saedeh khojasteh; farangis demehri; alireza afshani
Abstract
AbstractThe present study aimed to investigate the psychometric properties of the Autism Family Experience Questionnaire in families with autistic children in Yazd province. The study used a descriptive, correlational-normative method. The statistical population consisted of all families with autistic ...
Read More
AbstractThe present study aimed to investigate the psychometric properties of the Autism Family Experience Questionnaire in families with autistic children in Yazd province. The study used a descriptive, correlational-normative method. The statistical population consisted of all families with autistic children in 1403, from which a sample of 385 individuals was selected by convenience sampling. The measures used in this study were the Autism Family Experience Questionnaire, an Autism Symptom Severity scale, and a Social Support scale. The validity of the Autism Family Experience Questionnaire was confirmed through content validity (using CVI and CVR) and confirmatory factor analysis using AMOS software. An analysis of internal consistency revealed a positive and significant relationship between scores on the Autism Family Experience Questionnaire, Autism Symptom Severity, and Social Support. To examine the internal consistency reliability of the questionnaire, Cronbach's alpha was calculated. The findings showed a Cronbach's alpha of 0.929 for the autism parent experience subscale, 0.916 for the family life subscale, 0.94 for the child development, understanding, and social relations subscale, 0.897 for the child symptoms, feelings, and behavior subscale, and 0.952 for the total autism family experience scale. The results indicate that the Autism Family Experience Questionnaire has appropriate reliability and validity. Therefore, this scale can be used to assess the family experience of autism.Keywords: Psychometric Properties, Autism Family Experience Questionnaire, Autism Spectrum Disorder, Family Extended AbstractIntroductionFrom a systemic perspective, the functioning of each family member affects the overall system, and the challenges faced by one member can disrupt the functioning of others. Autism Spectrum Disorder (ASD) is one of the most prevalent neurodevelopmental disorders, characterized by impairments in social interaction, communication difficulties, and restricted, repetitive patterns of behavior (American Psychiatric Association, 2024). These challenges not only affect the lives of individuals with ASD but also impose significant psychological, social, and economic burdens on their families (Hodges et al., 2020). Prior research has consistently documented high levels of stress among families of children with ASD, which arises from factors such as stigma, intensive caregiving demands, social isolation, financial strain, and long-term concerns about the child’s future (Hoogsteen & Woodgate, 2013; Lutz et al., 2012; Gomes et al., 2015). Parents often report feelings of shame when unable to manage their child’s behaviors in public (Pisula-Barancko et al., 2021), while frequent "meltdown" episodes demand constant attention and reduce opportunities for rest (Ten Hoopen et al., 2010). Moreover, many families experience isolation from relatives and friends who fail to understand or accept their child’s condition, which further intensifies their stress (Pinto et al., 2016).Research also highlights differences in the lived experiences of mothers and fathers. Fathers often struggle with accepting developmental changes, employing effective coping strategies, navigating shifting paternal roles, and managing recurring feelings of shame and guilt following the diagnosis (Brown et al., 2021). Mothers frequently report experiencing ambivalent emotions, low psychological capital, and limited social networks (Ramezanloo et al., 2020). These findings underscore the importance of considering the entire family unit in intervention planning, as parental involvement is a key factor in improving treatment outcomes (Miner et al., 2023).Existing instruments measuring autism-related outcomes primarily focus on parental stress or general quality of life, paying limited attention to family-specific lived experiences (Leadbitter et al., 2018). Common tools—such as the Social Responsiveness Scale, Autism Spectrum Rating Scales, Aberrant Behavior Checklist, and child anxiety questionnaires—largely assess individual child symptoms (Ghadiri et al., 2022). This gap underscores the need for a comprehensive tool that evaluates both family experiences and child-related behaviors.The Autism Family Experience Questionnaire (AFEQ), developed by Leadbitter et al. (2018), was designed to capture the personal and family experiences of parents, as well as the developmental, behavioral, and emotional features of their children with ASD. The AFEQ assesses four domains: parenting experience, family life, child development, and social understanding/relationships, in addition to child symptomatology. It has demonstrated good internal consistency and convergent validity in studies conducted in the UK and Turkey (Leadbitter et al., 2018; Ebugla, 2024). Given the rising prevalence of ASD in Iran and the current lack of integrated tools assessing both family experiences and child symptoms, this study aims to examine the psychometric properties of the AFEQ within the Iranian context. Validating this instrument could provide researchers and clinicians with a comprehensive, reliable measure to assess the lived experiences of families raising children with ASD.Research QuestionDoes the Autism Family Experience Questionnaire (AFEQ) demonstrate valid and reliable psychometric properties for assessing the lived experiences of Iranian families of children with Autism Spectrum Disorder (ASD)? MethodologyThis study aimed to examine the psychometric properties of the Autism Family Experience Questionnaire (AFEQ) within an Iranian context. The research was applied in its purpose, quantitative in design, and descriptive-correlational in method, utilizing a survey approach. The statistical population consisted of all parents of children with Autism Spectrum Disorder (ASD) in Yazd Province, Iran, in 2024 (approximately 730 individuals, according to the Welfare Organization). A total of 391 parents were initially recruited via convenience sampling. After the removal of incomplete questionnaires, data from 385 participants were included in the final analysis.The inclusion criteria consisted of having at least one child with ASD and without comorbid ADHD, based on parent reports. The exclusion criterion was incomplete submission of the questionnaire. The study employed three instruments: (1) the Autism Family Experience Questionnaire (AFEQ; Leadbitter et al., 2018), a 48-item tool comprising four subscales that assess parenting experience, family life, child development and social relationships, and child symptoms; (2) the Gilliam Autism Rating Scale (GARS; Gilliam, 2014), a 56-item scale measuring restricted/repetitive behaviors, communication, social interaction, and emotional responses; and (3) the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1986), a 23-item measure assessing support from family, friends, and significant others. ResultsA total of 385 parents participated in the study, comprising 90 males (mean age = 43) and 295 females (mean age = 37). Among the participants, 202 had a high school diploma or lower, and 183 held a bachelor’s or master’s degree. The psychometric evaluation of the Autism Family Experience Questionnaire (AFEQ) included assessments of content validity, construct validity, and internal consistency reliability. Content validity, assessed by 10 experts using CVR and CVI indices, was satisfactory, with all items exceeding the recommended thresholds (CVR > 0.62, CVI > 0.79). Construct validity was examined using confirmatory factor analysis (CFA) in AMOS. The results showed that all factor loadings were above 0.4 and statistically significant (p <.001), and model fit indices confirmed the adequacy of the factor structure.Internal consistency analysis revealed a positive and significant correlation between autism symptom severity and family experience (p <.001), and a negative correlation between social support and family experience (p <.001). Reliability, assessed using Cronbach’s alpha, indicated high internal consistency for all subscales: Parenting Experience (α = 0.929), Family Life (α = 0.916), Child Development and Social Relationships (α = 0.940), Child Symptoms (α = 0.897), and the overall scale (α = 0.952). These results collectively demonstrate that the AFEQ is a valid and reliable instrument for assessing the experiences of Iranian families with children on the autism spectrum. Discussion and ConclusionThis study aimed to examine the psychometric properties of the Persian version of the Autism Family Experience Questionnaire (AFEQ), an instrument designed to assess parents' personal and family experiences alongside the developmental, emotional, and behavioral characteristics of their children with Autism Spectrum Disorder (ASD). The results demonstrated strong content validity, with all items meeting satisfactory indices. Reliability analysis revealed high internal consistency for all subscales, with Cronbach’s alpha coefficients ranging from 0.897 (Child Symptoms) to 0.940 (Child Development and Social Relationships), and 0.952 for the overall scale, a finding consistent with previous studies (Ibogla et al., 2024). Furthermore, confirmatory factor analysis supported the questionnaire's construct validity, demonstrating a good model fit (CMIN/df = 2.81, RMSEA = 0.06, PNFI = 0.606) and confirming that the four subscales—Parenting Experience, Family Life, Child Development, and Child Symptoms—measure distinct underlying dimensions.Correlation analyses revealed a significant positive relationship between autism symptom severity and family experience, indicating that families of children with more severe symptoms reported greater challenges. Conversely, a significant negative correlation was found between social support and family experience, suggesting that higher levels of perceived challenges were associated with lower levels of social support. This finding is consistent with Leadbitter et al. (2018).In summary, the findings indicate that the Persian version of the AFEQ is a valid, reliable, and practical instrument for assessing the experiences of families with children on the autism spectrum. Study limitations include the inability to control for cultural and socioeconomic variables, as well as differences in the treatment levels received by the children, which may affect the generalizability of the results. Future studies are recommended to include an assessment of test-retest reliability to further validate the instrument's consistency over time.
Sara Rouhani; Mohammad Narimani; Nader Hajloo; REZA Farzizadeh
Abstract
Abstract
The formulation of a therapeutic model centered on neurology can be crucial for the effective treatment of neurodevelopmental disorders. This research investigates the development and evaluation of an innovative "Neuro-Exuberant Proliferation Therapy" as a treatment modality for symptoms and ...
Read More
Abstract
The formulation of a therapeutic model centered on neurology can be crucial for the effective treatment of neurodevelopmental disorders. This research investigates the development and evaluation of an innovative "Neuro-Exuberant Proliferation Therapy" as a treatment modality for symptoms and developmental indicators in children diagnosed with Autism Spectrum Disorder (ASD). A mixed-methods approach was employed. In the qualitative component, inductive qualitative content analysis was applied to formulate the theoretical foundations and operational plan of the therapy. In the quantitative phase, an experimental design with a pre-test-post-test control group was used to assess the treatment's effectiveness. A total of 30 participants aged 3-5 years with autism spectrum disorder were recruited through convenience sampling and randomly allocated into an experimental group and a control group, each with 15 individuals. The therapeutic intervention consisted of 36 sessions, each lasting 45 minutes, over a period of 3 months. The measurement tools used were the GARS-3 (Gilliam Autism Rating Scale) and the ASQ-II (Ages and Stages Questionnaires, Parent-Administered). Data were analyzed using the Mann-Whitney U test, revealing significant positive outcomes in the domains of problem-solving, gross motor skills, communication, and autistic symptoms (p < 0.01). However, these positive changes were not observed in the areas of fine motor skills and personal-social behaviors. It can be concluded that Neuro-Exuberant Proliferation Therapy has a positive impact on the development and reinforcement of broader, foundational (macro) functions. However, this intervention does not appear to have a significant direct effect on specific, learned (micro) functions within a 3-month period.
Keywords: Neuro-centered Intervention, Autism Spectrum Disorder, Developmental Indicators, Neuro Exuberant Proliferation Therapy
Extended Abstract
Introduction
Autism spectrum disorder is a neurodevelopmental disorder with a substantial prevalence rate and considerable potential for causing functional limitations. It is characterized by two primary features: persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities (DSM-5). These symptoms pose significant challenges to the cognitive, communication, and social development of affected children (APA). The recent revisions in the DSM-5-TR emphasize the neurological underpinnings of autism spectrum disorder. Additionally, the theme chosen by the World Health Organization (WHO) for World Autism Awareness Day in both 2023 and 2024, which focuses on the necessity to transition toward a neurocentric approach, further underscores the significance of a neurological perspective in autism care.
It is crucial to recognize that autism spectrum disorder is primarily caused by defects in essential neurobiological processes such as neurogenesis, neuronal development, synapse formation, and synaptic plasticity, which disrupt the proper formation of layers of the cerebral cortex, as well as neural differentiation and signaling (Van Koten et al., 2008; Vegil et al., 2010; Parikshak et al., 2013; Gilbert & Manji, 2017). Among the various complications associated with children diagnosed with autism spectrum disorder, comorbid conditions such as depression, anxiety, attention deficit, hyperactivity, and sleep disturbances (Yang et al., 2022), along with cognitive-perceptual dysfunctions, executive dysfunction, and information processing difficulties, are commonplace (Weir et al., 2022). The collective accumulation of these functional and behavioral deficiencies culminates in increasingly divergent patterns of development from normative standards (Woznik et al., 2017). In examining autism spectrum disorder, two principal approaches come to light. The first approach focuses on addressing behavioral symptoms and remediating behavioral deficits via symptom-based interventions. Simultaneously, a neurodevelopmental perspective (which encompasses the researcher's viewpoint) prioritizes a developmental-oriented approach. Since development is intrinsically tied to the functionality of neuronal structures, transformation must originate from changes to those very structures (Chakraburty, 2021).
To effectively address this class of neurodevelopmental disorders through rehabilitation, it is imperative to identify interventions capable of instigating transformation in the neural development process and activating intrinsic self-repair mechanisms by harnessing the adaptive capabilities of the nervous system. Studies have revealed that certain techniques traditionally employed solely for educational purposes can also stimulate brain function and promote neurogenesis. Aerobic exercise is one such intervention that falls into this category. Aerobic exercise functions by activating the cardiovascular system and increasing heart rate while simultaneously pumping greater amounts of oxygen to the brain (Datta, 2019). Another highly effective intervention within the field of neurodevelopmental disorders is sports training. This is significant given that anomalies in the central oxytocinergic and serotonergic systems are recognized as a root cause behind the social-functional deficits exhibited by individuals diagnosed with autism spectrum disorder (Mohdi et al., 2013). It has been documented that sports training can help modulate this metabolism (Mohdi et al., 2013), which furthermore diminishes disruptive behaviors such as aggression.
The essence of this research revolves around the deliberate design of a therapeutic approach, coined as "Neuro-Exuberant Proliferation Therapy" by the researcher. This approach embodies a comprehensive, neurodevelopmental orientation, taking into account the dimensions and scope of the impairment and the unique individual variations of each child. By applying principles of play therapy, a targeted regimen of exercises is implemented to achieve desired transformational outcomes. The differentiation of the "Neuro-Exuberant Proliferation Therapy" method from traditional utilization of sports or mental exercises lies in its emphasis not only on employing the principle of synergy but also on directly targeting the activation of brain structures, fostering neurogenesis, and promoting neural network formation through behavioral interventions.
The execution model of "Neuro-Exuberant Proliferation Therapy" adheres to the mind's networking model, which pertains to the utilization of cognitive and executive functions. The exercises employed are designed to mimic the developmental stages of children's cognitive and executive functions. This modeling approach facilitates the activation of brain networks associated with cognitive tasks and decision-making. The foundational theory behind the Neuro-Exuberant Proliferation Therapy (NEPT) methodology is centered on the premise that the proliferation of beneficial neurons leads to the formation of developmental stages and milestones. Over time, this process leads to the elimination of non-useful neuronal pathways. From this perspective, exercises have been selected that are extensively researched and proven to yield significant neurodevelopmental advancements, specifically those categorized as "exuberant proliferation."
Literature Review
The meta-analysis conducted by Delani (2021) reveals that employing aerobic exercise, particularly at high intensity, is highly effective in mitigating the symptoms associated with autism spectrum disorder. Some observed effects of this intervention include a reduction in stereotyped behaviors and repetitive movements, as well as improvements in sleep pattern regularity and attention span. According to Delani (2021), these findings have the potential to substantially influence the design of therapy programs and the organization of special education in schools. Additionally, recent research by Jackson et al. (2022) highlights that performing aerobic exercises synergistically can yield even more substantial positive effects.
It has also been observed that when these exercises are performed intermittently at a high intensity and at a moderately to intensely challenging level, they can lead to significant enhancements in cognitive flexibility and social performance among individuals (Mamari et al., 2017). Sensory integration plays a pivotal role in the effectiveness of these interventions. Researchers have observed that the successful integration of sensory inputs, encompassing the proprioceptive (body position), vestibular (balance and movement), and interoceptive (internal bodily sensations) systems, has a profound impact during combined exercise training. This integrated sensory input is critical for developing the skills necessary for participating in a broad spectrum of daily activities (Miller et al., 2014).
Methodology
The research employed a mixed-methods approach, being both fundamental and applied in nature. To design and assess the desired intervention, the Goodman Delphi method (1987) was utilized. In the first step, the "pre-clinical stage," an extensive review of scientific databases was conducted using the keywords "Neurodevelopment," "Autism," and "Proliferation." A total of 103 studies demonstrating the highest reported rates of neurodevelopmental progress in children diagnosed with neurodevelopmental disorders, particularly autism spectrum disorder, were identified and collected for reference.
The review process, specifically the second step in the research methodology, involved the selection of 15 meta-analysis studies that comprehensively assessed recent research and included larger sample sizes with input from a broad group of expert researchers. The theoretical foundations and main aspects of the desired treatment method were extracted from these studies, in accordance with neurological functions and aligned with relevant specialized texts. The initial treatment plan was subsequently developed under the supervision of psychology professors. The principles, techniques, and theoretical and functional areas considered by the author in designing the chosen treatment method were presented to relevant field experts. These experts evaluated the components and provided feedback, which the author incorporated into the final intervention.
Results
The comparative analysis of the average scores of the subjects in the experimental group between the pre-test and post-test phases demonstrates a favorable progression in the attributes linked to communication, gross motor skills, and problem-solving abilities. The findings indicate a significant impact of the intervention strategy on these three specific factors.
The research data reveal statistically significant improvements in the problem-solving (p = 0.000), communication (p = 0.008), and gross motor skills variables. These three factors also exhibit substantial effect sizes of 43%, 27%, and 26%, respectively. Notably, the personal-social skills and fine motor skills variables, while showing change, were not statistically significant (p = 0.427 and p = 0.221, respectively) and did not demonstrate substantial effects within the three-month study period.
Table 1- The results of multivariate analysis of covariance of ASQ scales
Eta Squared
Level of Significance
F
Mean Square
Degree of Freedom
Sum of Squares
Source
0.269
0.008
8.458
246.637
1
246.637
Communicating
0.256
0.009
7.896
157.877
1
157.877
Gross Movements
0.064
0.221
1.586
4.948
1
4.948
Subtle Movements
0.430
0.000
17.334
161.24
1
161.24
Problem Solving
0.028
0.427
0.653
8.854
1
8.854
Personal-Social Skills
The GARS-3 test scores of the experimental group show considerable improvement between the pre-test and the post-test assessment across all dependent variables. According to the results obtained during the post-test phase, the NEPT method was found to be effective in addressing symptoms related to repetitive and stereotyped behaviors (67%), social interactions (57%), social communication (57%), and emotional reactions (67%). The overall efficacy of the therapy on the total symptoms of autism is estimated at 86%.
Table 2- Mancova test results of GARS-3 Gilliam autism scales
Eta Squared
Level of Significance
F
Mean Square
Degree of Freedom
Sum of Squares
Source
0.674
0.000
47.507
51.252
1
51.252
Stereotyped Behaviors
0.567
0.000
30.091
17.696
1
17.696
Social Interactions
0.570
0.000
30.531
5.936
1
5.936
Social Communication
0.675
0.000
47,860
11.418
1
11.418
Emotional Reactions
0.865
0.000
147.814
392.869
1
392.869
All Symptoms of Autism
Discussion
The findings align with several preceding meta-analytical studies pertaining to stereotypic behaviors, obsessive interests, and emotional reactions (Elliott et al., 1994; Seliberti et al., 1997; Long et al., 2010; Delaney, 2021). However, certain other investigations, such as Linderman et al. (1999), display conflicting results. These discrepancies can be attributed to various factors, including the age of the children at intervention, session quality, the combination of exercises, the level of the child's engagement in activities, and the number of sessions provided.
Studies conducted by Schaff et al. (2014), Basu et al. (2017), and Hong et al. (2020) corroborate the findings of this research. These researchers highlight that aerobic exercise leads to increased levels of brain-derived neurotrophic factor (BDNF), which supports the expansion of neural networks. This process results in modified behavioral patterns through heightened flexibility and the formation of new neural connections (Lees & Hopkins, 2013; Mandelsi et al., 2018; Arida et al., 2021).
Numerous meta-analyses, including those conducted by Liao et al. (2015), Basu et al. (2017), Hong et al. (2020), Jia et al. (2022), and Li et al. (2023), affirm the overall positive influence of aerobic exercise on cognitive performance, tasks related to the prefrontal cortex, and its beneficial impact on emotional states, mood, and emotional regulation. This positive effect can be attributed to the mechanisms of action of brain-derived neurotrophic factor (Caro et al., 2003) and nerve growth factors.
Conclusion
It can be stated that the NEPT method, as an initial behavioral intervention with a neurodevelopmentally oriented approach, has demonstrated considerable effects on developmental factors. Emphasizing the importance of development, rehabilitation must transcend survival and focus on nurturing growth. The NEPT method has the potential to spark a profound transformation in the realm of rehabilitation by shifting the focus from survival to comprehensive development.
Mohammad Hatami Nejad; Mohammadreza Noroozi Homayoon; Esmaeil Sadri Damirchi
Abstract
Abstract
The purpose of this study was to evaluate the effectiveness of cognitive behavioral play therapy and Transcranial direct-current stimulation on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder. This study was a quasi-experimental ...
Read More
Abstract
The purpose of this study was to evaluate the effectiveness of cognitive behavioral play therapy and Transcranial direct-current stimulation on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder. This study was a quasi-experimental design with pre-test, post-test, and control group. The statistical population consisted of all children aged 6-12 years with autism spectrum disorder who referred to special education schools, centers, and clinics in Ardabil city during the years 2022-2023. A total of 45 children with autism spectrum disorder were selected non-randomly and purposefully and randomly assigned to three groups (15 children in each group). The intervention included cognitive-behavioral play therapy and transcranial direct current stimulation. The tools of this study included the N-back computerized test, Wisconsin Card Sorting Test (WCST), Gross and John Emotion Regulation Questionnaire, and the Communication Skills Questionnaire. The findings considering the results of Bonferroni's post hoc test showed that in pairwise comparison of cognitive behavioral play therapy, Transcranial direct-current stimulation and the control group in the scores of executive functions, emotion regulation and communication skills variables, there was a significant difference between the cognitive behavioral play therapy group, Transcranial direct-current stimulation group and the control group (p<0.05). In conclusion, cognitive behavioral play therapy and Transcranial direct-current stimulation have an effect on emotional regulation, executive functions and communication skills in children with autism spectrum disorder.
Keywords: cognitive behavioral play therapy, transcranial direct-current stimulation, emotional regulation, executive functions, communication skills, autism spectrum disorder
Extended Abstract
Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction, along with restricted and repetitive behaviors, which significantly impair children's daily functioning and family dynamics. These challenges typically manifest as difficulties in emotional regulation, executive functions, and communication skills - critical domains for social integration and personal development. The current study aimed to examine the effectiveness of cognitive behavioral play therapy (CBPT) and transcranial direct current stimulation (tDCS) in enhancing emotional regulation, executive functions, and communication skills in children with ASD, responding to the need for integrated, non-pharmacological interventions that target these core deficits concurrently.
Research Questions
What is the effectiveness of cognitive behavioral play therapy (CBPT) and transcranial direct current stimulation (tDCS) on emotional regulation, executive functions, and communication skills in children with autism spectrum disorder (ASD)?
Is there a significant difference between CBPT and tDCS in their effectiveness for improving emotional regulation, executive functions, and communication skills in children with ASD?
Literature Review
Children with ASD frequently demonstrate significant impairments in emotional regulation, with studies suggesting that approximately 85% of individuals with ASD struggle with emotion management, leading to behavioral and social difficulties (Lee et al., 2022). Executive function deficits - particularly in working memory, cognitive flexibility, and impulse control - are commonly observed and associated with prefrontal cortex dysfunction and related neural network abnormalities (Costescu et al., 2024). Communication challenges, including problems with social cue interpretation, conversation initiation, and eye contact maintenance, often worsen social isolation (Clyde et al., 2024). Cognitive behavioral play therapy (CBPT) has demonstrated effectiveness in enhancing social and communication skills by creating a secure, play-based setting for emotional expression and social interaction practice, with research showing improved neural activity and social functioning (Chan & Ouyang, 2024; Kaur et al., 2024). Similarly, transcranial direct current stimulation (tDCS) has shown potential as an intervention, modulating prefrontal cortex activity to enhance cognitive and social outcomes in ASD (Kang et al., 2024; Han et al., 2023).
Play therapy has been shown to significantly improve social skills in children with autism by offering a structured yet adaptable environment for emotional expression and social learning (Elbeltagi et al., 2023, p. 5). However, limited research has directly compared CBPT and tDCS to assess their relative effectiveness in addressing the complex challenges of ASD, underscoring the importance of comparative studies to guide clinical decision-making.
Methodology
This study utilized a quasi-experimental design incorporating pre-test and post-test assessments with a control group. The target population comprised children aged 6-12 years with ASD diagnoses who were enrolled in special education schools, centers, and clinics in Ardabil, Iran during the 2022-2023 academic year. Using non-random purposive sampling, 45 participants were selected and subsequently randomly allocated to three experimental groups (n=15 each: CBPT, tDCS, and control). Inclusion criteria consisted of: (1) formal ASD diagnosis confirmed by both psychiatrist and psychologist, (2) parental consent, (3) normal IQ range, and (4) absence of comorbid conditions. Exclusion criteria involved missing more than two intervention sessions or voluntary withdrawal. The CBPT intervention implemented Drewes' (2009) protocol through eight weekly 60-minute sessions, while tDCS administration comprised ten 10-minute sessions delivered twice weekly over five weeks using a 2NEUROSTIM device (1-2 mA current applied to prefrontal cortex). Primary outcome measures included: the N-back Computerized Test (working memory), Wisconsin Card Sorting Test (Berg et al., 1948; cognitive flexibility), Emotion Regulation Questionnaire (Gross & John, 2003), and Communication Skills Questionnaire (Matson, 1983). MANCOVA was performed with pre-test scores as covariates to examine between-group differences, following confirmation of normality, homogeneity of variance, and regression slope assumptions (α=0.05).
Results
Both intervention groups (CBPT and tDCS) showed statistically significant improvements across all measured domains - emotional regulation, executive functions (working memory and cognitive flexibility), and communication skills - when compared to the control group. The CBPT group demonstrated particular strengths in emotional regulation and communication skills, which may be attributed to its structured play-based methodology that facilitates social learning and emotional expression. Conversely, the tDCS group showed more pronounced improvements in executive functions and social communication, likely resulting from enhanced neural activation in prefrontal cortical regions. Bonferroni-adjusted post-hoc analyses confirmed the superiority of both interventions over the control condition (p < 0.05), while revealing no statistically significant differences between CBPT and tDCS outcomes.
Table 1 Mean and Standard Deviation of Pre-test and Post-test Scores for Executive Functions, Emotional Regulation, and Communication Skills
Group
Variable
Pre-test Mean (SD)
Post-test Mean (SD)
CBPT
Executive Functions
45.12 (5.61)
52.34 (4.89)
Emotional Regulation
38.76 (6.12)
46.89 (5.43)
Communication Skills
42.45 (7.19)
50.67 (6.32)
tDCS
Executive Functions
44.89 (6.23)
53.12 (5.01)
Emotional Regulation
39.12 (5.98)
47.23 (5.67)
Communication Skills
41.89 (6.87)
51.34 (6.45)
Control
Executive Functions
45.67 (5.84)
46.12 (5.76)
Emotional Regulation
38.45 (6.34)
39.01 (6.28)
Communication Skills
42.12 (7.01)
42.89 (6.95)
Note. Data reflect significant improvements in intervention groups compared to the control group (p < 0.05)
Discussion
These findings align with existing evidence showing CBPT improves emotional regulation and communication skills through amygdala modulation and prefrontal cortex reinforcement, thereby enhancing emotion management and social interaction capabilities (Chan & Ouyang, 2024; Kaur et al., 2024). Similarly, tDCS's positive impact on executive functions and social communication corroborates research demonstrating its efficacy in optimizing prefrontal neural network functioning (Kang et al., 2024; Noroozi Homayoon et al., 2024). The absence of significant between-group differences indicates comparable effectiveness of CBPT and tDCS, despite their divergent mechanisms—CBPT employing experiential learning approaches while tDCS utilizes direct neural modulation. These outcomes highlight the value of non-pharmacological interventions for core ASD symptoms. Study limitations include uncontrolled environmental and cultural variables, along with insufficient long-term follow-up to evaluate treatment effect persistence, potentially affecting result generalizability.
Conclusion
Both CBPT and tDCS demonstrated effectiveness in enhancing emotional regulation, executive functions, and communication skills in children with ASD, providing clinically valuable non-pharmacological treatment options for therapeutic and educational applications. Future studies should incorporate larger, more diverse samples and longitudinal designs to assess treatment effect maintenance and improve the generalizability of results.
AcknowledgmentsThe authors gratefully acknowledge the valuable contributions of the children with ASD and their families in Ardabil who participated in this study, making this research possible through their time and commitment.
Farokh lagha Akafi broujeny; Masoumeh Behboodi; Farideh dokaneifard
Abstract
The present study was conducted with the aim of comparing the effectiveness of acceptance and commitment therapy and cognitive behavioral therapy on the personality traits of mothers having children with autism spectrum disorder. This study was semi-experimental with a pre-test-post-test design and a ...
Read More
The present study was conducted with the aim of comparing the effectiveness of acceptance and commitment therapy and cognitive behavioral therapy on the personality traits of mothers having children with autism spectrum disorder. This study was semi-experimental with a pre-test-post-test design and a control group. 45 mothers having children with autism spectrum disorder were selected by available sampling method and were equally and randomly placed in two experimental groups and one control group (15 people in each group). The experimental groups received separate training in acceptance and commitment therapy and cognitive behavioral therapy, while the members of the control group did not participate in these programs. Subjects were evaluated using the five major personality factors questionnaire (1987). The data was analyzed using univariate and multivariate analysis of covariance. The research findings indicated that acceptance and commitment therapy was effective on extroversion and cognitive-behavioral therapy was effective on the responsibility of this group of people (P<0.01). Also, examining the difference between the effectiveness of acceptance and commitment therapy and cognitive-behavioral therapy showed that there was a significant difference between the effectiveness of these two treatment methods on extroversion and responsibility (P<0.05). From this research, it can be concluded that acceptance and commitment therapy and cognitive behavioral therapy can play an important role in modulating the personality traits of mothers having children with autism spectrum disorder.
Adel Mohamadzade; Hasan hasanzade; Mohsen Shokoohi-Yekta; sogand ghasemzadeh
Abstract
Autism spectrum disorder (ASD) is a developmental disability that can cause significant communication challenges. Because communication skills are essential to developing other skills, it seems necessary to use early interventions to improve communication skills in children with ASD. Therefore, the aim ...
Read More
Autism spectrum disorder (ASD) is a developmental disability that can cause significant communication challenges. Because communication skills are essential to developing other skills, it seems necessary to use early interventions to improve communication skills in children with ASD. Therefore, the aim of this systematic review was to summarize current research about the effect of the Hanen parent program on the communication, interaction, and language skills of children with ASD. Accordingly, it was searched for all articles and dissertations indexed in Persian and foreign databases, in ScienceDirect, Sagepub, Eric, Wiley, Springer, Pubmed, ProQuest, Noormags, Sid, Magiran, and Irandoc in the period 1990 to 2022; using a combination of expressions including “autism spectrum disorder”, “Hanen parent program”, “communication skills” and “early intervention”. Thus, according to the eligibility criteria (Inclusion and exclusion), thirteen articles were included in this systematic review. The results of these studies showed that the Hanen parent program can lead to the natural acquisition of communication skills in children with ASD by relying on strategies in the natural environment and parent-child interaction. Therefore, it is suggested that the Hanen parent program be used as a beneficial early intervention for children with ASD. However, due to the research limitations that reduce the generalization of the results, its effectiveness requires more detailed studies.Keywords: Hanen Parent Program, Communication Skills, Early Intervention, Autism Spectrum Disorder. Extended Abstract IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by deficits in social communication skills and restricted and repetitive behaviors in early childhood (American Psychiatric Association, 2022). One of the basic problems observed in children with ASD is a lack of social communication skills (Erbas, Özcebe and Esen, 2020). These children do not have enough communication skills to interact with others in verbal and non-verbal contexts. It should be noted that the problem of these people in communication skills may range from minimal limitation to serious damage (Mohan, Kunnath, Philip, Mohan and Thampi, 2017). The communication deficits of these children may reduce their opportunities to facilitate language development and social interactions. Parents, as the first and most important people related to a child, play an important role in promoting their language and social development (Edmunds, Kover and Stone, 2019). The communication challenges of children with ASD are related to the quantity, quality, and duration of parent-child interactions, and the greater the communication problems of a child with ASD, the less successful the parents are in the child's social upbringing. The more these communication problems are, the interactions between parent and child will be less and of lower quality, and the time will be more limited (Laurent and Gorman, 2017).Therefore, it is necessary to apply parent-mediated based early interventions for children with ASD. In recent years, more emphasis has been placed on the role of parents and their intervention training in improving the skills of children with ASD. Research results indicate the positive effect of parent-based interventions in improving the responsiveness, language, and social skills of children with ASD (Reichow, 2012; Alonso-Esteban and Alcantud-Marín, 2022; Vinen, Clark and Dissanayake, 2022). One intervention that is parent-mediated based is the Hanen more than word program (HMTW). Since HMTW is based on the child's natural environment and family system, it can increase the ability to generalize these skills in children with ASD (Akamoglu and Meadan,2018). Since it seems that the effectiveness of HMTW on the social interactions and language skills of children with ASD has not been systematically investigated, therefore the aim of the current research was the systematic review of researches that show the effectiveness of HMTW on these skills.Literature ReviewThe research findings of Garnett, Davidson & Eadie (2022) showed that HMTW can be effective and reduce time and financial costs. The parents' insight towards the interaction, learning and behavior of themselves and their children was improved. Improvements in communication, interaction responsiveness and play in ASD children were also reported. But it didn't have much effect on parents' stress. Also, Lok, Qi & To (2021) emphasized that HTMW can affect the communication skills of children with ASD whose parents have a higher sense of competence. Erbas et al showed the effect of HTMW on parents' self-efficacy, anxiety, and stress. It also affects the parent-child interaction and language performance of children with ASD.MethodologyThe current research employed a systematic review method, utilizing the PRISMA model to analyze collected data. Relevant research articles from reputable databases, including ScienceDirect, PubMed, ERIC, PsycINFO, Scopus, Web of Science, Noormags, SID, Magiran, and IranDoc, were searched using keywords such as 'autism spectrum disorder,' 'communication skills,' 'early interventions,' and 'Hanen Parent Program' for the period spanning 1990 to 2022. All relevant sources cited in these articles were also examined. Following an initial search of the research background, articles were screened based on titles and abstracts to remove duplicates and irrelevant studies. Subsequently, the full text of the remaining articles was reviewed and evaluated by two referees according to predefined inclusion and exclusion criteria to identify eligible research. To mitigate the risk of bias in the studies included in this research, we utilized the quantitative studies quality assessment tool from the Effective Public Health Practice Project (EPHPP, 1998). Two evaluators assessed the studies using this tool, and the level of agreement between them was measured using the Kappa coefficient.ResultsAfter conducting investigations, we identified 390 studies, with 138 remaining after removing duplicates. Subsequently, we examined the titles and abstracts, eliminating 79 unrelated studies. This left 59 studies for full-text review. Following the application of inclusion and exclusion criteria, 46 studies were removed, resulting in the identification of 13 relevant studies for our analysis.Among the identified studies, 7 were experimental or quasi-experimental (53.85%), with 1 utilizing mixed methods. Additionally, there were 4 case studies (30.77%), 1 single-subject study (7.7%), and 1 longitudinal study (7.7%).The quality of the research was assessed using the Kappa coefficient, yielding a score of 0.92. Thus, 3 articles were deemed to have good quality, 5 had medium quality, and 5 had low quality. Studies receiving a low rating often had limitations in research methodology, sample size, and data collection methods, hindering generalizability to the community. These results are shown in Table 1. Overall, the effectiveness of HMTW in these studies can be categorized into quantitative (with statistical analysis) and qualitative or mixed-method research (descriptive and single-subject). It's important to note that the results of quantitative studies varied.Table 1 Results of quality assessment of studies using the EPHPPAuthors, year of publicationSelection biasStudy designConfoundersBlindingData collection methodsWithdrawals and drop-outsGlobal ratingGarnett, Davidson & Eadie (2022)1112222Lok et al (2021)3232223Erbas et al (2020)4122222Sokmum, Singh & Vandort (2017)4222222DeCarlos & Baixauli (2015)1112111Lieberman-Betz et al (2014)2221232Carter et al (2011)3323233Patterson & Smith (2011)1111121Prelock, Calhoun, Morris & Platt (2011)1111121Venker, McDuffie, Weismer & Abbeduto (2011)2211122Girolametto Sussman & Weitzman (2007)1111121McConachie, Randle, Hammal & LeCouteur (2005)3322323Sorensen (1992)1111111DiscussionThe results of this research indicate that the program is more effective than HMTW for improving the communication skills of children with ASD. However, except for Venkar et al.'s (2011) study, which showed a medium effect size, the rest reported weak effect sizes, attributed to small sample sizes and data collection methods.Active parental involvement in treatment supports the language and communication development of children with ASD (Lok et al., 2021). Conversely, Carter et al (2011) found HMTW to be more effective for children with ASD showing limited interest in objects.Children less interested in specific objects responded better to HMTW, while those more interested required additional support and different strategies. Therefore, attention should be given not only to the communication level but also to the level of interest in subjects.Furthermore, Sokmum et al (2017) concluded that parental intervention can be as effective as a therapist-led intervention. They observed minimal progress in communication skills among the control group subjected to clinical intervention compared to the experimental group undergoing HMTW.ConclusionIn general, it can be said that HMTW emphasizes the natural life and daily activities of children with ASD and considers parents' education as the main social and communication base of the child, and considering the positive results that these studies have obtained from its effectiveness, it confirms its usability and training as an early intervention - alone or in combination with other interventions. However, the effectiveness of this intervention in order to ensure its generalizability to the entire society, requires more detailed investigations and a higher sample size.
maryam shkoohirad
Abstract
Abstract
The aim of this study was to investigate the effectiveness of biomedical treatments on the symptoms and satisfaction of families with autism spectrum disorder. The present research method was a semi-experimental pre-test-post-test type with a control group. The statistical population of this ...
Read More
Abstract
The aim of this study was to investigate the effectiveness of biomedical treatments on the symptoms and satisfaction of families with autism spectrum disorder. The present research method was a semi-experimental pre-test-post-test type with a control group. The statistical population of this research was the autistic children of the autism group in virtual space, from which thirty autistic children aged four to twelve with autism, fifteen in the experimental group and fifteen in the control group were randomly assigned. The Autism Treatment Evaluation Checklist (ATEC) was used to collect research data. The program was conducted in three months by parents and the supervision of the researcher, and the research data was analyzed using the covariance analysis method. The results of covariance analysis showed that biomedical treatments in reducing the symptoms in the Autism Treatment Evaluation Checklist (ATEC) have caused families to be satisfied. It seems that with the continuation of this method and reaching higher stages of treatment, more changes can be made in reducing the symptoms of autism and following it, reducing the challenges of the families, leading to the families' satisfaction with the treatment.
Keywords: Biomedical Treatments, Family Satisfaction, Autism Spectrum Disorder.
Extended Abstract
Introduction
Autism is a complex neurodevelopmental genetics that is caused by a combination of environmental factors. In all areas of the child's development, it is affected and behaviorally, it is limited by social damage, indirect social connection and definition (Chast and Leboer, 2022). The personal and financial cost of an autistic person in families is very high (Hoffer et al., 2022). So far, only behavioral therapies have been the mainstay of managing this disorder (Pitson et al., 2020). The absence of effective treatments for the neurodevelopmental disorder of autism is significant (Aishwarya et al., 2022). The fact that autism treatment is unproven is itself a source of family dissatisfaction and requires an urgent need to focus on the mental health of the family and create consistency in the care of the autistic individual (Lerner, White and McPartland, 2022). Psychiatrically, there are still no approved medications for the main symptoms of the disorder, such as social and communication problems, repetitive behaviors, and secondary symptoms, such as irritability and aggression (Nirenius et al., 2022). Parents reported that supplements and diet were the most helpful treatments in reducing symptoms compared to other treatments they had used to treat autism (Adams et al., 2018). Since environmental chemicals and toxins are also associated with an increased risk of neurodevelopmental disorders and certain conditions such as autism. Research examines diet between environmental exposures and neurodevelopmental outcomes (Granro, 2022). Therefore, this research intends to determine the effectiveness of diet and supplements due to the types of severity of autism spectrum disorders and the lack of evidence of effectiveness (that drug treatments, behavioral therapies, and rehabilitation therapies have not led to treatment except for control and slight improvement). Natural biomedicals, with the help of their families, take a step towards knowing the solutions to reduce and improve the symptoms of autism. Therefore, due to the increase in the prevalence of autism all over the world in recent years, the need for various researches and more and more investigations in the field of discovering treatments that will guide us to the causes of autism is necessary.
Research Questions
Does diet affect neurodevelopmental outcomes? Is it possible to see a change in the symptoms of autism with diet and natural remedies and biomedicals?
Literature Review
Regarding biomedical treatments: in the meantime, biomedical treatments are related to the activation of the immune system and anti-inflammatory effects (Ostadkarmpour and Patnins, 2021). In a research, it was shown that there is a positive correlation between modulating glutamate in the basal ganglia and the balance of the excitatory-inhibitory system, with the reduction of autism symptoms (Pertzesh et al., 2019). Research has shown that early detection of the ratios of several mitochondrial biomarkers can predict autism and distinguish between high and low-functioning spectrums (Al-Ansari and others, 2018). In a research, it was shown that insufficient levels of vitamin D play a role in the severity of autism symptoms (Al-Ansari and others, 2018). Research has shown that digestive problems are highly associated with behavioral symptoms of autism (Magoid et al., 2022). In recent studies, the role of neuroinflammation in autism behaviors has been confirmed (Cristiano et al., 2022).
Methodology
This research was practical in terms of purpose and in terms of sampling method, it was a semi-experimental pre-test-post-test type with a control group. The statistical population of this research was made up of children with autism disorder aged 4 to 12 from the virtual autism group in Tehran. The inclusion criteria were having a diagnosis of autism from a psychiatrist and age 4 to 12 years. To obtain the required sample of participants with autism disorder in the virtual space group, 15 people were randomly selected. And 15 people were selected as the control group. Both groups first responded to the autism treatment evaluation checklist, and the evaluation score of their autism level in the pre-test was determined. The experimental group, with the full cooperation of their families, was subjected to a diet of complete elimination of sugar and sweets along with the use of biomedical methods for three months. The control group did not receive any intervention during this period. At the end of the three-month intervention period, the subjects of both groups responded to the autism treatment evaluation checklist, and their autism level evaluation score was determined in the post-test.
Results
In order to analyze the data, SPSS25 software and multivariate analysis of covariance were used. The presuppositions of using multivariate covariance analysis and homogeneity of variances were checked in Levine's test. The findings showed that the scores of the subjects of the experimental group in the post-test phase in the components of speech and communication, sociability, sensory-cognitive and physical health showed a decrease, but not much change was observed in the control group.
Table of the results of covariance analysis (MANCOVA) to investigate the significant difference between the two experimental and control groups in the components of speech and communication, sociability, sensory perception and physical health.
The dependent variable
sum of squares
DF
mean square
F
Sig
Ita
speech and communication
0.860
1
0.860
0.409
0.528
0.17
Sociability
0.009
1
0.009
0.005
0.944
0.001
sensory
0.197
1
0.197
0.414
0.526
0.017
physical health
0.991
1
0.991
0.210
0.651
0.009
speech and communication
91.980
1
91.980
43.803
0.001
0.65
Sociability
77.987
1
77.987
45.094
0.001
0.65
sensory
72.398
1
72.398
151.882
0.001
0.86
physical health
367.249
1
367.249
77.646
0.001
0.76
The results of the covariance analysis in the table show that after controlling for the pre-test effects, there is a statistically significant difference between the average scores of the two experimental and control groups in the total score of speech and communication (F=43.803). There were sociability (F=45.094), sensory (F=151.882), and physical health variables (F=77.646). According to the calculated effect size, 0.65, 0.65, 0.86 and 0.76 percent of the total variances of the experimental and control groups are due to the effect of the independent variable.
Fatemeh Hosseinjani; Mehdi Zemestani
Abstract
Abstract
Autism spectrum disorder (ASD) is one of the important neurodevelopmental disorders that always has a high comorbidity with other psychiatric disorders. One of the ways to investigate this comorbidity is to identify the underlying mechanisms involved in this association. The aim of the present ...
Read More
Abstract
Autism spectrum disorder (ASD) is one of the important neurodevelopmental disorders that always has a high comorbidity with other psychiatric disorders. One of the ways to investigate this comorbidity is to identify the underlying mechanisms involved in this association. The aim of the present study was to explore the mediating role of emotion regulation and intolerance of uncertainty in the development of externalizing disorders in children with ASD. The current research was a correlational study using structural equation modeling (pathway analysis). The statistical population included all children and adolescents with ASD in the age range of 8 to 18 years from autism schools and the autism society in Tehran, Tabriz, and Mianeh province. Using a convenience sampling method, a sample of 117 children was selected and the data were collected online from parents. Pearson correlation coefficient and pathway analysis were used for the statistical analysis of data by SPSS and AMOS software. The results of the present study showed that the symptoms of autism directly and significantly explain the symptoms of externalizing spectrum disorders. Also, emotion dysregulation and intolerance of uncertainty as mediating factors explain the severity of externalizing spectrum disorders impairments in children with autism disorder. According to these findings, it can be concluded that emotion dysregulation and intolerance of uncertainty as pathological transdiagnostic factors play an important mediating role in the exacerbation of the symptoms of externalizing disorders in children with ASD.
Keywords: Autism spectrum disorder, Transdiagnostic factors, Emotion regulation, Intolerance of uncertainty, Externalizing disorders.
Extended Abstract
Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by marked social and communication deficits, fixed interests, and repetitive behaviors (American Psychiatric Association, 2022). Children with ASD often have comorbid psychiatric disorders, including internalizing and externalizing disorders (Kaplan, Sadock, & Ruiz, 2019). Co-occurring externalizing problems (e.g. aggression, outburst behaviors, hyperactivity, and irritability) are very common in ASD across the lifespan and are often associated with poorer quality of life over and above the impact of ASD itself (Vaillancourt et al., 2017; Miller et al., 2019).
Considering the high prevalence of comorbid externalizing problems with ASD, the negative consequences of this comorbidity, identifying the underlying mechanisms involved in this comorbidity have important implications. Identifying and understanding the possible role of transdiagnostic mechanisms in the development and maintenance of externalizing pathologies in children with ASD have implications in the better explanation of the nature of comorbid disorders with ASD as well as in the modeling and developing effective treatment protocols for these children (Ozsivadjian et al., 2020).
Various transdiagnostic factors may play a mediating/moderating role in the development or maintenance of the symptoms of comorbid externalizing problems in children with ASD. Limited research has been conducted on transdiagnostic factors underlying the comorbidity of externalizing disorders in children with ASD. There is emerging empirical support for a number of cognitive-emotional mechanisms being implicated in the development and maintenance of high rates of externalizing problems in ASD (Mazefsky et al, 2013).
Among the important transdiagnostic factors that have been highly emphasized in recent studies on the externalizing problems in ASD, we can mention emotion regulation (Mazefsky et al, 2013; Morie et al., 2015) and intolerance of uncertainty (Neil, Olsson, & Pellicano, 2016; Vasa et al., 2018). These two constructs are among the important underlying transdiagnostic factors that have been emphasized in recent research on their influential and mediating role in the creation and continuation of comorbid disorders with autism spectrum disorder (Say et al., 2017; Saiz-Souanes et al., 2020).
The present study was conducted to explain the mediating role of emotion dysregulation and intolerance of uncertainty as transdiagnostic mechanisms in the development and maintenance of externalizing problems in children with ASD. The main question of the research was to what extent the two underlying and transdiagnostic constructs of emotion dysregulation and intolerance of uncertainty as mediating variables can explain the symptoms of externalizing symptoms in children with ASD?
Literature Review
Limited studies have been conducted on the role of emotion dysregulation and intolerance of uncertainty in the development of internalizing and externalizing problems in children with ASD. In this regard, Mazefsky et al. (2011) showed that children with ASD have problems in using adaptive emotion regulation strategies and they use maladaptive strategies to deal with negative daily tensions, which makes them prone to a wide range of internalizing psychopathologies including depression and anxiety. Morie et al. (2015) also showed that defect in emotion regulation plays an important role as a mediator in the development and exacerbation of anxiety and depressive symptoms in youth with ASD. Neil et al. (2016) and Vasa et al. (2018) showed that the high level of intolerance of uncertainty in children with ASD increases the level of tension and anxiety in them, and this tension in turn leads to the possibility of disruptive behaviors in them. Therefore, previous evidence shows that intolerance of uncertainty is an important element in the development and maintenance of internalizing pathologies in them. Therefore, previous pieces of evidence show that emotion dysregulation and intolerance of uncertainty in youth with ASD are among the important mediating risk factors for the development and maintenance of comorbid psychopathologies in them.
Methodology
A descriptive correlation research approach (structural equation model) is adopted in this study. The statistical population included all children and adolescents with ASD who were referred to exceptional children schools and autistic centers in Tehran, Tabriz, and Mianeh cities in 2019-2020. A convenience sampling method was used to select 117 children and adolescents with ASD as the study sample. The inclusion criteria were receiving ASD diagnosis based on the pediatric psychiatrics interview, ability to write and read, having ages between 8 and 18 years, and willingness to participate in the study. All participants were assessed by the Gilliam Autism Rating Scale-second edition (GARS-2), Strengths and Difficulties Questionnaire (SDQ), and Intolerance of Uncertainty Scale for Children (IUSC). To analyze the data, descriptive statistical metrics such as mean, standard deviation, and Pearson correlation and pathway analysis were employed using the SPSS-22 and Amos-24 software.
Results
The results of the matrix correlation showed a significant relationship between ASD symptoms, externalizing problems, emotion regulation strategies, and intolerance of uncertainty dimensions. The standardized direct effect of ASD symptoms on externalizing problems, emotion regulation strategies, and intolerance of uncertainty dimensions was significant (p> 0.05). Moreover, evaluation of indirect effects using the bootstrap method showed that the indirect effects of ASD symptoms on conduct problems, hyperactivity, emotion regulation strategies (i.e., suppression, reappraisal), and intolerance of uncertainty dimensions (prospective and inhibitory) were significant. Therefore, the indirect relationship between ASD symptoms and externalizing problems through emotion regulation and intolerance of uncertainty is significant (p> 0.05).
Conclusion
This study aimed to investigate the mediating role of transdiagnostic factors of emotion dysregulation and intolerance of uncertainty in the association between ASD symptoms and externalizing problems. The results of the present study showed that the symptoms of autism directly explain the externalizing problems in children with ASD. Also, emotion regulation and intolerance of uncertainty as mediating factors explain the severity of externalizing problems in children with ASD.
According to these findings, it can be said that emotion dysregulation and intolerance of uncertainty as pathologic transdiagnostic mechanisms probably play an important mediating role in explaining the development and maintenance of externalizing problems in children with ASD. Based on the results of this research, it can be said that the defect in emotional regulation and also the inability to tolerate ambiguous situations in autistic children and adolescents probably lead to the development of externalizing symptoms (conduct problems, hyperactivity) in them.
This study has limitations that should be considered in future research. Limitations related to the cross-sectional nature of the study, geographical region, small sample size, sampling method, and using self-reporting questionnaires as a data collection tool.
Farhad Ghadiri Sourman Abadi; khoshdavi ebrahimzade; Roya Zare; Mehrnoush Javaezi Shishavan,
Abstract
The present study was conducted with the aim of evaluating the psychometric properties of the anxiety scale of children with autism spectrum disorder (parent form). The method of the current research was a correlational description. The statistical population of the present study was all children with ...
Read More
The present study was conducted with the aim of evaluating the psychometric properties of the anxiety scale of children with autism spectrum disorder (parent form). The method of the current research was a correlational description. The statistical population of the present study was all children with autism spectrum disorder in Tehran city who were referred to autism education and rehabilitation centers in 2022. 315 children (193 boys and 122 girls) were selected using available sampling method. After translating and obtaining the opinions of experts and subjects, the face validity of the scale was confirmed. AMOS and SPSS software were used for statistical analysis. The results of confirmatory factor analysis showed that in the sample of Iranian children with autism spectrum disorder, the four-factor structure of the scale including performance anxiety, anxiety arousal, separation anxiety and uncertainty had a good fit with the data. The results related to the correlation between this scale and the Spence anxiety scale experimentally supported the convergent validity of the anxiety scale of children with autism spectrum disorder. The internal consistency coefficients of the whole scale and subscales of functional anxiety, anxiety arousal, separation anxiety and uncertainty were obtained as 0.79, 0.78, 0.81, 0.76 and 0.82, respectively. Overall, the results of the present study showed that the anxiety scale of children with autism spectrum disorder is a valid and reliable tool for measuring anxiety in Iranian children with autism spectrum disorder. This tool can be used to measure anxiety in Research and treatment sections.
Saeed Rezayi; Asgar Choobdari
Abstract
The aim of this study was to develop and validate a package of empowerment of pre-verbal (communication) skills for children with neurodevelopmental disorders, especially children with autism. This research was done descriptively-analytically. This research method had two parts: qualitative research ...
Read More
The aim of this study was to develop and validate a package of empowerment of pre-verbal (communication) skills for children with neurodevelopmental disorders, especially children with autism. This research was done descriptively-analytically. This research method had two parts: qualitative research and quantitative research. In the qualitative research section, the inductive qualitative content analysis method has been used. To analyze the qualitative content, a systematic search of articles, dissertations, and books related to the field of pre-verbal skills of children with autism spectrum disorder was used. Also, the face and content validity methods were used to check the validity of the developed package. Finally, the results of all content analyses performed on sources and components derived from them were presented in the form of a pre-verbal skills empowerment package. The results of content validity based on the opinions of 12 experts in this field showed that the designed package has good content validity (0.83). Therefore, it can be concluded that the pre-communication (verbal) skills empowerment package designed has the necessary formal and content validity and can be used in educational and clinical contexts.
zahra zarekhalili; Mehran Soleymani; Qorban HemmatiAlamdarlou,; hassan yaghoubi
Abstract
The aim of this study was to investigate the effect of Snoezelen method on the symptoms of children with autism spectrum disorder. The research method was quasi-experimental with pre-test and post-test design with control group. The statistical population of the present study was all children with autism ...
Read More
The aim of this study was to investigate the effect of Snoezelen method on the symptoms of children with autism spectrum disorder. The research method was quasi-experimental with pre-test and post-test design with control group. The statistical population of the present study was all children with autism spectrum disorder, from which a sample of 30 people was selected by convenience sampling method and randomly assigned to the experimental and control groups. So that each group was 15 people and from both groups pre-test was performed and the experimental group received the Snoezelen method in 40 sessions while the control group was not presented with this intervention and at the end for both groups the post-test was performed. The instrument used in this study was the Gilliam (Garz) survival rating scale. Data analysis using univariate analysis of covariance and multivariate covariance showed that the mean scores of autism syndrome and its sub-comparisons (social interaction and communication) increased significantly and stereotyped behavior decreased P (<0/05). The findings indicate that the Snoezelen method improves autism in children with autism spectrum disorder. Therefore, it is recommended to design and implement Snoezelen program to improve autism.
Hoda Faramarzi; marzieh ghanei
Abstract
The aim of this study was to determine the effectiveness of play therapy based on cognitive-behavioral therapy on challenging behaviors of high-functioning autistic children. The research method was semi-experimental with pre-test and post-test design with control group. The statistical population of ...
Read More
The aim of this study was to determine the effectiveness of play therapy based on cognitive-behavioral therapy on challenging behaviors of high-functioning autistic children. The research method was semi-experimental with pre-test and post-test design with control group. The statistical population of this study was all children aged 8 to 12 years old with autism spectrum disorder in health care centers of Arak in 2018. In this study, 16 high-functioning autistic children were selected by available sampling method using a questionnaire for measuring the range of autism spectrum disorder. They were randomly assigned to two groups of experimental (8 subjects) and control (8 subjects) groups. The Revised Scale of Challenging Behaviours of Bodfish, Symons, Parker & Lewis (2000), was used to assess challenging behaviors. The experimental group received 10 cognitive-behavioral treatments in a 10-minute session during a one-month period, while the control group did not receive such an intervention. At the end, the two groups were evaluated again. Data were analyzed using covariance analysis. The findings of this study showed that play therapy based on cognitive-behavioral therapy has a significant role in reducing the challenging behaviors of high-functioning autistic children.
Farzaneh Ghanimi; Asghar Dadkhah; Esmat Danesh; Sagegh Taghiloo
Abstract
Autism spectrum disorder is a type of neurodevelopmental disorder characterized by persistent impairment in social interactions and communication as well as repetitive and specific behaviors. The purpose of this study was to compare of the effectiveness of stress management and social support perception ...
Read More
Autism spectrum disorder is a type of neurodevelopmental disorder characterized by persistent impairment in social interactions and communication as well as repetitive and specific behaviors. The purpose of this study was to compare of the effectiveness of stress management and social support perception training based on cognitive-behavioral manner on quality of life of mothers of children with autism spectrum disorder. The research method was experimental with pretest, posttest and follow up design. First, the subjects were screened for inclusion criteria, then 30 mothers with children with autism spectrum disorder were selected and after being matched, they were randomly assigned to experimental and control groups (10 person in each group). Mothers in the two groups, stress management and social support perception management, received 8 sessions of 90 minutes of intervention and the control group received no intervention. The research instrument, including WHO Quality of Life Questionnaire (1996), was administered to the subjects in all three stages. Data analysis using statistical method of repeated measures analysis of variance, showed that training of social support perception, improves component of social relations (P<0.001), and training of stress management, improves component of physical health (P<0.001), more than other components of quality of life of mothers. Based on the findings, it is suggested that support programs be implemented in community mental health organizations to develop training packages and implement guidelines related to empowering parents with children with autism spectrum disorder.
Sedigheh Annabestani; Alimohammad Naemi
Abstract
The aim of this study was to determine the effects of positive thinking traning on self-compassion and life expectancy in mothers of children with autism spectrum disorder of Sabzevar, Iran. This study was semi -experimental and pretest-posttest with control group was used. The statistical population ...
Read More
The aim of this study was to determine the effects of positive thinking traning on self-compassion and life expectancy in mothers of children with autism spectrum disorder of Sabzevar, Iran. This study was semi -experimental and pretest-posttest with control group was used. The statistical population of the study consisted of all mothers of children with autism spectrum disorder of Sabzevar in the academic year 2017-18 that were selected according to eligibility criteria and were assigned to experimental (n = 18) and control (n = 18) groups through simple random sampling. After conducting the pre-test using the self-compassion scale and life expectancy scale, the experimental group received positive thinking traning during 10 sessions of 75 minutes, while the control group received no intervention. After the end of the program, the two groups were given a post-test. The collected data was analyzed using descriptive statistics methods (mean and standard deviation) and inferential statistics (analysis of covariance) with the help of version 23 of SPSS. The results showed that positive thinking traning have a significant effect on the self-Compassion and life expectancy with components of the mothers of children with autism spectrum disorder of Sabzevar. Accordingly, positive thinking training is an effective intervention program for helping mothers of children with autism spectrum disorder.
Maryam Bakhshi; Zekallah Morovati; Tahereh Elahi; Sara Shahmohamadian
Abstract
The purpose of this study was to determine the effectiveness of art therapy on social-communication skills, emotional regulation and behavioral flexibility in children with autism spectrum disorder. This research was quasi-experimental and it's plan was pre-test, post-test and follow-up two months with ...
Read More
The purpose of this study was to determine the effectiveness of art therapy on social-communication skills, emotional regulation and behavioral flexibility in children with autism spectrum disorder. This research was quasi-experimental and it's plan was pre-test, post-test and follow-up two months with the control group. The statistical population included 6-12 years old children with autism spectrum disorder in Zanjan. The sample consisted of 26 children who were selected by the available sampling method and then randomly assigned into two experimental and control groups (each group was 13). The instrument of research was questionnaire of Autism Social Skills Profile_ Scott Bellini's, the Emotion Regulation Checklist- Shields & Cicchetti, and the Gilliam Autism Rating Scale-Second Edition rating scale. The experimental group perch on art therapy interventation during 44 session for 4 months that extracted from art therapy program for children and adolescents with autism by Jennifer Beth Silvers (2008). In addition to descriptive statistics, inferential statistics, the repeated measure anova were used to analyze the data. Data analysis showed that art therapy had a good effect on social-communication skills and it's components, the components of emotional regulation and instability/negativity and also behavioral flexibility, means that the intervention program improved social communication, emotion regulation and behavioral flexibility. So according to the findings of this research, art therapy as a complementary therapeutic approach can be used to improve social-communication skills, emotion regulation and behavioral flexibility in children with autism spectrum disorder.