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Targeting Heterogeneity and Comorbidity in Children with Autism Spectrum Disorder Through the Resilience Builder Group Therapy Program

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Abstract

Background

Children with autism spectrum disorders (ASD) often carry co-morbid diagnoses and present with impairing heterogeneous symptomatology (Leyfer et al. in J Autism Dev Disord 36(7): 849–861, 2006. doi:10.1007/s10803-006-0123-0). However, research from controlled laboratory settings often fails to examine the vast number of co-occurring clinical challenges that are seen in youth with ASD treated in “real-world” clinical service settings (Ehrenreich-May et al. in Adm Policy Ment Health 38(5): 398–411, 2011. doi:10.1007/s10488-010-0328-6).

Objective

This study aimed to better understand this heterogeneity in children with ASD receiving services in clinical service settings and to assess the effectiveness of a group therapy intervention targeting these symptoms.

Methods

Thirty-nine children with ASD were treated in a large private practice with the Resilience Builder Program® (RBP). Pre- and post-treatment questionnaires assessing social, emotional and behavioral functioning were collected.

Results

Youth with ASD showed clinically elevated or at-risk pre-treatment levels of multiple behavioral and emotional symptoms. Children showed improvements in emotional control as well as a reduction in aggression and autistic symptomatology following treatment.

Conclusions

This study highlights the importance of understanding heterogeneity in ASD and indicates that the RBP is a promising intervention to improve overall emotional and behavioral functioning in children with ASD in a clinical service environment.

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References

  • Aduen, P. A., Rich, B. A., Sanchez, L., Brien, K. O., & Alvord, M. K. (2014). Resilience Builder Program therapy addresses core social deficits and emotion dysregulation in youth with high-functioning autism spectrum disorder. Journal of Psychological Abnormalities in Children. doi:10.4172/2329-9525.1000118.

    Google Scholar 

  • Ahmedani, B. K., & Hock, R. M. (2012). Health care access and treatment for children with co-morbid autism and psychiatric conditions. Social Psychiatry and Psychiatric Epidemiology, 47(11), 1807–1814. doi:10.1007/s00127-012-0482.

    Article  PubMed  Google Scholar 

  • Alvord, M. A., Rich, B. A., & Berghorst, L. (2014). Developing social competence through a resilience model. In S. Prince-Embury & D. H. Saklofske (Eds.), Resilience interventions for youth in diverse populations (pp. 329–351).  New York: Springer Books. doi:10.1007/978-1-4939-0542-3_15.

  • Alvord, M. K., Rich, B. A., & Berghorst, L. H. (2016). Resilience interventions. In APA (Ed.), Handbook of clinical psychology: Psychopathology and health (Vol. 4) (Vol. 27, pp. 505–519). Washington: American Psychological Association. doi:10.1037/14862-023.

    Chapter  Google Scholar 

  • Alvord, M. K., Zucker, B., & Grados, J. J. (2011). Resilience Builder Program for children and adolescents: Enhancing social competence and self-regulation—A cognitive-behavioral group approach. Champaign, IL: Research Press.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. The British Journal of Psychiatry, 175(5), 444–451. doi:10.1192/bjp.175.5.444.

    Article  PubMed  Google Scholar 

  • Bruni, T. P. (2014). Test review: Social responsiveness scale-second edition (SRS-2). Journal of Psychoeducational Assessment, 32(4), 365–369. doi:10.1177/0734282913517525.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years. MMWR, 63(2), 1–21.

    Google Scholar 

  • Constantino, J. (2012). Social responsiveness scale (2nd ed.). Los Angeles, CA: Western Psychological Services.

  • Davis, N. O., & Kollins, S. H. (2012). Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics, 9(3), 518–530. doi:10.1007/s13311-012-0126-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Derosier, M. E., Swick, D. C., Davis, N. O., McMillen, J. S., & Matthews, R. (2011). The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 41(8), 1033–1043. doi:10.1007/s10803-010-1128-2.

    Article  PubMed  Google Scholar 

  • Ehrenreich-May, J., Southam-Gerow, M. A., Hourigan, S. E., Wright, L. R., Pincus, D. B., & Weisz, J. R. (2011). Characteristics of anxious and depressed youth seen in two different clinical contexts. Administration and Policy in Mental Health, 38(5), 398–411. doi:10.1007/s10488-010-0328-6.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., Devincent, C. J., & Drabick, D. A. G. (2008). Oppositional defiant disorder as a clinical phenotype in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(7), 1302–1310. doi:10.1007/s10803-007-0516-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gadow, K. D., DeVincent, C. J., & Schneider, J. (2009). Comparative study of children with ADHD only, autism spectrum disorder+ ADHD, and chronic multiple tic disorder+ ADHD. Journal of Attention Disorders, 12(5), 474–485. doi:10.1177/1087054708320404.

    Article  PubMed  Google Scholar 

  • Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: How far have we come in the comorbidity debate? Neuroscience and Biobehavioral Reviews, 35(5), 1081–1088. doi:10.1016/j.neubiorev.2010.11.002.

    Article  PubMed  Google Scholar 

  • Goldin, R. L., Matson, J. L., Konst, M. J., & Adams, H. L. (2014). A comparison of children and adolescents with ASD, atypical development, and typical development on the Behavioral Assessment System for Children, Second Edition (BASC-2). Research in Autism Spectrum Disorders, 8(8), 951–957. doi:10.1016/j.rasd.2014.04.005.

    Article  Google Scholar 

  • Guttmann-Steinmetz, S., Gadow, K. D., & Devincent, C. J. (2009). Oppositional defiant and conduct disorder behaviors in boys with autism spectrum disorder with and without attention-deficit hyperactivity disorder versus several comparison samples. Journal of Autism and Developmental Disorders, 39(7), 976–985. doi:10.1007/s10803-009-0706-7.

    Article  PubMed  Google Scholar 

  • Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., McCracken, J. T., et al. (2013). Exploring the manifestations of anxiety in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(10), 2341–2352. doi:10.1007/s10803-013-1775-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Insel, T. (2013). NIMH’s new focus in clinical trials. Retrieved from http://www.nimh.nih.gov/funding/grant-writing-and-application-process/concept-clearances/2013/nimhs-new-focus-in-clinical-trials.shtml

  • Jaccard, J., & Guilamo-Ramos, V. (2002). Analysis of variance frameworks in clinical child and adolescent psychology: Issues and recommendations. Journal of Clinical Child & Adolescent Psychology, 31(1), 130–146.

    Article  Google Scholar 

  • Kaat, A. J., Gadow, K. D., & Lecavalier, L. (2013). Psychiatric symptom impairment in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41(6), 959–969. doi:10.1007/s10802-013-9739-7.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. The American Psychologist, 63(3), 146–159. doi:10.1037/0003-066X.63.3.146.

    Article  PubMed  Google Scholar 

  • Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., et al. (2009). Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics, 124(5), 1395–1403. doi:10.1542/peds.2009-1522.

    Article  PubMed  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861. doi:10.1007/s10803-006-0123-0.

    Article  PubMed  Google Scholar 

  • Mahan, S., & Matson, J. L. (2011). Children and adolescents with autism spectrum disorders compared to typically developing controls on the Behavioral Assessment System for Children, Second Edition (BASC-2). Research in Autism Spectrum Disorders, 5(1), 119–125. doi:10.1016/j.rasd.2010.02.007.

    Article  Google Scholar 

  • Masten, A. S., & Wright, M. O. (2010). Resilience over the lifespan: Developmental perspective on resistence, recovery and transformation. In J. W. Reich, A. Zautra, & J. S. Hall (Eds.), Handbook of adult resilience (pp. 213–237). New York, NY: Guildford Press.

  • Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28(4), 341–352. doi:10.1016/j.ridd.2005.12.004.

    Article  PubMed  Google Scholar 

  • McConachie, H., McLaughlin, E., Grahame, V., Taylor, H., Honey, E., Tavernor, L., et al. (2013). Group therapy for anxiety in children with autism spectrum disorder. Autism: The International Journal of Research and Practice. doi:10.1177/1362361313488839

  • Miller, A., Vernon, T., Wu, V., & Russo, K. (2014). Social skill group interventions for adolescents with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders. doi:10.1007/s40489-014-0017-6.

    Google Scholar 

  • Montes, G., & Halterman, J. S. (2007). Bullying among children with autism and the influence of comorbidity with ADHD: A population-based study. Ambulatory Pediatrics, 7(3), 253–257. doi:10.1016/j.ambp.2007.02.003.

    Article  PubMed  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410–419.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reynolds, C. R., & Kamphaus, R. W. (2006). BASC-2: Behavior assessment system for children (2nd ed.). Upper Saddle River, NJ: Pearson Education Inc.

    Google Scholar 

  • Rich, B. A., Hensler, M., Rosen, H. R., Watson, C., Schmidt, J., Sanchez, L., et al. (2013). Attrition from therapy effectiveness research among youth in a clinical service setting. Administration and Policy In Mental Health. doi:10.1007/s10488-013-0469-5.

    Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA: Western Psychological Service.

    Google Scholar 

  • Settipani, C. A., Puleo, C. M., Conner, B. T., & Kendall, P. C. (2012). Characteristics and anxiety symptom presentation associated with autism spectrum traits in youth with anxiety disorders. Journal of Anxiety Disorders, 26(3), 459–467. doi:10.1016/j.janxdis.2012.01.010.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi:10.1097/CHI.0b013e318179964f.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(11), 1152–1160. doi:10.1111/j.1469-7610.2005.00411.x.

    Article  Google Scholar 

  • Southam-Gerow, M. A., Weisz, J. R., & Kendall, P. C. (2003). Youth with anxiety disorders in research and service clinics: Examining client differences and similarities. Journal of Clinical Child & Adolescent Psychology, 32, 3–38675.

    Article  Google Scholar 

  • Stichter, J. P., O’Connor, K. V., Herzog, M. J., Lierheimer, K., & McGhee, S. D. (2012). Social competence intervention for elementary students with Aspergers syndrome and high functioning autism. Journal of Autism and Developmental Disorders, 42(3), 354–366. doi:10.1007/s10803-011-1249-2.

    Article  PubMed  Google Scholar 

  • Sukhodolsky, D. G., Bloch, M. H., Panza, K. E., & Reichow, B. (2013). Cognitive-behavioral therapy for anxiety in children with high-functioning autism: A meta-analysis. Pediatrics, 132(5), e1341–e1350. doi:10.1542/peds.2013-1193.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128. doi:10.1007/s10802-007-9165-9.

    Article  PubMed  Google Scholar 

  • Tan, C. S. (2007). Test review: Behavior assessment system for children. Assessment for Effective Intervention, 32(2), 121–124. doi:10.1177/026553220101800207.

    Article  Google Scholar 

  • Thede, L. L., & Coolidge, F. L. (2007). Psychological and neurobehavioral comparisons of children with Asperger’s disorder versus high-functioning autism. Journal of Autism and Developmental Disorders, 37(5), 847–854. doi:10.1007/s10803-006-0212-0.

    Article  PubMed  Google Scholar 

  • Thomson, K., Burnham Riosa, P., & Weiss, J. (2015). Brief report of preliminary outcomes of an emotion regulation intervention for children with autism spectrum disorder. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-015-2446-1.

    PubMed  Google Scholar 

  • Volker, M. A., Lopata, C., Smerbeck, A. M., Knoll, V. A., Thomeer, M. L., Toomey, J. A., et al. (2010). BASC-2 PRS profiles for students with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(2), 188–199. doi:10.1007/s10803-009-0849-6.

    Article  PubMed  Google Scholar 

  • Walden, T. A., Harris, V. S., & Catron, T. F. (2003). How I feel: A self-report measure of emotional arousal and regulation for children. Psychological Assessment, 15(3), 399–412. doi:10.1037/1040-3590.15.3.399.

    Article  PubMed  Google Scholar 

  • Watson, C. C., Rich, B. A., Sanchez, L., O’Brien, K., & Alvord, M. K. (2014). Preliminary Study of Resilience-Based Group therapy for improving the functioning of anxious children. Child & Youth Care Forum, 43(3), 269–286.

    Article  Google Scholar 

  • Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. doi:10.1016/j.cpr.2009.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the children and families who participated in our study.

Author information

Authors and Affiliations

  1. Department of Psychology, The Catholic University of America, 331 O’Boyle Hall, 620 Michigan Ave, N.E., Washington, DC, 20064, USA

    Serene Habayeb & Brendan Rich

  2. Alvord, Baker & Associates, LLC, 3200 Tower Oaks Blvd, Suite 200, Rockville, MD, 20852, USA

    Mary K. Alvord

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  1. Serene Habayeb
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  2. Brendan Rich
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  3. Mary K. Alvord
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Correspondence to Serene Habayeb.

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Conflict of interest

Mary K. Alvord is a co-author of the “Resilience Builder Program for Children and Adolescents: Enhancing social competence and self-regulation: A Cognitive-Behavioral approach” she receives royalties from the sale of the book, published by Research Press. Brendan Rich declares that he has no conflict of interest. Serene Habayeb declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Habayeb, S., Rich, B. & Alvord, M.K. Targeting Heterogeneity and Comorbidity in Children with Autism Spectrum Disorder Through the Resilience Builder Group Therapy Program. Child Youth Care Forum 46, 539–557 (2017). https://doi.org/10.1007/s10566-017-9394-1

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