Acceptability and Effectiveness of Humor- and Play-Infused Exposure Therapy for Fears in Williams Syndrome

Klein-Tasman, Bonnie; Young, Brianna N.; Levine, Karen; Rivera, Kenia; Miecielica, Elizabeth J.; Yund, Brianna; French, Sydni E.

doi:10.1080/23794925.2021.1950080

Cited by 9 publications

(9 citation statements)

References 76 publications

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“…This could prove very important. Nevertheless, several intervention-based studies were published in recent years that successfully implemented positive elements such as play and humor to address fear and anxieties in children with WS ( 79 ) or that were able to increase the use of positive emotion regulation strategies including Focusing on the Positive in individuals with ASD ( 80 ).…”

Section: Discussionmentioning

confidence: 99%

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

Samson

Sokhn

Herwegen³

et al. 2022

Front. Psychiatry

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BackgroundIndividuals with neurodevelopmental disorders often have atypical emotion profiles, but little is known about how they regulate their emotions. While several studies have examined emotion regulation strategy use in autism spectrum disorder (ASD), only a few have included individuals with intellectual disability (ID) or focused on specific syndromes such as Williams syndrome (WS).MethodsA parent-reported survey launched during the first months of the COVID-19 pandemic allowed to exploratorily study emotion regulation strategy use and its link to anxiety in individuals with ASD with (N=785) and without ID (N=596), WS (N=261), and Intellectual Disability not otherwise specified (N=649).ResultsUsing multilevel analyses, besides revealing specific group differences in emotion regulation strategy use, a variety of strategies (e.g., rumination, avoiding information, repetitive behaviors) were found to be linked to elevated levels of anxiety, while focusing on the positive was linked to lower anxiety levels in all groups. Moreover, only autistic people without ID used humor more frequently while experiencing lower anxiety levels.ConclusionThis study sheds light on an underexplored area of emotion regulation strategy use in different neurodevelopmental disorders. It also paves the way to further examine emotion regulation in more rigorous ways to better understand emotion regulation in different neurodevelopmental disorders as well as the impact on outcome measures such as anxiety. This exploratory study may help to develop and validate adequate measures to study a broad array of ER strategies used by individuals with neurodevelopmental disorders.

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Section: Discussionmentioning

confidence: 99%

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

Samson

Sokhn

Herwegen³

et al. 2022

Front. Psychiatry

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“…Participants were recruited through the Williams Syndrome Association's research registry as well as referrals from the PI of a largescale study of the cognitive and behavioral phenotype in Williams syndrome. Participants included four children with Williams syndrome who initially had high levels of anxiety and then showed reduced fear and anxiety based on parent and/or clinician report in our preliminary work (Klein-Tasman et al, 2022 ). Participants range from 4 to 9 years of age and include three boys and 1 girl.…”

Section: Methodsmentioning

confidence: 99%

“…Leveraging the socially motivated tendencies of individuals with Williams syndrome (Mervis et al, 2001 ) by using social, adult–child play and humor in the context of a behavioral intervention may be useful to treat anxiety in children with Williams syndrome. We are engaged in a research program to examine the impact of play- and humor-infused exposure therapy on fears in children ages 4 through 10 with Williams syndrome and have described preliminary evidence of the utility of this approach (Klein-Tasman et al, 2022 ). The approach used is based in well-established graduated exposure (APA Division 12 Society of Clinical Psychology, 2022 ), uses functional behavior assessment to tailor treatment (Davis et al, 2009 ), and is informed by client-directed principles of outcome-informed therapy (Duncan and Miller, 2000 ).…”

Section: Introductionmentioning

confidence: 99%

“…The current study employs behavioral coding to examine patterns of therapist use of graduated exposure and systematic desensitization using play and humor, and child anxiety behaviors in a subset of children with Williams syndrome who showed a positive response to the brief intervention in the pilot study (Klein-Tasman et al, 2022 ). For the purposes of this study, fear was operationally defined as observable child behaviors that indicated the child was experiencing emotional and/or physiological responses reflecting reluctance to engage with or an aversion to the stimulus.…”

Section: Introductionmentioning

confidence: 99%

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Addressing fears of children with Williams syndrome: therapist and child behavior in the context of a novel play-and humor-infused exposure therapy approach

Young,

Mohanty,

Levine

et al. 2023

Front. Psychol.

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Many children with Williams syndrome struggle with fears and phobias that significantly impact their daily lives. Yet, there is sparse literature about the impact of behavioral interventions to treat anxiety and phobias among children with Williams syndrome. Using observational coding of intervention videos, the current study examines patterns of the therapist's use of play and humor and relations to child behavioral responses for four children with Williams syndrome who were identified as treatment responders to humor- and play-infused exposure therapy for fears and anxieties. Sessions were coded for therapist behaviors (exposure with or without play/humor, stimulus type used during exposure, passive or invited attention to feared stimulus, and spontaneous parent participation in exposure) as well as positive, negative, and neutral child behaviors (verbalizations and behaviors). Temporal patterns between therapist and child behaviors were analyzed using lag sequential analyses. The results showed that tolerance of feared stimuli improved for two of the four children following this play- and humor-infused exposure therapy approach, and the remaining two participants demonstrated progress beyond tolerating the feared stimulus and showed increased positive behaviors with the feared stimulus across sessions. Findings also showed patterns of therapist attunement to the child's anxiety level demonstrated through efforts to flexibly adjust the degrees of exposure. Therapist-initiated invited attention behaviors, indicative of the therapist's use of narration and priming, were associated with child tolerance and positive behaviors during exposure to the feared stimulus. Limitations of this study include a very small sample size, short duration of intervention, and a single-subject research design, which limit the generalizability of findings. Implications and future directions of this research are discussed.

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“…The first analyzed videos of play and humor-infused exposure therapy sessions to address fears and phobias in four children with Williams syndrome (ages 4–9 years) to validate the previously published initial effectiveness of the intervention [25 ▪ ]. Previous work by this group utilized clinical rating scales to demonstrate the clinical utility of play and humor-based exposure therapy in children with Williams syndrome [27]. Systematically coded videos of the therapy sessions demonstrated that all four children demonstrated increased tolerance of the feared stimulus (i.e.…”

Section: Recent Findingsmentioning

confidence: 99%

Psychiatric and behavioral manifestations of Williams syndrome

Thom

2023

Current Opinion in Psychiatry

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Purpose of review The purpose of this review is to synthesize recent advances in the psychiatric and behavioral manifestations of Williams syndrome, a rare genetic syndrome. Recent advances have focused on more deeply characterizing the social phenotype and developing social skill interventions, improving the assessment and treatment of anxiety, and exploring eating behaviors. Recent findings The social cognitive phenotype in Williams syndrome, which consists of both high social drive and social cognition deficits, is present cross-culturally and may be related to reduced eye gaze. Social skills training for adults with Williams syndrome has demonstrated promise. Adapted exposure therapy and cognitive behavioral therapy programs for children and adults respectively, have been piloted in Williams syndrome. The majority of adults with Williams syndrome are either underweight or overweight, and problematic food-related behaviors likely contribute to bodyweight status. Summary Williams syndrome is associated with a number of core social and psychiatric difficulties which have a significant impact on functioning and quality of life. Recent work has begun to utilize a more nuanced understanding of the clinical presentations of these problems to develop interventions tailored to this unique population. However, larger trials, particularly those inclusive of a more diverse Williams syndrome population, are needed.

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Acceptability and Effectiveness of Humor- and Play-Infused Exposure Therapy for Fears in Williams Syndrome

Cited by 9 publications

References 76 publications

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

Addressing fears of children with Williams syndrome: therapist and child behavior in the context of a novel play-and humor-infused exposure therapy approach

Psychiatric and behavioral manifestations of Williams syndrome

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