Category: mental health

Bullying children with autism

Photo by Quin Stevenson

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BINGHAMTON, NY – Children with autism spectrum disorder (ASD) are more likely to experience bullying than children without ASD and this bullying gets worse with age, according to new research from Binghamton University, State University of New York.

Hannah Morton, a graduate student in the clinical psychology PhD program at Binghamton University, aimed to conceptualize bullying in children with ASD in order to specifically identify different bullying and behavior types. Her research also emphasizes the need to establish better definitions of bullying behaviors.

“This research is important because it contributes to our understanding of how bullying is nuanced,” said Morton. “This variability means it is crucial to establish a definition for bullying and have standard assessments to know when and what types of bullying are occurring.”

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Morton, along with Binghamton psychologists Jennifer Gillis, Richard Mattson and Raymond Romanczyk, focused this study on teachers and parents of children with ASD, and community members without an ASD child. Participants took a survey containing 80 scenarios of interactions between two school-aged children. The scenarios varied from children ages four to fifteen. Sixty-four of these scenarios contained a type of bullying behavior (i.e. physical, verbal, interpersonal and cyber). The participants were randomly presented with 16 scenarios, and were asked to rate the severity of the interaction between the two children, as well as indicate which types of bullying were present.

Results showed that a child’s increased age predicted higher bullying severity ratings. The findings also showed that bullying among older children with ASD is viewed as especially problematic by their parents, and that perceived bullying severity differed according to the type of bullying behavior (i.e., physical, verbal, interpersonal, and cyber). 

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“This paper emphasizes that bullying is a really broad construct,” said Morton. “What any two people might be referring to when they use the term ‘bullying’—regardless if they are parents, teachers, researchers, etc.— likely differs, and perhaps in subtle ways.”

Morton plans to further her research on this topic by focusing specifically on the bullying behaviors that children with ASD experience compared to children without ASD.

This research was conducted through Binghamton University’s Institute for Child Development, which offers early intervention services, speech services and more to children and families in the Binghamton region. 

The paper, “Conceptualizing bullying in children with autism spectrum disorder: Using a mixed model to differentiate behavior types and identify predictors,” was published in Autism.

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Autistic Adolescents Want to Learn to Drive

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Photo by Alex Jumper

Specialized driving instructors stress life skill development, parent-supervised practice, and individualized training to enhance learning and independence

Autistic adolescents need the support of their parents or guardians to prioritize independence so that they are prepared for learning to drive, according to a study of specialized driving instructors who have worked specifically with young autistic drivers. These findings were compiled by researchers at Children’s Hospital of Philadelphia (CHOP) and recently published in the journal Autism in Adulthood.

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Driving instructors also emphasized the need to develop and refine best practices to guide assessment and delivery of highly individualized instruction for autistic adolescents. 

The study was conducted by a multidisciplinary team of researchers from CHOP’s Center for Injury Research and Prevention, Center for Autism Research, and Division of Emergency Medicine, as well as the University of Pennsylvania School of Nursing and the Virginia Tech Transportation Institute (VTTI), as part of a five-year study aimed at understanding mobility issues for autistic adolescents funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH). This is the first paper published as part of the study.

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“Through our interviews with specialized driving instructors, we learned they believe parents are a critical partner in preparing for and undertaking independent driving,” said Rachel K. Myers, PhD, lead author of the study and scientist at the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia (CHOP). “Instructors recommend that parents help their children develop independent life skills, including the use of alternative forms of transportation such as bicycling or mass transit, and to practice pre-driving skills, such as navigation, before undertaking on-road driving lessons.”

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Driving instructors are an important resource for families, especially for those with autistic adolescents learning to drive. However, because not much is known about the specific experience of teaching autistic adolescents how to drive, this limits the ability to provide adolescents and families with proper guidance preparing for the learning-to-drive process. To help bridge this gap, researchers conducted in-depth interviews with specialized driving instructors who had experience working with autistic adolescents and young adults. This is the first study to examine the process and experience of driving instructors who provide behind-the-wheel training specifically for this population.

The study revealed a set of common themes that underscored the importance of parents of autistic adolescents in preparation for the learning-to-drive process, with driving instructors viewing parents as essential partners in supporting their efforts in teaching driving skills and promoting independence. Participating instructors said parents can support and prioritize independence by encouraging their autistic adolescents to develop life skills, such as mowing the lawn, cooking, and taking public transportation, before learning to drive.

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Although the driving instructors identified a need to develop and refine best practices for assessment and instruction, they recognized that specific approaches must be tailored to meet the unique needs of each autistic adolescent driver, reflecting the spectrum that affects each adolescent differently. Other suggestions from the instructors involved in this study included using of state-level vocational rehabilitation services to provide financial support for instruction, identifying and promoting prerequisite life skills prior to undertaking driving, parent-supervised driving instruction in partnership with professional driving instruction, and tailoring instruction to address the particular needs of learner drivers.

“What these specialized driving instructors told us about the disconnect between driving and other life skills was surprising,” said Benjamin E. Yerys, PhD, study author and psychologist at the Center for Autism Research at Children’s Hospital of Philadelphia. “Some parents may not let their autistic adolescents use a stovetop oven, but are asking if their teens are ready to drive. Whether or not their children decide to drive, parents should encourage greater independence by encouraging them to get around on their own. Traveling independently by driving or other modes of transportation is key to continuing their education, working, and staying connected with friends and family.”

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Obtaining a driver’s license is a major milestone in the transition to adulthood. This milestone increases the independence and mobility of adolescents, which can potentially lead to improved access to educational, occupational training, social, and community engagement opportunities. According to previous CHOP research, nearly one-third of autistic adolescents obtain a driver’s license by the time they are 21 years old, which may improve their ability to transition into independent adulthood.

Resources for families to help their teens with ASD transition to adulthood are available at The Center for Autism Research at CHOP and TeenDriverSource.org.

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health awards R01HD079398 and R01HD096221.

Myers et al, “Teaching Autistic Adolescents and Young Adults to Drive: Perspectives of Specialized Driving Instructors.” Autism in Adulthood, online May 22, 2019. doi.org/10.1089/aut.2018.0054.

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About Children’s Hospital of Philadelphia: Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 564-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

The Happiness in the Workplace

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Photo by Ian Stauffer

If you want a better business, make sure your employees are happy. If you want to be a more successful employee, make sure not to neglect your own happiness.

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That’s the advice of Raj Raghunathan, professor of marketing at the McCombs School of Business at The University of Texas at Austin. Raghunathan studies happiness and shares his insights in both his in-person classes at McCombs and in his award-winning online Coursera class that has been taken by more than 260,000 people in 196 countries since it launched in 2015.

Now, Raghunathan is offering a new online class aimed at making workplaces better for employers, employees, clients and customers. Happier Employees and Return on Investment, an open-access four-week course offered by McCombs through edX, is now open for enrollment.

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The course explores five critical issues: why happiness at work matters; what the five most important determinants of happiness at work are; what holds people back from feeling happy and fulfilled at work; what people can do to enhance their own happiness levels at work; and what they can do to enhance the happiness of coworkers.

“When employees are happy on the job, they are more productive for their company and earn more for themselves, said Raghunathan. “They take fewer sick days, are more collegial, perform better in teams, are more creative and objective, and make better decisions.”

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There are no prerequisites for the course. It is open to anyone who wishes to register. The online video lectures can be started and stopped on whatever timeline is convenient for each student. And the course is supported by an interactive website with resources, exercises and communication portals.

“We spend so much of our lives at work,” said Raghunathan. “It makes sense for us to do everything we can to maximize how happy we are in our jobs.”

This is the first online course that McCombs is offering in collaboration with edX, with a number of others soon to be launched.

Raghunathan is the Zale Centennial Professor of Business at the McCombs School of Business at The University of Texas at Austin. His work has appeared in The Atlantic, The New York TimesFortune, Forbes, Harvard Business Review, Inc., and Fast Company. He writes about happiness and leadership in a blog for Psychology Today called Sapient Nature. His book, If You’re So Smart, Why Aren’t You Happy? was published in 2016 and has been translated into 13 languages. His TED Talk has been viewed by more than 17 million people worldwide.

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For more information about Raghunathan’s work, read these McCombs Big Ideas feature stories or view the McCombs video Top Five Ways to Be Happier at Work.

For more information, contact Molly Dannenmaier at molly.dannenmaier@mccombs.utexas.edu or 512-232-6779.

Autism Drug Citalopram Is Ineffective

Photo by JOSHUA COLEMAN
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A drug commonly given to autistic children to reduce repetitive behaviors is ineffective compared to placebo and, in some children, may actually increase repetitive behaviors, the largest study of autistic children to date has found.

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“What we found, much to our surprise, is that there was no significant difference in positive response between kids treated with citalopram and kids who received the placebo. And the kids treated with citalopram tended to have more side effects,” said Linmarie Sikich, M.D., a co-author of the study and associate professor of psychiatry in the University of North Carolina at Chapel Hill School of Medicine.

“I cannot emphasize this enough: This was not at all what we expected to see,” Sikich said.

Results of the study, a randomized controlled clinical trial of the drug citalopram, are published in the June 29, 2009 issue of Archives of General Psychiatry. It was funded by the National Institutes of Health and took place at six academic medical centers across the country. Principal investigator and lead author of the study is Bryan H. King, M.D., who began the study at Dartmouth and continued to oversee it there after he moved to the University of Washington, where he is currently director of psychiatry and behavioral medicine at Seattle Children’s Hospital.

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Citalopram, which is sold under the brand name Celexa, is one of a class of antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs. SSRIs are the most frequently used medications for children with autism. They are also used to treat depression, anxiety and obsessive compulsive disorder in both adults and children. Prior to this study there was very little scientific evidence to support the use of SSRIs in autistic children, but some preliminary studies showed promising results for citalopram, Sikich said.

Hypothesizing that citalopram would improve the overall functioning of autistic children and adolescents by reducing repetitive behavior, Sikich and colleagues recruited 149 children ages 5 to 17 to take part in the 12-week trial. Seventy-three received daily doses of liquid citalopram while 76 received daily doses of liquid placebo. Researchers measured the children’s’ response to treatment using the Clinical Global Impression-Improvement scale (CGI-I). They also recorded measures of repetitive behavior and side effects.

At the end of the trial, some children in both groups showed a positive response. However, there was no significant difference between the groups: the positive response in the citalopram group was 32.9 percent versus 34.2 percent in the placebo group. In addition, children in the citalopram group were significantly more likely to experience adverse side effects such as increased energy level, impulsiveness, decreased concentration, hyperactivity, increased repetitive movements and behaviors, diarrhea, insomnia, and dry itchy skin.

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The researchers concluded that citalopram “is not an effective treatment” for autistic children with repetitive behaviors. In addition, they wrote, this trial shows that the use of SSRIs in autistic children “is not without risk” and “at present there is insufficient research evidence to merit a clear recommendation regarding the use of SSRIs as a class” for the treatment of repetitive behavior in children with autism spectrum disorders.

“The obvious short term message is, this treatment didn’t work. And that surprised us a great deal,” Sikich says. “But the really important take-home message is that we have to do large, scientifically-sound comparative studies like this to really know whether a specific treatment works and is safe. Simply relying on doctors’ and families’ impressions often leads us to use medications that really don’t work and may do more harm than good” says Sikich.

Safe and effective medication and behavioral treatments are desperately needed to help children with autism realize their potentials and keep from harming themselves or others, Sickish says.

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“Well-done studies, using methods like the ones in this study, have shown that another drug, risperidone, is useful in reducing irritability and aggression in children with autism,” she says. “Thus, this study shouldn’t be interpreted as saying all medications don’t help people with autism and are harmful. Instead it says that citalopram doesn’t help most children with autism and is harmful to some children. Clearly we need more research to develop and test other interventions for this important problem.”

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People with autism are severely impaired by the disorder and experience major problems with highly repetitive behaviors, often including self-injurious behaviors, communicating and interacting appropriately with others. Frequently the repetitive behaviors keep children with autism from learning in school or participating in age appropriate activities. When it is time to stop the repetitive behavior and begin a new, functional activity, many children with autism become distraught and aggressive. These repetitive behaviors also contribute to the difficulties that make it hard for most people with autism to live independently or work as adults, Sikich says.

In addition to UNC, academic medical centers taking part in the study were Mt. Sinai School of Medicine, North Shore-Long Island Jewish Health System, Dartmouth, UCLA and Yale University.

The study was conducted as part of the NIH-sponsored Studies to Advance Autism Research and Treatment network.

6 ways to overcome the holiday blues

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Charlie Brown might have said it best as he opined to his pal, Linus: “Christmas is coming, but I’m not happy. I don’t feel the way I’m supposed to feel.”

Yes, the holiday season can foster moments of great joy, but it can also at times be a source of distress.

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Whether you’re worried about purchasing the right mix of decorations to create the perfect atmosphere for a Thanksgiving meal, or finding a way to connect with family members who live on the opposite coast, the holidays can be tricky to navigate.

It’s easy, especially in our increasingly social media-driven world, to “compare and despair,” says Dr. Michelle Paul, psychologist and director of The PRACTICE Mental Health Clinic at UNLV.

“It’s difficult to tear ourselves away from constant messages of what they’re doing and what we’re, in turn, not doing,” Paul said. 

As pumpkin pies bake, and grocery stores line their shelves with peppermint-flavored treats, Paul explained the sources of holiday blues that can sometimes affect us, and shared some practical ways to greet this time of year.

What causes holiday stress?

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There are a number of things about the holidays that can potentially be sources of distress. For each person it’s going to be different, but there are some general themes that we can reliably predict.

  • Loss of a loved one: If someone has lost a loved one, that loss can be made all the more poignant, and experienced more deeply, around the holidays. The holidays generally represent a time where family and friends get together, and enjoy each other’s company, so having lost someone can create distress.
  • Materialism: In our culture, the holidays represent a focus on having gifts and possessions. There is marketing around how the Thanksgiving table ‘should’ be set, and how the holiday decorations inside and outside of our homes ‘should’ appear. However, not everyone has the means to make extra purchases, setting the stage for comparing and judging others or ourselves negatively for ‘failing’ to keep up.
  • Hustle and bustle: Rushing to make sure I have the right groceries, the perfect gift for that someone special, and the best decorations, is magnified during the holidays. It’s difficult to find a balance around celebrating in a way that’s meaningful, and not getting caught up in a long to-do list.
  • Unrealistic Expectations: If your circumstances don’t match the cultural ideal of a Norman Rockwell painting, your mind tends to go to a place of judgment. And with judgment comes shame. You start thinking, ‘What’s wrong with me that I can’t have it the way they do?’

How does social media contribute to holiday stress?

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Social media is supposed to help us connect. But the unintended consequences of social media include increased stress, isolation, and a decreased sense of belonging. It’s had this weird, paradoxical effect of giving us this ongoing, never-ending opportunity to look in the mirror and compare ourselves to others. We’re constantly bombarded through our phones, with young people being particularly vulnerable to the pressures of social media. 

As an adolescent, you’re figuring out who you are and where you fit in. It’s a time when friendships are very important and meaningful, and you begin to build relationships outside of your family. Today, teens are also being asked to manage these social media messages about what is cool and not cool, and you can’t get away from it. You could escape it 40 years ago. You could go home and take a break from whatever drama was going on at school, or what a classmate wore to class and what you didn’t. 

As human beings, we naturally want to find where we feel in, instead of out, where we belong and feel connected. The holidays add another layer of that, with strong messages that circulate around us for months in advance.

What are some tips that can help people cope with these and other holiday stressors?

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  • Determine your values: Step back and think intentionally about what you want the holidays to represent. Who do you want to be in relation to the holidays? What kind of values do you want to connect to? Once you make that determination, you can behave in accordance with those values. 
  • Act on your values: Behaving in ways that are consistent with your values is more important than making comparisons or judgments. Thanksgiving, for example, is all about being thankful for what you have. And there are lots of activities around Thanksgiving that wouldn’t require spending a ton of money. Maybe on that day, you can take a walk in nature in order to contemplate or spend time appreciating what you have. If you’re missing family members, why not do a Friendsgiving? Enjoy food and company and embrace the fact that you’re a ragtag team of people spending time together. Or, go out and volunteer. If you’re feeling that you’re not receiving, why not do the opposite and do some giving?
  • Avoid compare and despair: Have self-compassion. You can compare, but you don’t have to add in the layer of judgment. If someone’s reality is different than yours, that’s OK! Stop “shoulding” all over yourself, and stop using damaging or punishing language. Instead of saying, ‘I should do this,’ or ‘I must do that,’ you could try, ‘I preferably should.’ Be mindful of your own mental chatter and the automatic tendency to go toward punishing language.
  • Make connections: Focus on creating space for belonging or acceptance. Find places where you can receive support, but also give support in return. Reach out to others. Think about worth, value, and appreciation versus the enemies of comparison, judgment, shaming, blaming, and pushing people away.
  • Take stock: Take an inventory of what your individual sources of stress are because it’s different for everybody. Ask yourself: If I could change one or two things to feel better, what would they be? Do some active problem solving. If you lost a loved one, for example, celebrate that person’s life, or change up what might have been a holiday routine with that person. Make room for it to not be a happy time — it’s OK if it’s not a happy time. 
  • Seek help: If you’re really feeling that you can’t cope with the stressors around you, it’s perfectly reasonable to reach out to others, or even a mental health professional. Sometimes we get muddled in our own brains, and an outside perspective from a trusted mental health practitioner can help provide you with clarity and relief. 
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About The PRACTICE

The PRACTICE is a UNLV mental health clinic that offers counseling and other services to campus and community members. Faculty experts in clinical and school psychology and mental health counseling train and supervise advanced graduate students in high-quality mental and behavioral health care. Faculty and student clinicians work together to provide evidence-based care, drawing upon the most up-to-date research and knowledge available.