| 1. |
- Choque Olsson, Nora
(author)
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Social skills group training for children and adolescents with autism spectrum disorder
- 2016
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to examine the efficacy and effectiveness of social skills group training (SSGT) in children and adolescents with high functioning autism spectrum disorder (HFASD) and psychiatric comorbidity. Prior to the trial, a systematic review was conducted on the effectiveness of randomized controlled trial (RCT) of SSGT. In addition, evaluation of two tools (Developmental Disabilities Children’s Global Assessment Scale [DD-CGAS] and the OSU Autism Clinical Global Impression [CGI-S]) used in the trial, was performed. Sixteen vignettes of 8 clinical patients with HFASD and psychiatric comorbidity were rated by 16 clinicians. The trial was conducted based on the convergent mixed method approach (quantitative and qualitative). The quantitative, a multicenter pragmatic randomized control trial (PRCT) included a total of 296 children and adolescents with HFASD and psychiatric comorbidity aged 8 to 17 years. They were randomly assigned to an experimental (KONTAKT+ treatment as usual [TAU]) and a control group, TAU only. The qualitative study included 11 participants (6 high responders and 5 low responders) from the experimental group and their parents were interviewed and a qualitative responder analysis was performed. The results showed a lack of information about recruitment, comorbidity, treatment providers, settings, and limited eligible population. The intraclass correlation coefficients (ICCs) for experienced clinicians were .75 for the DD-CGAS and .72 for the OSU Autism CGI. Among inexperienced clinicians, these ICCs were .58 and .59 respectively. The multicenter PRCT showed positive effects in experimental and control groups in social responsiveness skills. The experimental group showed a significant effect on social cognition, maintained after 3 months (B=-1.33, Z=-1.44, p=.02), but no effect according to blinded teacher ratings. Adolescents in the experimental group showed better results (B>-8.34, Z>-2.54 p<.001) for social responsiveness compared with the child group, particularly in social communication, but again not for blinded teacher ratings. Several secondary outcome measures identified improvements following SSGT. The qualitative study showed improvements in several areas of social skills. Even low-non-responders showed gains after treatment. Effectiveness studies are lacking that use RCTs for SSGT. Reliability is better for experienced vs less experienced clinicians for DD-CGAS and OSU Aut CGI. SSGT-KONTAKT can be successfully implemented in “real-world” clinical health care. Time effect for both KONTAKT+TAU and TAU are positive. A significant effect on social cognition in the experimental group was found. When compared to children, adolescents showed a greater positive effect in social communication, social motivation, and social cognition, whereas children had better effects in terms of everyday functioning, and symptom severity. Parents of children showed decreased stress, but no changes in perceived stress were identified among the children and adolescents after treatment. More efficacy and effectiveness studies on SSGT using convergent mixed methods (quantitative, qualitative) are needed before any robust conclusions can be drawn.
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| 2. |
- Choque Olsson, Nora, et al.
(author)
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Social Skills Training for Children and Adolescents With Autism Spectrum Disorder : A Randomized Controlled Trial
- 2017
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In: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 56:7, s. 585-592
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Social skills group training (SSGT) for children and adolescents with autism spectrum disorder (ASD) is widely applied, but effectiveness in real-world practice has not yet been properly evaluated. This study sought to bridge this gap.METHOD: This 12-week pragmatic randomized controlled trial of SSGT compared to standard care alone was conducted at 13 child and adolescent psychiatry outpatient units in Sweden. Twelve sessions of manualized SSGT ("KONTAKT") were delivered by regular clinical staff. Participants (N = 296; 88 females and 208 males) were children (n = 172) and adolescents (n = 124) aged 8 to 17 years with ASD without intellectual disability. The primary outcome was the Social Responsiveness Scale rating by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and 3-month follow-up. Moderator analyses were conducted for age and gender.RESULTS: Significant treatment effects on the primary outcome were limited to parent ratings for the adolescent subgroup (posttreatment: -8.3; 95% CI = -14.2 to -1.9; p = .012, effect size [ES] = 0.32; follow-up: -8.6; 95% CI = -15.4 to -1.8; p = .015, ES = 0.33) and females (posttreatment: -8.9; 95% CI = -16.2 to -1.6; p = .019, ES = 0.40). Secondary outcomes indicated moderate effects on adaptive functioning and clinical severity.CONCLUSION: SSGT for children and adolescents with ASD in regular mental health services is feasible and safe. However, the modest and inconsistent effects underscore the importance of continued efforts to improve SSGT beyond current standards.CLINICAL TRIAL REGISTRATION INFORMATION: Social Skills Group Training ("KONTAKT") for Children and Adolescent With High-functioning Autism Spectrum Disorders; https://clinicaltrials.gov/; NCT01854346.
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| 3. |
- Choque Olsson, Nora, et al.
(author)
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Treatment satisfaction with cognitive-behavioral therapy among children and adolescents with anxiety and depression : A systematic review and meta-synthesis
- 2021
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In: Journal of Behavioral and Cognitive Therapy. - : Elsevier BV. - 2589-9791. ; 31:2, s. 147-191
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Journal article (peer-reviewed)abstract
- Recent reviews estimated that the worldwide prevalence of anxiety and depression in children and adolescents is increasing, which has led to rising demands for treatment. Studies on clinical outcomes have shown positive effects of cognitive-behavioral therapy (CBT) in children and adolescents with anxiety and depression. However, there is a limited body of studies on the perspectives and experiences of the treatment participants. The objective of this review was to investigate treatment satisfaction with CBT among children and adolescents with anxiety and depression. We focused on the reporting quality of the treatment satisfaction and experiences of participants in the selected studies. From 1379 identified studies, 35 were selected based on inclusion and exclusion criteria. The results of a meta-synthesis and proportional meta-analysis suggest moderate to high treatment satisfaction with CBT in depressed and anxious children and adolescents. The included studies showed moderate to good reporting quality on treatment satisfaction. The measurements used varied, indicating a risk of different evaluations under the concept of “treatment satisfaction”. The common topics measured for treatment satisfaction were acceptability, treatment usefulness, alliance, barriers, recommendation, and others, leading to uncertainty concerning generalization. A wide variety of measures were used, indicating the need for standardized measures for treatment satisfaction in future research.
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| 4. |
- Georén, Lisa, et al.
(author)
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Internet-delivered Cognitive Behavioral Therapy for insomnia in youth with autism spectrum disorder : A pilot study
- 2022
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In: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 29
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Journal article (peer-reviewed)abstract
- Adolescents with ASD often suffer from sleep disorders affecting their development and quality of life. Research concerning psychological treatment of insomnia in this population is scarce. The objective of this pilot study was to examine the feasibility of internet-delivered CBT for insomnia (iCBT-I) and the participants' experiences after completing the treatment. Both quantitative and qualitative methods were used. Six adolescents with ASD and insomnia, aged 13 to 17, participated in the study. The results of the qualitative investigation showed general satisfaction with the iCBT-I. The participants experienced both better sleep and insights into their sleep patterns. Thematic analysis revealed five themes: experience of the structure of the treatment, treatment content, experienced outcomes, experienced difficulties, and suggested improvements. The results indicate the need for additional support for some participants and suggest distinct recommendations for further studies. The quantitative investigation showed large reductions in insomnia symptoms indicating the feasibility of the treatment in this population. The findings suggest promising results, but more studies are needed to define the efficacy of iCBT-I for adolescents with ASD.
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| 5. |
- Jones Piltz, Veronica, et al.
(author)
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Symptom similarities and differences in social interaction between autistic children and adolescents with and without ADHD
- 2024
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In: Current Psychology. - : Springer Science and Business Media LLC. - 1046-1310 .- 1936-4733. ; 43, s. 3503-3513
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Journal article (peer-reviewed)abstract
- Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are two often co-occurring neurodevelopmental conditions. Nevertheless, there is limited research about symptom differences between ASD and ASD + ADHD groups. This study examined differences in social interaction and communication between children and adolescents with ASD and with ASD + ADHD. A total of 112 participants were identified from two clinical trials. Fifty-six children and adolescents with ASD aged 8–17 years were matched for age, gender and general intelligence quotient with fifty-six children and adolescents with ASD + ADHD. Group differences in scores on the Autism Diagnostic Observation Schedule were analysed. Our results showed that participants with ASD and with ASD + ADHD had similar profiles of social communication interaction challenges and restricted behaviour. However, items assessing gestures: Conventional, Instrumental or Informational Gestures and Empathic or Emotional gestures showed significant differences between the groups suggesting that the ASD + ADHD group used descriptive gestures to communicate to a greater extent than the ASD group. These findings suggest that children and adolescents in both groups have similar difficulties in social communication and interaction with observed differences in the use of gestures. Possible reasons and implications for the differences in the use of gestures are discussed.
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| 6. |
- Jonsson, Ulf, 1974-, et al.
(author)
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Can findings from randomized controlled trials of social skills training in autism spectrum disorder be generalized? : The neglected dimension of external validity.
- 2016
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In: Autism. - : SAGE Publications. - 1362-3613 .- 1461-7005. ; 20:3, s. 295-305
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Journal article (peer-reviewed)abstract
- Systematic reviews have traditionally focused on internal validity, while external validity often has been overlooked. In this study, we systematically reviewed determinants of external validity in the accumulated randomized controlled trials of social skills group interventions for children and adolescents with autism spectrum disorder. We extracted data clustered into six overarching themes: source population, included population, context, treatment provider, treatment intervention, and outcome. A total of 15 eligible randomized controlled trials were identified. The eligible population was typically limited to high-functioning school-aged children with autism spectrum disorder, and the included population was predominantly male and Caucasian. Scant information about the recruitment of participants was provided, and details about treatment providers and settings were sparse. It was not evident from the trials to what extent acquired social skills were enacted in everyday life and maintained over time. We conclude that the generalizability of the accumulated evidence is unclear and that the determinants of external validity are often inadequately reported. At this point, more effectiveness-oriented randomized controlled trials of equally high internal and external validity are needed. More attention to the determinants of external validity is warranted when this new generation of randomized controlled trials are planned and reported. We provide a tentative checklist for this purpose.
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| 7. |
- Jonsson, Ulf, 1974-, et al.
(author)
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Long-term social skills group training for children and adolescents with autism spectrum disorder : a randomized controlled trial.
- 2019
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In: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 28:2, s. 189-201
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Journal article (peer-reviewed)abstract
- Social skills group training (SSGT) is widely used for intellectually able children and adolescents with autism spectrum disorder (ASD). Previous studies indicate small to moderate effects on social communication capacities. The duration of most available programs is relatively short, and extended training might lead to further improvement. This randomized controlled trial compared an extended 24-week version of the SSGT program KONTAKT with standard care. The weekly sessions gradually shifted in content from acquisition of new skills to real-world application of the acquired skills. A total of 50 participants with ASD (15 females; 35 males) aged 8-17 years were included. The study was conducted at two child and adolescent psychiatry outpatient units in Sweden. The primary outcome was the Social Responsiveness Scale-Second Edition (SRS-2) rated by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and at 3-months follow-up. Parent-rated SRS-2 scores indicated large effects posttreatment [- 19.2; 95% CI - 29.9 to - 8.5; p < .001, effect size (ES) = 0.76], which were maintained at follow-up (- 20.7; 95% CI - 31.7 to - 9.7; p < .0001, ES = 0.82). These estimates indicate substantially larger improvement than previously reported for shorter SSGT. However, the effects on teacher-rated SRS-2 and most secondary outcomes did not reach statistical significance. Our results suggest added benefits of extended SSGT training, implying that service providers might reach better results by optimizing the delivery of SSGT.
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| 8. |
- Li, Danyang, et al.
(author)
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Rare variants in the outcome of social skills group training for autism
- 2022
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In: Autism Research. - : Wiley. - 1939-3792 .- 1939-3806. ; 15:3, s. 434-446
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Journal article (peer-reviewed)abstract
- Exome sequencing has been proposed as the first-tier genetic testing in autism spectrum disorder (ASD). Here, we performed exome sequencing in autistic individuals with average to high intellectual abilities (N = 207) to identify molecular diagnoses and genetic modifiers of intervention outcomes of social skills group training (SSGT) or standard care. We prioritized variants of clinical significance (VCS), variants of uncertain significance (VUS) and generated a pilot scheme to calculate genetic scores of rare and common variants in ASD-related gene pathways. Mixed linear models were used to test the association between the carrier status of VCS/VUS or the genetic scores with intervention outcomes measured by the social responsiveness scale. Additionally, we combined behavioral and genetic features using a machine learning (ML) model to predict the individual response. We showed a rate of 4.4% and 11.3% of VCS and VUS in the cohort, respectively. Individuals with VCS or VUS had improved significantly less after standard care than non-carriers at post-intervention (β = 9.35; p = 0.036), while no such association was observed for SSGT (β = −2.50; p = 0.65). Higher rare variant genetic scores for synaptic transmission and regulation of transcription from RNA polymerase II were separately associated with less beneficial (β = 8.30, p = 0.0044) or more beneficial (β = −6.79, p = 0.014) effects after SSGT compared with standard care at follow-up, respectively. Our ML model showed the importance of rare variants for outcome prediction. Further studies are needed to understand genetic predisposition to intervention outcomes in ASD.
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| 9. |
- Li, Danyang, et al.
(author)
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The influence of common polygenic risk and gene sets on social skills group training response in autism spectrum disorder
- 2020
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In: NPJ Genomic Medicine. - : Nature Publishing Group. - 2056-7944. ; 5:1
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Journal article (peer-reviewed)abstract
- Social skills group training (SSGT) is a frequently used behavioral intervention in autism spectrum disorder (ASD), but the effects are moderate and heterogeneous. Here, we analyzed the effect of polygenic risk score (PRS) and common variants in gene sets on the intervention outcome. Participants from the largest randomized clinical trial of SSGT in ASD to date were selected (N = 188, 99 from SSGT, 89 from standard care) to calculate association between the outcomes in the SSGT trial and PRSs for ASD, attention-deficit hyperactivity disorder (ADHD), and educational attainment. In addition, specific gene sets were selected to evaluate their role on intervention outcomes. Among all participants in the trial, higher PRS for ADHD was associated with significant improvement in the outcome measure, the parental-rated Social Responsiveness Scale. The significant association was due to better outcomes in the standard care group for individuals with higher PRS for ADHD (post-intervention: β = −4.747, P = 0.0129; follow-up: β = −5.309, P = 0.0083). However, when contrasting the SSGT and standard care group, an inferior outcome in the SSGT group was associated with higher ADHD PRS at follow-up (β = 6.67, P = 0.016). Five gene sets within the synaptic category showed a nominal association with reduced response to interventions. We provide preliminary evidence that genetic liability calculated from common variants could influence the intervention outcomes. In the future, larger cohorts should be used to investigate how genetic contribution affects individual response to ASD interventions.
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| 10. |
- Melin, Johanna, et al.
(author)
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Clinical practitioners' experiences of psychological treatment for autistic children and adolescents with school attendance problems : a qualitative study
- 2022
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: School attendance problems (SAPs) are common among children and adolescents with autism spectrum disorder (ASD). Currently, there is a lack of guidelines for treatment or interventions aimed at this group.Method: Twelve clinical practitioners were interviewed via in-depth interviews using a semi-structured question guide. Interviews were audiotaped, transcribed verbatim, and initially independently coded by two coders. The interviews were analyzed according to thematic analysis.Results: The majority of the clinicians reported that it was common that children and adolescents with ASD at CAP had prolonged SAPs. A total of four themes and 22 sub-themes were identified in the analysis: the treatment situation; treatment goals at CAP; treatment interventions; and desired development. Insufficient adaptations in response to core impairment of ASD and lack of support in their daily life could be factors to the development of SAPs. Prolonged social isolation in combination with severe psychiatric comorbidities was reported as a treatment barrier. Also, insufficient collaboration between mental health care services, school and social services obstructed the return to school for this group of students. Favorable factors for positive treatment outcome were: early detection, accurate assessment and coordination between mental health care and schools and environmental adaptation at school as well as at home, parent support and sometimes change of school. Concerning useful therapeutic techniques, exposure from cognitive-behavioral treatment was reported.Conclusion: Children and adolescents with ASD with limited societal support tend to develop SAPs. Important factors that impact the outcome of treatment were the length of the absence from school and the severity of psychiatric comorbidities. Tailored and adapted interventions at school, parent support and mental health care are needed. Research about assessment and treatment for children and adolescents with ASD and SAPs is needed.
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