Adolescence coincides with a dramatic rise in the onset of psychiatric conditions including depression. Depression symptoms may be particularly prevalent and impairing for youth with autism spectrum ...disorder (ASD). While prior research suggests adolescence is associated with worsening depression symptoms for typically developing (TD) and autistic youth, it is unclear if they follow a similar course.
The study examined the trajectory of depressive symptoms in autistic and neurotypical youth over a 4-year longitudinal study using linear and logistic mixed effects models. In youth with clinically relevant depressive scores (t-score > 65), moderating factors (i.e., diagnosis, age, puberty, sex) were explored. During Year 1, the sample included 244 youth 10-to-13 years: 140 in the ASD group (36 females) and 104 in the TD group (46 females).
Autistic youth had elevated depression scores compared to TD peers (p < 0.001) and females were higher than males in both groups (p = 0.001). There was significant diagnosis by age (p < 0.001) and diagnosis by pubertal stage (p < 0.05) interactions. In the ASD group, elevated depressive scores presented in early adolescence and decreased during middle adolescence and puberty, whereas the TD group showed the opposite trend with an increase in depression symptoms with advancing development.
Limitations include an unequal sex distribution (fewer females), non-representative autistic sample (e.g., cognition and race/ethnicity), and potential confound of the COVID-19 pandemic.
Autistic youth present with higher rates of depressive symptoms early in development; yet, approaching middle adolescence and puberty, the symptom trajectory in the autistic youth declines coinciding with an increase in the TD youth. While group trajectories are divergent, they lead to similar levels of depression in late adolescence with higher symptoms in females. Findings suggest a period of quiescence in depressive symptomology influenced by biopsychosocial factors impacting affective profiles.
Recent research suggests there may be differences in the social presentations of autistic males and females. Camouflaging is believed to account for some of these differences and executive function ...(EF) may support compensatory social behaviors. As few studies have explored the role of sex and everyday EF when evaluating specific social difficulties among autistic youth, the present study seeks to address this. The Social Responsiveness Scale-2 (SRS-2) was used to measure types of social difficulties and the Behavioral Rating Inventory of Executive Function-2 (BRIEF-2) served as a measure of everyday EF. Four three-step hierarchical multiple regressions were conducted with SRS-2 social subscales as dependent variables. Autism symptom severity, BRIEF-2 EF Indices (i.e., behavioral, emotional, and cognitive regulation), and sex served as independent variables. Types of EF impairment significantly predicted social symptoms of autism. Behavioral dysregulation predicted all social symptoms assessed, cognitive dysregulation predicted social awareness and communication challenges, and emotion dysregulation predicted social motivation and communication difficulties. Sex significantly predicted social communication and cognition challenges, beyond the contributions of age, IQ, autism severity, and EF impairment. Findings from this study provide evidence for the contribution of EF to observed social symptoms of autism. Results suggest there may be sex-based differences in the relationship between EF and social problems for autistic youth. Implications and future directions are discussed.
Autism spectrum disorder (ASD) is characterized by challenges in social competence that persist in adulthood, yet few treatment options exist. A pilot randomized clinical trial (RCT) of a ...peer-mediated, theatre-based intervention with established efficacy in youth with ASD was examined in autistic adults. The final sample consisted of forty-seven 18-to-40-year-old participants randomized to the experimental (EXP N = 23) or waitlist control (WLC N = 24) condition. A multimodal, social interdependent model was employed to examine social competence changes in brain (incidental face memory (IFM) using event-related potentials), cognition (Wechsler Memory Scale-III), behavior (Contextual Assessment of Social Skills) and function (Social Responsiveness Scale (SRS); Adaptive Behavior Assessment Scale (ABAS) Social Composite). Using analysis of covariance in which pretest was controlled in the model, posttest between-group differences were observed on IFM (p = 0.016, η
= 0.139, d = 0.79) and several social and adaptive functional (SRS, ABAS) outcomes in social communication and interaction (SCI) (p = 0.019, η
= 0.121, d = -00.45), communication (p = 0.044 η
= 0.09, d = -00.31), and motivation (p = 0.001, η
= 0.229, d = -0.79) domains. At two-month follow-up, gains in social motivation remained (p = 0.041, η
= 0.100, d = -0.77). The results offer preliminary support for a unique theatre-based social skills intervention for autistic adults who have few treatment options to enhance social competence. The trial was pre-registered with ClinicalTrials.gov (Identifier: NCT04349644).
Depression is common among autistic youth and has a significant negative impact on quality of life and day-to-day functioning. Despite great need for efficacious treatments, there are currently ...limited research-supported interventions for depression symptoms in autistic young people. This study tested a novel, behavior-based approach or psychotherapy for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A) with 15 youth (11-16 years old). BA-A is an individually delivered 12-session therapy that was developed for and to meet the needs of autistic youth with depression. Results found that autistic youth and their caregivers were able to participate in BA-A therapy sessions, and clinicians were able to deliver BA-A in accordance with the treatment manual. Notably, results demonstrated that autistic youth depression symptoms significantly improved after participating in BA-A. Furthermore, anxiety symptoms and social skills significantly improved following BA-A.
How does media hinder and flourish the development of diverse black female sexualities?The intersectionality within "the black woman" established a need to be the strong familial head by the ...religious subordinate, racially loyal, and overtly sexual. Adding on "millennial" as a generational demographic creates additional levels of open-mindedness and balance between family and career.
Defense mechanisms are widely accepted as important psychological constructs. However, each theoretical community is obliged to reinterpret such complex constructs in light of its own ultimate ...framework and set of goods. For the Christian, this entails an examination of biblical and theological materials that bear upon the defenses. Søren Kierkegaard's work illustrates the possible fruits of original sin and Christian exploration of defensive activity. As is well-known, Freud and his followers developed an orientation to the defenses that is rich, but is also one rooted in secular, naturalistic assumptions. The article concludes with a discussion of some developmental, moral, and treatment implications regarding the defenses from a Christian standpoint.
This article describes how teachers who were once isolated by distance and the nature of their jobs are connecting across schools in online professional learning communities. While riding the wave of ...technology, St. Mary's County Public Schools in Leonardtown, Maryland, is providing a connection for teachers that extends beyond school walls. Collaboration is at the core of professional learning in St. Mary's County Public Schools. The expectation that every teacher would collaborate to foster professional learning and improved student learning led to the need to find differentiated processes to ensure that every teacher, regardless of position or content area, had the opportunity to engage in high-quality, job-embedded learning. It was found that electronic tools can be used to achieve this purpose. Collaborative professional development is focused on clarity of purpose and centered on student learning and results. Looking at models for professional learning, it was clear that collaborative, purposeful, and results-oriented professional development was necessary to ensure high levels of learning for both teachers and students. To get to these higher levels of learning, teachers needed to work together, plan together, and learn together. Expectations for collaborative planning and professional learning communities are even embedded in St. Mary's County Public Schools' teacher evaluation system through a unified effort with the education association.
Correspondence to Mr Brian T Burroughs; burroughs.brian@mayo.edu Background Unnecessary antimicrobial prescribing in upper respiratory infections (URI) is common and remains a focus of antimicrobial ...stewardship programmes (ASP).1 2 Multiple studies have employed peer comparison data dissemination and clinician education as components of a multimodal approach to improve antimicrobial prescribing practices.3 However, there have been varying conclusions drawn regarding sustainability and generalisability of outcomes.4–6 This quality improvement project aimed to reduce unnecessary antimicrobial prescribing in ambulatory URI encounters. Peer comparison emails included individual and departmental prescribing rates for tier 3 URI diagnoses, tier 3 URI encounter definition, two-part negative-positive communication strategies, recommendations for appropriate ICD-10 coding and highlighted tools developed by the institutional ASP (antibiotic order panel, symptomatic management pad, provider-facing dashboard and diagnosis calculator).3 7 8 During the 5-month course of PDSA 1, tier 3 antimicrobial prescription decreased from 16.81% to 14% (p=0.24), as compared with the previous year (table 1). Contributors The authors confirm their contribution to the paper as follows: study conception and design: BTB, CC and KJ; data collection: KJ; analysis and interpretation of results: BTB and KJ; draft manuscript preparation: BTB. Sustained reductions in overall and unnecessary antibiotic prescribing at primary care clinics in a veterans affairs healthcare system following a multifaceted stewardship intervention.
Brexpiprazole is an oral antipsychotic agent indicated for use in patients with schizophrenia or as adjunctive treatment for major depressive disorder. As obesity (body mass index ≥35 kg/m2) has the ...potential to affect drug pharmacokinetics and is a common comorbidity of both schizophrenia and major depressive disorder, it is important to understand changes in brexpiprazole disposition in this population. This study uses a whole‐body physiologically based pharmacokinetic model to compare the pharmacokinetics of brexpiprazole in obese and normal‐weight (body mass index 18‐25 kg/m2) individuals known to be cytochrome P450 2D6 extensive metabolizers (EMs) and poor metabolizers (PMs). The physiologically based pharmacokinetic simulations demonstrated significant differences in the time to effective concentrations between obese and normal‐weight individuals within metabolizer groups according to the label‐recommended titration. Simulations using an alternative dosing strategy of 1 week of twice‐daily dosing in obese EMs or 2 weeks of twice‐daily dosing in obese poor metabolizers, followed by a return to once‐daily dosing, yielded more consistent plasma concentrations between normal‐weight and obese patients without exceeding the area under the plasma concentration–time curve observed in the normal‐weight EMs. These alternative dosing strategies reduce the time to effective concentrations in obese patients and may improve clinical response to brexpiprazole.
Brexpiprazole is an oral antipsychotic agent indicated for use in patients with schizophrenia, or as adjunctive treatment for major depressive disorder. As cytochrome P450 (CYP) 2D6 contributes ...significantly to brexpiprazole metabolism, there is a label‐recommended 50% reduction in dose among patients with the CYP2D6 poor metabolizer phenotype. This study uses a whole‐body physiologically based pharmacokinetic (PBPK) model to compare the pharmacokinetics of brexpiprazole in patients known to be extensive metabolizers (EMs) and poor metabolizers (PMs). A PBPK model was constructed, verified, and validated against brexpiprazole clinical data, and simulations of 500 subjects were performed to establish the median time to effective concentrations in EMs and PMs. The PBPK simulations captured brexpiprazole PK well and demonstrated significant differences in the time to effective concentrations between EMs and PMs according to the label‐recommended titration. Additionally, these simulations suggest that CYP2D6 PMs consistently achieve lower minimum concentrations during the dosing interval than CYP2D6 EMs. Simulations using an alternative dosing strategy of twice‐daily dosing (as opposed to once daily) in PMs during the first week of brexpiprazole dosing yielded more consistent plasma concentrations between EMs and PMs, without exceeding the area under the plasma concentration–time curve observed in the EMs. Taken together, the results of these PBPK simulations suggest that product labeling for brexpiprazole titration in CYP2D6 PMs likely overcompensates for the decreased clearance seen in this population. We propose an alternative dosing strategy that decreases the time to effective concentrations and recommend a reevaluation of steady‐state PK in this population to potentially allow for higher daily doses in CYP2D6 PMs.
