulties they encounter before and during their studies. Student wellbeing affects the quality of life of autistic students in higher education (Van Hees, Moyson, & Roeyers, 2015). ...
In this PhD thesis, we aimed to improve understanding of the study progression and success of autistic students in higher education by comparing them to students with other disabilities and students without disabilities. We studied their background and enrollment characteristics, whether barriers in progression existed, how and when possible barriers manifested themselves in their student journey, and how institutions should address these issues. We found autistic students to be different from their peers but not worse as expected based on existing findings. We expect we counterbalanced differences because we studied a large data set spanning seven cohorts and performed propensity score weighting.
Most characteristics of autistic students at enrollment were similar to those of other students, but they were older and more often male. They more often followed an irregular path to higher education than students without disabilities. They expected to study full time and spend no time on extracurricular activities or paid work. They expected to need more support and were at a higher risk of comorbidity than students with other disabilities. We found no difficulties with participation in preparatory activities. Over the first bachelor year, the grade point averages (GPAs) of autistic students were most similar to the GPAs of students without disabilities. Credit accumulation was generally similar except for one of seven periods, and dropout rates revealed no differences. The number of failed examinations and no-shows among autistic students was higher at the end of the first semester. Regarding progression and degree completion, we showed that most outcomes (GPAs, dropout rates, resits, credits, and degree completion) were similar in all three groups. Autistic students had more no-shows in the second year than their peers, which affected degree completion after three years.
Our analysis of student success prediction clarified what factors predicted their success or lack thereof for each year in their bachelor program. For first-year success, study choice issues were the most important predictors (parallel programs and application timing). Issues with participation in pre-education (absence of grades in pre-educational records) and delays at the beginning of autistic students’ studies (reflected in age) were the most influential predictors of second-year success and delays in the second and final year of their bachelor program. Additionally, academic performance (average grades) was the strongest predictor of degree completion within three years.
Our research contributes to increasing equality of opportunities and the development of support in higher education in three ways. First, it provides insights into the extent to which higher education serves the equality of autistic students. Second, it clarifies which differences higher education must accommodate to support the success of autistic students during their student journey. Finally, we used the insights into autistic students’ success to develop a stepped, personalized approach to support their diverse needs and talents, which can be applied using existing offerings.
... Despite the consistent findings that ASD college students have difficulty with daily living skills that are essential for achieving functional independence as emerging adults, the existing literature is minimally focused on these skills as targets for intervention. When daily living skills are included in the intervention training, they are not a focus of the intervention (Capriola-Hall et al., 2020;Hillier et al., 2018;Lucas & James, 2018;Rando et al., 2016;Schindler et al., 2015;Weiss & Rohland, 2015;White et al., 2019;White, Richey, et al., 2016). The Connections intervention described above dedicated a week of training to discussing and improving time management skills (Hillier et al., 2018). ...
... Many of these social skills interventions target improvements in social communication (Ashbaugh et al., 2017;Capriola-Hall et al., 2020;Lucas & James, 2018;Rando et al., 2016;Schindler et al., 2015;Weiss & Rohland, 2015;White et al., 2019). For instance, the Communication Coaching Program described above was largely focused on training social communication skills (Weiss & Rohland, 2015). ...
... Some interventions also provide structured social activities so that ASD students could observe and practice learned skills (Ashbaugh et al., 2017;Capriola-Hall et al., 2020;Koegel et al., 2013;White et al., 2019;White, Richey, et al., 2016). Ashbaugh et al. (2017) developed and tested a social skills intervention for ASD college students that was mediated by peer mentors who modeled social behavior in real social settings. ...
Autistic individuals often struggle to successfully navigate emerging adulthood (EA). College is an increasingly common context in which individuals learn and hone the necessary skills for adulthood. The goal of this paper is to systematically review and assess the existing research on college as a context of EA development in autistic individuals, particularly in terms of understanding whether and how this context might be critically different for those who are typically developing or developing with other disabilities. Our findings indicate that ASD college students report feeling prepared academically, but exhibit weaknesses in daily living and social skills. Interventions largely focus on social skills, and rarely evaluate outcomes relevant to college success or longer-term emerging adulthood independence. We conclude with hypotheses and recommendations for future work that are essential for understanding and supporting ASD students as they navigate potentially unique challenges in college and their transition to independence during EA.
... The study characteristics of the 41 included articles are described in Table 2. The majority of the RCT studies (n = 23) were conducted in the US (Capriola-Hall et al., 2020;Cox et al., 2017;Eack et al., 2018;Faja et al., 2012;Gantman et al., 2012;Gentry et al., 2015;Gorenstein et al., 2020;Hayes et al., 2015;Laugeson et al., 2015;Maisel et al., 2019;McVey et al., 2016;McVey et al., 2017;Morgan et al., 2014;Murza et al., 2014;Oswald et al., 2018;Smith et al., 2014;Strickland et al., 2013;Van Bourgondien et al., 2003;Wehman et al., 2017;Wehman et al., 2014;Wehman et al., 2020;White et al., 2016;White et al., 2019), with three in Japan (Kumazaki et al., 2019;Kumazaki et al., 2017;Miyajima et al., 2016), three studies in the UK (Ashman et al., 2017;Gaigg et al., 2020); Russell et al. (2013) and Germany (Bölte et al., 2002;Mastrominico et al., 2018;Rosenblau et al., 2020) respectively, two studies in Spain (Garcia-Villamisar & Dattilo, 2010;Garcia-Villamisar et al., 2016), and the Netherlands (Spek et al., 2013;Wijker et al., 2020) respectively, and one study in Israel (Saban-Bezalel & Mashal, 2015), Sweden (Hesselmark et al., 2014) and Canada (Nadig et al., 2018), Nigeria (Akabogu et al., 2019), Australia (Tang et al., 2020) respectively. The studies spanned a period of 18 years, conducted between 2002 and 2020, with most studies published between 2014 and 2019 (see Table 2). ...
... Eleven of the included studies evaluated cognitive training interventions (see Table 3). Four focused on reducing comorbid symptoms (Capriola-Hall et al., 2020;Gaigg et al., 2020;Russell et al., 2013;Spek et al., 2013), three focused on improving cognitive and social functioning (Miyajima et al., 2016;Rosenblau et al., 2020;Tang et al., 2020), one on improving QoL or social emotional outcomes (Hesselmark et al., 2014;Tang et al., 2020), one on core cognitive and social cognitive outcomes with employment as a secondary outcome (Eack et al., 2018), one on adjustment to college (White et al., 2019), and one on reducing distressing thoughts (Maisel et al., 2019). Most studies reported significant improvements following cognitive training intervention. ...
... Most studies reported significant improvements following cognitive training intervention. Three studies (Eack et al., 2018;Gaigg et al., 2020;Spek et al., 2013;White et al., 2019) reported significant large intervention effects. Hesselmark et al. (2014) reported significant moderate effects for improving QoL. ...
To determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts were retrieved, of which 41 articles met all inclusion criteria: randomised controlled trial; non-pharmacological intervention; adults with autism; and English publication. Twenty included studies had strong methodological quality ratings. No meta-analysis could be performed due to heterogeneity between studies. Articles reported on interventions for (1) social functioning and language skills, (2) vocational rehabilitation outcomes, (3) cognitive skills training, and (4) independent living skills. Social functioning was the most studied intervention. PEERS for young adults and Project SEARCH plus ASD support interventions had the strongest evidence. Emerging evidence suggests non-pharmacological interventions could be effective.
... Range= 16-25 years) enrolled in a randomized controlled trial (RCT). The experimental intervention was a transition support program for secondary or postsecondary students interested in pursuing higher education (White et al., 2021). For the trial, participants either had to have autism listed as an educational classification in their individualized education plans, or an ASD diagnosis was confirmed by a research-reliable administration of the ADOS-2 (Lord et al., 2012). ...
... The majority of the sample identified as White (86 %) and Male (80 %). See (White et al., 2021) for further details on the RCT and exclusion criteria. Recruitment occurred in a southeastern state in both rural and small city/suburban settings, including efforts to recruit through local school districts and two-and four-year postsecondary programs. ...
Background:
Adolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention.
Method:
Fifty-seven autistic adolescents and adults (16-25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms.
Results:
ASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety.
Conclusions:
Although preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.
... A few existing transition support programs such as STEPS (White et al., 2017(White et al., , 2019 and the Summer Transition Program (Hotez, Shane-Simpson, & Obeid, 2018) appear promising, and may, increase the transition readiness and adjustment of autistic students and foster the social and self-advocacy skills they would need in HEI, respectively. Researchers agree however that more evidence-based services addressing the needs of autistic students who are transitioning to HEI should be developed (Anderson & Butt, 2017;Hotez et al., 2018;White et al., 2017). ...
... Only a handful of studies have developed and examined college transition programs for autistic students. Still, existing transition programs for autistic students have shown positive results in terms of reduced anxiety and loneliness and increased self-esteem (Hillier, Goldstein, & Murphy, 2018), smoother college adaptation (White et al., 2019), development of social connections (Rothman, Maldonado, & Rothman, 2008), better academic achievement, and successful completion of the first year (Shmulsky, Gobbo, & Donahue, 2015). Students' appreciation of transition programs shown in this study adds more evidence supporting the importance of structured transition programs in autistic students' transition to HEI. ...
Background
Only a limited number of studies have specifically examined autistic undergraduate students’ perspectives on transition. Positive experiences during the initial transition from high school to college lead to long-term success in college.
Method
This study examined the transition and adjustment experiences of 27 autistic undergraduate students attending higher education institutions (HEIs) in the United States. Semi-structured interviews were analyzed using qualitative content analysis.
Results
The majority (66.7 %) of participants described the transition experience in negative terms. They also reported that geographical proximity to home and family support, social relationships, transition programs, structural changes from their high school experiences, and logistic difficulties were important aspects of their transition experiences during the first few months of HEI. All participants indicated they felt adjusted to college life at the time of the interview, and adjustment was facilitated by familiarity with campus routines, academic achievement, and positive social experiences.
Conclusions
Themes associated with autistic students’ transition and adjustment experiences should be followed-up in future quantitative research. Careful transition planning that informs autistic students about expectations associated with HEI, familiarizes them with college life, helps them gain practical skills needed in colleges (e.g., transportation), and helps them find a balance between parental support and independence is needed to support autistic students through transition and adjustment.
... These findings suggest that while opportunities at home and school exist for students, they may need more support in skills surrounding explicit instruction in self-determination or activities that promote self-determination, emphasizing school-based supports. To date, one intervention incorporates explicit self-determination instruction in autistic youth without co-occurring ID ages 16-25 (White et al., 2017(White et al., , 2019. The STEPS program incorporates an explicit focus on self-determination through cognitive-behavioral strategies (White et al., 2017). ...
... The STEPS program incorporates an explicit focus on self-determination through cognitive-behavioral strategies (White et al., 2017). Results showed that students with higher self-determination levels at baseline predicted increases in college adjustment intervention gains (White et al., 2019). These findings were preliminary due to small sample sizes and did not demonstrate a change in selfdetermination over time; thus, more research is needed to examine self-determination interventions for transition-aged youth on the autism spectrum. ...
Self-determination refers to an individual's capacity and opportunities to act as a causal agent in their own lives to make choices, decisions, and set goals. The current study examined self- and parent-reports of the AIR Self-Determination Scale in transition-aged autistic youth (Based on stakeholder preferences, we use identity-first(autistic) or neutral language (on the autism spectrum) (Bottema-Beutel in JAMA 3:18–29, 2020)). Autistic youth completed depression and executive function measures, and parents rated their child's social-communication and executive function difficulties. Despite differences between youth and parent reports, both youth and their parents reported lower self-determination skills (capacity) than opportunities to practice self-determined behaviors. Both depression and executive function skills were related to self-determination capacity, highlighting potential intervention targets for transition-aged youth to facilitate increased self-determination and potentially improved adult outcomes.
... We drew our data from the National Database for Autism Research (NDAR), an NIH-funded data repository, and from existing data of one of the authors (MC). We used data from three NDAR studies (including Rabany et al., 2019;White et al., 2019) in the current analyses (Table 1). The Institutional Review Board (IRB) at Marquette University waived approval due to the deidentified and archival nature of the NDAR data. ...
... Study detailsInformation in quotations is pulled directly from NDAR website or publications resulting from the studies where indicated(Rabany et al., 2019;White et al., 2019) *S.White (personal communication, February 15 and 28, 2021) ...
Emotion dysregulation is common among autistic people, yet few measures have received psychometric evaluation in this population. We examined the factor structure, reliability, and validity of a commonly-used measure of emotion dysregulation, the Difficulties with Emotion Regulation Scale (DERS), in a sample of 156 autistic adolescents and adults. Data were drawn from the NIH National Database for Autism Research (NDAR) and an author’s existing dataset. Results demonstrated that the factor structure generally conformed to the original 6-factor model, with modifications. Reliability analyses revealed good-to-excellent internal consistencies. Validity analyses indicated that the DERS was positively associated with measures of anxiety, depression, and alexithymia. Our findings provide preliminary evidence for the utility of the DERS in a small autistic sample, with minor modifications.
... Moreover, with most ASPs beginning only in the last six years, individual programs often change from year to year as they grow and evolve (Barnhill, 2016;Cox et al., 2020a). Although a few transition supports have been examined independently (e.g., Ames et al., 2016;Lei et al., 2020;White et al., 2019), there has been little scholarship that examines these programs collectively (Barnhill, 2016;Cox et al., 2020a;Nachman, 2020). Finally, while various websites highlight specific ASPs (e.g., Col-legeAutismSpectrum.org), and some ASPs appear within databases of transition programs serving college students with disabilities more generally (e.g., ThinkCollege.net), ...
... The ASPs we identified represent the most comprehensive institutional efforts to support autistic college students, and it seems reasonable to assume that services provided by these programs are improving students' college experiences and/or increasing their graduation and subsequent employment rates. Only a few publications have reported on assessments of individual programs (e.g., Ames et al., 2016;Lei et al., 2020) and empirical evidence about which interventions affect which outcomes for which students remain limited (Anderson et al., 2019;Cox et al., 2020aCox et al., , 2020bNuske et al., 2019;White et al., 2019). ...
Many postsecondary institutions have begun their own Autism-Specific College Support Programs (ASPs) to integrate the emergence of autistic students into college and offer supports aiding their success (Longtin in J Postsecond Educ Disabil 27(1):63–72, 2014), yet little is known about these programs. We conducted an exhaustive, year-long search of all postsecondary institutions in the United States to identify all ASPs. Although we identified a total of 74 programs located in 29 states, our analyses suggest these are unavailable to students in large portions of the country. When they are available, these programs appear to be disproportionately located at 4-year institutions, public institutions, and in the Mid-East. Our study highlights inequities based on institutional type and geography, as well as offers a complete public list of ASPs.
... Poor adjustment to college decreases the likelihood of degree completion, 8,9 and elevated levels of autistic traits in the general population are associated with poorer adjustment. 10 Furthermore, programs designed to ease the transition from high school to college have demonstrated gains in college adjustment in autistic students relative to autistic control groups that did not receive intervention, 11,12 highlighting the practical relevance of this construct to the autism population. ...
... The sample size in this study was smaller than what is ideal for analysis of quantitative surveys. Furthermore, while the SACQ has been used on autistic students in previous research, 11,12 it has not been specifically validated for use in this population, which is a necessity for future studies. We also had unequal gender distributions between the mentors and mentees, requiring male mentees to be matched with female mentors on many occasions. ...
Unlabelled:
The number of autistic students in colleges is growing rapidly. However, their needs are not being met, and graduation rates among this population remain low. This article describes the implementation and evaluation of the Autism Mentorship Initiative (AMI) for autistic undergraduates (mentees), who received 1-on-1 support from upper-level undergraduate or graduate students (mentors) at their university. We examined changes in college adjustment (n = 16) and grade point average among mentees (n = 19) before and after participation in AMI for two or more semesters. We also examined surveys completed by both mentees (n = 16) and mentors (n = 21) evaluating their experiences in AMI. Data from the Student Adaptation to College Questionnaire showed that mentees displayed lower than average social, emotional, and academic adjustment to college compared with neurotypical norms, but participation in AMI resulted in notable gains in all facets of college adjustment. Survey data revealed that both mentors and mentees reported personal, academic, and professional benefits from participating in AMI. However, no improvements in academic achievement of the mentees were found. This study provided preliminary evidence for the benefits of an easily implemented and cost-effective peer mentorship program for autistic students in a college setting.
Lay summary:
Why was this program developed?: There are a growing number of autistic students attending college. However, the percentage of autistic students who complete their degree is quite low. We believe that colleges should be offering more support services to address the unique needs of their autistic students.What does the program do?: The Autism Mentorship Initiative (AMI) matches incoming autistic undergraduates with upper-level (third or fourth year) neurotypical undergraduates or graduate students who provide 1-on-1 mentorship. The autistic undergraduates meet regularly with their mentors to discuss personal and professional goals, discuss solutions for problems they are experiencing in college, and discuss ideas for increased integration into college campus life (e.g., joining clubs or attending social events). The neurotypical mentors receive ongoing training from program supervisors about autism and meet regularly with program supervisors to discuss progress with their mentees and troubleshoot issues they may be experiencing with their mentees.How did the researchers evaluate the program?: We evaluated AMI by administering the Student Adaptation to College Questionnaire at multiple time points to examine whether autistic mentees reported improvements in social, emotional, and academic adjustment to college as a result of participating in AMI. In addition to tracking changes in cumulative grade point average (GPA), we also administered program evaluation surveys to determine whether AMI is meeting its core aims and to assess satisfaction with the program from the perspectives of both mentors and mentees.What are the early findings?: While there were no changes in GPA, participation in AMI resulted in notable changes in mentees' academic, social, and emotional adjustment. Both mentors and mentees reported personal, academic, and professional benefits from their participation in AMI.What were the weaknesses of this project?: The sample size was small, so it is questionable whether the findings generalize to a broader autistic student population. In addition, there was no control group, so we cannot be certain that improvements in college adjustment were due to participation in AMI. Moreover, this study only assessed one program at one university in Western Canada, so it is unknown whether this program could be successfully implemented at other universities or in different geographic locations.What are the next steps?: As participation in AMI increases each year, follow-up studies will utilize larger sample sizes. We will seek to obtain control data by examining GPA and college adjustment in autistic students who do not participate in AMI. We will aim to conduct multisite trials to examine whether similar programs can be implemented at other universities.How will this work help autistic adults now and in the future?: We hope that our research will help faculty members and staff from disability support offices to gain ideas and insights in implementing similar-or better-programs at their respective institutions. Our experience is that mentorship programs can be both cost-effective and easily implemented, while offering an invaluable support system to autistic students that may increase the likelihood of degree completion.
... Dengan demikian, penting untuk mengkaji lebih lanjut peran Subjective Norm di antara penjaja makanan karena juga bisa menjadi bagian dari efek kausal terhadap niat untuk menggunakan EFFP (Ham & Jeger, 2015). Selain itu, telah dicatat bahwa pengaruh pelanggan (Albrecht et al., 2017), pengaruh media (Husin et al., 2016), dan kewajiban moral juga penting untuk memeriksa masalah secara menyeluruh (White et al., 2021) ...
Robo advisor merupakan penasihat keuangan yang salah satunya ada pada bareksa untuk membantu pengguna untuk melakukan alokasi aset saham, obligasi dan investasi lainnya yang telah disesuaikan dengan profil risiko terhadap masing-masing investor. Tujuan dari perancangan penelitian ini adalah untuk mengetahui sejauh mana kepahaman masyarakat di kota Batam terhadap robo advisor dalam melakukan suatu kegiatan investasi. Teknik pengambilan sampel yang dipakai adalah non-probability sampling dengan metode purposive sampling. Kriteria dalam penelitian ini adalah responden yang pernah/sedang menggunakan robo advisor sehingga memperoleh 300 data sampel. Hasil penelitian menunjukkan bahwa attitude tidak berpengaruh signifikan positif terhadap intention to use, perceived ease of use berpengaruh signifikan positif terhadap intention to use, perceived usefulness berpengaruh signifikan positif terhadap intention to use, subjective norm (external influce) berpengaruh signifikan positif terhadap intention to use, dan subjective norm (internal influce) tidak berpengaruh signifikan positif terhadap intention to use.
... Dans cet article, nous avons proposé une analyse écosystémique de cette transition en nous appuyant sur le modèle développé par Bronfenbrenner (1979Bronfenbrenner ( , 2005, permettant d'appréhender en quoi les caractéristiques des jeunes avec un TSA, des microsystèmes dans lesquels ils évoluent mais plus largement des politiques publiques et des attitudes et représentations sociales associées à l'autisme peuvent constituer autant d'obstacles dans la transition vers l'enseignement supérieur. Nous avons aussi rappelé que plus de deux décennies de recherche ont permis d'établir que soutenir l'autodétermination constitue une pratique fondée sur des preuves qui permet d'améliorer la transition vers l'enseignement supérieur chez les jeunes avec un TSA (Carter et al., 2013;Wehmeyer et al., 2012;White et al., 2017White et al., , 2021, tout particulièrement dans le cadre de programmes de planification de la transition (e.g., Hatfield et al., 2016Hatfield et al., , 2017. afin d'appréhender les obstacles qui n'ont pas pu être dépassés. ...
Adolescents with autism spectrum disorder (ASD) without intellectual disabilities are at greater risk than other atypically developing young people of dropping out of school during the transition to higher education. In this article, we propose an ecological analysis of the transition to higher education for these young people with reference to Bronfenbrenner's ecosystemic theoretical model. We emphasise the central role of self-determination for young people with ASD in preparing for the transition from high school to higher education by pointing out the often noted lack of self-determination opportunities available to them. We present an example of a transition planning programme that aims to promote the self-determination of young people in the preparation phase of the transition, before discussing the research perspectives that should mobilise researchers in the years to come.
... As faculty support and habits of mind are found to be related (Hurtado & DeAngelo, 2012), it is important that students receive early, pre-college exposure to habits of mind and professors examine ways to integrate skills related to habits of mind into their curriculum. Transition programs prior to and upon entering college that fosters skills related to college-readiness and habits of mind can support autistic students' college experiences (White et al., 2021). Additionally, providing institution-wide opportunities to start building relationships with faculty, staff, and peers, as well as to familiarize students with available campus-facilitated activities prior to entering college through various modalities (e.g., orientations, school visits, summer camps, online meetings) can be especially beneficial for autistic students. ...
This study examines autistic and non-autistic college students’ experiences of discrimination and harassment and identifies protective and risk factors. A nationwide survey was used to match autistic students (N = 290) and non-autistic students (N = 290) on co-occurring diagnoses and demographic characteristics. Multiple regression and interaction analysis revealed that faculty support was protective against discrimination and harassment regardless of autism status. Habits of mind was particularly protective for autistic students against harassment. Any student who engaged in school-facilitated events was more likely to experience discrimination and harassment, but the risk was heightened for autistic students. Findings highlight the importance of faculty support in fostering positive interpersonal experiences on campus, and demonstrate the need to address deeper college campus issues with respect to neurodiversity.
... Indeed, given that the transition to early adulthood can be particularly challenging for youths with ASD [80], booster sessions may be especially helpful to youths and their families as they navigate this transition. ...
Youths with autism spectrum disorder (ASD) often engage in aggressive and other disruptive behaviors that interfere with important aspects of their lives, such as family, friends, and school. Effective treatments are needed to address the wide variety of risk factors that contribute to disruptive behaviors in this population of youths. Multisystemic therapy (MST) is a comprehensive family- and community-based treatment approach that has been effective in reducing problem behaviors in other challenging clinical populations. In this chapter, we review the broad range of possible contributing factors for disruptive behaviors in youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a research framework and empirical findings related to the development and evaluation of the MST model for youths with ASD. Implications of those findings and future directions in our continued development of MST for ASD are discussed.
... Given the high prevalence of co-occurring mental health conditions [46] that often emerge in elementary and middle school years and persist if left untreated [47], research in this area is essential. Promising research on interventions targeting executive functioning [48], anxiety [49], social skills [50], and transition to adulthood [51] seek to adapt and test EBPs to address these areas in schools, though these have primarily been researcher implemented. Future research that prioritizes educator-or peerimplemented intervention is a crucial next step to address the social-emotional and other needs of autistic students. ...
Purpose of Review
The purpose of this review is to provide an update on the recent research (2016–2021) that evaluates the effectiveness of school-implemented interventions for students with autism (3–21 years old) from preschool to high school.
Recent Findings
Overall, the recent literature demonstrated that there are EBPs that help students with autism acquire a variety of skills across domains (academic, social communication). Though many educators and peers were able to achieve high-fidelity implementation, there remains variable fidelity of intervention use in some studies.
Summary
Though there is some evidence that educators and peers can successfully implement interventions, there are additional focal areas that are missing from the literature that are needed in schools (e.g., mental health, vocational). Future research should leverage implementation science approaches to support the use of proven efficacious interventions in schools.
... Recent studies demonstrated that web-delivered psychoeducational programs addressed to both ASD youths and their parents have proven effectiveness in boosting skills during transition-age [21][22][23]. In fact, nowadays, telehealth interventions (teletherapy, telesupport) represent promising models for individuals with ASD, providing easy access to services otherwise not available in extreme circumstances, such as the lockdown has been [24,25]. ...
Children with autism spectrum disorder (ASD) and their families have represented a fragile population on which the extreme circumstances of the COVID-19 outbreak may have doubly impaired. Interruption of therapeutical interventions delivered in-person and routine disruption constituted some of the main challenges they had to face. This study investigated the impact of the COVID-19 lockdown on adaptive functioning, behavioral problems, and repetitive behaviors of children with ASD. In a sample of 85 Italian ASD children (mean age 7 years old; 68 males, 17 females), through a comparison with a baseline evaluation performed during the months preceding COVID-19, we evaluated whether after the compulsory home confinement any improvement or worsening was reported by parents of ASD individuals using standardized instruments (Adaptive Behavior Assessment System (Second Edition), Achenbach Child Behavior Checklist, Repetitive Behavior Scale-Revised). No significant worsening in the adaptive functioning, problematic, and repetitive behaviors emerged after the compulsory home confinement. Within the schooler children, clinical stability was found in reference to both adaptive skills and behavioral aspects, whereas within preschoolers, a significant improvement in adaptive skills emerged and was related to the subsistence of web-delivered intervention, parental work continuance, and online support during the lockdown.
... It is critical that autistic young adults have access to proactive evidence-based effective approaches to improve the likelihood of meaningful community engagement. For example, White et al. [2019] developed and evaluated the efficacy of the Stepped Transition in Education Program for Students with ASD to improve self-determination and selfregulation for psychosocial readiness for graduating from secondary school and for the demands of early adulthood. In a preliminary randomized trial, results suggested a very high degree of feasibility and acceptability of the program, and greater improvements in transition readiness for high school students and greater college adjustment for post-high school students, compared to those in a waitlist condition. ...
Transitioning into adulthood is fraught with challenges for autistic youth. A greater understanding of the facilitators of community involvement in school and employment during this period is warranted. The current study examines changes in service need and receipt, and the stability of accessing daily structured activities, for autistic young adults over their transition period compared to adolescents and adults that did not enter the transition period. Baseline caregiver survey data were taken from the Canadian Autism Spectrum Disorders Alliance National Autism Needs Assessment Survey in 2014, and caregivers (n = 304) completed the same set of questions in 2017 about sociodemographic factors, clinical need, service receipt and typical weekday activities. Three cohorts were compared: (1) pretransition age youth, (2) transition‐age youth, and (3) young adults who were past transition age. Results suggest that transition‐age youth were found to have a unique set of priority service needs compared to pre transition‐age adolescent and to adult groups, and both transition‐age and adult groups had lower levels of priority service receipt compared to pretransition‐age adolescents. The transition‐age group experienced the greatest loss of structured weekday activity between time points, and were more likely than pretransition‐age adolescents to not have structured weekday activities at Time 2. A recovery of structured daily activity was not observed in young adults. Our results highlight the tumultuous nature of the transition period for autistic youth, which continues into adulthood, and the urgent need for supports during this time.
Lay Summary
This research highlights that autistic young people who are transitioning to adulthood are at greatest risk of losing structured weekday activities, and that once in adulthood, many continue to struggle to obtain meaningful community engagement. These results can help guide the design of adolescent and young adult transition programs.
... The Stepped Transition in Education Program for Students with ASD (STEPS; White et al. 2019) is a CBT-based transition support curriculum created for adults with ASD who are interested in or already attending a postsecondary institution. The program incorporates CBT and its guiding principles (i.e., goal-oriented, problem focused, structured sessions) in order to increase students' self-determination, self-regulation, and self-knowledge . ...
Young adults with autism spectrum disorder (ASD) experience increased rates of anxiety and depression which can impact academic success. The Stepped Transition in Education Program for Students with ASD (STEPS) applies cognitive-behavioral principles to help young adults with ASD improve their adjustment to postsecondary education. We aimed to determine if STEPS had an effect on anxiety and depression. Treatment-seeking adults with ASD (n = 32; Mage = 19.74) were randomized to STEPS or transition as usual (TAU; i.e., waitlist control group). STEPS participants evinced significantly greater declines in depressive symptoms from pre-treatment to post-treatment compared to the waitlist. Anxiety symptoms did not significantly change. Results suggest that transition support for young people with ASD may improve mental health.
... Data were used from 57 adults, 16-25 years of age (M = 19.05, SD = 2.03) who were enrolled in a randomized controlled trial (RCT) which examined the effects of a college transition readiness curriculum for emerging adults with ASD (White et al., 2017(White et al., , 2019. Participants were recruited through advertisements in local schools, autismspecific email listservs, and local mental health clinics. ...
Lay abstract:
Adults with autism spectrum disorder often experience a range of co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as difficulties with executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder, and limited research has suggested that individuals with autism spectrum disorder may experience sluggish cognitive tempo. We examined co-occurring mental health problems and executive function in 57 young adults with autism spectrum disorder, aged 16-25 years to better understand sluggish cognitive tempo in autism spectrum disorder. Parents of the young adults answered questions about their children's sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms, and the young adults completed tests of their executive function. Results demonstrated that nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were related, our findings suggest they are not the same constructs. Increased sluggish cognitive tempo is related to more difficulties with executive function and increased depression, but not anxiety symptoms. Results demonstrate that sluggish cognitive tempo may pose heightened difficulties for adults with autism spectrum disorder, making it an important construct to continue studying. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.
Importance:
Autism spectrum disorder (ASD), characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, is a neurodevelopmental disorder affecting approximately 2.3% children aged 8 years in the US and approximately 2.2% of adults. This review summarizes evidence on the diagnosis and treatment of ASD.
Observations:
The estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018, which is likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness. No biomarkers specific to the diagnosis of ASD have been identified. Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play. The criterion standard for the diagnosis of ASD is a comprehensive evaluation with a multidisciplinary team of clinicians and is based on semistructured direct observation of the child's behavior and semistructured caregiver interview focused on the individual's development and behaviors using standardized measures, such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview. These diagnostic measures have sensitivity of 91% and 80% and specificity of 76% and 72%, respectively. Compared with people without ASD, individuals with ASD have higher rates of depression (20% vs 7%), anxiety (11% vs 5%), sleep difficulties (13% vs 5%), and epilepsy (21% with co-occurring intellectual disability vs 0.8%). Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication (small to medium effect size based on standardized mean difference). Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder. Risperidone and aripiprazole can improve irritability and aggression (standardized mean difference of 1.1, consistent with a large effect size) compared with placebo. Psychostimulants are effective for attention-deficit/hyperactivity disorder (standardized mean difference of 0.6, consistent with a moderate effect size) compared with placebo. These medications are associated with adverse effects including, most commonly, changes in appetite, weight, and sleep.
Conclusions and relevance:
ASD affects approximately 2.3% of children aged 8 years and approximately 2.2% of adults in the US. First-line therapy consists of behavioral interventions, while co-occurring psychiatric conditions, such as anxiety or aggression, may be treated with specific behavioral therapy or medication.
Background
Transitioning youth living with HIV to adult care is a crucial step in the HIV care continuum; however, tools to support transition in sub-Saharan Africa are insufficient. We assessed the effectiveness of an adolescent transition package (ATP) to improve youth readiness for transition to independent HIV care.
Methods
In this hybrid type 1, multicentre, cluster randomised clinical trial, we assessed the effectiveness of an ATP (administered by routine clinic staff, which included standardised assessments and chapter books to guide discussions at scheduled clinic visits) in four counties in Kenya, with HIV clinics randomly assigned 1:1 to ATP or control (standard-of-care practice). Clinics were eligible to participate if they had at least 50 youth (aged 10–24 years) living with HIV enrolled in care. We used restricted randomisation to achieve cluster balance and an independent biostatistician used computer-generated random numbers to assign clinics. We excluded very large clinics with more than 1000 youth, clinics with fewer than 50 youth, paediatric-only clinics, clinics with logistical challenges, and the smallest clinics in Homa Bay county. Youth were eligible for the transition intervention if they were enrolled in participating clinics, were aged 15–24 years, and were aware of their positive HIV diagnosis. Study staff assessed transition readiness scores overall and by four domains (HIV literacy, self-management, communication, and support) in youth with HIV, which were then compared between groups by use of mixed-effects linear regression models. Analysis was by intention-to-treat and was adjusted for multiple comparisons. This trial is registered with ClinicalTrials.gov, NCT03574129.
Findings
We identified 35 clinics in four counties; of these, ten were assigned to the intervention group and ten to the control group. Of 1066 youth with HIV enrolled between Nov 1, 2019, and March 18, 2020, 578 (54%) were in intervention and 488 (46%) in control sites. Mean baseline transition readiness score was 12·1 (SD 3·4) in ATP sites and 11·4 (3·7) in control sites. At 1 year, adjusting for baseline scores, age, and months since HIV disclosure, participants in the ATP group had significantly higher overall transition readiness scores (adjusted mean difference 1·7, 95% CI 0·3–3·1, p=0·024), and higher scores in HIV literacy domain (adjusted mean difference 1·0, 0·2–1·7, p=0·011). At 12 months, 15 serious adverse events were recorded, none of which were thought to be related to study participation.
Interpretation
Integrating ATP approaches could enhance long-term HIV care in youth with HIV as they age into adulthood.
Funding
US National Institutes of Health.
Transitioning to adulthood presents particular difficulties for young people on the autistic spectrum. This review looks at the views of key stakeholders regarding the transition to adulthood and associated support, within the UK. Four databases were searched and of the 564 initial results, nine papers met the inclusion criteria. A framework synthesis approach was taken, using the biopsychosocial ecological model (Kranzler et al., 2020) (School Psychology, 35, 2020 and 419) to map the experiences of individuals on the autistic spectrum, their families and professionals. Data analysis was conducted deductively with findings highlighting the challenging experiences young people and their families face and systemic barriers to accessing and providing support. Facilitative factors are identified, indicating a need for more inter‐agency collaboration, inclusivity and individualisation of support. There was substantial interaction between the systems surrounding the child, indicating a complex and multi‐faceted impact on experience. Further support is provided for the applicability of ecosystemic models to the study of autism. Key policy suggestions and gaps in the research base are considered.
Self-determination (SD) is linked to autonomy and better adult outcomes. Adults with autism spectrum disorder (ASD) are often less independent than cognitively matched peers. Given the frequency with which depression co-occurs in ASD and the established association between depression and SD, we sought to evaluate the influence of both ASD severity and depression on SD among cognitively able emerging adults with ASD. Emerging adults (n = 59) with ASD completed measures of SD, ASD severity, and depression. Both ASD severity and depression were moderately correlated with SD (r = − 0.473; − 0.423, respectively) and with each other (r = 0.625). After controlling for ASD severity, depression did not significantly predict SD. Strengthening SD should be considered in programming to promote independence.
Background
As students with autism spectrum disorder (ASD) are increasingly enrolling at institutions of higher education, their new experiences and offered supports impact their success in this realm. The current review extends previous syntheses of literature related to support systems for students with ASD in higher education, as well as their first-hand experiences.
Method
This review systematically considered experiences of students with ASD in higher education and supports offered to them in both academic and non-academic realms as reported by students themselves. Of the 2,354 screened studies, 24 met inclusion criteria for review.
Results
Students with ASD experience high rates of mental health issues, sensory challenges, and social, academic, and communication difficulties. Academic supports, which were infrequently reported, include tutoring, accommodations, and coursework modifications. Non-academic supports included social skills training, peer-mediated interventions, counseling, and other university disability services. Although available, these supports may not be fully utilized due to students’ nondisclosure of their ASD diagnosis.
Conclusions
Non-academic supports for students with ASD are increasing along with this population’s enrollment in higher education, yet the development of academic supports appears to be less prevalent. These findings suggest institutions of higher education focus on the development and accessibility of academic supports, and additionally, provide faculty and staff with effective professional development to address the stigmatization of seeking out and utilizing available support systems.
Transition to the adult age represents a rather challenging period of life for youth with Autism Spectrum Disorder (ASD) and for their families.
Given the actual lack of integrated healthcare systems for autistic young-adults, enhancing parental skills could represent a feasible program to improve skills preparatory for transition in adult life.
The online approach, providing easy access to services which otherwise would burden a daily family organization, already strenuous for a family with an autistic person, can represent an innovative way of delivering intervention.
Therefore, we developed an online psychoeducational parental training, named TrASDition Training, with a 6 months duration, addressed to parents of autistic youth with and without Intellectual Disability during the transition age.
The aim of this study was to longitudinally evaluate the impact of the online parental training on the adaptive functioning, on the repetitive and problematic behaviors of ASD youth (n=23) and on parental stress.
After 6 months of Training, we found a significant improvement in adaptive functioning of ASD participants and a reduction of parental stress.
Research has documented elevated rates of co-occurring depression and anxiety in autistic adults, with some noting particularly high rates for autistic students enrolled in postsecondary education. Difficulty coping with the stressors that accompany daily life as they navigate college campuses may contribute to development or exacerbation of co-occurring conditions. Autistic students have reported that depression, anxiety and stress interfere with their success in college, but that they have difficulty identifying and accessing the supports that they need. Though many postsecondary institutions have established programs that provide academic supports to autistic students, few programs directly support mental health and wellness. Recently, stakeholders have advocated for mental health to be prioritized in adult autism research. We suggest that a specific focus on autistic students in postsecondary education is warranted and provide a brief overview of the relatively limited literature in this area. To inform development of mental health services and supports that will be both accessible and acceptable to the range of autistic students attending postsecondary education, research is recommended in four areas: factors positively and negatively affecting mental health; types of supports; outreach; on-campus training and education. It will be essential for researchers to establish community partnerships with autistic individuals to inform study design and specific research questions. This will ensure that autistic voices guide development of supports that will foster positive mental health in postsecondary education and beyond.
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
Social anxiety disorder (SAD) is commonly comorbid with autism spectrum disorder (ASD). Here, in a sample of 86 children and adolescents (MAGE = 12.62 years; 68.6% male), 28 of whom were diagnosed with ASD, 34 with SAD, and 24 with comorbid ASD and SAD, we compared parent-reported scores from the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber in Social Responsiveness Scale (SRS; Constantino and Gruber 2012) to determine the sensitivity and specificity of the measure in cases of differential diagnosis between SAD and ASD. Results suggest that neither the subscales, nor the SRS-2 total score, consistently differed between ASD and SAD. Sensitivity and specificity analyses suggested that the SRS-2 total poorly discriminated ASD from SAD. When screening socially anxious youth for possible ASD, caution should be taken.
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
Purpose of Review
This synthesis of treatment research related to anxiety and depression in adolescents and adults with autism spectrum disorder (ASD) focuses on the scientific support for various forms of psychosocial interventions, useful adaptations to standard interventions, and engagement of candidate therapeutic mechanisms.
Recent Findings
There is considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) to treat co-occurring problems with anxiety, but there has been relatively little research on treatment of co-occurring depression. Multiple mechanisms of treatment effect have been proposed, but there has been little demonstration of target engagement via experimental therapeutics.
Summary
Comorbidity between ASD and anxiety and/or mood problems is common. Although there is evidence for the use of CBT for anxiety, little work has addressed how to effectively treat depression. There is emerging support for alternative treatment approaches, such as mindfulness-based interventions. We encourage rigorous, collaborative approaches to identify and manipulate putative mechanisms of change.
Problem/condition:
Autism spectrum disorder (ASD).
Period covered:
2014.
Description of system:
The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported.
Results:
For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ] <70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ >85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85).
Interpretation:
Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability.
Public health action:
Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.
Addressing the challenges of adolescents and emerging adults with autism spectrum disorder is crucial to improving the outcomes of these students in the postsecondary setting. Although secondary and postsecondary educators and staff are critical to helping these students access services, there has been little investigation into the perspectives of this stakeholder group, with respect to the needs of postsecondary students with autism spectrum disorder. A series of focus groups was conducted with secondary and postsecondary educators to understand educator perspectives related to the challenges faced by postsecondary students with autism spectrum disorder. Competence, autonomy and independence, and the development and sustainment of interpersonal relationships emerged as primary areas of difficulty and corresponding need. Results suggest that targeted interventions addressing these areas should be implemented, prior to and during enrollment in a postsecondary setting, to facilitate transition in a comprehensive manner.
Empirically based, consumer-informed programming to support students with Autism Spectrum Disorder (ASD) transitioning to college is needed. Informed by theory and research, the Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address this need. The first level (Step 1) supports high school students and the second level (Step 2) is for postsecondary students with ASD. Herein, we review the extant research on transition supports for emerging adults with ASD and describe the development of STEPS, including its theoretical basis and how it was informed by consumer input. The impact of STEPS on promotion of successful transition into college and positive outcomes for students during higher education is currently being evaluated in a randomized controlled trial.
Understanding the needs of adolescents and emerging adults with Autism Spectrum Disorder (ASD) with respect to transition to postsecondary education is critical to development of user-informed transition programming. Parents of adolescents and emerging adults with ASD (n = 52) and ADHD (n = 47) completed an online survey. Social interaction training and independent living training were services frequently requested by parents in the ASD group. Additionally, parents of postsecondary students with ASD endorsed distinct challenges with self-advocacy, managing emotions, and managing personal/adaptive skills relative to postsecondary students with ADHD. The profile of parent-reported difficulties and needed services compared to transition to postsecondary education for students with ASD is distinguishable from that for ADHD, suggesting individualized transition planning and in-college supports.
This chapter examines the theory of emerging adulthood from the perspective of cultural psychology. First it provides a brief overview of the theory. Then it addresses the ways "one size fits all" with respect to emerging adulthood, that is, the demographic and cultural changes that have taken places in many regions worldwide to lay the groundwork for the emerging adulthood life stage. Next it describes the demographic and cultural variability that exists in emerging adulthood worldwide. Finally, the chapter bridges cultural and developmental psychology by focusing on the cultural beliefs that are at the heart of emerging adulthood, in the West and in other world regions.
We examined the relationship between characteristics associated with autism spectrum disorder and college adjustment in a sample of neurotypical college students. Using the Broad Autism Phenotype Questionnaire and the Student Adaptation to College Questionnaire, we found that higher levels of autism spectrum disorder characteristics were associated with poorer adjustment to college. One subscale of the Broad Autism Phenotype Questionnaire, pragmatic language difficulties, explained the most variance in adjustment. In addition, students who met the previously established cut-off scores for possessing the broad autism phenotype scored significantly lower on all Student Adaptation to College Questionnaire subscales. Finally, pragmatic language difficulties mediated the relationship between college major and academic adjustment. These findings underscore the need for future research to examine how pragmatic language difficulties may impede college success in students with autism spectrum disorder and in the typical population.
This study used propensity score techniques to assess the relationship between transition planning participation and goal-setting and college enrollment among youth with Autism Spectrum Disorders. Using data from Waves 1 through 5 of the National Longitudinal Transition Study-2, this study found that 2- or 4-year college enrollment rates were significantly higher among youth with ASDs who participated in transition planning and those who had a primary transition goal of college enrollment. Educational implications are discussed.
Objective:
Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases.
Method:
The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization.
Results:
This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases.
Conclusions:
The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record
Youth with autism spectrum disorders (ASD) experience poor outcomes in the areas of independence, employment, and
postsecondary education. This article provides a critical review of the key aspects of the transition process and identifies
recommendations for policy and practice. The review highlights the literature and explores recommendations across the
manifold elements of this transition, including social and psychological development, high school curriculum, work, and college.
Five policy recommendations are outlined in the areas of school curriculum, employment development, postsecondary
education, inclusion with nondisabled peers, and systematic instruction. Finally, the authors offer recommendations for
further research in the areas of social interaction, increased academic and vocational rigor, employment, technology,
independence, and postsecondary education.
Little research has examined the popular belief that individuals with an autism spectrum disorder (ASD) are more likely than the general population to gravitate toward science, technology, engineering, and mathematics (STEM) fields. This study analyzed data from the National Longitudinal Transition Study-2, a nationally representative sample of students with an ASD in special education. Findings suggest that students with an ASD had the highest STEM participation rates although their college enrollment rate was the third lowest among 11 disability categories and students in the general population. Disproportionate postsecondary enrollment and STEM participation by gender, family income, and mental functioning skills were found for young adults with an ASD. Educational policy implications are discussed.
We examined the prevalence and correlates of postsecondary education and employment among youth with an autism spectrum disorder (ASD).
Data were from a nationally representative survey of parents, guardians, and young adults with an ASD. Participation in postsecondary employment, college, or vocational education and lack of participation in any of these activities were examined. Rates were compared with those of youth in 3 other eligibility categories: speech/language impairment, learning disability, and mental retardation. Logistic regression was used to examine correlates of each outcome.
For youth with an ASD, 34.7% had attended college and 55.1% had held paid employment during the first 6 years after high school. More than 50% of youth who had left high school in the past 2 years had no participation in employment or education. Youth with an ASD had the lowest rates of participation in employment and the highest rates of no participation compared with youth in other disability categories. Higher income and higher functional ability were associated with higher adjusted odds of participation in postsecondary employment and education.
Youth with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school. Those from lower-income families and those with greater functional impairments are at heightened risk for poor outcomes. Further research is needed to understand how transition planning before high school exit can facilitate a better connection to productive postsecondary activities.
This report describes the post-high school educational and occupational activities for 66 young adults with autism spectrum disorders who had recently exited the secondary school system. Analyses indicated low rates of employment in the community, with the majority of young adults (56%) spending time in sheltered workshops or day activity centers. Young adults with ASD without an intellectual disability were three times more likely to have no daytime activities compared to adults with ASD who had an intellectual disability. Differences in behavioral functioning were observed by employment/day activity group. Our findings suggest that the current service system may be inadequate to accommodate the needs of youths with ASD who do not have intellectual disabilities during the transition to adulthood.
We examined whether exiting high school was associated with alterations in rates of change in autism symptoms and maladaptive behaviors. Participants were 242 youth with ASD who had recently exited the school system and were part of our larger longitudinal study; data were collected at five time points over nearly 10 years. Results indicated overall improvement of autism symptoms and internalized behaviors over the study period, but slowing rates of improvement after exit. Youth who did not have an intellectual disability evidenced the greatest slowing in improvement. Lower family income was associated with less improvement. Our findings suggest that adult day activities may not be as intellectually stimulating as educational activities in school, reflected by less phenotypic improvement after exit.
Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
To address methodological challenges in research on psychosocial interventions for autism spectrum disorder (ASD), a model was developed for systematically validating and disseminating interventions in a sequence of steps. First, initial efficacy studies are conducted to establish interventions as promising. Next, promising interventions are assembled into a manual, which undergoes pilot-testing. Then, randomized clinical trials test efficacy under controlled conditions. Finally, effectiveness studies evaluate outcomes in community settings. Guidelines for research designs at each step are presented. Based on the model, current priorities in ASD research include (a) preparation for efficacy and effectiveness trials by developing manuals for interventions that have shown promise and (b) initial efficacy studies on interventions for core features of ASD such as social reciprocity.
Praise for the First Edition of Statistical Analysis with Missing Data “An important contribution to the applied statistics literature.... I give the book high marks for unifying and making accessible much of the past and current work in this important area.”—William E. Strawderman, Rutgers University “This book...provide[s] interesting real-life examples, stimulating end-of-chapter exercises, and up-to-date references. It should be on every applied statistician’s bookshelf.”—The Statistician “The book should be studied in the statistical methods department in every statistical agency.”—Journal of Official Statistics Statistical analysis of data sets with missing values is a pervasive problem for which standard methods are of limited value. The first edition of Statistical Analysis with Missing Data has been a standard reference on missing-data methods. Now, reflecting extensive developments in Bayesian methods for simulating posterior distributions, this Second Edition by two acknowledged experts on the subject offers a thoroughly up-to-date, reorganized survey of current methodology for handling missing-data problems. Blending theory and application, authors Roderick Little and Donald Rubin review historical approaches to the subject and describe rigorous yet simple methods for multivariate analysis with missing values. They then provide a coherent theory for analysis of problems based on likelihoods derived from statistical models for the data and the missing-data mechanism and apply the theory to a wide range of important missing-data problems. The new edition now enlarges its coverage to include: Expanded coverage of Bayesian methodology, both theoretical and computational, and of multiple imputation Analysis of data with missing values where inferences are based on likelihoods derived from formal statistical models for the data-generating and missing-data mechanisms Applications of the approach in a variety of contexts including regression, factor analysis, contingency table analysis, time series, and sample survey inference Extensive references, examples, and exercises Amstat News asked three review editors to rate their top five favorite books in the September 2003 issue. Statistical Analysis With Missing Data was among those chosen.
The number of young adults with Autism Spectrum Disorders (ASD) enrolled in higher education institutions has steadily increased over the last decade. Despite this, there has been little research on how to most effectively support this growing population. The current study presents data from a pilot trial of two novel intervention programs developed for college students with ASD. In this small randomized controlled trial, college students with ASD (n = 8) were assigned to one of two new programs - either an intervention based on a virtual reality-Brain-Computer Interface for ASD (BCI-ASD) or a psychosocial intervention, the College and Living Success (CLS) program. Preliminary evidence supports the feasibility and acceptability of both programs, although behavioral outcomes were inconsistent across participants and interventions. Results indicate that expanded research on psychosocial and computer-assisted intervention approaches for this population is warranted, given the preliminary support found in this pilot study.
PART I THE LOGIC OF HIERARCHICAL LINEAR MODELING Series Editor 's Introduction to Hierarchical Linear Models Series Editor 's Introduction to the Second Edition 1.Introduction 2.The Logic of Hierarchical Linear Models 3. Principles of Estimation and Hypothesis Testing for Hierarchical Linear Models 4. An Illustration PART II BASIC APPLICATIONS 5. Applications in Organizational Research 6. Applications in the Study of Individual Change 7. Applications in Meta-Analysis and Other Cases where Level-1 Variances are Known 8. Three-Level Models 9. Assessing the Adequacy of Hierarchical Models PART III ADVANCED APPLICATIONS 10. Hierarchical Generalized Linear Models 11. Hierarchical Models for Latent Variables 12. Models for Cross-Classified Random Effects 13. Bayesian Inference for Hierarchical Models PART IV ESTIMATION THEORY AND COMPUTATIONS 14. Estimation Theory Summary and Conclusions References Index About the Authors
The population of adults with autism spectrum disorder (ASD) is growing at a pace that exceeds our scientific and financial resources. Few supports are available for adults with ASD, and much remains unknown about this developmental period. Fortunately, greater scientific attention is now being paid to the unique challenges and needs of adults with ASD. In this chapter we summarize research on adult outcome and prognosis, including the stability of ASD core and secondary symptoms. We discuss developmental challenges and transitions, identify the most common clinical issues presented by adults with ASD, and summarize the limited available research on adult services and treatment.
Background:
There is a growing call for empirically based programming to support the success of students with autism spectrum disorder (ASD) as they transition to college.
Aims:
The purpose of this study was to identify the needs and challenges faced by adolescents and young adults with ASD in postsecondary education.
Methods:
A mixed methods approach was taken to explore the needs of college-bound and college-enrolled students with ASD. Primary stakeholders (i.e., parents, educators/support staff from secondary and postsecondary institutions, and students) participated in an online survey (n=67) and focus groups (n=15).
Results:
Across the stakeholder groups, commonly identified areas of difficulty included limited interpersonal competence, managing competing demands in postsecondary education, and poor emotional regulation. There was a high degree of agreement across stakeholders in the identified needs and challenges.
Implications:
Findings from this preliminary needs analysis will inform the development of programming to support students with ASD.
Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving specialeducation services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described. Results: For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71-85), and 46% in the average or above average range of intellectual ability (IQ > 85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity. Interpretation: These findings from CDC's ADDM Network, which are based on 2010 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD in multiple communities in the United States. Because the ADDM Network sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States population. Consistent with previous reports from the ADDM Network, findings from the 2010 surveillance year were marked by significant variations in ASD prevalence by geographic area, sex, race/ethnicity, and level of intellectual ability. The extent to which this variation might be attributable to diagnostic practices, underrecognition of ASD symptoms in some racial/ethnic groups, socioeconomic disparities in access to services, and regional differences in clinical or school-based practices that might influence the findings in this report is unclear. Public Health Action: ADDM Network investigators will continue to monitor the prevalence of ASD in select communities, with a focus on exploring changes within these communities that might affect both the observed prevalence of ASD and population-based characteristics of children identified with ASD. Although ASD is sometimes diagnosed by 2 years of age, the median age of the first ASD diagnosis remains older than age 4 years in the ADDM Network communities. Recommendations from the ADDM Network include enhancing strategies to address the need for 1) standardized, widely adopted measures to document ASD severity and functional limitations associated with ASD diagnosis; 2) improved recognition and documentation of symptoms of ASD, particularly among both boys and girls, children without intellectual disability, and children in all racial/ethnic groups; and 3) decreasing the age when children receive their first evaluation for and a diagnosis of ASD and are enrolled in community-based support systems.
This study examined the reliability and validity and hypothesized factor structure of two assessments of self-determination, the Arc’s Self-Determination Scale (SDS) and the American Institutes for Research Self-Determination Scale (AIR) in students with autism spectrum disorders (ASD). Ninety-five middle and high school students (17% female and 83% male) aged 13 through 21 years participated. Item analysis and confirmatory factor analysis were conducted separately for the SDS and AIR data. Together, the findings of this study suggest that (a) the two measures in this study show reliability and validity in the measurement of global self-determination in students with ASD and (b) the parameter estimates and the model fit statistics support the hypothesized factor structure of both instruments (with light variation for the SDS). Suggestions for future research and implications for educators are discussed.
This article reports a follow-up study of school leavers with mental retardation or learning disabilities who were surveyed 1- and 3-years after they left school to determine what they were doing in major life areas (employment, independent living or community integration). Students were divided into two groups based on self-determination scores collected during their final year at high school. Comparisons between these groups on outcomes at 1 and 3 years post-graduation indicate that students who were more self-determined fared better across multiple life categories, including employment and access to health and other benefits, financial independence, and independent living.
Studies in the social and behavioral sciences frequently suffer from missing data. For instance, sample surveys often have some individuals who either refuse to participate or do not supply answers to certain questions, and panel studies often have incomplete data due to attrition. Recent comprehensive treatments of the subject of missing data include three volumes produced by the Panel on Incomplete Data of the Committee on National Statistics (Madow, Nisselson, and Olkin 1983; Madow and Olkin 1983; Madow, Olkin, and Rubin 1983) and Little and Rubin (1987).
This study examined correlates of participation in postsecondary education and employment over 12 years for 73 adults with autism spectrum disorders and average-range IQ whose families were part of a larger, longitudinal study. Correlates included demographic (sex, maternal education, paternal education), behavioral (activities of daily living, maladaptive behaviors, autism symptoms), and family (size of maternal social network; maternal depressive symptoms, anxiety, and pessimism) factors. Although two-thirds of adults with autism spectrum disorder participated in competitive employment/postsecondary education during the study, fewer than 25% maintained these activities over the study period. Behavioral characteristics distinguished those who never had competitive employment/postsecondary education from those who sometimes or consistently participated in these activities. Women were considerably less likely than men to maintain employment/postsecondary education over time.
© The Author(s) 2015.
Objective:
We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS).
Method:
CAMS youth (N = 488; 74% ≤ 12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up.
Results:
The majority (>80%) of acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment.
Conclusions:
COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials.gov. Unique identifier: NCT00052078.
Change is constant in everyday life. Infants crawl and then walk, children learn to read and write, teenagers mature in myriad ways, and the elderly become frail and forgetful. Beyond these natural processes and events, external forces and interventions instigate and disrupt change: test scores may rise after a coaching course, drug abusers may remain abstinent after residential treatment. By charting changes over time and investigating whether and when events occur, researchers reveal the temporal rhythms of our lives. This book is concerned with behavioral, social, and biomedical sciences. It offers a presentation of two of today's most popular statistical methods: multilevel models for individual change and hazard/survival models for event occurrence (in both discrete- and continuous-time). Using data sets from published studies, the book takes you step by step through complete analyses, from simple exploratory displays that reveal underlying patterns through sophisticated specifications of complex statistical models.
The transition from school services to adulthood can be particularly difficult for many adolescents with autism spectrum disorders (ASD). Although some individuals with ASD are able to successfully transition, most are faced with significant obstacles in multiple areas as they attempt to negotiate their way into college, work, community participation, and independent living. This article contains a review of research related to the transition from school to adulthood for youth with ASD in the areas of education, employment, community living, and community integration. These key areas of the transition process are crucial for success in adulthood. A summary of principal conclusions drawn from the current literature and suggestions for future research are provided.
Because leisure activities are often viewed as optional, their value to people with disabilities may not be recognized. This study explored the benefits of leisure activities for eight young people who are blind. These activities provided them with supportive relationships, a desirable identity, experiences of power and control, and experiences of social justice. They enabled the young people we studied to thrive despite adversity.
Promoting self-determination has become an important aspect of the educational programs of students with disabilities. There is now a sufficient literature base to support some syntheses that enable researchers to judge their progress in this area to date and to provide direction for future research and practice. For this study, we conducted a literature review of studies that measured or examined global self-determination.
The adaptation of expatriate families to a host country seems crucial to successful fulfilment of international business assignments. The present study focused on personality, family characteristics and characteristics of expatriates’ work life as determinants of the intercultural adjustment of expatriate spouses. Among a sample of 247 expatriate spouses it was first shown that in particular the traits of open-mindedness and emotional stability were associated with expatriate spouses’ adjustment. In addition, family cohesion and family adaptability were found to have an impact on the spouses’ adjustment. Of the work related variables, both support from the company and work satisfaction were related to indicators of adjustment. These effects sustained after controlling for the influence of demographic variables such as duration of expatriation, command of the local language, having visited the country prior to relocation and economic situation that were also found to contribute to spouses’ adjustment. The implications of these findings are discussed.
Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms. This article provides a conceptual and methodologic framework for understanding compromised emotion regulation (ER) in ASD.
After defining ER and related constructs, methods to study ER were reviewed with special consideration on how to apply these approaches to ASD. Against the backdrop of cognitive characteristics in ASD and existing ER theories, available research was examined to identify likely contributors to emotional dysregulation in ASD.
Little is currently known about ER in youth with ASD. Some mechanisms that contribute to poor ER in ASD may be shared with other clinical populations (e.g., physiologic arousal, degree of negative and positive affect, alterations in the amygdala and prefrontal cortex), whereas other mechanisms may be more unique to ASD (e.g., differences in information processing/perception, cognitive factors [e.g., rigidity], less goal-directed behavior and more disorganized emotion in ASD).
Although assignment of concomitant psychiatric diagnoses is warranted in some cases, poor ER may be inherent in ASD and may provide a more parsimonious conceptualization for the many associated socioemotional and behavioral problems in this population. Further study of ER in youth with ASD may identify meaningful subgroups of patients and lead to more effective individualized treatments.
Many experiments aim at populations with persons nested within clusters. Randomization to treatment conditions can be done at the cluster level or at the person level within each cluster, The latter may result in control group contamination, and cluster randomization is therefore often preferred in practice. This article models the control group contamination, calculates the required sample sizes for both levels of randomization, and gives the degree of contamination for which cluster randomization is preferable above randomization of persons within clusters, Moreover, it provides examples of situations where one has to make a choice between both levels of randomization.
Introduction Assumptions EM and Inference by Data Augmentation Methods for Normal Data More on the Normal Model Methods for Categorical Data Loglinear Models Methods for Mixed Data Further Topics Appendices References Index
Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30 adolescents with ASD and anxiety symptoms of moderate or greater severity. The treatment was acceptable to families, subject adherence was high, and therapist fidelity was high. A 16 % improvement in ASD social impairment (within-group effect size = 1.18) was observed on a parent-reported scale. Although anxiety symptoms declined by 26 %, the change was not statistically significant. These findings suggest MASSI is a feasible treatment program and further evaluation is warranted.
This study aimed to investigate the longitudinal course of daily living skills in a large, community-based sample of adolescents and adults with autism spectrum disorders (ASD) over a 10-year period.
Adolescents and adults with ASD (n = 397) were drawn from an ongoing, longitudinal study of individuals with ASD and their families. A comparison group of 167 individuals with Down syndrome (DS) were drawn from a linked longitudinal study. The Waisman Activities of Daily Living Scale was administered four times over a 10-year period.
We used latent growth curve modeling to examine change in daily living skills. Daily living skills improved for the individuals with ASD during adolescence and their early 20s, but plateaued during their late 20s. Having an intellectual disability was associated with lower initial levels of daily living skills and a slower change over time. Individuals with DS likewise gained daily living skills over time, but there was no significant curvature in the change.
Future research should explore what environmental factors and interventions may be associated with continued gains in daily living skills for adults with ASD.
Most community-based participatory research (CBPR) projects involve local communities defined by race, ethnicity, geography, or occupation. Autistic self-advocates, a geographically dispersed community defined by disability, experience issues in research similar to those expressed by more traditional minorities.
We sought to build an academic-community partnership that uses CBPR to improve the lives of people on the autistic spectrum.
The Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) includes representatives from academic, self-advocate, family, and professional communities. We are currently conducting several studies about the health care experiences and well-being of autistic adults.
We have learned a number of strategies that integrate technology and process to successfully equalize power and accommodate diverse communication and collaboration needs.
CBPR can be conducted successfully with autistic self-advocates. Our strategies may be useful to other CBPR partnerships, especially ones that cannot meet in person or that include people with diverse communication needs.
As more young people are identified with autism spectrum diagnoses without co-occurring intellectual disability (i.e. high-functioning autism spectrum disorder; HFASD), it is imperative that we begin to study the needs of this population. We sought to gain a preliminary estimate of the scope of the problem and to examine psychiatric risks associated HFASD symptoms in university students. In a large sample (n = 667), we examined prevalence of ASD in students at a single university both diagnostically and dimensionally, and surveyed students on other behavioral and psychiatric problems. Dependent upon the ascertainment method, between .7 per cent and 1.9 per cent of college students could meet criteria for HFASD. Of special interest, none of the students who were found to meet diagnostic criteria (n = 5) formally for HFASD in this study had been previously diagnosed. From a dimensional perspective, those students scoring above the clinical threshold for symptoms of autism (n = 13) self-reported more problems with social anxiety than a matched comparison group of students with lower autism severity scores. In addition, symptoms of HFASD were significantly correlated with symptoms of social anxiety, as well as depression and aggression. Findings demonstrate the importance of screening for autism-related impairment among university students.
Previous studies found substantial variability in adult outcome for people with autism whose cognitive functioning was within the near-average and average ranges. This study examined adult outcome for 41 such individuals (38 men and 3 women) originally identified through an epidemiological survey of autism in Utah. Mean age at the time of their previous cognitive assessment was 7.2 years (SD=4.1, range=3.1-25.9 years) and at follow-up was 32.5 years (SD=5.7 years, range=22.3-46.4 years). Outcome measures included standardized assessments of diagnostic status, cognitive ability, and adaptive behavior. Additional information collected concerned demographic variables, indicators of independence, social relationships, medical and psychiatric conditions, and social service use. Outcomes for this sample were better than outcomes described in previous work on individuals with similar cognitive functioning. For example, half of the participants were rated as "Very Good" or "Good" on a global outcome measure. As in previous studies, there was considerable variability in measured cognitive ability over time. Over half of the sample had large gains or losses of cognitive ability of greater than 1 standard deviation. Cognitive gain was associated with better outcome, as was better adaptive functioning. While all participants had baseline IQs in the nonimpaired range, there was limited evidence to support the use of other early childhood variables to predict adult outcome.
Executive functioning (EF) is an overarching term that refers to neuropsychological processes that enable physical, cognitive, and emotional self-control. Deficits in EF are often present in neurodevelopmental disorders, but examinations of the specificity of EF deficits and direct comparisons across disorders are rare. The current study investigated EF in 7- to 12-year-old children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and typical development using a comprehensive battery of measures assessing EF, including response inhibition, working memory, cognitive flexibility, planning, fluency and vigilance. The ADHD group exhibited deficits in vigilance, inhibition and working memory relative to the typical group; however, they did not consistently demonstrate problems on the remaining EF measures. Children with ASD showed significant deficits in vigilance compared with the typical group, and significant differences in response inhibition, cognitive flexibility/switching, and working memory compared with both groups. These results lend support for previous findings that show children with autism demonstrate generalized and profound impairment in EF. In addition, the observed deficits in vigilance and inhibitory control suggest that a significant number of children with ASD present with cognitive profiles consistent with ADHD.
Prospective population-based follow-up study of 120 individuals with autism followed from childhood to adulthood.
Individuals with autism, diagnosed in childhood, were followed prospectively for a period of 13-22 years and re-evaluated at ages 17-40 years. The instruments used at follow-up were the DISCO, WAIS-R, WISC-III, Vineland Adaptive Behavior Scales, psychiatric-medical examination and GAF-scale. A set of criteria was used for the classification of outcomes, taking into consideration employment, higher education/vocational training, independent living and peer relations.
Six of the 120 (5%) had died at the time of follow-up, and six declined participation. Overall outcome was poor in 78% of cases. Only four individuals were independent albeit leading fairly isolated lives. Childhood IQ-level was positively correlated with better adult outcome, as was the existence of some communicative phrase speech at age six years.
Children with autism as diagnosed in the 1960s, 1970s, and 1980s may have an even worse psychosocial outcome than previously believed.