A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes

Dickson, Kelsey S.; Lind, Teresa; Jobin, Allison; Kinnear, Mikaela; Lok, Ho; Brookman‐Frazee, Lauren

doi:10.1007/s10488-021-01133-7

Cited by 18 publications

(16 citation statements)

References 148 publications

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“…That said, a number of clients struggle to access mental health services as a result of not fitting neatly within the guidelines of a typical target population or even within the population parameters of an EBP due to symptom severity or psychological co-morbidities (e.g. Camm-Crosbie et al, 2019;Dickson et al, 2021;Tint and Weiss, 2018). This is particularly true of adults with autism spectrum disorder (ASD), an area in which many mental health clinicians receive little to no training and, as a result, are less likely to accept adults on the spectrum as therapy clients (Crane et al, 2019;Maddox et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A pilot study of dialectical behaviour therapy skills training for autistic adults

Ritschel

Guy

Maddox

2021

Behav. Cogn. Psychother.

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Background: Autism spectrum disorder (ASD) is a common and lifelong neurodevelopmental disorder with the hallmark features of social impairment and restricted and repetitive patterns of behaviour. Individuals with ASD often experience co-occurring mental health difficulties, some of which may obfuscate the ASD features themselves. Although there is a high need for mental health services for autistic adults, there are surprisingly few evidence-based treatments (EBTs) available; moreover, many mental health practitioners who are well-trained in EBTs shy away from treating autistic individuals due to lack of training in ASD. Aims: The aim of the current study was to evaluate the feasibility and acceptability of dialectical behaviour therapy skills training (DBT-ST) in a sample of autistic adults without intellectual disability. Method: Sixteen adults with ASD were recruited from a treatment waiting list to enrol in this study, which included 24 weeks of DBT-ST delivered in a group setting. Feasibility and acceptability were assessed using retention and attendance data and a participant satisfaction questionnaire. Results: Retention (81.3%) and attendance data (mean 87.5%) provided support for the feasibility of this intervention. Overall satisfaction ratings were high (mean 4.5 out of 5), and participants reported that they felt that DBT-ST would probably be helpful for others with ASD (mean 4.5 out of 5). Conclusions: The study findings provide preliminary evidence of (1) the feasibility of providing DBT-ST for autistic adults in community-based clinics, and (2) the perceived benefit of DBT-ST for this under-served population. Recommended modifications to the standard DBT-ST materials are discussed.

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Section: Introductionmentioning

confidence: 99%

A pilot study of dialectical behaviour therapy skills training for autistic adults

Ritschel

Guy

Maddox

2021

Behav. Cogn. Psychother.

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“…The current project was part of a larger systematic review characterizing interventions tested for co-occurring mental health conditions in autistic youth, including necessary adaptations for use with this population (see Dickson et al, 2021). No community is involved in this study.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of co-occurring mental health conditions confers vulnerability to greater functional impairment and worse outcomes across the lifespan (Cadman et al, 2012; Factor et al, 2017). There has been a prolific growth in research developing, adapting, and testing mental health interventions for autism spectrum disorder (ASD) over the past two decades, resulting in numerous evidence-based interventions (EBIs) targeting co-occurring mental health problems in autistic youth (Dickson et al, 2021). Several recent narrative and systematic reviews denote the beneficial effects of these EBIs (Keefer et al, 2018; Weston et al, 2016).…”

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confidence: 99%

Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder

Dickson

Galligan

Lok

2021

Autism

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There have been significant efforts to develop, adapt, and test interventions targeting the co-occurring mental health conditions common among autistic youth, with several extant narrative and systematic reviews demonstrating the efficacy of these interventions. Yet, a methodological analysis of the literature testing these interventions, particularly the characteristics of the participant samples comprising this evidence base, is needed to contextualize our current understanding of treatment effects and highlight current gaps in the current evidence base to inform future research. This systematic quantitative methodology review characterized participants included in the mental health treatment research for autistic youth. One hundred and thirty-one articles testing mental health interventions for autism spectrum disorder were coded for youth, caregiver, and provider participant demographics. Findings indicated limited representation of females, transition age youth, racial/ethnic minority groups, and youth diverse in cognitive functioning and co-occurring mental health symptoms or conditions. Limited inclusion of providers’ representative of the clinical workforce was also noted. These results illuminate several critical gaps in the current evidence base for mental health interventions for autistic youth and provide recommendations for future research directions. Lay abstract Previous research has highlighted the importance of mental health treatment for autistic youth. In that research base, most studies focus on demonstrating the efficacy of a particular intervention with a sample of autistic youth. However, understanding the characteristics of samples used within these studies (i.e. demographics) is an important avenue for expanding this research to a more diverse, representative sample of autistic youth in community settings. As such, the current review examined and characterized participants included within mental health treatment research. We coded studies for various demographics among the youth sample, caregivers, and providers participants. Results indicated that while efforts have been made to increase diversity in research, very few studies including transition-aged youth, those identifying as female, and/or those identifying as non-Caucasian. Clinically, a few studies included youth with lower cognitive abilities and/or those with specific mental health problems (e.g. trauma and depression) or more than one co-occurring mental health conditions. Overall, our results highlight several critical gaps in our current evidence base regarding mental health treatment for autistic youth, including the limited clinical representativeness of both provider and child participants.

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“…Implementation outcomes are important to consider as they are a necessary precondition for clinical or treatment outcomes (Proctor et al, 2011). This framework has been successfully applied to interventions for autism within public schools (Locke et al, 2016) as well as mental health interventions used with individuals with autism (Dickson et al, 2021). The Proctor and colleagues (2011) taxonomy specifies eight distinct outcomes: (1) acceptability (satisfaction); (2) adoption (intervention use or intention to try); (3) appropriateness (intervention relevance or usefulness); (4) feasibility (or intervention fit or utility); (5) fidelity (adherence and delivery quality); (6) implementation cost (cost-benefit and cost-effectiveness); (7) penetration (proportion of clients with whom the intervention is used); and (8) sustainability (continued use and routinization).…”

Section: Implementation Outcomes Frameworkmentioning

confidence: 99%

Provider perspectives and reach of an evidence-based intervention in community services for toddlers

Rieth

Dickson

Ko³

et al. 2022

Autism

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Best-practice recommendations for young children at high likelihood of autism include active involvement of caregivers in intervention. However, the use of evidence-based parent-mediated interventions in community practice remains limited. Preliminary evidence suggests that Project ImPACT for Toddlers demonstrates positive parent and child outcomes in community settings. Project ImPACT for Toddlers was adapted specifically for toddlers and teaches parents of young children strategies to build their child’s social, communication, and play skills in daily routines. This study reports implementation outcomes from the initial community rollout of Project ImPACT for Toddlers and examines the system-wide intervention reach, with the goal of informing continued community sustainment and scale-up. Participants include 38 community providers who participated in a Project ImPACT for Toddlers’ training study who completed an implementation survey and semi-structured interviews after approximately 3 months of community implementation. Participants perceived the training model as acceptable and appropriate, and identified several strengths of the approach. Interview themes also supported the feasibility, acceptability, and utility of the intervention in community settings. Quantitative findings complemented the thematic results from interviews. Intervention reach data indicate an increasing number of agencies delivering and families receiving Project ImPACT for Toddlers. Efforts to scale-up evidence-based interventions in early intervention should continue to build upon the model of the Bond, Regulate, Interact, Develop, Guide, and Engage Collaborative. Lay abstract Expert recommendations for toddlers who are likely to develop autism include caregivers being actively involved in the services children receive. However, many services available in the community may not follow these recommendations. Evidence suggests that an intervention named Project ImPACT for Toddlers demonstrates positive parent and child outcomes for families in the community. Project ImPACT for Toddlers was designed specifically for toddlers by a group of parents, clinicians, researchers, and funders. It teaches parents of young children strategies to support their child’s development in daily routines. This study reports the perspectives of early intervention providers who learned to use Project ImPACT for Toddlers on whether the intervention was a good fit for their practice and easy to use. The study also examines how many agencies are using Project ImPACT for Toddlers and how many families have received the intervention in the community. The goal of the study is to inform the continued use of Project ImPACT for Toddlers in the community and support offering the intervention in other regions. Participants include 38 community providers who participated in a training study of Project ImPACT for Toddlers and completed a survey and semi-structured interview after approximately 3 months of using Project ImPACT for Toddlers with families. Participants perceived the training model as acceptable and appropriate, and identified the group-based model of training, comprehensive materials, and agency support as strengths of the approach. Survey findings complemented the results from the interviews. Data indicate an increasing number of agencies and families accessing Project ImPACT for Toddlers. Efforts to expand evidence-based intervention in early intervention should continue to build upon the model used for Project ImPACT for Toddlers.

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A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes

Cited by 18 publications

References 148 publications

A pilot study of dialectical behaviour therapy skills training for autistic adults

A pilot study of dialectical behaviour therapy skills training for autistic adults

Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder

Provider perspectives and reach of an evidence-based intervention in community services for toddlers

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