Impact of providing psychiatry specialty pharmacist intervention on reducing drug‐related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open‐label study The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study Clinical assessment of autism in high-risk 18-month-olds Sleep behaviors and sleep quality in children with autism spectrum disorders. Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention Using The Transporters DVD as a Learning Tool for Children with Autism Spectrum Disorders (ASD) Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Autism spectrum disorders in extremely preterm children. Use of Social Stories to Improve Self-Regulation in Children with Autism Spectrum Disorders A randomized, placebo controlled trial of omega-3 fatty acids in the treatment of young children with autism A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. A randomized controlled trial evaluating a brief parenting program with children with autism spectrum disorders. A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder
WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient 's function and quality of life . Due to the complicated neurobiological aetiology of autism spectrum disorder ( ASD ) , a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population . We evaluate the impact of providing specialty psychiatry ( PS ) pharmacist intervention in identifying and resolving drug-related problems ( DRPs ) among children with ASD associated with disruptive behaviours . METHODS An eight-week-long , prospect i ve , r and omized open-label study was conducted . Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included . They were r and omly assigned to an intervention or a control group . Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist , while those in control group were cared by a hospital pharmacist . The primary outcome was the number of patients who resolved of at least one DRP by the end of the study . The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability ( ABC-I ) scores between the two groups . RESULTS Twenty-five patients were r and omly assigned to either an intervention or control group . At week 8 , the total number of patients who resolved of at least one DRP was 13 ( 52 % ) in the intervention group and 4 ( 16 % ) in the control group , respectively ( P=.016 ) . Improper drug selection , medication non-adherence and subtherapeutic dosage were the most common DRPs . Mean ABC-I scores improved in the intervention group more than in the control group ( 9.8±5.6 vs 17.7±7.9 ; P<.001 ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD . The reduction in common DRPs mostly result ed from the PS pharmacist interventions , including selection of antipsychotic agent , adjustment of dosage based on ABC-I scores and provision of individualized drug counselling . Reducing DRPs led to the improvement of any disruptive behaviour . In addition , multidisciplinary team should develop drug therapy protocol s to promote the role of pharmacists in this setting Objective : Sleep problems are common in children with autism spectrum disorders ( ASD ) and ADHD and impact adversely on child and parent well-being . The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD – ASD . Method : A sub sample of children with ADHD – ASD ( n = 61 ; 5 - 13 years ; 89 % male ) participating in the Sleeping Sound With ADHD study were included in the current investigation . The sub sample comprised of 28 children r and omized to the sleep intervention group , while 33 were r and omized to usual clinical care .  The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and st and ardized behavioral strategies . Results : Children with ADHD – ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-r and omization . Conclusion : These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD – ASD Background Sleep difficulties are prevalent in children with autism spectrum disorder ( ASD ) . The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking . Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder . Methods Repeated sleep measures were available at 1.5 , 3 , 6 , and 9 years of age in 5151 children participating in the Generation R Study , a large prospect i ve birth cohort in the Netherl and s. Autistic traits were determined with the Pervasive Developmental Problems score ( PDP ) of the Child Behavior Checklist ( CBCL ) at 1.5 and 3 years and the Social Responsiveness Scale ( SRS ) at 6 years . This cohort included 81 children diagnosed with ASD . Results Sleep problems in early childhood were prospect ively associated with a higher SRS score , but not when correcting for baseline PDP score . By contrast , a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages , even when adjusting for baseline sleep problems . Likewise , a trajectory of increasing sleep problems was associated with ASD . Conclusions Sleep problems and ASD are not bidirectionally associated . Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood . Over time , children with ASD have an increase in sleep problems , whereas typically developing children have a decrease in sleep problems . Our findings suggest that sleep problems are part of the construct ASD Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD STUDY OBJECTIVES ( 1 ) Compare sleep behaviors of children with autism spectrum disorders ( ASD ) with sleep behaviors of typically developing ( TD ) children using the Children 's Sleep Habits Question naire ( CSHQ ) ; ( 2 ) compare sleep quality --defined as mean activity , sleep latency , number of awakenings , sleep efficiency and total sleep time -- of the cohort of children with ASD and TD , as measured by 10 nights of actigraphy ; and ( 3 ) estimate the prevalence of sleep disturbances in the ASD and TD cohorts . DESIGN Descriptive cross-sectional study . SETTING The Children 's Hospital of Philadelphia . PARTICIPANTS R and omly selected children from the Regional Autism Center . The ASD cohort of 59 children , aged 4 to 10 years , ( 26 with autism , 21 with pervasive developmental disorder-not otherwise specified [ PDD-NOS ] , and 12 with Asperger disorder ) were compared with 40 TD control subjects . MEASUREMENTS AND RESULTS The  CSHQ  ,  sleep diaries  , and 10 nights of actigraphy  using the Sadeh algorithm of children with ASD and TD control subjects were compared . CSHQ showed 66.1 % of parents of children with ASD ( 62.5 % autism , 76.2 % PDD-NOS , 58.3 % Asperger disorder ) and 45 % of parents of the control subjects reported that their children had sleep problems . Actigraphic data showed that 66.7 % of children with ASD ( 75 % autism , 52.4 % PDD-NOS , 75 % Asperger disorder ) and 45.9 % of the control subjects had disturbed sleep . CONCLUSIONS The prevalence estimate of 45 % for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern . The prevalence estimate of 66 % for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face . The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD Early intervention for autism spectrum disorder ( ASD ) tends to focus on enhancing social-communication skills . We report the acceptability , feasibility and impact on child functioning of a new 8 weeks parent-group intervention to manage restricted and repetitive behaviours ( RRB ) in young children with ASD aged 3–7 years . Forty-five families took part in the pilot RCT . A range of primary and secondary outcome measures were collected on four occasions ( baseline , 10 , 18 and 24 weeks ) to capture both independent ratings and parent-reported changes in RRB . This pilot established that parents were willing to be recruited and r and omised , and the format and content of the intervention was feasible . Fidelity of delivery was high , and attendance was 90 % . A fully powered trial is now planned Data from two groups of children who were r and omly allocated to those groups showed that the ability of children with ASD to identify and label basic and complex facial expressions following a 3-week home based DVD intervention significantly improved when viewing The Transporters DVD . Improvements in emotion recognition appear related to the content of the DVD as participants in a control group who observed an alternate DVD showed no such improvement . Although social behaviour improved significantly as a result of watching The Transporters , a significant improvement in social behaviour was however , also observed in the Thomas the Tank Engine condition suggesting the unique content of The Transporters DVD was not pivotal to the improvement of social behaviour in general Anxiety is common in children with autism spectrum disorders ( ASD ) , with specific fears and phobias one of the most frequent subtypes . Specific fears and phobias can have a serious impact on young people with ASD and their families . In this study we developed and evaluated a unique treatment combining cognitive behaviour therapy ( CBT ) with graduated exposure in a virtual reality environment ( VRE ) .  Nine verbally fluent boys with an ASD diagnosis and no reported learning disability , aged 7 to 13 years old , were recruited . Each had anxiety around a specific situation ( e.g. crowded buses ) or stimulus ( e.g. pigeons ) . An individualised scene was recreated in our ‘ wrap-around ’ VRE . In the VRE participants were coached by a psychologist in cognitive and behavioural techniques ( e.g. relaxation and breathing exercises ) while the exposure to the phobia/fear stimulus was gradually increased as the child felt ready . Each child received four 20–30 minute sessions . After participating in the study , eight of the nine children were able to tackle their phobia situation . Four of the participants completely overcame their phobia . Treatment effects were maintained at 12 months . These results provide evidence that CBT with VRE can be a highly effective treatment for specific phobia/fear for some young people with ASD . Trial Registration Controlled-Trials.com IS RCT N58483069 Early intervention has been reported to improve outcome in children with autism spectrum disorders ( ASDs ) . Several studies in the field have been r and omized controlled trials ( RCTs ) . The aim of this study was to assess ASD outcome in a large naturalistic study . Two hundred and eight children , aged 20 - 54 months , with a clinical diagnosis of ASD were given intervention and monitored prospect ively in a naturalistic fashion over a period of 2 years . The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county . They fell into three cognitive subgroups : one with learning disability , one with developmental delay , and one with normal intellectual functioning . Data on intervention type and intensity were gathered prospect ively in a systematic fashion . Intervention was classified into intensive applied behaviour analysis ( ABA ) and non-intensive , targeted interventions , also based on ABA principles . Children were comprehensively assessed by a research team before the onset of intervention , and then , again , 2 years later . Change in Vinel and adaptive behaviour scales composite scores from intake ( T1 ) to leaving the study ( T2 ) was set as the primary outcome variable . The research team remained blind to the type and intensity of interventions provided . One hundred and ninety-eight ( 95 % ) of the original sample s stayed in the study throughout the whole 2-year period and 192 children had a complete Vinel and composite score results both at T1 and T2 . Vinel and composite scores increased over the 2-year period . This increase was accounted for by the subgroup with normal cognitive functioning . There was no significant difference between the intensive and non-intensive groups . Individual variation was considerable , but no child in the study was " problem-free " at follow-up . Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA OBJECTIVES To investigate the prevalence , correlates , and antecedents of autism spectrum disorders ( ASD ) in extremely preterm children . STUDY DESIGN We conducted a prospect i ve study of all births < 26 weeks gestation in the United Kingdom and Irel and in 1995 . Of 307 survivors at 11 years , 219 ( 71 % ) were assessed and compared with 153 term-born classmates . Parents completed the  Social Communication Question naire ( SCQ )  to assess autism spectrum symptoms , and ASD were diagnosed by using a psychiatric evaluation . An IQ test and clinical evaluation were also administered . Longitudinal outcome data were available for extremely preterm children . RESULTS Extremely preterm children had significantly higher SCQ scores than classmates ( mean difference , 4.6 points ; 95 % CI , 3.4 - 5.8 ) . Sixteen extremely preterm children ( 8 % ) were assigned an ASD diagnosis , compared with none of the classmates . By hospital discharge , male sex , lower gestation , vaginal breech delivery , abnormal cerebral ultrasound scanning results , and not having had breast milk were independently associated with autism spectrum symptoms . By 6 years , independent associates were cognitive impairment , inattention and peer problems , withdrawn behavior at 2.5 years , and not having had breast milk . CONCLUSIONS Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood . These symptoms and disorders were associated with neurocognitive outcomes , suggesting that ASD may result from abnormal brain development in this population ABSTRACT A multiple baseline across participants design was used to evaluate the effects of Social Stories to help preschool-aged children with characteristics of Autism Spectrum Disorders ( ASD ) increase their engagement in functional behaviors and use sensory integrative-based strategies to promote self-regulation . Three children , 3–5 years old , from a self-contained preschool classroom were selected to participate in the study . The intervention package included reading individualized Social Stories that discussed desired behaviors and self-regulation strategies . The research ers measured the percentage of intervals in which participants engaged in desired behaviors . The frequency of desired behaviors increased for all participants . The use of self-regulation strategies varied across participants . These findings suggest that the intervention was successful in increasing desired behaviors of the three children . Further research is recommended on the effectiveness of embedding sensory integrative strategies into Social Stories . Practitioners may consider the use of Social Stories as a tool to increase independence and encourage self-regulated behaviors in children with characteristics of ASD Background Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder affecting more than 1 % of children . It is characterized by social communication deficits and repetitive behaviors/restricted interests . In the absence of any medications known to improve core symptom domains , parents often use complementary alternative treatments , including omega-3 fatty acid supplements . Methods We conducted a 6-month , r and omized , placebo controlled trial of omega-3 fatty acid supplements ( 1.5 g ) vs placebo in children 2 to 5 years of age with ASD . Primary outcome measures included the autism composite score of the Pervasive Developmental Disorders Behavioral Inventory ( PDDBI ) and the externalizing problems score of the Behavior Assessment System for Children ( BASC-2 ) . Secondary outcome measures included clinical global improvement ( Clinical Global Impression-Improvement ( CGI-I ) ) , adaptive function ( Vinel and Adaptive Behavior Scale ( VABS-II ) ) , and language gains ( Preschool Language Scale ( PLS-4 ) ) , as well as safety . Exploratory analysis investigated potential correlations between changes in cytokine profiles and treatment response . Results Thirty-eight participants were r and omized in a 1:1 fashion . There was no significant difference between groups on the 0- to 24-week change in PDDBI autism composite scores ( p = 0.5 ) . There was a significant group by week interaction on the BASC-2 externalizing problem score , with participants r and omized to the treatment group demonstrating worsening scores ( p = 0.02 ) . There was no statistically significant week by group effect on either adaptive function ( p = 0.09 ) or language ( p = 0.6 ) . Omega-3s were relatively well tolerated . Changes in cytokines during the study did not significantly correlate with treatment response . Conclusions This study does not support high dose supplementation of omega-3 fatty acids in young children with ASD.Trial registration Clinical trials.gov NCT01248728 . Registered 22 November 2010 BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention OBJECTIVE This r and omized controlled trial evaluated the efficacy of Primary Care Stepping Stones Triple P , a brief individualized parenting program , in a sample of parents of children with autism spectrum disorder ( ASD ) . METHOD Sixty-four parents of children aged 2 - 9 years ( M = 5.67 , SD = 2.14 ) with an ASD diagnosis participated in the study . Eighty-six percent of children were male , and 89 % of parents identified their child 's ethnicity as Australian/White . Families were r and omly assigned to 1 of 2 conditions ( intervention or care-as-usual ) and were assessed at 3 time points ( preintervention , postintervention , and 6-month follow-up ) . Parents completed a range of question naires to assess changes in child behavior  ( Eyberg Child Behavior Inventory ) and parent outcomes ( Parenting Scale , Depression Anxiety Stress Scale-21 , Parent Problem Checklist , Relationship Quality Inventory , Parental Stress Scale ) and 30-min home observations of parent-child interactions . RESULTS Relative to the care-as-usual group , significant short-term improvements were found in the intervention group on parent-reported child behavior problems , dysfunctional parenting styles , parenting confidence , and parental stress , parental conflict , and relationship happiness . No significant intervention effects were found on levels of parental depression or anxiety , or on observed child disruptive and parent aversive behavior . The effect sizes for significant variables ranged from medium to large . Short-term effects were predominantly maintained at 6-month follow-up , and parents reported high levels of goal achievement and satisfaction with the program . CONCLUSIONS The results indicate that a brief low intensity version of Stepping Stones Triple P is an efficacious intervention for parents of children with ASD BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention programme ( Therapy Outcomes By You ; TOBY ) in young children with ASD . METHODS TOBY is an app-based learning curriculum design ed for children and parents as a complement to early behavioural intervention . Eighty children ( 16 female ) were recruited to this RCT within 12 months of receiving a diagnosis of ASD ( M age = 3.38 ; SD = 0.69 ) and r and omised to receive either treatment-as-usual ( community-based intervention , n = 39 ) or the TOBY therapy ( at least 20 min/day ) plus treatment-as-usual ( n = 41 ) for a period of 6 months . Outcomes were assessed at 3 and 6 months postbaseline . ( Australian New Zeal and Clinical Trials Registry : ACTRN12614000738628 ; www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365463 ) . RESULTS Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months , but only 2 min/day during the second 3 months . There was no group difference in scores on the primary outcome , the Autism Treatment Evaluation Checklist , at either the 3- or 6-month follow-up . However , significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes : the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index . Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function , although these decreased in magnitude from the 3- to 6-month follow-up . CONCLUSIONS This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD . However , sustained use of the app over the full 6-month period was a challenge for most families
Conclusions We found patchy evidence on reliability and validity , for only a few of the tools used to measure behaviour problems in young children with ASD .
Background Behaviour problems are common in young children with autism spectrum disorder ( ASD ) .
There are many different tools used to measure behavior problems but little is known about their validity for the population .
Objectives To evaluate the measurement properties of behaviour problems tools  used in evaluation of intervention or observational research studies with children with ASD up to the age of six years .