Publications by authors named "Ailsa Russell"

40 Publications

To What Extent Can Digitally-Mediated Team Communication in Children's Physical Health and Mental Health Services Bring about Improved Outcomes? A Systematic Review.

Child Psychiatry Hum Dev 2021 May 8. Epub 2021 May 8.

Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.

Digital communication technologies can be used for team consultation, case management, and information sharing in health and mental health services for children and young people (CYP). The objective of the systematic review was to investigate the evidence as to whether digitally-mediated team communication for CYP improves outcomes. We searched PsycINFO, PubMed, Web of Science, and Cochrane Library for relevant studies. Results were synthesised narratively. Seven studies were identified from 439 initial records. Analysis highlighted that digitally-mediated team communication is generally valued by professionals for supporting practice and that there is overall satisfaction with the process. There was preliminary evidence (from one study) that clinical outcomes from digitally-mediated team communication are comparable to those achieved by a collaborative service model with direct specialist care to service users via digital communication technology. There is a need for further high-quality research into clinical outcomes and service user experience, as well as financial implications.
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http://dx.doi.org/10.1007/s10578-021-01183-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105145PMC
May 2021

Understanding the role of self-determination in shaping university experiences for autistic and typically developing students in the United Kingdom.

Autism 2021 Feb 3:1362361320984897. Epub 2021 Feb 3.

Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK.

Lay Abstract: Prior research suggests that autistic students in higher education might struggle with developing autonomy, competence and establish relatedness due to their executive functioning and social communication difficulties. We interviewed 18 autistic and 18 typically developing students to explore how students perceived themselves to be in control of their university experience. Both groups provided anecdotal examples that supported similar perceptions of self-determination in shaping the academic, daily living and socialisation aspects of university life. Autistic students reflected on their cognitive strengths such as attention to detail, persistence and ability to tailor their academic studies towards their interest. Varying degrees of sociability were noted, with some autistic students preferring to focus their self-determination efforts on academic success, while others treasured the novel social experiences including peer support and friendship at university. Compared to greater flexibility endorsed by typically developing students, autistic students perceived establishing a routine at university to be a necessity and were self-determined in maintaining stability amid a sea of change. Recognising strengths and self-determination efforts in autistic students can help stakeholders support their personal development towards independent living and self-sufficiency in adulthood and to successfully transition and of university.
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http://dx.doi.org/10.1177/1362361320984897DOI Listing
February 2021

The relationship between adverse interpersonal experiences and self-esteem in people with intellectual disabilities: The role of shame, self-compassion and social support.

J Appl Res Intellect Disabil 2020 Dec 10. Epub 2020 Dec 10.

Learning Disabilities Service, 2Gether NHS Foundation Trust, Gloucester, UK.

Background: People with intellectual disabilities are reported to have low self-esteem and to experience high rates of adverse interpersonal experiences (AIEs). This study aimed to investigate whether shame and self-compassion mediate the relationship between AIEs and self-esteem for people with intellectual disabilities and whether perceived social support moderates this relationship.

Method: This study employed a cross-sectional design, involving between-group comparisons. Forty-seven people with intellectual disabilities and 50 people without intellectual disabilities completed self-report questionnaires measuring shame, self-compassion, self-esteem, early AIEs and social support.

Results: Shame and self-compassion were found to mediate the relationship between AIEs and self-esteem for people with intellectual disabilities. There was no evidence for a moderating effect of social support and no difference between groups in shame or self-compassion.

Conclusions: The findings suggest shame and self-compassion are important concepts for people with intellectual disabilities. Clinical and research implications are discussed.
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http://dx.doi.org/10.1111/jar.12844DOI Listing
December 2020

An Evaluation of a New Autism-Adapted Cognitive Behaviour Therapy Manual for Adolescents with Obsessive-Compulsive Disorder.

Child Psychiatry Hum Dev 2020 Oct 6. Epub 2020 Oct 6.

OCD, BDD and Related Disorders Clinic, South London and Maudsley NHS Trust, Michael Rutter Centre, De Crespigny Park, London, SE5 8AZ, UK.

Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) frequently co-occur. Standard cognitive behaviour therapy (CBT) for OCD outcomes are poorer in young people with ASD, compared to those without. The aim of this naturalistic study was to evaluate the effectiveness of a novel adolescent autism-adapted CBT manual for OCD in a specialist clinical setting. Additionally, we examined whether treatment gains were maintained at 3-month follow-up. Thirty-four adolescents underwent CBT; at the end of treatment, 51.51% were treatment responders and 21.21% were in remission. At 3-month follow-up, 52.94% were responders and 35.29% remitters. Significant improvements were also observed on a range of secondary measures, including family accommodation and global functioning. This study indicates this adapted package of CBT is associated with significant improvements in OCD outcomes, with superior outcomes to those reported in previous studies. Further investigation of the generalizability of these results, as well as dissemination to different settings, is warranted.
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http://dx.doi.org/10.1007/s10578-020-01066-6DOI Listing
October 2020

I Have a Fear of Negative Evaluation, Get Me Out of Here! Examining Latent Constructs of Social Anxiety and Autistic Traits in Neurotypical and Autistic Young People.

J Autism Dev Disord 2021 May;51(5):1729-1747

Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK.

Understanding shared and unique constructs underlying social communication difficulties in autism spectrum disorder (ASD) and social anxiety disorder (SAD) can address potential diagnostic overshadowing when evaluating SAD in the context of autism. Using self-report measures, factor analyses examined constructs underlying autistic traits, social anxiety, internalising symptoms and wellbeing amongst 267 neurotypical (17-19 years) and 145 autistic (15-22 years) students in the UK. Shared constructs across measures assessed general social communication competency (e.g., social distress in new situations and peer relationships). Fear of Negative Evaluation (FNE) was identified in both samples as a stable construct unique to social anxiety. Adapting interventions targeting SAD in autism should target FNE during adolescence which marks a period of heightened peer interaction and social vulnerability.
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http://dx.doi.org/10.1007/s10803-020-04657-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084828PMC
May 2021

The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis.

Clin Psychol Rev 2020 08 11;80:101875. Epub 2020 Jun 11.

Department of Psychology, University of Bath, BA2 7AY, UK.

Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia.
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http://dx.doi.org/10.1016/j.cpr.2020.101875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441311PMC
August 2020

"I'm Proud to be a Little Bit Different": The Effects of Autistic Individuals' Perceptions of Autism and Autism Social Identity on Their Collective Self-esteem.

J Autism Dev Disord 2021 Feb;51(2):704-714

Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.

This study aimed to identify the attributes that autistic people perceive as positively and negatively impacting on their identity and wellbeing. In Study 1, we recruited 140 autistic participants for an online survey. Participants completed autism social identification and collective self-esteem measures and listed attributes they associated with autism. In Study 2, we conducted focus groups with 15 autistic people to explore how positively they perceived the attributes of autism. Participants then discussed the autism attributes in relation to their own experiences and identity. We found a positive relationship between the number of positive attributes participants associated with autism, and their collective self-esteem, to the extent that they identified with other autistic people.
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http://dx.doi.org/10.1007/s10803-020-04575-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835309PMC
February 2021

What Are the Peer Interaction Strengths and Difficulties in Children with Developmental Language Disorder? A Systematic Review.

Int J Environ Res Public Health 2020 04 30;17(9). Epub 2020 Apr 30.

Department of Psychology, University of Bath, Bath BA2 7AY, UK.

The current review gathers together research investigating peer interaction skills in children with Developmental Language Disorder (DLD) to give an overview of the strengths and challenges experienced by these children when interacting with other children. A systematic review was conducted to summarise the literature on peer interaction strengths and difficulties in children with DLD. No restrictions on time-period were made and the selection criteria accounted for many of the diagnostic labels previously used to refer to DLD. Studies included in this review involve English-speaking children of UK primary school age (4-11 years). A systematic search of databases identified 28 papers that met the inclusion criteria. Children with DLD are found to experience many challenges when interacting with peers. Difficulties have been found in studies exploring discourse characteristics such as turn-taking and in behaviours during play, such as access behaviours. Heterogeneity was however notable and peer interaction strengths are found in terms of the children's abilities to make friends, use verbal and non-verbal behaviour to make joint decisions with peers, and abilities to engage with peers in social pretend play. While it is encouraging to find research exploring many different areas of peer interaction competence in children with DLD, the research is highly disparate and there are many research findings awaiting replication. The current evidence base is unable to comprehensively define the characteristics of peer interactions of children with DLD.
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http://dx.doi.org/10.3390/ijerph17093140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246450PMC
April 2020

Evaluating the Role of Autistic Traits, Social Anxiety, and Social Network Changes During Transition to First Year of University in Typically Developing Students and Students on the Autism Spectrum.

J Autism Dev Disord 2020 Aug;50(8):2832-2851

Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.

This is the first longitudinal study to quantitatively evaluate changes in social network structure (SNS) and perceived social support (PSS) amongst first-year students on the autism spectrum (n = 21) and typically developing (TD; n = 182) students transitioning to university. The relative impact of changes in SNS/PSS, students' social anxiety and autistic traits, on first-year university transition outcomes were also examined. Both groups gained friends over time who provided better support quantity and quality during first year of university. Social anxiety showed long-term differential negative impact on students on the autism spectrum and TD students' academic, social and personal/emotional adjustments, and institutional attachment, suggesting stakeholders should focus on delivering interventions to reduce social anxiety to improve university transition outcomes.
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http://dx.doi.org/10.1007/s10803-020-04391-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374465PMC
August 2020

Guided self-help for depression in autistic adults: the ADEPT feasibility RCT.

Health Technol Assess 2019 12;23(68):1-94

Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Background: Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive-behavioural therapy for depression. To the authors' knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive-behavioural therapy for depression in autism.

Objectives: The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial.

Design: The study comprised a randomised controlled trial ( = 70) with a nested qualitative evaluation ( = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual.

Setting: Adult autism services in two NHS regions.

Participants: Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive-behavioural therapy in the previous 6 months were excluded.

Interventions: The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression.

Main Outcome Measures: Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive-compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori.

Results: The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses.

Conclusions: The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted.

Future Work: Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure.

Trial Registration: Current Controlled Trials ISRCTN54650760.

Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
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http://dx.doi.org/10.3310/hta23680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943380PMC
December 2019

Differences in anxieties and social networks in a group-matched sample of autistic and typically developing students transitioning to university.

Autism 2020 07 19;24(5):1138-1151. Epub 2019 Dec 19.

University of Bath, UK.

Transitioning to university can be anxiety-provoking for all students. The relationship between social anxiety, autistic traits and students' social network structure, and perceived support is poorly understood. This study used a group-matched design where autistic students ( = 28) and typically developing students ( = 28) were matched on sex, age (17-19 years), ethnicity, pre-university academic performance and degree subject at university. Autistic students reported greater transition to university worries, and a smaller social network size compared to typically developing students, though perceived similar levels of support from their social networks. Autistic and typically developing students showed differential patterns of association with both autistic traits and social anxiety. Broader clinical and practical implications of findings are discussed.
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http://dx.doi.org/10.1177/1362361319894830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433695PMC
July 2020

The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) - a pilot randomised controlled trial.

Autism 2020 08 29;24(6):1360-1372. Epub 2019 Nov 29.

University of Bristol, UK.

Low-intensity cognitive behaviour therapy including behavioural activation is an evidence-based treatment for depression, a condition frequently co-occurring with autism. The feasibility of adapting low-intensity cognitive behaviour therapy for depression to meet the needs of autistic adults via a randomised controlled trial was investigated. The adapted intervention (guided self-help) comprised materials for nine individual sessions with a low-intensity psychological therapist. Autistic adults (n = 70) with depression (Patient Health Questionnaire-9 score ⩾10) recruited from National Health Service adult autism services and research cohorts were randomly allocated to guided self-help or treatment as usual. Outcomes at 10-, 16- and 24-weeks post-randomisation were blind to treatment group. Rates of retention in the study differed by treatment group with more participants attending follow-up in the guided self-help group than treatment as usual. The adapted intervention was well-received, 86% (n = 30/35) of participants attended the pre-defined 'dose' of five sessions of treatment and 71% (25/35) attended all treatment sessions. The findings of this pilot randomised controlled trial indicate that low-intensity cognitive behaviour therapy informed by behavioural activation can be successfully adapted to meet the needs of autistic people. Evaluation of the effectiveness of this intervention in a full scale randomised controlled trial is now warranted.
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http://dx.doi.org/10.1177/1362361319889272DOI Listing
August 2020

Executive Function: Cognition and Behaviour in Adults with Autism Spectrum Disorders (ASD).

J Autism Dev Disord 2019 Oct;49(10):4181-4192

Department of Psychology, University of Bath, Bath, BA2 7AY, UK.

Studies of executive function (EF) in autism spectrum disorder (ASD) have reported mixed findings. Possible confounds include EF domain assessed and co-occurring neurodevelopmental diagnoses. EF task performance across multiple domains and everyday function of autistic adults (n = 110) was significantly different to age- and IQ-matched controls (n = 31). Although significantly more likely to fall into the clinically impaired range, 35.8% of the ASD group showed no impairment on EF measures. Factor analysis revealed a single unifying EF construct rather than a selective pattern of impairment. Dysexecutive behaviours were frequently reported in the ASD group, unrelated to Autism symptoms, EF task performance or co-occurring conditions. This study suggests autistic adults can experience clinically significant executive function difficulties and co-occuring dysexecutive behaviours that are disabling in everyday life.
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http://dx.doi.org/10.1007/s10803-019-04133-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751156PMC
October 2019

Is There a Relationship Between Cyber-Dependent Crime, Autistic-Like Traits and Autism?

J Autism Dev Disord 2019 Oct;49(10):4159-4169

Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, BA2 7AY, UK.

International law enforcement agencies have reported an apparent preponderance of autistic individuals amongst perpetrators of cyber-dependent crimes, such as hacking or spreading malware (Ledingham and Mills in Adv Autism 1:1-10, 2015). However, no empirical evidence exists to support such a relationship. This is the first study to empirically explore potential relationships between cyber-dependent crime and autism, autistic-like traits, explicit social cognition and perceived interpersonal support. Participants were 290 internet users, 23 of whom self-reported being autistic, who completed an anonymous online survey. Increased risk of committing cyber-dependent crime was associated with higher autistic-like traits. A diagnosis of autism was associated with a decreased risk of committing cyber-dependent crime. Around 40% of the association between autistic-like traits and cyber-dependent crime was mediated by advanced digital skills.
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http://dx.doi.org/10.1007/s10803-019-04119-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751221PMC
October 2019

Self-reported motivations for offending by autistic sexual offenders.

Autism 2020 02 28;24(2):307-320. Epub 2019 Jun 28.

University of Bath, UK.

Autism spectrum disorder is a neurodevelopmental disorder estimated to have elevated prevalence in forensic populations (approximately 4.5%). It has been suggested that offenders with autism spectrum disorder engage more frequently in crimes against the person and sexual offences than other types of offences such as property, driving and drug offences. To date little is empirically known about the reasons why autistic individuals engage in sexual offences, yet understanding the motivation(s) for offending are key to developing and implementing effective interventions to help reduce both initial offending and also re-offending. In this study, semi-structured interviews were conducted with nine autistic sexual offenders in prisons and probation services across England and Wales. Thematic analyses revealed five main themes (social difficulties, misunderstanding, sex and relationship deficits, inadequate control and disequilibrium). Analyses indicated that social skills difficulties, lack of perspective/weak central coherence, misunderstanding the seriousness of their behaviours and a lack of appropriate relationships were the main reasons for offending reported by this group of autistic sexual offenders. Findings highlight a need to develop sex and relationship education interventions which are tailored to the needs of autistic individuals, to address both their reported reasons for offending and their reported lack of sexual knowledge and awareness.
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http://dx.doi.org/10.1177/1362361319858860DOI Listing
February 2020

Adapted cognitive behavior therapy for obsessive-compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study.

Autism 2020 01 12;24(1):190-199. Epub 2019 Jun 12.

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Obsessive-compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive-compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale-Brown Obsessive-Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive-compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive-compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
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http://dx.doi.org/10.1177/1362361319856974DOI Listing
January 2020

Developing an Online Tool to Measure Social Network Structure and Perceived Social Support Amongst Autistic Students in Higher Education: A Feasibility Study.

J Autism Dev Disord 2019 Sep;49(9):3526-3542

Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, BA2 7AY, Bath, UK.

The academic, daily-living, and social challenges all students face during university transition can become magnified for many autistic students, who might struggle to adapt to changes in their social network structure (SNS) and perceived social support (PSS). This study assessed the development, feasibility, and convergent validity of a novel online tool (Social Network and Perceived Social Support-SNaPSS) designed to quantitatively and qualitatively evaluate SNS and PSS during university transition. SNaPSS demonstrated good feasibility for completion amongst autistic students (Study 1, n = 10, 17-19 years), and adequate convergent validity against other PSS, autism symptom severity, and social anxiety measures amongst autistic (n = 28) and typically developing students (Study 2, n = 112, 17-19 years). Broader implications of SNaPSS to measure SNS/PSS are discussed.
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http://dx.doi.org/10.1007/s10803-019-04070-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667418PMC
September 2019

Autism and the transition to university from the student perspective.

Autism 2019 08 22;23(6):1531-1541. Epub 2018 Dec 22.

2 University of Bath, UK.

University provides individuals with the opportunity to develop greater independence in living skills and social networks, while also gaining valuable qualifications. Despite a high proportion of autistic individuals aspiring to attend university, many either do not seek or gain entry or drop out prematurely. Although some steps have been taken to develop effective support, a recent review highlighted the scarcity of research into programmes designed to support autistic students transitioning to university. In addition, few studies have examined the views of autistic students themselves. This study investigated the perspectives of autistic students transitioning to university. Three focus groups were conducted with 25 autistic students preparing to start university. Participants were asked about their hopes for starting university, as well as their worries and concerns. Data were analysed using thematic analysis, from which five main themes were identified: and . The results provide an important account of the challenges autistic students face when transitioning to university, as well as their aspirations. These findings have a number of practical implications.
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http://dx.doi.org/10.1177/1362361318803935DOI Listing
August 2019

Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder.

J Autism Dev Disord 2020 Jul;50(7):2397-2411

Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.

Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16-19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students' quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.
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http://dx.doi.org/10.1007/s10803-018-3776-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308263PMC
July 2020

Compliance in autism: Self-report in action.

Autism 2019 05 31;23(4):1005-1017. Epub 2018 Aug 31.

2 University of Bath, UK.

Previous research indicates that autistic individuals are more likely to be bullied, and that they experience heightened anxiety and diminished self-esteem. These factors are known to predict heightened compliance, which is the tendency to agree with or carry out the requests and demands of others. This has a range of potentially serious consequences, particularly for an autistic person. This study utilised self-report (the Gudjonsson Compliance Scale) and behavioural measures of compliance (the door-in-the-face task) with 26 autistic and 26 typically developing adults. Participants also completed measures of early life bullying experiences, anxiety and self-esteem. Autistic participants were more compliant on both self-report and experimental tasks, and they reported more bullying experiences, higher anxiety and reduced self-esteem. Looking at both groups, bullying, anxiety and self-esteem were all correlated with self-reported compliance on the Gudjonsson Compliance Scale, yet only self-esteem was a unique predictor. None of these predictor variables related to behavioural compliance on the door in the face; nor did Gudjonsson Compliance Scale scores predict door-in-the-face performance, which may be better explained by situational and motivational factors. Findings have important implications for a range of real-life settings including requests made in the context of research, schools, the criminal justice system and the workplace.
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http://dx.doi.org/10.1177/1362361318795479DOI Listing
May 2019

Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups.

J Autism Dev Disord 2018 Dec;48(12):3995-4006

Centre for Applied Autism Research, Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.

High rates of gender variance have been reported in autistic people, with higher variance in autistic females than males. The social component of gender identity may be affected, with autistic females experiencing lower identification with and feeling less positively about their gender groups than controls. We measured gender identification, gender self-esteem, and aspects of gender expression (masculinity and femininity) in autistic natal males and females, and controls (N = 486). We found that autistic people had lower gender identification and gender self-esteem than controls, and autistic natal females had lower gender identification than autistic natal males and natal female controls. In conclusion, autistic people, particularly natal females, had lower social identification with and more negative feelings about a gender group.
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http://dx.doi.org/10.1007/s10803-018-3590-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223803PMC
December 2018

Protocol for a feasibility study and randomised pilot trial of a low-intensity psychological intervention for depression in adults with autism: the Autism Depression Trial (ADEPT).

BMJ Open 2017 Dec 3;7(12):e019545. Epub 2017 Dec 3.

Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Introduction: High rates of co-occurring depression are reported in autism spectrum disorder (ASD), a neurodevelopmental condition characterised by social communication impairments and repetitive behaviours. Cognitive-behavioural interventions adapted for ASD have been effective for anxiety problems. There have been evaluation studies of group cognitive-behavioural therapy for co-occurring depression, but no randomised trials investigating low-intensity psychological interventions as recommended in clinical guidelines for mild-moderate depression.

Methods And Analysis: A feasibility study comprising a randomised controlled trial (RCT) and nested qualitative evaluation is under way as preparation for a definitive RCT. Participants (n=70) will be randomised to Guided Self-Help: a low-intensity psychological intervention based on behavioural activation adapted for ASD or treatment as usual. Outcomes including depression symptoms, anxiety, social function and service use will be measured at 10, 16 and 24 weeks postrandomisation and will be blind to group allocation for measures that are not self-administered. The analysis will aim to establish the rates of recruitment and retention for a larger-scale RCT as well as the most appropriate measure of depression to serve as primary outcome. The qualitative study will purposively sample up to 24 participants from each treatment group to consider the acceptability and feasibility of the intervention and the trial design.

Ethics And Dissemination: Ethical approval has been received from WALES REC 3 (IRAS project ID: 191558) and the Health Research Authority with R&D approval from Avon and Wiltshire Mental Health Partnership and Northumberland, Tyne and Wear Foundation NHS Trusts. To our knowledge, this is the first study of a low-intensity intervention for depression in adults with autism. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal publications reporting the quantitative and qualitative research findings of the study and presentations at national and international conferences.

Trial Registration Number: ISRCTN54650760; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2017-019545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736092PMC
December 2017

Emotion awareness and cognitive behavioural therapy in young people with autism spectrum disorder.

Autism 2018 10 28;22(7):837-844. Epub 2017 Jul 28.

1 University of Bath, UK.

Young people with autism spectrum disorder experience high levels of emotional problems, including anxiety and depression. Adapted cognitive behavioural therapy is recommended for such difficulties. However, no evidence suggests whether emotion awareness is important in treatment outcome for young people on the autism spectrum. This study aimed to investigate the potential differences in emotion awareness between (1) young people on the autism spectrum and typically developing youth and (2) young people on the autism spectrum with and without experience of cognitive behavioural therapy. Three groups (aged 11-20 years) participated: (1) typically developing young people ( n = 56); (2) young people on the autism spectrum with no experience of cognitive behavioural therapy ( n = 23); and (3) young people on the autism spectrum who had attended cognitive behavioural therapy ( n = 33). All participants completed the Emotion Awareness Questionnaire-30 item version. Young people on the autism spectrum differed significantly from typically developing young people on the emotional awareness measure. Young people on the autism spectrum who had attended cognitive behavioural therapy scored significantly lower on the Differentiating Emotions subscale, and significantly higher on the Attending to Others' Emotions subscale, compared to young people on the autism spectrum who had not attended cognitive behavioural therapy. This study highlights the importance of psycho-educational components of cognitive behavioural therapy when adapting for young people on the autism spectrum.
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http://dx.doi.org/10.1177/1362361317710215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084774PMC
October 2018

Personality traits, autobiographical memory and knowledge of self and others: A comparative study in young people with autism spectrum disorder.

Autism 2017 04 9;21(3):357-367. Epub 2016 Jul 9.

3 University of Bath, UK.

The relationship between dissociable components of autobiographical memory (e.g. semantic personality traits and episodic memory retrieval) and other cognitive skills that are proposed to enable one to develop a sense of self (e.g. introspection) have not previously been explored for children with autism spectrum disorder. This study compared autobiographical memory (semantic and episodic) and knowledge of self (internal/external self-knowledge and introspection/mentalising abilities) in children (aged 11-18 years) with high-functioning autism spectrum disorder and typically developing controls (total N = 48). Novel and standard tasks were employed. Compared to typically developing controls, young people with autism spectrum disorder had autobiographical memory difficulties that were characterised by a reduction in the retrieval of semantic personality traits, with more initial prompts required to facilitate episodic memory retrieval and fewer episodic memories containing emotional and sensory information. Knowledge of the self and others was also impaired, with reduced introspection and poorer mentalising abilities. Young people with autism spectrum disorder were also identified as presenting with an atypical relationship between autobiographical memory and self-knowledge, which was significantly different from typically developing controls. Test performance is discussed in relation to the functions of autobiographical memory, with consideration of how these cognitive difficulties may contribute to clinical practices and the social and behavioural characteristics of autism spectrum disorder.
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http://dx.doi.org/10.1177/1362361316645429DOI Listing
April 2017

The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: A clinic report.

Autism 2016 07 15;20(5):623-7. Epub 2015 Oct 15.

Kings College London, UK South London and Maudsley NHS Foundation Trust, UK.

Growing awareness of autism spectrum disorders has increased the demand for diagnostic services in adulthood. High rates of mental health problems have been reported in young people and adults with autism spectrum disorder. However, sampling and methodological issues mean prevalence estimates and conclusions about specificity in psychiatric co-morbidity in autism spectrum disorder remain unclear. A retrospective case review of 859 adults referred for assessment of autism spectrum disorder compares International Classification of Diseases, Tenth Revision diagnoses in those that met criteria for autism spectrum disorder (n = 474) with those that did not (n = 385). Rates of psychiatric diagnosis (>57%) were equivalent across both groups and exceeded general population rates for a number of conditions. The prevalence of anxiety disorders, particularly obsessive compulsive disorder, was significantly higher in adults with autism spectrum disorder than adults without autism spectrum disorder. Limitations of this observational clinic study, which may impact generalisability of the findings, include the lack of standardised structured psychiatric diagnostic assessments by assessors blind to autism spectrum disorder diagnosis and inter-rater reliability. The implications of this study highlight the need for careful consideration of mental health needs in all adults referred for autism spectrum disorder diagnosis.
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http://dx.doi.org/10.1177/1362361315604271DOI Listing
July 2016

Obsessive-Compulsive Disorder in Adults with High-Functioning Autism Spectrum Disorder: What Does Self-Report with the OCI-R Tell Us?

Autism Res 2015 Oct 7;8(5):477-85. Epub 2015 Feb 7.

Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

Little is known about the symptom profile of obsessive-compulsive disorder (OCD) in individuals who have autism spectrum disorders (ASD). It is also unknown whether self-report questionnaires are useful in measuring OCD in ASD. We sought to describe the symptom profiles of adults with ASD, OCD, and ASD + OCD using the Obsessive Compulsive Inventory-Revised (OCI-R), and to assess the utility of the OCI-R as a screening measure in a high-functioning adult ASD sample. Individuals with ASD (n = 171), OCD (n = 108), ASD + OCD (n = 54) and control participants (n = 92) completed the OCI-R. Individuals with ASD + OCD reported significantly higher levels of obsessive-compulsive symptoms than those with ASD alone. OCD symptoms were not significantly correlated with core ASD repetitive behaviors as measured on the ADI-R or ADOS-G. The OCI-R showed good psychometric properties and corresponded well with clinician diagnosis of OCD. Receiver operating characteristic analysis suggested cut-offs for OCI-R Total and Checking scores that discriminated well between ASD + versus -OCD, and fairly well between ASD-alone and OCD-alone. OCD manifests separately from ASD and is characterized by a different profile of repetitive thoughts and behaviors. The OCI-R appears to be useful as a screening tool in the ASD adult population.
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http://dx.doi.org/10.1002/aur.1461DOI Listing
October 2015

Protocol for a proof of concept randomized controlled trial of cognitive-behavioural therapy for adult ADHD as a supplement to treatment as usual, compared with treatment as usual alone.

BMC Psychiatry 2014 Sep 3;14:248. Epub 2014 Sep 3.

Background: ADHD is prevalent in adults and frequently associated with impairment and distress. While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone, cannot tolerate medication or do not wish to take it. Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option. To date, individual cognitive-behaviour therapy (CBT) has been found to be efficacious in three randomized controlled trials (RCTs). There is a need for more RCTs to be carried out in order to replicate these results in different sites, to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model. This randomized controlled trial investigates the efficacy of individual, formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone.

Methods/design: Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to 1 of 2 treatments, 'Treatment as Usual' (TAU) or TAU plus 16 sessions individual CBT (TAU + CBT). In the TAU + CBT, the first 15 sessions take place over 30 weeks with a 16th 'follow-up' session at 42 weeks. Outcomes are assessed at 30 weeks and 42 weeks following randomization. The two primary outcomes are self-rated ADHD symptoms and functioning (occupational and social). Secondary outcomes include distress, mood, ADHD-related cognitions, ADHD-related behaviours and informant-rated ADHD symptoms. The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments. Secondary outcomes will be analysed similarly.

Discussion: The results of the study will provide information about a) whether CBT adds benefit over and above TAU for ADHD and, b) if CBT is found to be efficacious, potential mechanisms of change and predictors of efficacy.

Trial Registration: Current Controlled Trials ISRCTN03732556, assigned 04/11/2010.
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http://dx.doi.org/10.1186/s12888-014-0248-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158100PMC
September 2014

Attention deficit hyperactivity disorder symptoms in adults with autism spectrum disorders.

Autism Res 2013 Aug 20;6(4):225-36. Epub 2013 Jun 20.

Kings College London, Institute of Psychiatry/South London and Maudsley NHS Foundation Trust, Forensic Psychology Service, National and Specialist Child and Adolescent Mental Health Service, Michael Rutter Centre, De Crespigny Park, London, UK.

Features of attention deficit hyperactivity disorder (ADHD) and impairments on neuropsychological, tests of attention have been documented in children with autism spectrum disorders (ASDs). To date, there has been a lack of research comparing attention in adults with ASD and adults with ADHD. In study 1, 31 adults with ASD and average intellectual function completed self-report measures of ADHD symptoms. These were compared with self-report measures of ADHD symptoms in 38 adults with ADHD and 29 general population controls. In study 2, 28 adults with a diagnosis of ASD were compared with an age- and intelligence quotient-matched sample of 28 adults with ADHD across a range of measures of attention. Study 1 showed that 36.7% of adults with ASD met Diagnostic and Statistical Manual-IV criteria for current ADHD "caseness" (Barkley Current self-report scores questionnaire). Those with a diagnosis of pervasive developmental disorder-not otherwise specified were most likely to describe ADHD symptoms. The ASD group differed significantly from both the ADHD and control groups on total and individual symptom self-report scores. On neuropsychological testing, adults with ASD and ADHD showed comparable performance on tests of selective attention. Significant group differences were seen on measures of attentional switching; adults with ADHD were significantly faster and more inaccurate, and individuals with Asperger's syndrome showed a significantly slower and more accurate response style. Self-reported rates of ADHD among adults with ASD are significantly higher than in the general adult population and may be underdiagnosed. Adults with ASD have attentional difficulties on some neuropsychological measures.
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http://dx.doi.org/10.1002/aur.1283DOI Listing
August 2013

Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial.

Depress Anxiety 2013 Aug 6;30(8):697-708. Epub 2013 Feb 6.

Department of Psychology, Institute of Psychiatry, Kings College London, London, United Kingdom.

Background: High rates of anxiety disorders, particularly obsessive compulsive disorder (OCD) are reported in people with Autism spectrum disorders (ASD). Group cognitive behavioral treatment (CBT) has been found effective for anxiety in young people with ASD but not been OCD specific. One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy.

Methods: Forty-six adolescents and adults (mean age 26.9 years, 35 Males) with ASD and comorbid OCD were randomized to CBT for OCD or anxiety management (AM), a plausible control treatment. Treatments were matched in duration (mean of 17.4 sessions CBT; 14.4 sessions AM), the Yale-Brown Obsessive Compulsive Severity Scale (YBOCS) as primary outcome measure and evaluations blind to treatment group. Treatment response was defined as > 25% reduction in YBOCS total severity scores.

Results: Both treatments produced a significant reduction in OCD symptoms, within-group effect sizes of 1.01 CBT group and 0.6 for the AM group. There were no statistically significant differences between the two groups at end of treatment, although more responders in the CBT group (45 versus 20%). Effect sizes for self-rated improvement were small (0.33 CBT group; -0.05 AM group). Mild symptom severity was associated with improvement in the AM but not the CBT group. Family/carer factors were important for both groups, in that increased family accommodation was associated with poorer outcome.

Conclusions: Evidence-based psychological interventions, both AM and CBT, were effective in treating comorbid OCD in young people and adults with ASD.
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http://dx.doi.org/10.1002/da.22053DOI Listing
August 2013