Tackling bullying could help reduce depression in autistic teens

University of Bristol| June 2018 | Tackling bullying could help reduce depression in autistic teens

A new study from Bristol University has found teenagers with difficulties in social communication, including autism, have greater rates of depression, especially if they are being bullied. 


The researchers used data from a longitudinal study and  discovered that children with autism, and young people with autistic traits, had greater symptoms of depression at age 10 than peers without autism. This trend continued until the children and young people were 18 (via Science Daily).


The full news story is available to read from Science Daily

An article based on this study has been published in JAMA Psychiatry


Importance  Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear.

Objectives  To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying.

Design, Setting, and Participants  Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017.

Main Outcomes and Measures  Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule–Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years.

Results  The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results.

Conclusions and Relevance  Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.


The article can  be read in full at JAMA Psychiatry 

Full reference:

Rai D, Culpin I, Heuvelman H, et al.| Association of Autistic Traits With Depression From Childhood to Age 18 Years| JAMA Psychiatry | Published online June 13, 2018| doi:10.1001/jamapsychiatry.2018.1323



US study uses phone app to screen for autism

Science Daily |June 2018 | Mobile app for autism screening yields useful data

A new US study that uses a smartphone app to screen young children for signs of autism has found the application produces reliable data. It was also accessible for children and praised by caregivers (via Science Daily).

During the year-long  there were over 10000 downloads of the app; parents completed more than 5000 surveys and uploaded 4441 videos. These data were collected, 88 per cent of the videos yielding useful data.  The app uses video footage of the adolescents filmed while watching films and designed to identify patterns of emotion and attention, autism risk factors, on the device.  The videos are then analysed by behavioural coding software which tracks the child’s response and quantifies their emotions and attention.

A member of the research team Geraldine Dawson, Director of the Duke Center for Autism and Brain Development, remarked “This demonstrates the feasibility of this approach.

“Many caregivers were willing to participate, the data were high quality and the video analysis algorithms produced results consistent with the scoring we produce in our autism program here at Duke.”

The full news article is available from Science Daily 
The study has now been published in the open access journal npj Digital Medicine. It can be accessed through Nature 

Full reference:

Egger, H. L. et al .| 2018| Automatic emotion and attention analysis of young children at home: a ResearchKit autism feasibility study |npj Digital Medicine| Vol. 1 |DOI: 10.1038/s41746-018-0024-6

University of Huddersfield researchers: Children with autism do engage in imaginary play

University of Huddersfield | May 2018 | Children with Autism are able to create imaginary friends 

A new study demonstrates that children with Austistic Spectrum Disorder (ASD) are able to create imaginary friends. This challenges previous research that suggests children with autism are unable to engage in imaginary play (via Science Daily).


The researchers used over 200 questionnaires completed by UK and US parents of children diagnosed with ASD and parents of children with typical development (TD). Although the findings show that children with a diagnosis of ASD were less likely to create an imaginary friend (16.2 per cent) compared to 42 per cent of their TD peers; they were older when they begin engaging in this kind of play, and were also more likely to play with a   “personified object” such as a stuffed toy or doll. The researchers argue that there is no difference in the quality of the play the children engage in.

According to Dr Paige Davis, of the University of Huddersfield and the lead author of the study: “The finding that children diagnosed with ASD even spontaneously create such imaginary companions refutes existing beliefs that they are not imagining in the same way as typically developing children.”

The press release is available from the University of Huddersfield 

The article is published in the Journal of Autism and Developmental Disorders, it can be requested by Rotherham NHS staff here 

New study finds CBT helps children with ASD to regulate their emotions

Science Daily|Cognitive behavioral therapy can improve emotion regulation in children with autism

A Canadian study that examined the impact of cognitive behavioural therapy (CBT) on young children with autism spectrum disorder (ASD) found that children assigned to the intervention (CBT) group demonstrated improved emotional regulation, compared to those in the control.  The 68 children who participated in the study each received 10 sessions of CBT intervention, this was intended to improve their emotional regulation and   This study is the first of its kind to demonstrate the benefits of CBT extend beyond treating anxiety (via Science Daily). 



Mental health problems are common among individuals with autism spectrum disorder (ASD), and difficulties with emotion regulation processes may underlie these issues. Cognitive behavior therapy (CBT) is considered an efficacious treatment for anxiety in children with ASD. Additional research is needed to examine the efficacy of a transdiagnostic treatment approach, whereby the same treatment can be applied to multiple emotional problems, beyond solely anxiety. The purpose of the present study was to examine the efficacy of a manualized and individually delivered 10‐session, transdiagnostic CBT intervention, aimed at improving emotion regulation and mental health difficulties in children with ASD.


Sixty‐eight children (M age = 9.75, SD = 1.27) and their parents participated in the study, randomly allocated to either a treatment immediate (= 35) or waitlist control condition (= 33) (ISRCTN #67079741). Parent‐, child‐, and clinician‐reported measures of emotion regulation and mental health were administered at baseline, postintervention/postwaitlist, and at 10‐week follow‐up.


Children in the treatment immediate condition demonstrated significant improvements on measures of emotion regulation (i.e., emotionality, emotion regulation abilities with social skills) and aspects of psychopathology (i.e., a composite measure of internalizing and externalizing symptoms, adaptive behaviors) compared to those in the waitlist control condition. Treatment gains were maintained at follow‐up.


This study is the first transdiagnostic CBT efficacy trial for children with ASD. Additional investigations are needed to further establish its relative efficacy compared to more traditional models of CBT for children with ASD and other neurodevelopmental conditions.


Full reference: Weiss, J.A., Thomson, K.,   Burnham Riosa, P.,  Albaum, C.,  Chan, V.,   Maughan, A.,  Tablon, P., Black, K. |  A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism |Journal of Child Psychology and Psychiatry |  2018; DOI: 10.1111/jcpp.12915

Rotherham NHS staff can request the article here  


Science Daily Cognitive behavioral therapy can improve emotion regulation in children with autism

Children with autism more likely to be prescribed antipsychotic medication than peers

Researchers have discovered that children diagnosed with autism or intellectual difficulty are more likely to be antipsychotic medication than their peers. Professor Sinead Brophy and her colleagues at Swansea University investigated how antipsychotics are used in the NHS.  As part of the cohort study they connected hospital, GP and educational records for 3028 young people who had been prescribed an antipsychotic (via Science Daily).


The study’s key findings:

children with intellectual difficulty or autism were more likely to be given an antipsychotic. The study found:

  • 2.8% had been prescribed antipsychotics
  • 75% of these children had autism
  • This compares with 0.15% of those without intellectual disability.

Objective: Antipsychotics are licensed for psychosis and are also prescribed for behavior control. This study aims to examine characteristics and outcomes of children prescribed antipsychotics.

Methods: A cohort study using general practice and hospital records linked with education records for 1,488,936 children living in Wales between 1999 and 2015. The characteristics of the children who were prescribed antipsychotics are presented using descriptive statistics and outcomes such as respiratory illness, diabetes, and injury were analyzed using multilevel logistic regression and the prior event rate ratio (PERR).

Results: Children with intellectual difficulty/autism were more likely to be prescribed antipsychotics (2.8% have been prescribed an antipsychotic [75% with autism] compared with 0.15% of children without intellectual difficulty). Those with intellectual disabilities/autism were prescribed antipsychotics at a younger age and for a longer period. Antipsychotic use was associated with a higher rate of respiratory illness for all (PERR of hospital admission: 1.55 [95% CI: 1.51–1.598] or increase in rate of 2 per 100 per year in those treated), and for those with intellectual difficulty/autism, there was a higher rate of injury and hospitalized depression. However, among those without intellectual difficulty/autism, there were lower rates of depression (PERR: 0.55 [95% CI: 0.51–0.59]).

Conclusions: This work shows real-world use of antipsychotics and provides information on the rate of possible adverse events in children treated. Antipsychotics are predominantly used for those with intellectual difficulty/autism rather than those with a psychotic diagnosis. There is evidence that rates of respiratory disease, epilepsy, and diabetes are also higher post antipsychotic use for all. In those with intellectual difficulty/autism, hospital-admitted depression and injury are higher post antipsychotic use. The use of antipsychotics for behavioral management is likely to have increased cost implications to the healthcare system.

Full reference:
Brophy, S., et al |April 2018 | Characteristics of Children Prescribed Antipsychotics: Analysis of Routinely Collected Data |  Journal of Child and Adolescent Psychopharmacology | Doi:  10.1089/cap.2017.0003

 The full journal article can be read at the Journal of Child and Adolescent Psychopharmacology here 

Project to improve access to information for children and young people, their families and carers in Nottinghamshire relating to Autistic Spectrum Disorder

NICE’s shared learning database has been updated with the details of a new project developed to deliver information to support the care, development and day to day life of children and young people with Autistic Spectrum Disorder (ASD) as recommended in NICE CG170: Information and involvement in decision-making (CG170 recommendation 1.1.11).  


A multi-disciplinary team (MDT) which consisted of consultant community paediatricians, specialist nurses and a member of the Trust Library & Knowledge Team, met regularly to share information and suggestions on all aspects of the project.
The project intentionally used differing information formats and media so that children, their families and carers could access the information in the easiest and most useful way possible. (Guide to Producing Health Information for Children and Young People, PIF 2014).

The three main outcomes were:

  • the development of an online portal;
  • a post diagnosis support pack;
  •  a collection of books for parents to borrow from the library

Patients, families and carers value the information provided by the Library as they trust that the information is current and from a reliable source.

Full details of the project are available from NICE 

Do children with gender dysphoria show symptoms that overlap with Autism Spectrum Disorder?

Zucker, K. et al. | Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher’s Report Form | Child and Adolescent Psychiatry and Mental Health | Published 25 September 2017

This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD.

To assess these constructs, we examined Items 9 and 66 on the Teacher’s Report Form (TRF), which measure obsessions and compulsions, respectively.

For Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children.

These findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213–19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.

Full document available via Biomed Central