Publications by authors named "Inge Kamp-Becker"

60 Publications

Health Services Use and Costs in Individuals with Autism Spectrum Disorder in Germany: Results from a Survey in ASD Outpatient Clinics.

J Autism Dev Disord 2021 Mar 17. Epub 2021 Mar 17.

Department of Child and Adolescent Psychiatry, University of Ulm, Ulm, Germany.

Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce. Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed. Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs. In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.
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http://dx.doi.org/10.1007/s10803-021-04955-4DOI Listing
March 2021

Special educational support in children and adolescents with Autism Spectrum Disorder in Germany: Results from a parent survey.

Res Dev Disabil 2021 May 6;112:103931. Epub 2021 Mar 6.

Department of Child and Adolescent Psychiatry, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany.

Objective: Children and adolescents with Autism Spectrum Disorder (ASD) often receive special educational support (SES). This study aimed to evaluate SES prevalence in children and adolescents with ASD in Germany.

Methods: A mail survey was distributed to the caregivers of 637 children and adolescents recruited at three German ASD outpatient clinics.

Results: Among the 211 respondents (response: 33.1 %), 82.5 % were provided with a special educational needs statement, and 63.9 % received special education, most of them attending a public special school (57.9 %). The most frequently indicated additional support was a classroom assistant (69.0 %), followed by smaller learning groups (31.7 %). Special education was less frequently provided to individuals with Asperger syndrome than to those with childhood or atypical autism (36.0 %, 76.1 %, and 63.4 %, respectively). Using logistic regression analysis, receiving special education was significantly associated with lower IQ (<85) (Odds Ratio (OR): 8.72; 95 % confidence interval (CI): 3.41-22.32) and younger age (≤11 years, OR: 2.87; 95 % CI: 1.11-7.38), but not with ASD symptom severity.

Conclusions: The majority of children and adolescents with ASD received SES, indicating a satisfactory supply of such services in Germany. The finding that lower IQ but not ASD symptom severity predicted access to SES raises questions about the specificity of the used selection criteria.
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http://dx.doi.org/10.1016/j.ridd.2021.103931DOI Listing
May 2021

Associations of subclinical autistic-like traits with brain structural variation using DTI and VBM.

Eur Psychiatry 2021 Mar 3:1-38. Epub 2021 Mar 3.

Cognitive Neuropsychiatry Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg / Marburg University Hospital - UKGM, Marburg, Germany.

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http://dx.doi.org/10.1192/j.eurpsy.2021.15DOI Listing
March 2021

A systematic review of risk and protective factors of mental health in unaccompanied minor refugees.

Eur Child Adolesc Psychiatry 2020 Nov 9. Epub 2020 Nov 9.

Department of Clinical Child and Adolescent Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.

In recent years, there has been a rising interest in the mental health of unaccompanied minor refugees (UMR), who are a high-risk group for mental disorders. Especially the investigation of predictive factors of the mental health of young refugees has received increasing attention. However, there has been no review on this current issue for the specific group of UMR so far. We aimed to summarize and evaluate the existing findings of specific risk and protective factors to identify the most verified influences on the mental health of UMR. Therefore, we conducted a systematic literature search. Study designs were limited to quantitative cross-sectional and longitudinal designs. Eight databases were searched in four different languages and article reference lists of relevant papers were screened. 27 studies were included (N = 4753). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor for mental health of UMR. A stable environment and social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors could be pointed out, such as type of accommodation, family contact, gender and cultural competences. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. This review helps to improve our understanding of determinants of UMRs mental health and thus to provide more targeted treatment. Furthermore, it provides information on how to prevent the development of mental health problems by specifying factors that can be modified by different health and immigration sectors in advance. Further research is needed focusing on the interaction between the various predictive factors.
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http://dx.doi.org/10.1007/s00787-020-01678-2DOI Listing
November 2020

The Trajectory of Hemispheric Lateralization in the Core System of Face Processing: A Cross-Sectional Functional Magnetic Resonance Imaging Pilot Study.

Front Psychol 2020 2;11:507199. Epub 2020 Oct 2.

Laboratory for Multimodal Neuroimaging, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.

Face processing is mediated by a distributed neural network commonly divided into a "core system" and an "extended system." The core system consists of several, typically right-lateralized brain regions in the occipito-temporal cortex, including the occipital face area (OFA), the fusiform face area (FFA) and the posterior superior temporal sulcus (pSTS). It was recently proposed that the face processing network is initially bilateral and becomes right-specialized in the course of the development of reading abilities due to the competition between language-related regions in the left occipito-temporal cortex (e.g., the visual word form area, VWFA) and the FFA for common neural resources. In the present pilot study, we assessed the neural face processing network in 12 children (aged 7-9 years) and 10 adults with functional magnetic resonance imaging (fMRI). The hemispheric lateralization of the core face regions was compared between both groups. The study had two goals: First, we aimed to establish an fMRI paradigm suitable for assessing activation in the core system of face processing in young children at the single subject level. Second, we planned to collect data for a power analysis to calculate the necessary group size for a large-scale cross-sectional imaging study assessing the ontogenetic development of the lateralization of the face processing network, with focus on the FFA. It was possible to detect brain activity in the core system of 75% of children at the single subject level. The average scan-to-scan motion of the included children was comparable to adults, ruling out that potential activation differences between groups are caused by unequal motion artifacts. Hemispheric lateralization of the FFA was 0.07 ± 0.48 in children (indicating bilateral activation) and -0.32 ± 0.52 in adults (indicating right-hemispheric dominance). These results thus showed, as expected, a trend for increased lateralization in adults. The estimated effect size for the FFA lateralization difference was = 0.78 (indicating medium to large effects). An adequately powered follow-up study (sensitivity 0.8) testing developmental changes of FFA lateralization would therefore require the inclusion of 18 children and 26 adults.
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http://dx.doi.org/10.3389/fpsyg.2020.507199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566903PMC
October 2020

[Autism spectrum disorder in childhood and adults: diagnosis and differential diagnoses].

Nervenarzt 2020 May;91(5):457-470

Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Fachbereich Medizin, Philipps-Universität Marburg, Hans-Sachs-Str. 4, 35039, Marburg, Deutschland.

Autistic disorders are summarized in DSM‑5 under the term autism spectrum disorder (ASD) and are severe, lifelong, pervasive neurodevelopmental disorders. Core features manifested even in childhood are impairments in social interaction and communication as well as restricted and repetitive behavior. The intensity of symptoms, language and cognitive impairments vary but the majority of affected individuals have below average intelligence and 80% have at least one comorbid disorder. The diverse pathology and heterogeneity in phenotypes are caused by a complex genetic etiology, which is associated with a reduced synaptic plasticity of neural networks. The disorder is associated with a clearly reduced quality of life as well as a high familial burden. The differential diagnostics have a high relevance and the diagnosis should be carried out by specialized institutions. Behavioral therapeutic interventions are indicated.
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http://dx.doi.org/10.1007/s00115-020-00901-4DOI Listing
May 2020

Identifying predictive features of autism spectrum disorders in a clinical sample of adolescents and adults using machine learning.

Sci Rep 2020 03 18;10(1):4805. Epub 2020 Mar 18.

Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.

Diagnosing autism spectrum disorders (ASD) is a complicated, time-consuming process which is particularly challenging in older individuals. One of the most widely used behavioral diagnostic tools is the Autism Diagnostic Observation Schedule (ADOS). Previous work using machine learning techniques suggested that ASD detection in children can be achieved with substantially fewer items than the original ADOS. Here, we expand on this work with a specific focus on adolescents and adults as assessed with the ADOS Module 4. We used a machine learning algorithm (support vector machine) to examine whether ASD detection can be improved by identifying a subset of behavioral features from the ADOS Module 4 in a routine clinical sample of N = 673 high-functioning adolescents and adults with ASD (n = 385) and individuals with suspected ASD but other best-estimate or no psychiatric diagnoses (n = 288). We identified reduced subsets of 5 behavioral features for the whole sample as well as age subgroups (adolescents vs. adults) that showed good specificity and sensitivity and reached performance close to that of the existing ADOS algorithm and the full ADOS, with no significant differences in overall performance. These results may help to improve the complicated diagnostic process of ASD by encouraging future efforts to develop novel diagnostic instruments for ASD detection based on the identified constructs as well as aiding clinicians in the difficult question of differential diagnosis.
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http://dx.doi.org/10.1038/s41598-020-61607-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080741PMC
March 2020

[Transition in autism spectrum disorders].

Z Kinder Jugendpsychiatr Psychother 2020 Nov 16;48(6):440-442. Epub 2020 Mar 16.

Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg.

Transition in autism spectrum disorders Children and adolescents with autism spectrum disorder (ASD) are regularly seen by child and adolescent psychiatrists. Many diagnostic and therapeutic interventions are available for this age group. However, ASD is a rather unknown disorder in adult services, including psychiatry - despite the chronic course and the individual need for diagnosis, intervention, and support also in adulthood. Transition from childhood into adulthood is a rather complex topic that includes the challenge of mastering education and employment. This article presents these transition-related aspects and recommendations to improve healthcare in Germany.
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http://dx.doi.org/10.1024/1422-4917/a000715DOI Listing
November 2020

Do German Children Differ? A Validation of Conners Early Childhood™.

J Atten Disord 2020 Mar 14:1087054720907955. Epub 2020 Mar 14.

Philipps University Marburg, Germany.

The present study aimed to validate the German version of the Conners Early Childhood (EC)™ among German-speaking children. A total of 720 parental and 599 childcare provider ratings of 2- to 6-year-old children were surveyed throughout Germany. Validity was assessed by calculating exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs), and a series of multivariate analyses of variance (MANOVAs) to analyze associations between Conners EC™ symptom ratings and sociodemographic variables. In addition, parent and childcare provider ratings of Conners EC™ scales were correlated with a number of other well-validated German measures assessing preschoolers' behaviors. Although the EFA yielded different factors than the original scales, CFA revealed acceptable to good model fits. Overall, we confirmed the factor structure of the Conners EC's™ American original within the German validation. The use of the American factor structure is justified and can be recommended to facilitate international research on psychopathology in early childhood.
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http://dx.doi.org/10.1177/1087054720907955DOI Listing
March 2020

[Blessing or curse? The World Wide Web as information source for autism and Asperger Syndrome].

Z Kinder Jugendpsychiatr Psychother 2020 16;48(2):133-143. Epub 2019 Oct 16.

Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg.

The World Wide Web is today one of the most common methods used for obtaining health-related information, though the quality of the information is sometimes questionable. The present study addresses the quality of the information source internet and the resulting implications and discusses examples related to autism spectrum disorder. We systematically evaluated 96 German websites, with the aim of estimating specific characteristic features, reliability of publications, presentation of information as well as overall website quality. We also analyzed the clinical implications of the presentations. Only 39 % of the websites provided references to scientifically well-founded information, whereas advertisements were found on 53 % of websites. The greatest percentage of false information (17 %) was disseminated concerning therapy. 75 % of the websites provided incomplete information. Only 10 % of websites discussed the impairment or familial burden. The quality of information was insufficient on 30 %, poor on 41 %, and good on only 6 % of the websites. Similar to results available for English-language websites, the quality of German websites providing health-related information can be considered low. Implications concerning confirmation bias, stigma, overidentification, in-group/outgroup, contrast and snowball effects are discussed.
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http://dx.doi.org/10.1024/1422-4917/a000693DOI Listing
March 2020

Effectiveness of the Stepping Stones Triple P group parenting program in reducing comorbid behavioral problems in children with autism.

Autism 2020 02 20;24(2):423-436. Epub 2019 Aug 20.

Philipps-University Marburg, Germany.

Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families' quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents' and teachers' judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents' judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers' judgment particularly revealed an improvement in children's social relationships. Effect sizes were large ( ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents' ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.
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http://dx.doi.org/10.1177/1362361319866063DOI Listing
February 2020

Affiliate stigma in caregivers of children and adolescents with autism spectrum disorder in Germany.

Psychiatry Res 2020 02 11;284:112483. Epub 2019 Jul 11.

Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.

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http://dx.doi.org/10.1016/j.psychres.2019.112483DOI Listing
February 2020

Empathy in Females With Autism Spectrum Disorder.

Front Psychiatry 2019 18;10:428. Epub 2019 Jun 18.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.

Despite the fact that autism spectrum disorder (ASD) is a common psychiatric diagnosis, knowledge about the special behavioral and neurobiological female phenotype is still scarce. The present study aimed to investigate neural correlates of empathy for physical and social pain and to assess the impact of egocentric perspective taking on social pain empathy in complex social situations in women and girls with ASD. Nine female individuals with high functioning ASD were compared to nine matched peers without ASD during two functional magnetic resonance imaging (fMRI) experiments, examining empathy for physical and social pain using well-established paradigms. Participants viewed multiple pictorial stimuli depicting a social target in either physically painful or socially unpleasant situations. In the social situations, the participant either shared the social target's knowledge about the inappropriateness of the situation (observed social target is aware about the embarrassment of the situation; e.g., tripping in public) or not (observed social target is unaware about the embarrassment of the situation; e.g., open zipper). Females with ASD did not rate the physical pain stimuli differently from non-clinical controls. Social pain situations, however, posed a greater challenge to females with ASD: For non-shared knowledge situations, females with ASD rated the social target's embarrassment as more intense. Thus, compared to non-clinical controls, females with ASD had a stronger egocentric perspective of the situation rather than sharing the social target's perspective. On the neural systems level, both groups showed activation of areas of the so-called empathy network that was attenuated in females with ASD during empathy for physical and social pain with a particular reduction in insula activation. Females with high functioning ASD are able to share another person's physical or social pain on the neural systems level. However, hypoactivation of the anterior insula in contrast to individuals without ASD suggests that they are less able to rely on their shared representations of emotions along with difficulties to take over a person's perspective and to make a clear distinction between their own and someone else's experience of embarrassment.
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http://dx.doi.org/10.3389/fpsyt.2019.00428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591689PMC
June 2019

Internalised stigma in adults with autism: A German multi-center survey.

Psychiatry Res 2019 06 22;276:94-99. Epub 2019 Apr 22.

Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, Oldenburg 26129, Germany.

The aim of this study was to evaluate the extent of internalised stigma and possible predictors in adults with a diagnosis of autism spectrum disorder (ASD). We measured internalised stigma in a sample of 149 adults with ASD and an IQ ≥70 (79.2% male, mean age 31.8 years), using the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). The mean ISMI-10 score was 1.93 (SD=0.57), with 15.4% of participants reporting moderate or severe internalised stigma. Moderate or severe stigma was more frequent in persons aged ≥35 years (OR: 4.36), and in individuals with low educational level (OR: 6.00). IQ, sex and ASD diagnostic subtype (ICD-10) did not influence stigma severity. Compared to other mental disorders, the level of internalised stigma in adults with ASD without intellectual disability appears to be lower.
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http://dx.doi.org/10.1016/j.psychres.2019.04.023DOI Listing
June 2019

Pathways to a diagnosis of autism spectrum disorder in Germany: a survey of parents.

Child Adolesc Psychiatry Ment Health 2019 21;13:16. Epub 2019 Mar 21.

5Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/Heinrich-Heine University Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany.

Background: Early identification of autism spectrum disorders (ASD) is a prerequisite for access to early interventions. Although parents often note developmental atypicalities during the first 2 years of life, many children with ASD are not diagnosed until school age. For parents, the long period between first parental concerns and diagnosis is often frustrating and accompanied by uncertainty and worry.

Methods: This study retrospectively explored the trajectories of children with a confirmed ASD diagnosis during the diagnostic process, from first parental concerns about their child's development until the definite diagnosis. A survey concerning the diagnostic process was distributed to parents or legal guardians of children with ASD from three specialized ASD outpatient clinics in Germany.

Results: The response rate was 36.9%, and the final sample consisted of carers of 207 affected children (83.6% male, mean age 12.9 years). The children had been diagnosed with childhood autism (55.6%), Asperger syndrome (24.2%), or atypical autism (20.3%). On average, parents had first concerns when their child was 23.4 months old, and an ASD diagnosis was established at a mean age of 78.5 months. Children with atypical autism or Asperger syndrome were diagnosed significantly later (83.9 and 98.1 months, respectively) than children with childhood autism (68.1 months). Children with an IQ < 85 were diagnosed much earlier than those with an IQ ≥ 85. On average, parents visited 3.4 different health professionals (SD = 2.4, range 1-20, median: 3.0) until their child received a definite ASD diagnosis. Overall, 38.5% of carers were satisfied with the diagnostic process.

Conclusions: In this sample of children with ASD in Germany, the time to diagnosis was higher than in the majority of other comparable studies. These results flag the need for improved forms of service provision and delivery for suspected cases of ASD in Germany.
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http://dx.doi.org/10.1186/s13034-019-0276-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429704PMC
March 2019

Mental health in refugees and asylum seekers (MEHIRA): study design and methodology of a prospective multicentre randomized controlled trail investigating the effects of a stepped and collaborative care model.

Eur Arch Psychiatry Clin Neurosci 2020 Feb 22;270(1):95-106. Epub 2019 Feb 22.

Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.

The sudden arrival of culturally diverse asylum seekers and refugees into Germany has created a strong demand for recognizing and appropriately treating those suffering from mental health issues. Due to many systemic, organizational, cultural and socio-linguistic barriers, psychiatric treatment of refugees is posing a major challenge to Germany's mental health care system. Thus, there is a need for alternative models that allow for increased access to adequate, effective and efficient culturally sensitive mental health care services. Here, we describe the Mental Health in Refugees and Asylum Seekers (MEHIRA) project, a multicentre randomized controlled trial investigating a stepped collaborative care model (SCCM) for providing mental health treatment in this vulnerable population. The proposed SCCM aims to decrease the aforementioned barriers. Adult and adolescent participants will be screened for depressive symptoms and matched to appropriate psychological interventions, including group-level interventions (START intervention, Empowerment/Gender-sensitive/Peer to peer), and other innovative, digital treatment approaches (Smartphone application). The therapeutic effect of the SCCM will be compared to TAU (treatment-as-usual). All interventions have been designed to be culturally sensitive, and offered in two different languages: Arabic and Farsi. The outcome of this study may contribute significantly to future clinical and legal guidelines in developing parallel and efficient new structures of treatment. Collected data will inform primary and secondary mental health care providers with recommendations concerning the design and implementation of effective treatment models and programmes. Guidelines and recommendations may also potentially be adopted by other host countries, developing countries and also in humanitarian aid programmes.
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http://dx.doi.org/10.1007/s00406-019-00991-5DOI Listing
February 2020

Complementary and alternative medicine use in adults with autism spectrum disorder in Germany: results from a multi-center survey.

BMC Psychiatry 2019 02 1;19(1):53. Epub 2019 Feb 1.

Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/ Heinrich-Heine University Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany.

Background: Complementary and Alternative Medicine (CAM) is widely used both in the general population and for the treatment of somatic and psychiatric disorders. Studies on CAM use among patients with autism spectrum disorder (ASD) have so far only focused on children and adolescents. The aim of this study was to investigate patterns of CAM use among adults with ASD.

Methods: A questionnaire survey concerning current and lifetime use of CAM was distributed to adults with ASD between November 2015 and June 2016. Participants diagnosed by experienced clinicians using the current diagnostic gold standard were recruited from four ASD outpatient clinics in Germany. Questionnaire data was then linked to supplementary clinical data.

Results: The final sample consisted of 192 adults (response: 26.8%) with a mean age of 31.5 years (80% male; diagnoses: Asperger's syndrome (58%), childhood autism (27%), atypical autism (12%)). 45% of the respondents stated that they were currently using or had used at least one CAM modality in their life. Among the participants with lifetime CAM use, almost half had used two or more different types of CAM. Alternative medical systems (e.g. homeopathy, acupuncture) were most frequently used, followed by mind-body interventions (e.g. yoga, biofeedback, animal assisted therapy). Overall, 20% of respondents stated that they would like to try at least one listed CAM modality in the future.

Conclusions: This is the first study on CAM use in adults with ASD, demonstrating considerable CAM use in this population. Given the popularity of CAM, patients should be informed about the effectiveness and potentially dangerous side effects of CAM treatments, as evidence for the majority of CAM methods in ASD is still limited.
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http://dx.doi.org/10.1186/s12888-019-2043-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6359789PMC
February 2019

Willingness to try and lifetime use of complementary and alternative medicine in children and adolescents with autism spectrum disorder in Germany: A survey of parents.

Autism 2019 10 17;23(7):1865-1870. Epub 2019 Jan 17.

1 Carl von Ossietzky University of Oldenburg, Germany.

Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind-body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects.
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http://dx.doi.org/10.1177/1362361318823545DOI Listing
October 2019

Effectiveness of the Stepping Stones Triple P Group Parenting Program as an Additional Intervention in the Treatment of Autism Spectrum Disorders: Effects on Parenting Variables.

J Autism Dev Disord 2019 Mar;49(3):913-923

Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, University Hospital Marburg (UKGM), Philipps-University Marburg, Hans-Sachs-Str. 6, 35039, Marburg, Germany.

Parents of children with autism spectrum disorders (ASD) often are faced with the challenges of difficult parenting situations. We explored the effectiveness of the Stepping Stones Triple P (SSTP) group parent training as an additional intervention in the treatment of ASD. Parents (n = 23) went through a waiting period and participated afterwards in the training program. We assessed parenting variables via self-report measures. After the intervention, there was a significant reduction of over-reactive parenting behaviors, role restriction and an increase in parental self-efficacy. At follow-up, the effects remained stable and we additionally found a reduction of laxness and less parenting stress. Effect sizes were high (η: 0.18-0.24). The SSTP, offered as an additional intervention in the treatment of ASD, proved to be effective in enhancing parenting.
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http://dx.doi.org/10.1007/s10803-018-3764-xDOI Listing
March 2019

[The diagnostics of autism spectrum disorder in children, adolescents and adults: Overview of the key questions and main results of the first part of the German AWMF-S3 - clinical guideline].

Z Kinder Jugendpsychiatr Psychother 2019 Jul 17;47(4):359-370. Epub 2018 Oct 17.

1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe Universität.

The diagnostics of autism spectrum disorder in children, adolescents and adults: Overview of the key questions and main results of the first part of the German AWMF-S3 - clinical guideline Autism spectrum disorders (ASD) include ICD-10 diagnoses of childhood autism, Asperger syndrome, and atypical autism; there is a lifetime prevalence of ~1 %. The aim of the evidence-based clinical guideline (AWMF-S3-Guideline) is to summarize the current evidence concerning diagnostic and therapeutic processes for professionals working in healthcare and social welfare and to provide consensus on clinical recommendations. The present study summarizes the most important results of the diagnostic part of this guideline. The guideline group comprised 14 clinical and scientific expert associations from the German healthcare system, in addition to representatives of relatives and patients. Recommendations were based on results of a systematic literature search, data extraction, the evaluation of study quality, and, if possible, meta-analytic aggregation of included data in combination with the clinical expertise of the respective representatives. Consensus-based recommendations were determined via nominal group technique. The AWMF-S3-Clinical Guideline, Diagnostic Part, summarizes current research on this topic. The main focus is put on the question of obligatory versus redundant diagnostic procedures. After a general introduction to the clinical picture of ASD, essential aspects like obtaining the medical history, the effective use of screening and diagnostic instruments, medical examination, the full diagnostic work-up as well as communicating the diagnostic results to relatives and patients are described in detail. We also conducted a meta-analysis on the stability of early diagnosis. This first part of the ASD guideline offers users the opportunity to inform themselves about the background of ASD as well as evidence-based and broadly consented information on the correct diagnostic process of ASD from infancy to adulthood.
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http://dx.doi.org/10.1024/1422-4917/a000621DOI Listing
July 2019

Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems.

PLoS One 2018 26;13(9):e0202855. Epub 2018 Sep 26.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Marburg, Germany.

Objective: The aim of this study is to perform the first meta-meta-analysis on the effectiveness of parent-based interventions for children with externalizing behavior problems. Even though parent-based interventions are considered as effective treatments the effects reported in meta-analyses are heterogeneous and the implementation in clinical practice is suboptimal. Recapitulative valid effect predictions are required to close the still existing gap between research findings and clinical practice. The meta-meta-analytic results on changes in child behavior shall result in a clear signal for clinical practice.

Methods: This meta-meta-analysis encompasses 26 meta-analyses identified via search in electronic databases (PsycINFO, Medline, PubMed). Meta-analyses had to report effects of parent-based interventions on child behavior and focus on children under the age of 13 years with externalizing behavior problems in a clinical setting. Analyses were based on random-effects models. To combine results, the effect estimates of the meta-analyses were transformed to SMD and weighted to correct for primary study overlap. The meta-meta-analysis is registered on PROSPERO, registration number CRD42016036486 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA).

Results: The results indicate a significant moderate overall effect for child behavior (SMD = 0.46) as well as for parent reports (SMD = 0.51) and observational data (SMD = 0.62). Further analyses focusing on child externalizing behavior yielded significant and moderate effects (SMD = 0.45). All effects remained stable to follow-up. Considerable heterogeneity was observed within results.

Conclusion: Parent-based interventions are shown to be effective in improving behavior in children with externalizing behavior problems, as assessed using parent reports and observational measures. The present results should encourage health care providers to apply evidence-based parent-based interventions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202855PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157840PMC
February 2019

Disruptive Behaviors across Different Disorders: Evaluation of a Clinical Sample Using the Eyberg Child Behavior Inventory.

Z Kinder Jugendpsychiatr Psychother 2019 Jan 19;47(1):35-47. Epub 2018 Jul 19.

4 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany.

Objective: The study reports the prevalence of disruptive behaviors in a help-seeking sample of young children across a diverse range of clinical diagnoses (based on ICD-10).

Method: The Eyberg Child Behavior Inventory (ECBI), a parent rating scale of disruptive behaviors, was completed on 310 children (2-11 years) at three child and adolescent psychiatry clinics in three German states (Bavaria, Hesse, Lower Saxony); the majority of children were outpatients.

Results: Mean intensity scores of disruptive behaviors differed significantly by diagnostic group, with the lowest ratings within a community sample, and increasingly higher scores in children with a diagnosis from the internalizing spectrum, those with pervasive developmental disorders, and finally, those with externalizing disorders (e. g. hyperkinetic disorder, conduct disorders). Seventy percent of the clinical sample, compared to only 17 % of the community sample, exceeded the normative cut-off score of 111, indicating that disruptive behaviors are common in young German children seeking help for different mental health problems.

Conclusions: These findings support the Research Domain Criteria approach by showing that disruptive behaviors cross our current diagnostic labels and may need to be assessed and conceptualized in treatment planning, even in children without a primary diagnosis from the externalizing spectrum.
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http://dx.doi.org/10.1024/1422-4917/a000601DOI Listing
January 2019

Treatment of child externalizing behavior problems: a comprehensive review and meta-meta-analysis on effects of parent-based interventions on parental characteristics.

Eur Child Adolesc Psychiatry 2019 Aug 8;28(8):1025-1036. Epub 2018 Jun 8.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hans-Sachs-Straße 4, 35039, Marburg, Germany.

This is the first meta-meta-analysis examining the effects of parent-based interventions for children with externalizing behavior problems on parental characteristics (parenting, parental perceptions, parental mental health, parental relationship quality). Parent training interventions are recognized as evidence-based interventions for the treatment of externalizing behavior problems, although meta-analytic effects are heterogeneous. The objective of the present study was to comprehensively combine meta-analytic results on parent training interventions to arrive at valid effect predictions. Electronic databases were searched (PsycINFO, Medline, PubMed). In total, 11 meta-analyses were included that mainly comprised parents of children under the age of 13 years. Analyses were based on random effects models. Effect estimates were transformed to standardized mean differences (SMD) and corrected for primary study overlap. Results revealed a significant moderate overall effect for parenting (SMD 0.53) as well as for parents' report of parenting (SMD 0.60) and parental perceptions (SMD 0.52). Effects remained stable to follow-up. Results for observational data, parental mental health and parental relationship quality were small and only partially significant. Considerable heterogeneity within results was revealed. Overall, parent training interventions proved to be effective in improving parental characteristics for parents of children with externalizing behavior problems. Effectiveness was stronger regarding characteristics explicitly targeted by interventions. The findings should encourage health-care providers to apply evidence-based parent training interventions.
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http://dx.doi.org/10.1007/s00787-018-1175-3DOI Listing
August 2019

Study protocol of the ASD-Net, the German research consortium for the study of Autism Spectrum Disorder across the lifespan: from a better etiological understanding, through valid diagnosis, to more effective health care.

BMC Psychiatry 2017 06 2;17(1):206. Epub 2017 Jun 2.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Clinic, Philipps-University Marburg, Marburg, Germany.

Background: Autism Spectrum Disorder (ASD) is a severe, lifelong neurodevelopmental disorder with early onset that places a heavy burden on affected individuals and their families. Due to the need for highly specialized health, educational and vocational services, ASD is a cost-intensive disorder, and strain on health care systems increases with increasing age of the affected individual.

Methods: The ASD-Net will study Germany's largest cohort of patients with ASD over the lifespan. By combining methodological expertise from all levels of clinical research, the ASD-Net will follow a translational approach necessary to identify neurobiological pathways of different phenotypes and their appropriate identification and treatment. The work of the ASD-Net will be organized into three clusters concentrating on diagnostics, therapy and health economics. In the diagnostic cluster, data from a large, well-characterized sample (N = 2568) will be analyzed to improve the efficiency of diagnostic procedures. Pattern classification methods (machine learning) will be used to identify algorithms for screening purposes. In a second step, the developed algorithm will be tested in an independent sample. In the therapy cluster, we will unravel how an ASD-specific social skills training with concomitant oxytocin administration can modulate behavior through neurobiological pathways. For the first time, we will characterize long-term effects of a social skills training combined with oxytocin treatment on behavioral and neurobiological phenotypes. Also acute effects of oxytocin will be investigated to delineate general and specific effects of additional oxytocin treatment in order to develop biologically plausible models for symptoms and successful therapeutic interventions in ASD. Finally, in the health economics cluster, we will assess service utilization and ASD-related costs in order to identify potential needs and cost savings specifically tailored to Germany. The ASD-Net has been established as part of the German Research Network for Mental Disorders, funded by the BMBF (German Federal Ministry of Education and Research).

Discussion: The highly integrated structure of the ASD-Net guarantees sustained collaboration of clinicians and researchers to alleviate individual distress, harm, and social disability of patients with ASD and reduce costs to the German health care system.

Trial Registration: Both clinical trials of the ASD-Net are registered in the German Clinical Trials Register: DRKS00008952 (registered on August 4, 2015) and DRKS00010053 (registered on April 8, 2016).
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http://dx.doi.org/10.1186/s12888-017-1362-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455122PMC
June 2017

[Between Hype and Hope – considerations for research in autism spectrum disorders].

Z Kinder Jugendpsychiatr Psychother 2017 ;45(3):175-179

2 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Göttingen.

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http://dx.doi.org/10.1024/1422-4917/a000527DOI Listing
October 2017

[Diagnostic accuracy of the ADOS-2 taking account of gender effects].

Z Kinder Jugendpsychiatr Psychother 2017 2;45(3):193-207. Epub 2016 Nov 2.

1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Marburg und Philipps-Universität Marburg.

Objectives: The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a revision of the standardized assessment for individuals with suspected autism spectrum disorders (ASD). The study examines the diagnostic accuracy of the original and revised algorithms for Modules 1 through 3.

Methods: In a large clinical sample of children and adolescents (N = 1080, age 1.7 to 20.5), the differentiation of ASD from relevant differential diagnoses was investigated. As studies on the diagnostic accuracy for girls are sparse, comparisons concerning the diagnostic accuracy for gender subgroups were undertaken.

Results: The revised algorithms exhibit an improvement in sensitivity (84.9 %) and a slight reduction in specificity (85.7 %). The improvements in the ADOS-2 pertain especially to cases with core autism and girls. Including the repetitive behavior domain in the algorithm contributes to a correct clinical ASD classification in modules 2 and 3. This was not found for younger children examined with module 1. Results also suggest less effective diagnostic differentiation for children and adolescents with internalizing disorders and conduct disorder.

Conclusions: Good diagnostic accuracy was found for children in the average range of cognitive abilities. Results suggest good diagnostic utility for the ADOS-2 in clinical settings, provided that thorough diagnostics are given by experienced examiners.
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http://dx.doi.org/10.1024/1422-4917/a000492DOI Listing
July 2017

Narratives of Girls and Boys with Autism Spectrum Disorders: Gender Differences in Narrative Competence and Internal State Language.

J Autism Dev Disord 2016 Mar;46(3):840-52

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Marburg, 35032, Marburg, Germany.

Since gender differences in the symptomatology of autism spectrum disorder (ASD) are not well understood, the current study examines the communicative skills of males and females with ASD. Narrative competence and internal state language (ISL) was investigated using narrations elicited by a wordless picture book. 11 girls and 11 boys with ASD and 11 typically developing girls were individually matched. Although results demonstrate largely comparable narrative skills across groups, the groups differed with respect to the size and use of ISL: Girls with ASD verbalized and motivated internal states more often than boys, and both groups with ASD fell behind typically developing children in production of affective words. Implications for the clinical presentation of males and females with ASD are discussed.
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http://dx.doi.org/10.1007/s10803-015-2620-5DOI Listing
March 2016

Evidence from pupillometry and fMRI indicates reduced neural response during vicarious social pain but not physical pain in autism.

Hum Brain Mapp 2015 Nov 14;36(11):4730-44. Epub 2015 Sep 14.

Department of Psychiatry and Psychotherapy, Social Neuroscience Lab | SNL, University of Lübeck, Ratzeburger Allee 160, Lübeck, D-23538, Germany.

Autism spectrum disorder (ASD) is characterized by substantial social deficits. The notion that dysfunctions in neural circuits involved in sharing another's affect explain these deficits is appealing, but has received only modest experimental support. Here we evaluated a complex paradigm on the vicarious social pain of embarrassment to probe social deficits in ASD as to whether it is more potent than paradigms currently in use. To do so we acquired pupillometry and fMRI in young adults with ASD and matched healthy controls. During a simple vicarious physical pain task no differences emerged between groups in behavior, pupillometry, and neural activation of the anterior insula (AIC) and anterior cingulate cortex (ACC). In contrast, processing complex vicarious social pain yielded reduced responses in ASD on all physiological measures of sharing another's affect. The reduced activity within the AIC was thereby explained by the severity of autistic symptoms in the social and affective domain. Additionally, behavioral responses lacked correspondence with the anterior cingulate and anterior insula cortex activity found in controls. Instead, behavioral responses in ASD were associated with hippocampal activity. The observed dissociation echoes the clinical observations that deficits in ASD are most pronounced in complex social situations and simple tasks may not probe the dysfunctions in neural pathways involved in sharing affect. Our results are highly relevant because individuals with ASD may have preserved abilities to share another's physical pain but still have problems with the vicarious representation of more complex emotions that matter in life.
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http://dx.doi.org/10.1002/hbm.22949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6869621PMC
November 2015

[Screening interview for early detection of high-functioning autism spectrum disorders].

Z Kinder Jugendpsychiatr Psychother 2015 May;43(3):207-18; quiz 218-9

1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Phillips-Universität Marburg.

Objective: Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities.

Method: The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD.

Results: The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74.

Conclusion: The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.
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http://dx.doi.org/10.1024/1422-4917/a000354DOI Listing
May 2015