Browsing by Author "Smith, Tristram"

Now showing 1 - 4 of 4
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    Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial
    (Elsevier, 2016-07) Scahill, Lawrence; Bearss, Karen; Lecavalier, Luc; Smith, Tristram; Swiezy, Naomi; Aman, Michael G.; Sukhodolsky, Denis G.; McCracken, Courtney; Minshawi, Noha; Turner, Kylan; Levato, Lynne; Saulnier, Celine; Dziura, James; Johnson, Cynthia; Department of Psychiatry, IU School of Medicine
    Objective This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. Methods This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3−7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. Results At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. Conclusion These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time.
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    An exploration of concomitant psychiatric disorders in children with autism spectrum disorder
    (Elsevier, 2019-01) Lecavalier, Luc; McCracken, Courtney E.; Aman, Michael G.; McDougle, Christopher J.; McCracken, James T.; Tierney, Elaine; Smith, Tristram; Johnson, Cynthia; King, Bryan; Handen, Benjamin; Swiezy, Naomi B.; Arnold, L. Eugene; Bearss, Karen; Vitiello, Benedetto; Scahill, Lawrence; Psychiatry, School of Medicine
    Objective We explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD). Methods Participants were 658 children with ASD (age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics. Results Of the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented. Conclusion In this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.
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    Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder
    (Springer Nature, 2017-08) Lecavalier, Luc; Smith, Tristram; Johnson, Cynthia; Bearss, Karen; Swiezy, Naomi; Aman, Michael G.; Sukhodolsky, Denis G.; Deng, Yanhong; Dziura, James; Scahill, Lawrence; Psychiatry, School of Medicine
    We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3-7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.
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    Predictors of Caregiver Strain for Parents of Children with Autism Spectrum Disorder
    (Springer, 2021) Bradshaw, Jessica; Gillespie, Scott; McCracken, Courtney; King, Bryan H.; McCracken, James T.; Johnson, Cynthia R.; Lecavalie, Luc; Smith, Tristram; Swiezy, Naomi; Bearss, Karen; Sikich, Linmarie; Donnelly, Craig; Hollande, Eric; McDougle, Christopher J.; Scahill, Lawrence; Pediatrics, School of Medicine
    Parents of children with autism spectrum disorder (ASD) face higher levels of caregiver strain compared to parents of children with other disabilities. This study examined child clinical features that predict high levels of caregiver strain for 374 parents of children with ASD. Caregiver strain was measured using the Caregiver Strain Questionnaire (CGSQ) objective, subjective internalized, and subjective externalized subscales. Confirmatory factor analysis indicated an acceptable fit for the original CGSQ three-factor solution. The strongest child predictors across CGSQ subscales were: disruptive behavior for objective strain, autism severity and disruptive behavior for subjective internalized strain, and oppositional behavior and hyperactivity for subjective externalized strain. Individualized interventions that attend to specific elements of parental strain may reduce strain and improve family wellbeing.