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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 [...]

School non-attendance in autism spectrum disorders has received very little attention to date. The study aimed to provide a comprehensive description of school non-attendance in students with autism spectrum disorders. Through an online survey, parents of 486 children (mean age: 11 years) reported on school attendance over 1 month and reasons for instances of non-attendance. On average, students missed 5 days of school of a possible 23 days. Persistent non-attendance (absent on 10%+ of available sessions) occurred among 43% of students. School non-attendance was associated with child older age, not living in a two-parent household, parental unemployment and, especially, attending a mainstream school. School refusal accounted for 43% of non-attendance. School exclusion and school withdrawal each accounted for 9% of absences. Truancy was almost non-existent. Non-problematic absenteeism (mostly related to medical appointments and illness) accounted for 32% of absences. Non-problematic absenteeism was more likely among those with intellectual disability, school refusal was more likely among older students and school exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings suggest that school non-attendance in autism spectrum disorders is a significant issue, and that it is important to capture detail about attendance patterns and reasons for school non-attendance.

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.]

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder-related functioning. World Health Organization's International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder--one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (?17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder-related functioning in educational, administrative, clinical, and research settings.

Background: Traditional treatment for the behavioural symptoms in autism spectrum disorder (ASD) remains unsatisfactory. There is an urgent need for new, biologically relevant therapies that target both the core and comorbid symptoms that children may experience. This article builds on research previously published by the authors. Method: We report a mixed-methods analysis from a 24-week double-blind randomised controlled trial of adjunctive "N"-acetylcysteine (NAC) for the treatment of behavioural symptoms in ASD. Ninety-eight children between the ages of 3 and 9 years, diagnosed with ASD, participated in the study. Outcome measures included parents' assessment reports (obtained before, during, and after the trial), clinicians' observations, and the researchers' detailed case notes. Thematic analysis of textual data (n = 85) was carried out, followed by an evaluation of differences in the frequency with which changes in behaviour were qualitatively reported. Results: Compared with placebo, the parents of the group that received NAC reported improved calmness, decreased aggression and agitation, and greater improvements in verbal communication. Conclusions: These results support the usefulness of NAC for treating potentially disruptive behaviour (e.g., aggression and hyperactivity) in children with ASD and provide a novel finding: potentially improved verbal communication following NAC treatment. This paper supports the utility of a mixed-methods analysis for detecting latent signals in clinical trials.

The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a valid and reliable instrument to assist the diagnosis of adults with Autism Spectrum Disorders (ASD). The 80-question scale was administered to 779 subjects (201 ASD and 578 comparisons). All ASD subjects met inclusion criteria: DSM-IV-TR, ADI/ADOS diagnoses and standardized IQ testing. Mean scores for each of the questions and total mean ASD vs. the comparison groups' scores were significantly different (p

The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned. [ABSTRACT FROM AUTHOR]

Qualitative exploration of the experience of psychoanalytic psychotherapy complemented the quantitative evaluation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice‐weekly treatment was offered to adults for 2 years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low‐cost community service over 8 years. This paper is the second of two presenting the qualitative arm of the study, involving in‐depth narrative interviews with patients and psychotherapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of psychoanalytic psychotherapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psychotherapy and perspectives of both patients and psychotherapists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facilitative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psychotherapy may have affected the Implementation, Effectiveness and Maintenance of the program. The most notable facilitative factors emerging were the exploratory, insight‐oriented nature of the work, elements of the patient‐psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2‐year treatment, as both an expectation and a limit, probably inhibited program Reach, Adoption and overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implications for further investigation, are discussed. [ABSTRACT FROM AUTHOR]

The naturalistic, longitudinal Melbourne Study of Psychoanalytic Psychotherapy was conducted in a subsidized community clinic established by the Victorian Association of Psychoanalytic Psychotherapists as a demonstration project operating over 8 years. It offered lower SES adults twice‐weekly psychoanalytic psychotherapy for 2 years. An independent research program used the RE‐AIM planning and evaluation framework to investigate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. Complementary quantitative and qualitative methodologies studied mental health and general‐life functioning outcomes and underlying processes of treatment. Two papers present the qualitative arm of the research, exploring the lived experience of the psychotherapy, reported contemporaneously and retrospectively by patients and psychotherapists. This first paper details the qualitative design and methods employed. In‐depth semi‐structured narrative interviews during psychotherapy, upon completion at 2 years, and at an additional 8‐month follow‐up point for patients, were conducted. Analysis of the narrative transcripts of 143 participant interviews revealed themes regarding patient expectations of treatment and the perceptions of both patients and psychotherapists of the long‐term psychoanalytic psychotherapy experience and its benefits. Narratives thus provided evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. The findings enrich understanding of the effective processes underlying the outcomes of the quantitative arm of the study reported separately. The second qualitative paper presents the findings concerning participants' experiences of facilitative and challenging aspects of the treatment, as well as the implications of the qualitative findings overall. [ABSTRACT FROM AUTHOR]

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, [...]

Aim: To determine the effect of parent education on adaptive behaviour, autism symptoms and cognitive/language skills of young children with autistic disorder. Method: A randomised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample. Two rural and two metropolitan regions were randomly allocated to intervention groups ("n" = 70) or control ("n" = 35). Parents from autism assessment services in the intervention regions were randomly allocated to parent education and behaviour management ("n" = 35) or parent education and counselling ("n" = 35). Results: Parent education and behaviour management resulted in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour. Parent education and behaviour management was superior to parent education and counselling. We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children.

Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.