Sunday, October 26, 2014

Emotional Intelligence (EI) and Asperger Syndrome



Emotional intelligence (EI) is broadly defined as the ability to identify, assess, and control the emotions of oneself, of others, and of groups. The interest and research relating to EI has grown dramatically over the past decade. Currently, there are two emotional intelligence constructs: ability EI (or cognitive-emotional ability) and trait EI (or trait emotional self-efficacy). They are differentiated by the type of measurement used in the operationalization process. For example, the ability perspective conceives EI as a form of intelligence best assessed via performance tests and has stronger relationships with cognitive ability hierarchies. Thus, ability EI refers to individual differences in the ability to process and use emotional information to promote effective functioning in everyday life. Trait EI concerns behavioral dispositions and self-perceived abilities and is measured through self-report. Trait EI has stronger relationships with personality and concerns people’s perceptions of their emotional abilities (how good we believe we are in understanding and managing our own and other people’s emotions, rather than how good we actually are). These perceptions are generally stable over time and have a direct influence on mood, behavior, achievement, and action. In other words, trait EI is defined, not as a cognitive ability, but as a collection of personality traits concerning people's perceptions of their emotional abilities. 
Trait EI and ASD  
The defining feature of autism spectrum disorders (ASD) is impairment in interpersonal relating and communication. This includes difficulty communicating with others, processing and integrating information from the environment, establishing and maintaining reciprocal social relationships, taking another person’s perspective, inferring the interests of others, and transitioning to new learning environments. While all individuals with ASD experience core social-communication deficits, we now recognize that autism-related traits are quantitatively distributed in the general population and that autism is best conceptualized as a spectrum disorder, rather than a categorical diagnosis. Even mild degrees of what might be called autistic social impairment can significantly interfere with adaptive behavior. Likewise, a combination of mild autistic symptomatology and other psychological liabilities (e.g., attention problems, mood problems, aggression) can have an adverse effect on social and emotional adjustment. Unfortunately, the core features of ASD may not diminish with development. Typically, individuals do not ‘‘outgrow’’ their deficits. Distress may actually increase as the social milieu becomes more complex and challenging. These difficulties may then persist well into adulthood and lead to comorbid emotional symptoms. Indeed, high stress, anxiety and depression are regularly present in persons with ASD.
ASD involves deficits that are directly relevant to the constellation of emotional self-perceptions encompassed by trait EI. Trait emotional intelligence (trait EI) encompasses many of the aspects of social-emotional functioning that have been shown to be impaired in ASD in the form of self-perceptions. Research has begun to examine the link between higher functioning ASD (e.g., Asperger syndrome) and trait EI. A recent study compared the trait EI profiles of men and women diagnosed with Asperger syndrome (AS) with those of a normative sample, group-matched on age and gender. Participants were thirty adults diagnosed with AS (16 women and 14 men) who volunteered for the study and were subsequently group-matched with 43 typically developing adults (22 women and 21 men). There were no significant differences in the mean age of the participants with and without AS and no significant between-group differences in the distribution of gender. All participants completed the Trait Emotional Intelligence Questionnaire (TEIQue), a self-report inventory specifically designed to comprehensively measure the trait EI construct. The TEIQue consists of 153 items rated on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree) and includes 15 subscales (facets) organized under four factors (Well-Being, Self-Control, Emotionality, and Sociability) and global trait EI. It has been shown to have satisfactory psychometric properties in various studies. Below is a list of the 15 trait EI facets, along with a brief description of each.  These facets comprise the current sampling domain of trait emotional intelligence in adults and adolescents.   
Facets                                                    High scorers perceive themselves as…
Adaptability                                            flexible and willing to adapt to new conditions.
Assertiveness                                         forthright, frank, & willing to stand up for rights.
Emotion perception (self; others)        clear about their own & other people’s feelings.
Emotion expression                               capable of communicating their feelings to others.
Emotion management (others)            capable of influencing other people’s feelings.
Emotion regulation                                capable of controlling their emotions.
Impulsiveness (low)                              reflective & less likely to give in to their urges.
Relationships                                          capable of having fulfilling personal relationships.
Self-esteem                                             successful & self-confident.
Self-motivation                                      driven & unlikely to give up in the face of adversity.
Social awareness                                    accomplished networkers with excellent social skills.
Stress management                               capable of withstanding pressure & regulating stress.
Trait empathy                                        capable of taking someone else’s perspective.
Trait happiness                                      cheerful & satisfied with their lives.
Trait optimism                                       confident & likely to “look on the bright side” of life.
Findings and Implications  
The researchers hypothesized if individuals with Asperger syndrome have limited understanding their social-communication deficits, then they would score similarly to typical adults on the TEIQue. However, if they have an accurate understanding of these deficits, then they would score significantly lower. The researchers also sought to shed light on the gender discrepancy routinely observed in ASD, particularly in those more able individuals diagnosed with ASD.
The results showed that individuals with AS had significantly lower scores on most TEIQue variables, including the global trait EI score. The Asperger group scored significantly lower on 12 out of the 15 facets of the Trait Emotional Intelligence Questionnaire (TEIQue). They rated themselves particularly low on questions relating to social awareness, emotion management, adaptability, empathy, and emotion perception. The finding appears to be consistent with the clinical presentation of ASD. Differences were much smaller, or non-existent, on questions relating to self-control (especially, impulse control and emotion control). With respect to gender, males scored higher than females, albeit with small effect sizes. Overall, the findings suggest that individuals with Asperger syndrome have insight into the nature of their condition and are aware of the strengths and weaknesses of their personality. These data also suggest that the female phenotype of AS may be associated with greater impairment than the male phenotype.
This research contributes to the evidence documenting the effect of trait EI self-perceptions and dispositions on socio-emotional development and overall psychological well-being. The well-being component of trait EI may be especially relevant in the adjustment process, since positive emotions contribute to the development of those physical, intellectual and social resources necessary to cope successfully with the demands of the social world. There are extensive individual differences in people's perceptions of their emotional abilities. Because trait EI affects behavior, self-referent cognitions and mental health, it is an important variable to consider in the evaluation and treatment of higher functioning individuals with ASD. Although individuals with ASD appear to be aware of their social-communication deficits, further study is needed into the capacity for insight and how it may be utilized in treatment/intervention. Likewise, further study is also needed to examine the relationship of trait EI variables to symptom severity and determine to what extent individual self-perceptions predict outcomes (e.g., life satisfaction, coping strategies, and job performance).  Perceived emotional self-efficacy also plays an important role in emotion management and regulation in education. Consequently, further research on trait EI should include children with ASD. A child version of the TEIQue (TEIQue-Child Form) is available for children aged between 8 and 12 years of age and measures nine distinct facets. An examination of trait EI profiles of children with ASD may assist with identification, intervention, and progress monitoring.
Petrides, K. V., Hudry, C., Michalaria, G., Swami, V., & Sevdalis, N. (2011). Comparison of the trait emotional intelligence profiles of individuals with and without Asperger syndrome. Autism, 15, 671–682. doi 10.1177/1362361310397217
Detailed information about trait EI and the various facets of the TEIQue can be found at http://www.psychometriclab.com 
The online version of this article can be found at http://aut.sagepub.com/content/15/6.toc

Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).




Thursday, October 9, 2014

Role of Parental Occupation in Autism Diagnosis and Severity

Children of fathers in healthcare and finance have greater risk of having offspring with ASD while children of parents with technical occupations exhibit greater ASD severity, according to researchers at The University of Texas Health Science Center at Houston (UTHealth). The findings were presented at the International Meeting for Autism Research (IMFAR) in Atlanta and appear in the peer reviewed journal, Research in Autism Spectrum Disorders.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in (a) social communication and (b) restricted and/or repetitive behaviors or interests that varies in severity of symptoms, age of onset, and association with other disorders. According to recent estimates, approximately 1 in 68 children in the United States has an ASD diagnosis. In addition, a recent study of parent reports suggests that prevalence of ASD in the US could be as high as 1 in 50.  Despite this growing literature on prevalence and incidence of ASD, less is known about the etiology of this complex neurodevelopmental disorder.
It has been suggested that parents of children with autism spectrum disorder (ASD) may present with less recognizable autistic-like phenotypic characteristics or traits (broader ASD phenotype), leading them to highly systemizing occupations such as science, engineering, mathematics, computer science, accounting, and medicine. Others have suggested that many professionals with highly systemizing occupations are functioning with undiagnosed ASD. Using secondary analysis of data from two previous studies of children with ASD, the researchers tested associations between parental occupations and ASD diagnosis and the association of parental occupational characteristics on ASD severity. Children for both studies were recruited from the same educational, clinical, and community sources. Suspected ASD cases were determined by clinical interview and observation.  Those meeting DSM-IV-TR criteria were administered both the Autism Diagnostic Interview, Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to confirm diagnosis. Parental occupations were established through demographic questionnaires during assessment. The researchers used the Standard Occupational Classification (SOC) system to classify occupational characteristics of interest. Parents were divided into those who had more non-people-oriented jobs (technical) or more people-oriented jobs (non-technical).  For example, those working in engineering, scientific research, and accounting were considered having technical, white-collar occupations while those in healthcare professions were consider having non-technical, white-collar positions. Statistical analyses were used to explore associations of ASD status with certain white-collar occupations and occupational characteristics and to investigate differences in mean ADOS and ADI-R domain and total scores for parental occupation characteristics.
The results indicated that for paternal occupations, fathers who worked in engineering were two times as likely to have a child with an autism spectrum disorder (ASD) as compared to all other white-collar occupations. Additionally, fathers of ASD cases were seven times more likely to work in healthcare occupations and five times more likely to work in accounting/financial analysis. There was no association with a mother's occupation. However, children who had both parents in technical fields were associated with significant social impairment and a higher risk of having more severe overall autistic symptomatology.
The findings suggest that there is a joint association between parental occupation and ASD severity, as well as a relationship between paternal occupation and ASD diagnosis. These results are also supportive of a “broader ASD phenotype” in parents of children with ASD which includes individuals with mild impairments in social and communication skills that are similar to those shown by individuals with ASD, but exhibited to a lesser degree. The tendency of people with autistic-like characteristics to marry (assortative mating) might contribute to intergenerational transmission and having offspring with greater ASD severity. "Parental occupation could be indicative of autistic-like behaviors and preferences and serve as another factor in a clinician's diagnosis of a child with suspected autism. Medical students can be taught that this is one of the things to consider," said. Aisha S. Dickerson, first author of the study. More analysis should be done to determine what factors contribute to occupation choices, and how these factors, if identifiable, can add to the risk of communication or social impairment in the offspring of these individuals.
Dickerson, A. S., Pearson, D. A., Loveland, K. A., Rahbar, M. H.,  & Filipek, P. A. (2014).
Role of Parental Occupation in Autism Spectrum Disorder Diagnosis and Severity. Research in Autism Spectrum Disorders, 8, 997–1007
Lee A. Wilkinson, PhD, CCBT, NCSP is a school psychologist and author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

Wednesday, October 1, 2014

Group Cognitive Behavioral Therapy (CBT) for Adults with Autism

The dramatic increase in the prevalence of autism spectrum conditions among children and adolescents and the correspondingly large number of youth transitioning into adulthood has created an urgent need to address the problems faced by many adults on the autism spectrum. Unfortunately, there are few validated treatment options are available for adults with autism spectrum disorder (ASD). Much of the published literature is clinical or anecdotal, or purely based on theory. There is unquestionably a need for the development of treatment options for adults with ASD. At present, alternative treatment options to psycho-therapeutical interventions are social training programs and other group activities. Group settings enable social interaction and sharing experiences with others, thereby reducing social isolation. 

A study published in the peer reviewed journal Autism assessed the effectiveness of two group interventions for adults with ASD: cognitive behavioral therapy (CBT) and recreational activity. A total of 68 adults with ASD participated in the study and were stratified by gender and blindly randomized to one of the two treatment conditions. Both interventions comprised 36 weekly 3-hour sessions led by two therapists in groups of 6–8 participants. The CBT group intervention was adapted to suit adults with ASD and consisted of five elements: (a) structure, (b) group setting, (c) psycho-education (e.g. lectures and discussions on ASD and psychiatric symptoms, including learning to identify and reappraise maladaptive thoughts), (d) social training (e.g. skill building such as practicing phone calls and asking for help) and (e) cognitive behavioral techniques (e.g. setting goals, role-playing, exposure exercises and conducting behavior analysis). A manual describing the 36 individual sessions was created prior to starting the treatment. Each session followed a strict agenda: (a) introduction and presentation of the agenda of the day, (b) review of homework assignments from the previous session, (c) psycho-educative lecture and discussions on the session topic, (d) coffee break with buns or sandwiches and social interaction, (e) relaxation or mindfulness exercise, (f) discussions and exercises on the session topic, (g) distribution of homework and (h) evaluation and end of session.
The purpose of the recreational activity intervention was to facilitate social interaction and to break social isolation. The therapists did not provide any deliberate techniques, such as psycho-education, social training, or CBT. Rather, this intervention relied on structure and group setting only. During the first session, participants were asked to write down group activities they would like to engage in. The therapists created a list of the suggested activities, such as visiting museums, playing board games, cooking, restaurant visits, boating, cinema, and taking walks. Each week, participants voted for the next session’s activity.
The researchers hypothesized that both interventions would lead to improvement in primary measures of quality of life, sense of coherence, and self-esteem, as well as in the exploratory analysis of the secondary measures of psychiatric symptoms. A greater effect in the CBT intervention compared to recreational activity was also expected, due to participants in the CBT intervention receiving a wider range of psychotherapeutic techniques. Several self-report questionnaire measures were administered to the adults before and after the interventions: Quality of Life Inventory (health, relationships, employment, and living conditions), Sense of Coherence (manageability and meaningfulness in life), Rosenberg Self Esteem Scale and an exploratory analysis on measures of psychiatric health (e.g., anxiety and depression). A long-term follow-up was conducted which ranged from 8 to 57 months after treatment termination.
Participants in both treatment conditions reported an increased quality of life at post-treatment, with no significant difference between the group CBT and group recreational activity interventions. Comorbid psychiatric symptoms, sense of coherence, and self-esteem were not affected by either intervention. CBT resulted in less attrition (drop out) than recreational activity. Participants who received CBT also rated themselves as more improved at post-treatment. At follow-up, CBT participants reported better well-being, greater understanding of their own difficulties and improved ability to express needs, compared to participants in the recreational activity intervention. This may reflect the recreation activity intervention’s focus on the intervention elements of structure and group setting, while the CBT intervention also included the elements of psycho-education, social training and CBT techniques. As a result, participants in CBT may have developed greater understanding of their own difficulties and improved ability to express needs and receive support because the objective of psycho-education and social training is to enhance these capabilities. The difference in well-being scores at follow-up may also represent greater insight gained from CBT rather than recreational activity.
Both interventions appear to be promising treatment options for adults with ASD, as they appeared to improve the participants’ quality of life. The similar efficacy of the interventions may be due to the common elements of structure and group setting. The group setting of both interventions enabled social interaction and sharing experiences. This may have promoted participants’ self-acceptance by allowing them to gain insight into both the impairments and the strengths that characterize ASD, and to recognize that others share similar challenges. CBT may be additionally beneficial in terms of increasing specific skills, greater understanding and insight, and minimizing dropout. Future studies on treatment of comorbid psychiatric symptoms in ASD should include larger samples to differentiate between adults with specific psychiatric problems in order to more effectively assess treatment effects.
Hesselmark, E., Plenty, S., & Bejerot, S. (2014). Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders: A preliminary randomized controlled trial. Autism, 18(6) 672–683. doi: 10.1177/1362361313493681
 Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

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