Background: Challenging behavior has been examined in older children and adolescents with autism spectrum disorder (ASD), but less is known about these behaviors in toddlers, due in part to variability in measurement and limited instruments available for this population. To address this need, this study examined the psychometric properties of the Child Behavior Checklist (CBCL), a commonly used and widely validated measure of challenging behavior, in a group of toddlers with ASD. Method: Participants included 496 toddlers aged 18-48 months with (n=398) and without (n= 100) a diagnosis of ASD. Psychometrics of the CBCL were analyzed including internal consistency, factor structure, and measurement invariance. Results: Confirmatory factor analysis results indicated acceptable fit for the tested model, and internal consistency was largely acceptable. All levels of measurement invariance were tested for each subscale. The Emotional Reactivity, Anxious/Depressed, Withdrawn, and Aggressive Behavior subscales achieved scalar invariance, while the Attention Problems subscale achieved metric invariance, and the Somatic Complaints subscale did not achieve even configural invariance. Conclusions: Results indicate the current CBCL conceptualization of challenging behavior in autistic toddlers is consistent with such constructs in older autistic children and provide preliminary support for the use of the CBCL to assess for challenging behavior in toddlers with ASD. Measurement invariance (MI) analyses support the construct validity of the CBCL in toddlers with ASD. However, based on the results of the MI analyses, some caution is warranted with specific subscales when conducting group comparison analyses between toddlers with and without ASD.

It is well documented that autistic people are at an increased risk for co-occurring mental health challenges and suicide.1 There is also a robust and ever-growing body of literature delineating the challenges of meeting the varied mental health needs of autistic children, adolescents, and adults-most notably, access to efficacious treatments. For those who are able to access services, there are concerns about ableism and the failure of clinicians to understand how autistic characteristics may interact with mental health presentation and treatment response. Access difficulties are exacerbated by the general lack of disability- and autism-related content in curricula of preprofessional programs, resulting in a workforce who report being ill prepared to work with this population.2,3 It is imperative to have evidence-based mental health treatments. Equally important is the method by which such treatments are developed, studied, and disseminated. The autism community has identified key considerations for researchers who study treatment development, implementation, and dissemination.4,5 Most notable is the inclusion of and collaboration with autistic people, from all stages of research, treatment conceptualization through dissemination, and examining outcomes that matter to them. The emergence of rigorous randomized controlled trials (RCTs) such as those by White et al.6 are a strong step forward in addressing issues about efficacious treatment, as well as inclusion of the autistic community. As such, the White et al.6 study can serve as a model for others. Furthermore, the research community needs to diversify the composition of study participants, and as a field we need to turn more focus toward dissemination and training, both of which are imperative for improving access.

IntroductionThe current study obtained perspectives on psychotherapy practices from adults with intellectual disability receiving psychotherapy and mental health clinicians serving adults with intellectual disability. The goal was to identify opportunities, successes, and challenges through the perspective of adults with intellectual disability who have received mental health treatment (i.e. clients) and clinicians providing psychotherapy.MethodA total of six virtual focus groups, three with clinicians and three with clients with intellectual disability who had experience with psychotherapy, were conducted. Transcripts were coded by two independent reviewers guided by grounded theory.ResultsBroadly, analyses indicated overlapping themes with rich perspectives from both groups. Both clinicians and clients with intellectual disability identified a number of key aspects that were perceived as foundational to therapy and to improving the therapeutic relationship and comfort of the client with intellectual disability. Themes related to rapport building and self-determination emerged, despite not being directly asked of either group. Both clinicians and clients with intellectual disability discussed the therapeutic process at length, related to general types of treatment modality as well as the importance of individualizing treatment strategies. Clinicians spoke of regularly making accommodations to increase treatment accessibility.ConclusionThe focus group results align with and supplement treatment outcome research and have implications for training, practice, and future research.

Introduction Neonatal abstinence syndrome (NAS) is a complex condition resulting from prenatal substance exposure that has become increasingly prevalent as a result of the opioid epidemic. NAS can lead to long-term developmental challenges. Interdisciplinary teams with experience working with children with disabilities that focus on social determinants of health can be effective at supporting families affected by NAS. Unfortunately, interdisciplinary teams often lack sufficient training, ongoing practice support, and public health policies to support these families. The objective of this project was to determine the feasibility and impact of a National Training Initiative, called Project SCOPE, to improve the capacity of providers to address the needs of children with NAS and their families.Methods Fourteen (14) sites were trained to fidelity in the ECHO model and SCOPE curriculum, and then each team implemented this model for at least one, eight to 12 session series between 2019-2022. The reach, impact, satisfaction, and intention to implement the model were assessed from administrative records, pre/post surveys, and post-session evaluations.Results SCOPE state teams delivered the curriculum to 9,392 individuals across 33 US states. Surveys from 2,197 individuals were used for analysis. Most participants (84%) had previous training in trauma informed care, but only 53% had any training on the NAS or the opioid crisis' impact on children. Satisfaction with SCOPE sessions was high (96.4%), and there was a statistically significant increase of self-reported knowledge change from pre- to post-SCOPE. Over 94% reported their skills increased because of participation. Over 97% of participants indicated their motivation to work with this population increased from SCOPE participation and that they could successfully apply what they learned. Almost 70% reported they were "very" or "extremely" likely to use their new skills.Discussion Project SCOPE is a highly effective and impactful model that can radically improve capacity to support children affected by the opioid epidemic, thereby increasing the capacity of our healthcare system to respond to this epidemic. Moreover, this model can be rapidly deployed and reach a wide geographic region, especially areas that are affected by the opioid crisis and underserved rural communities.

Public Health Significance Statement Significant barriers to mental health treatment for adults with ID continue to persist. Contributing to this is clinicians' reported lack of training, resources, and knowledge to serve individuals with ID. In order to address this, it is imperative that clinicians and researchers are aware of the state of research in this area, both its advancement over the past 20 years as well as the persisting gaps. This systematic review updates the current state of the literature, paying particular attention to the advancements in use of outcome measures and manualized treatments and the persist challenges related to diagnostic assessment and sample characterization. The value of practice and treatment guidelines in improving mental health care is well established; however, no such guidelines exist for the mental health treatment of adults with intellectual disability. An essential step in the composition of guidelines is broad and careful consideration of the relevant empirical literature. The purpose of this systematic review was to identify efficacious and effective treatment practices for individuals with intellectual disability and co-occurring psychiatric disorders. The search across three databases (PubMed, PsycINFO, Embase) resulted in 37 studies that met inclusion criteria. The methodological rigor and study designs were evaluated to identify research gaps. The methodological strength of each study was rated on four indicators, participant characterization, intervention description, outcome measures, and statistical analyses. Only 13.5% of the studies reviewed were randomized controlled trials; 54.1% were quasi-experimental (either with pre/post interventions or use of non-randomized waitlist control, and 24.3% used some type of case series design. The majority of studies were from a cognitive behavioral orientation. While studies varied in scientific rigor, no one study was rated highly on all four indicators. Implications for future research and practice are discussed.

OBJECTIVES:The US opioid epidemic contributes to a growing population of children experiencing neonatal abstinence syndrome (NAS) and adverse childhood experiences (ACEs). A review of the developmental impacts of the opioid crisis highlights that both prenatal exposure to teratogens and ACEs can result in developmental delay and disabilities. Training for the early intervention/early childhood (EI) systems is needed to enable them to meet the needs of this growing population.METHODS:To address this, an IRB-approved online training on best practices for NAS, developmental monitoring and referral, and trauma-informed care was created for Ohio EI providers who provided informed consent to participate. The feasibility of utilizing an online training was assessed. Knowledge on opioid addiction, NAS, ACEs, and early intervention provider characteristics were collected for 2973 participants.RESULTS:Within 6 months, the training reached providers in all Ohio counties and seventeen other states. 57% of providers reported caring for one or more children with a caregiver who has confirmed opioid use. 31% reported these children had experienced four or more ACEs. Providers' ACEs awareness was moderately associated with their experiences with prenatally-exposed youth. There was a significant increase in knowledge following training. Differences in post-training knowledge differed only by county-level opioid death rates, where those providers with low-medium opioid death rates reported more awareness of children with prenatal opioid exposure compared to participants who lived in a county with medium and medium-high opioid death rates.CONCLUSIONS:Online-training is feasible for closing gaps in the early intervention system.

Mental disorders in adults with intellectual disability (ID) occur at rates much higher than in those without ID; however, many clinicians report little to no training in providing clinical services to this population. Due to the historically qualitative nature of the most literature in this field, it has been difficult for clinicians to identify appropriate accommodations and assessments to make treatment more accessible to those with ID. The objective of this scoping review was to identify psychotherapy practices for adults with ID in the areas of treatment accommodations and outcome measures/treatment monitoring tools. In the absence of treatment guidelines for this population, practices were drawn from treatment outcome research. Research reports describing treatment for this population were examined to identify the types of accommodations and practices employed by clinical research scientists when delivering psychotherapy. Specific practices, accommodations and tools are suggested based on the available research. The most common type of intervention was cognitive behavior therapy (i.e., 48.1%). Key aspects of accommodations to treatment included incorporating self-determination, the use of simplified language, visual supports, involving caregivers, and teaching prerequisite skills. This review details the accommodations and provides some practical suggestions and resources for clinicians when providing psychotherapy to adults with ID.

BACKGROUND:Individuals with intellectual and developmental disabilities (IDD) may be especially vulnerable to changes associated with the COVID-19 pandemic given an increased likelihood of health concerns, low socioeconomic status, and difficulty accessing services. AIMS:The purpose of this study was to explore mental health problems and services in individuals with IDD during the pandemic. We explored whether number of mental health problems differed by disability, age, gender, living situation, physical health, and access to services. METHODS AND PROCEDURES:An online survey about experiences during the pandemic was administered to adults with IDD and their caregivers in the United States and in Chile. OUTCOMES AND RESULTS:In both Chile and the United States, few people endorsed increased health problems. Half of the sample in Chile and 41 % of the sample in the United States endorsed increased mental health problems. Approximately 15 % of the sample in the US reported no longer receiving state developmental disability services. CONCLUSIONS AND IMPLICATIONS:Healthcare and disability-specific agencies should consider strategies to tailor supports to improve mental health functioning and access to community.

Some research suggests that GI symptoms seen in children with ASD may relate to behavior problems. The objective of this pilot study was to assess the effect of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet on GI and behavioral problems in children with ASD. At follow-up, the low FODMAP diet group had significant relief in some GI problems compared with both baseline in the group and control group. At baseline and at follow-up, there were no significant differences in behavioral problems between the low FODMAP diet group and the control group. Randomized controlled studies including larger sample sizes are needed to confirm the effects of low FODMAP diets in children with autism who have gastrointestinal problems.

Identification of problems with socioemotional functioning is an important task in early childhood, particularly for children in early intervention (EI). However, socioemotional concerns raised by families may be under-identified in practice. In accordance with Division for Early Childhood (DEC) recommended practices, Part C providers could benefit from additional guidance on socioemotional screening and assessment, including additional research on available tools. Therefore, we examined agreement among three commonly used measures of socioemotional functioning in an EI sample ( N = 50). Overall, the measures did not have adequate agreement. We found substantial agreement between the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE, first edition) and the Brief Infant Toddler Social-Emotional Assessment (BITSEA), moderate agreement between the ASQ:SE and the Child Behavior Checklist (CBCL), and fair agreement between the BITSEA and CBCL. We also examined their potential to screen for autism spectrum disorder (ASD) by examining agreement with the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). The BITSEA had substantial agreement with the M-CHAT-R/F, providing initial support for its use as an ASD screener. These findings are preliminary and further study in larger, more diverse samples would be beneficial. Evaluation of the sensitivity and specificity of these tools is also needed.

"Breaking Down Silos: Innovation in Dual Diagnosis Systems." Journal of Mental Health Research in Intellectual Disabilities, 11(1), pp. 105–106

Introduction: Parents and their children with Intellectual and Developmental Disabilities (IDD) are under significant amounts of stress (Lecavalier, Leone & Wiltz, 2006). When stress escalates to crisis, some children with IDD are admitted to the emergency department or an inpatient unit. While existing measures evaluate stress over time, we lack a valid measure to assess the experience of crisis. The current study aimed to validate a measure of crisis in a clinical sample of parents of children with IDD. Validating such a measure will provide a precise depiction of a family's perception of crisis and their relative distress, and improve communication between clinicians and families. Methods: Parents and caregivers of children and adolescents, age 5 to 17 and diagnosed with IDD including autism spectrum disorder completed measures, reporting on their level of caregiver strain (using the Caregiver Strain Questionnaire-CGSQ) and their current level of crisis (using the Brief Family Distress Scale-BFDS). Psychometric data from the BFDS and CGSQ were analyzed to examine aspects of reliability and validity. Results: Results from analyses indicated significant associations between the CGSQ and BFDS and excellent overall internal consistency within the CGSQ. Additionally, the BFDS detected differences between inpatient and outpatient conditions and validly categorized participants into crisis groups. Conclusions: Validation of the BFDS further demonstrates its clinical utility and continues to clarify the experience of parents of children with IDD in times of crisis. Future research should examine the role of problem behavior in crisis and the utility of the BFDS as a measure of change.

Mental Health and Wellness Supports in Youth with IDD (Baker & Blumberg, 2013) is a recent publication from the National Association for the Dually Diagnosed that covers a variety of topics as they...

The Children's Interview for Psychiatric Syndromes-Parent Version (P-ChIPS) is a structured psychiatric interview designed to assess the presence of psychiatric disorders in children and adolescents. This study examined the reliability and validity of the P-ChIPS in 61 youngsters (6- to 17-years-old) with Autism Spectrum Disorders. Reliability analyses were conducted according to level of functioning and language level. Results indicated that interrater reliability values were largely in the good to excellent range. Concordance between the P-ChIPS and the Child and Adolescent Symptoms Inventory was fair for the majority of disorders. Percent overall agreement for most disorders was good, lending support to the validity of the P-ChIPS. The results of this study suggest that the P-ChIPS is appropriate for this population.

OBJECTIVE/BACKGROUND The National Institute of Mental Health (NIMH) Research Units on Pediatric Psychopharmacology (RUPP) Autism Network found an effect size of d = 1.2 in favor of risperidone on the main outcome measure in an 8-week double-blind, placebo-controlled trial for irritability in autistic disorder. This paper explores moderators and mediators of this effect. METHOD Intention-to-treat (ITT) analyses were conducted with suspected moderators and mediators entered into the regression equations. MacArthur Foundation Network subgroup guidelines were followed in the evaluation of the results. RESULTS Only baseline severity moderated treatment response: Higher severity showed greater improvement for risperidone but not for placebo. Weight gain mediated treatment response negatively: those who gained more weight improved less with risperidone and more with placebo. Compliance correlated with outcome for risperidone but not placebo. Higher dose correlated with worse outcome for placebo, but not risperidone. Of nonspecific predictors, parent education, family income, and low baseline prolactin positively predicted outcome; anxiety, bipolar symptoms, oppositional-defiant symptoms, stereotypy, and hyperactivity negatively predicted outcome. Risperidone moderated the effect of change in 5'-nucleotidase, a marker of zinc status, for which decrease was associated with improvement only with risperidone, not with placebo. CONCLUSION The benefit-risk ratio of risperidone is better with greater symptom severity. Risperidone can be individually titrated to optimal dosage for excellent response in the majority of children. Weight gain is not necessary for risperidone benefit and may even detract from it. Socioeconomic advantage, low prolactin, and absence of co-morbid problems nonspecifically predict better outcome. Mineral interactions with risperidone deserve further study.

There is mounting evidence that the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides an appropriate conceptualization for psychiatric disorders in individuals with autism spectrum disorders (ASDs). The current study examined symptoms of disruptive behavior, anxiety, and mood disorders and how IQ and language skills impacted their manifestation in a sample of 61 children with ASD and significant emotional/behavioral problems. Subsyndromal presentation and the role of behavior equivalents were also explored. Analyses indicated that children with IQ < 70 had fewer reported symptoms than those with IQ ≥ 70. Symptoms endorsement also varied based on language levels. Individuals with IQ < 70 were more likely to be subsyndromal for Generalized Anxiety Disorder and nonverbal individuals were more likely to be subsyndromal for Oppositional Defiant Disorder. Only one of the seven behavior equivalents was associated with internalized disorders. Special considerations may be necessary when applying some DSM criteria to assess comorbid disorders in individuals with ASDs.