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Socialization difficulties in children with an Autism Spectrum Disorder (ASD) are often associated with peer rejection and impaired academic achievement. Schools might appear to offer an ideal setting for social-emotional skills (SES) instruction. However, common challenges to successful implementation of school-based programs include inadequate staffing and resourcing, and a lack of ASD-specific staff training. This paper describes how barriers to program implementation were overcome in a project evaluating the Secret Agent Society (SAS) SES training intervention within Autism Spectrum Australia (Aspect) specialist classes. Questionnaire data was collected from school staff over a one-year period. Findings supported the effectiveness of the adoption process used, and suggest that SAS was feasible and acceptable to school staff.

Background: This systematic review aimed to explore the effects of sport and physical activity on behaviour and emotional problems, mental health and psychosocial well-being of children and adolescents with intellectual disability. Method: Five databases were searched systematically (ERIC, MEDLINE, PsycINFO, SportDISCUS and SCOPUS), up to 28 February 2021. Thirty-two studies met criteria for inclusion. Results: Studies in this review included case studies (n = 15), treatment trials (n = 14), cross sectional studies (n = 2) and a cohort study (n = 1). Evidence was positive, though high risk of bias in treatment trials (7 of 14 rated high) meant generalisability of results was limited. Conclusions: The available evidence suggests a positive relationship between physical activity and improved behaviour and emotional problems, mental health and psychosocial well-being; however, more robust randomised controlled trials are required to confirm this.

Background: This systematic review aimed to explore how adults with autism participate in the community, the impact of community participation on quality of life and mental health, and factors that support and hinder participation. Method: A systematic review was conducted including studies published from inception to 17 January 2021. Results: Sixty-three reports were included, reporting on 58 studies. Solitary activities, organised group activities, community activities, religious groups and online social participation were identified. The relationship between community participation and quality of life was examined. Barriers and facilitators to increased community participation were identified. Most studies had a moderate to high risk of bias. Conclusion: Adults with autism participate in a range of independent and community activities. The impact of community participation on quality of life and mental health warrants further exploration. Future studies should find effective ways of supporting adults with autism to participate in the community.

: Objectives: Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research. Method: We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011–2020. Results: Parenting intervention research received 0.25% of the NHMRC and ARC research budgets. Conclusions: There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short‐ and long‐term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding. Implications for public health: Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families., Parenting interventions play a central role in promoting and protecting the health, wellbeing and educational outcomes of children, adolescents and families, as well as preventing and treating difficulties when they [...]

Background: The aim of this feasibility study was to adapt and model a behavioural intervention for anxiety with autistic adults with moderate to severe intellectual disabilities. Method: Twenty‐eight autistic adults with moderate or severe intellectual disabilities, 37 carers, and 40 therapists took part in this single‐group non‐randomised feasibility study designed to test intervention feasibility and acceptability, outcome measures, and research processes. Results: The intervention was judged as feasible and acceptable by autistic adults with intellectual disabilities, carers, and therapists. Minor intervention revisions were suggested. Carers completed 100% of outcome measures and the missing data rate was low. Complying with legislation governing the inclusion of participants who lack capacity to decide whether they wanted to take part in this study led to an average 5‐week enrolment delay. Conclusion: The intervention and associated study processes were judged to be feasible and acceptable and should now be tested within a larger randomised trial. [ABSTRACT FROM AUTHOR]

Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to 'problem-solve' complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly 'home mission' assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents' engagement with these elements of the intervention was linked to the quality of their children's participation and performance. Sixty-eight 8-14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children's competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children's social and emotional skill gains over the course of the program.

Group Stepping Stones Triple P (GSSTP), is an evidence‐based intervention for parents of children with intellectual disability that aims to improve child behavioural difficulties. GSSTP was designed to be delivered face‐to‐face, but during the COVID‐19 pandemic some services started delivering it remotely. The evidence base for remote intervention is growing, but few studies have focused on the experiences of practitioners delivering the interventions and the consequences of their service provision. We aimed to explore UK practitioners' experiences of delivering remotely GSSTP. The objectives were to identify the advantages and disadvantages of remote GSSTP, to determine whether adjustments were made to enable delivery, and to assess perceived acceptability. Participants were identified using consecutive sampling from the Triple P UK practitioner network. Eleven practitioners, who had experience of delivering GSSTP remotely and face‐to‐face, reported their experiences in an online survey. Ten participants also took part in semi‐structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. According to 55% of practitioners, parent attendance had increased with remote delivery, and 73% of practitioners found remote GSSTP equally or more effective than face‐to‐face. Survey findings about managing parent engagement remotely were mixed and building rapport with patients was considered equally or more difficult remotely. The key themes from the thematic analysis were the practitioners' 'sincere enthusiasm' over the advantages of the remote GSSTP provision, the 'person‐centered strategies' that characterised their practice, the emergence of 'remote delivery as the way forward' for parenting services and finally, the 'challenges of remote delivery'. Remote GSSTP was perceived to be acceptable to participants and practitioners; the advantages of remote delivery appeared to outweigh the disadvantages. Practitioners reported strategies to prompt engagement and recreate group interactions in the remote setting that could be integrated in the practice of other group parenting providers. [ABSTRACT FROM AUTHOR]

This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n = 29) and children with other developmental disabilities (n = 20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children's attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children's attachment quality in early interventions. [This article represents a collaborative effort on behalf of the Mental Health of Young People with Developmental Disabilities (MHYPeDD) team.]

Background: The Secret Agent Society (SAS) Program, an intervention to enhance social-emotional skills, was provided by schools for children with autism spectrum disorder (ASD). The program was assessed to determine if it improved social skills at school and home, and whether improvements were maintained. Methods: Eighty-four students participated. Key outcomes were parent and teacher ratings of emotion regulation, social skills, and direct child social problem-solving measures. The standard school curriculum served as the control condition. Phase 1 was a two-group waitlist-control comparison of SAS versus the standard curriculum. Phase 2 was a follow up of all participants before and after the intervention and at 12-months post-intervention. Results: Parent and child measures improved after the intervention but not in the waitlist condition. Improvements in parent, child, and teacher measures were apparent at 12 months. Conclusions: The SAS Program warrants further research as a potential program for schools that serve children with ASD.

Background: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non‐refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. Methods: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non‐refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Results: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non‐refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Conclusion: Similarly, high proportions of women of refugee and non‐refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care. [ABSTRACT FROM AUTHOR]

Background: Children with intellectual and developmental disabilities (IDD) experience heightened attention difficulties which have been linked to poorer cognitive, academic and social outcomes. Although, increasing research has focused on the potential of computerised cognitive training in reducing attention problems, limited studies have assessed whether this intervention could be utilised for those with IDD. This study aimed to assess the efficacy of a computerised attention training programme in children with IDD. Methods: In a double-blind randomised controlled trial, children (n = 76; IQ < 75) aged 4-11 years were assigned to an adaptive attention training condition or a nonadaptive control condition. Both conditions were completed at home over a 5-week period and consisted of 25 sessions, each of 20-min duration. Outcome measures (baseline, posttraining and 3-month follow-up) assessed core attention skills (selective attention, sustained attention and attentional control) and inattentive/hyperactive behaviour. Results: Children in the attention training condition showed greater improvement in selective attention performance compared to children in the control condition (SMD = 0.24, 95% CI 0.02, 0.45). These improvements were maintained 3 months after training had ceased (SMD = 0.26, 95% CI 0.04, 0.48). The attention training programme was not effective in promoting improvements in sustained attention, attentional control or inattentive/hyperactive behaviours. Conclusions: The findings suggest that attention training may enhance some aspects of attention (selective attention) in children with IDD, but the small to medium effect sizes indicate that further refinement of the training programme is needed to promote larger, more global improvements.

There has been limited study of the relationship between child attachment and caregiver wellbeing amongst children with autism spectrum disorder (ASD). This study examined self-reported child attachment quality alongside caregivers' report of their own psychological distress, parenting stress and attachment style, amongst 24 children with high-functioning autism or Asperger's disorder (ASD; aged 7-14 years) and 24 typically developing children (aged 7-12 years), and their primary caregiver. Children with ASD were no less secure, but their caregivers were more stressed and reported more attachment-related anxiety, compared to typically developing dyads. Child attachment security was related to caregiver psychological distress and attachment style, but only amongst typically developing children. Impacts of emotion processing impairments on caregiver-child relationships in ASD are discussed.

Changes to the DSM-5 Autism Spectrum Disorder (ASD) criteria raised concerns among parents and practitioners that the criteria may exclude some children with Pervasive Developmental Disorder (PDD). Few studies have examined DSM-5 sensitivity and specificity in children less than 5 years of age. This study evaluated 185 children aged 20-55 months with DSM-IV PDD or developmental delay. Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) data was assigned to DSM-5 subdomains. Children displaying the required symptomatology were classified with DSM-5 ASD. DSM-IV clinical diagnoses were compared to DSM-5 classifications. Using combined ADI-R/ADOS information, sensitivity was 0.84 and specificity was 0.54. Comorbid behaviour and emotional problems were significantly lower in children with PDD that did not meet DSM-5 criteria.

This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n = 29) and children with other developmental disabilities (n = 20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children's attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children's attachment quality in early interventions., Author(s): Samantha J. Teague [sup.1] , Louise K. Newman [sup.1] [sup.2] , Bruce J. Tonge [sup.1] [sup.3] , Kylie M. Gray [sup.1] [sup.3] Author Affiliations: (Aff1) 0000 0004 1936 7857, [...]

Difficulties with attention, impulsivity, and hyperactivity are thought to be as common among children with intellectual disability (ID) as they are in children without ID. Despite this, there is a lack of scales to specifically assess ADHD symptomatology in children and adolescents with ID. This article describes the development and evaluation of a teacher-completed measure; the Scale of Attention in Intellectual Disability (SAID). A community survey of 176 teachers of children 5-13 years of age, with ID at all levels of impairment indicated that the T-SAID is a reliable and valid measure. Integrating this scale with neuropsychological and clinical research holds exciting promise for enhancing our understanding of the nature of attention difficulties within populations with ID.

Background: Depending on the severity of their disabilities, children with Down syndrome (DS) and with cerebral palsy (CP) may remain pre-symbolic for prolonged periods of time. When interacting with pre-symbolic children, communication partners have a role in identifying which of their behaviours are communicative, to be able to respond to those behaviours and maintain reciprocal interaction. To date, most research on these children's communication development has been conducted within the context of mother-child interaction. Seldom have they been observed interacting with other family members, and in interactions other than dyadic, despite these interactions also occurring daily. Aims: To explore and compare the interaction of mothers and siblings with pre-symbolic children with DS and with CP in dyadic and triadic contexts. Methods & Procedures: Twelve pre-symbolic children with DS (aged 1;10-5;04 years) and 12 with CP (aged 1;09-5;07 years), and their mothers and siblings participated in this study. They were recruited from early intervention centres from the West Coast of Peninsular Malaysia. Children were observed as they engaged in three play interactions: mother-child, sibling-child and mother-sibling-child (triadic). Outcomes & Results: Children produced the most pre-symbolic communicative behaviours during mother-child, followed by triadic and lastly sibling-child interaction, suggesting that the mother's presence encouraged children to communicate. Mothers created a more facilitative communication environment for the children than did siblings, by directing high rates of initiations towards them and by taking turns that paved the way for the child's next turn. Although siblings' low rates of interaction did not provide children with as many opportunities to produce communicative behaviours, it encouraged them to produce high proportions of initiations. During triadic interaction, mothers and siblings had to direct interaction towards two communication partners, causing them to direct less interaction towards the children with DS or CP. There was no significant difference in mother and sibling responsiveness to children's communicative behaviours across interactions and disability types, suggesting that mothers and siblings might have adapted to the children's various early communicative behaviours. Conclusions & Implications: From this study, it was evident that mothers and siblings of pre-symbolic children with DS and with CP engaged them in reciprocal interaction. Findings on how mothers and siblings influence pre-symbolic children's communication suggest the need to involve them in assessment and intervention for these children.

Longitudinal research has demonstrated that social outcomes for adults with autism are restricted, particularly in terms of employment and living arrangements. However, understanding of individual and environmental factors that influence these outcomes is far from complete. This longitudinal study followed a community sample of children and adolescents with autism into adulthood. Social outcomes in relation to community inclusion and living skills were examined, including the predictive role of a range of individual factors and the environment (socio-economic disadvantage). Overall, the degree of community inclusion and living skills was restricted for the majority, and while childhood IQ was an important determinant of these outcomes, it was not the sole predictor. The implications of these findings in relation to interventions are discussed.

Children with Down syndrome (DS) and cerebral palsy (CP) are at risk of remaining pre-symbolic in their communication and play for prolonged periods. The aim of this study was to explore the early communication and play of children with DS and with CP who communicated at the pre-symbolic stage, and to determine the association between these skills. This study was conducted in Malaysia. Twelve children with DS and 12 with CP who met the criterion of demonstrating pre-symbolic communication were observed during interaction with their mothers and siblings, and the interactions were coded for the children's communicative behaviors and play. The children were observed to communicate using pre-symbolic modalities most accessible to them. The children with DS demonstrated more communicative behaviors (intentional communicative acts and pre-intentional communicative acts) compared with children with CP. Participants produced little or no symbolic play, showing a preference for functional play instead. The symbolic play of the children with DS was negatively associated with their pre-symbolic intentional communicative acts, suggesting that both skills need to be targeted in intervention aimed at transitioning them to symbolic communication. The physical limitations of children with CP limited their demonstration of communicative behaviors and play.

Background: To develop effective education strategies, a detailed knowledge of the working memory profile in Down syndrome (DS) and autism with intellectual disability (ID) is required. Materials and Methods: Fifteen adolescents with DS, 11 boys with autism and ID, and 12 boys with nonspecific ID (NSID) were compared on 2 versions of a novel working memory task that varied only in modality of presentation (visual or auditory). Results: The groups with DS and with autism and ID demonstrated significantly poorer working memory performances than the group with NSID. No predictors of working memory performance were found. Conclusions: Recommendations to support the working memory difficulties of the groups with DS and autism and ID in the classroom include reducing the amount of information to be processed at a time, as well as providing visual or verbal (as appropriate) prompts and cues to reduce the need to hold information in working memory.

This study assessed the relationship between emotion recognition ability and social skills in 42 young children with autistic disorder aged 4-7 years. The analyses revealed that accuracy in recognition of sadness, but not happiness, anger or fear, was associated with higher ratings on the Vineland-II Socialization domain, above and beyond the influence of chronological age, cognitive ability and autism symptom severity. These findings extend previous research with adolescents and adults with autism spectrum disorders, suggesting that sadness recognition is also associated with social skills in children with autism.

Background: Children with autism have difficulties in emotion recognition and a number of interventions have been designed to target these problems. However, few emotion training interventions have been trialled with young children with autism and co-morbid ID. This study aimed to evaluate the efficacy of an emotion training programme for a group of young children with autism with a range of intellectual ability. Methods: Participants were 55 children with autistic disorder, aged 4-7 years (FSIQ 42-107). Children were randomly assigned to an intervention (n = 28) or control group (n = 27). Participants in the intervention group watched a DVD designed to teach emotion recognition skills to children with autism (the "Transporters"), whereas the control group watched a DVD of "Thomas the Tank Engine." Participants were assessed on their ability to complete basic emotion recognition tasks, mindreading and theory of mind (TOM) tasks before and after the 4-week intervention period, and at 3-month follow-up. Results: Analyses controlled for the effect of chronological age, verbal intelligence, gender and DVD viewing time on outcomes. Children in the intervention group showed improved performance in the recognition of anger compared with the control group, with few improvements maintained at 3-month follow-up. There was no generalisation of skills to TOM or social skills. Conclusions: The "Transporters" programme showed limited efficacy in teaching basic emotion recognition skills to young children with autism with a lower range of cognitive ability. Improvements were limited to the recognition of expressions of anger, with poor maintenance of these skills at follow-up. These findings provide limited support for the efficacy of the "Transporters" programme for young children with autism of a lower cognitive range. (Contains 4 tables and 1 figure.)

This study investigated the relationship between structural language skills, and communication skills, adaptive behavior, and emotional and behavior problems in pre-school children with autism. Participants were aged 3-5 years with autism (n = 27), and two comparison groups of children with developmental delay without autism (n = 12) and typically developing children (n = 20). The participants were administered standardised tests of structural language skills, and parents completed the Vineland Adaptive Behavior Scales and the Developmental Behaviour Checklist. Results indicated that for children with autism, communication skills, and in particular receptive communication skills, were associated with social and daily living skills, and behavior problems. Receptive structural language skills were associated with expressive communication skills. There were no associations found between structural language skills and social or daily living skills, nor behavior problems. The results of this study suggest that communication skills are more closely linked to functional and behavioral outcomes in autism than structural language skills. (Contains 3 tables.)

This study investigated whether the novel Comic Strip Task (CST) could be used to detect Theory-of-Mind impairments (ToM) in 4- to 8-year-old children with high functioning Autism Spectrum Disorders (ASD). Twelve children with either high-functioning autism or Asperger's Disorder and 12 typically-developing children completed the 21-item measure. The overall CST demonstrated moderate internal consistency but the Belief-understanding subscale was excluded from the test due to poor reliability. As predicted, the ASD group performed significantly more poorly than controls on the overall 2-subscale CST and on the intention-understanding subscale. No group differences were found in emotion-understanding subscale performance. Controlling for age, verbal ability was positively correlated with overall CST performance across groups. CST performance in the ASD group positively correlated with parent-reports of communication difficulties. Despite some limitations with the belief-understanding subscale, the CST has promising psychometric features warranting further development of this measure. (Contains 4 tables and 2 figures.)