Thursday, February 22, 2018

Autism and Self-Acceptance

What is Self-Acceptance?

Self-acceptance is an important component of cognitive-behavioral therapy (CBT). It means fully accepting yourself no matter where you are on the autism spectrum or how you perform or achieve. Self-acceptance is not the same as self-esteem, self-confidence or self-regard. These terms imply that you can accept yourself because you perform or behave in a specific way or because people accept you based on your achievements. Self-acceptance means that you non-judgmentally accept yourself for who you are without rating or evaluating yourself or requiring the approval of others.

Self-acceptance also means accepting one’s individual reality and combating perfectionism and unhelpful thinking habits. As human beings, we are fallible and highly imperfect. Demand and all-or-nothing thinking results in self-defeating behavior that invariably leads to feelings of anxiety and depression. The idea that there is an absolute and perfect solution to life’s troubles is unrealistic since few things are black and white, and typically there are many alternative solutions to a problem situation. Here are some general ideas derived from CBT for accepting your personal reality and remaining uniquely you:

  • Surrender the belief that you must perform competently in every situation. Challenge the assumption that you must always please others and achieve perfectly. Avoid the tendency to evaluate yourself and accept failure as undesirable but not awful or catastrophic. Accept compromise and reasonable rather than absolute and perfect solutions to life’s problems.
  • Strongly dispute the belief that you must feel accepted by every significant person for nearly everything that you do. Rather, keep the approval of others as desirable, but not an essential goal. Seriously consider other people’s criticisms of your traits without agreeing with their negative evaluations of you. Strive to do what you really enjoy rather than what other people think you must or should do.
  • When others behave badly towards you or in relation to themselves, ask yourself whether you should really upset yourself about their behavior. Will people change their behavior because you expect or demand that they do so? Telling yourself that the person or situation is unlikely to change no matter how much you think they should and accept that fact, will keep you from feeling inappropriately angry and resentful. People are independent entities. While we are in control of our own emotional destiny, we do not have control over the behavior of others.

Adapted from Wilkinson, L. A. (2015). Overcoming Anxiety on the Autism Spectrum: A Self-Help Guide Using CBTLondon and Philadelphia: Jessica Kingsley Publishers.

© 2018 Lee A. Wilkinson, PhD

Saturday, February 10, 2018

Autism and School Psychology Practice

More children than ever before are being identified with autism spectrum disorder (ASD). The U.S. Centers for Disease Control and Prevention (CDC) now estimates that 1 in 54 eight year-old children has an ASD. The occurrence of autism is also evident in the number of students with receiving special educational services. Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA), the number of students receiving special education services in this category has increased over 900 percent nationally. The number of students receiving assistance under the special education category of autism over the past decade has increased from 5 percent to 11 percent of all identified disabilities. Autism now ranks fourth among all IDEA disability categories for students age 6-21. 

School psychologists and other school-based professionals are now more likely to be asked to participate in the screening, identification, and educational planning for students with ASD than at any other time in the past. Moreover, the call for greater use of evidence-based practice has increased demands that school psychologists be knowledgeable about evidence-based assessment and intervention strategies for students with ASD. Guidelines and standards have been developed recommending best practice procedures for the assessment and treatment of ASD. There is a large and expanding scientific literature base that documents the existence of two major elements of evidence-based practice: (a) assessments shown to be psychometrically sound for the populations on whom they are used and (b) interventions with sufficient evidence for their effectiveness. 
The National Association of School Psychologists (NASP) endorses the use of evidence-based assessment (EBA), and guidelines and standards are available for best practices in ASD for school psychologists (Campbell, Ruble, & Hammond, 2014; Wilkinson, 2017; Esler & Ruble, 2015; Filipek et al., 1999; Ozonoff, Goodlin-Jones, & Solomon, 2005). Elements of EBA in ASD include the following: (a) the use of psychometrically sound assessments for ASD; (b) a developmental perspective that characterizes abilities over the lifespan; (c) assessment of core areas of impairment associated with ASD; and (d) the use of information from multiple sources, including direct and indirect observation from parents and teachers to better estimate skills beyond those that may be dependent on characteristics of the environment

Although school psychologists are often called on to assume a leadership role in evaluating, identifying, and providing interventions for students with ASD in our schools, there is little research to show how closely school psychologists align their practices with the parameters of best practice. Due to the increase in the number of children receiving special education services under the classification of autism, research is needed regarding the preparedness of school psychologists and schools to address the needs of children with ASD. 

Although there is a paucity of research focusing on the delivery of school psychological services for students with ASD, there are several national and state-wide surveys which provide exploratory information regarding school psychologists’ level of knowledge in the area of autism assessment and intervention; assessment methods, measures, and techniques; level of training; and perceived level of preparation and confidence.
  • Aiello & Ruble (2011, 2017) investigated school psychologists’ knowledge and skills in identifying, evaluating, and providing interventions for students with ASD. A total of 402 participants from 50 states completed their survey. Results indicated that despite a limited amount of training received during their graduate education or pre-service training for working with the autism population, most school psychologists’ self-reported knowledge of ASD was in the expected direction for agreement. However, there were gaps in knowledge regarding the differences between emotional and behavioral disorders and autism, developmental delays and autism, and special education eligibility versus DSM diagnoses that need to be addressed through more training. The survey also indicated the need for additional training opportunities in providing interventions, strategies, and supports for students with autism in the following areas: developing family-centered educational plans; training peer mentors; and translating assessment information into teaching goals and activities.
  • Rasmussen (2009) also completed a national survey of school psychologists to determine their level of knowledge in the area of autism assessment; level of training; and perceived preparation and confidence in providing services to children with ASD. Results indicated that training positively affected school psychologists’ knowledge about autism; their levels of involvement with students with autism; and their perceived levels of preparation to work with this population. Of the 662 participants, the majority accurately identified diagnostic features and true and false statements about autism, suggesting an adequate understanding of autism. Participants with more training reported an increased level of involvement on multidisciplinary teams and an ability to diagnose autism when compared to those with less training. Brief rating scales were among the most commonly used instruments, while more comprehensive and robust instruments were among the least-often employed, suggesting school psychologists are either not trained or are limited in the time and resources needed to use evidence-based instruments. Participants felt more prepared to provide consultation and assessment services and less prepared to provide interventions. Although a majority (96.5%) of the respondents reported they had attended workshop presentations or in-service trainings on autism, less than half (43.7%) had completed formal course work in autism in their training program and less than one third (32.3%) had internship or residency experience with autism. These data and previous research suggest school psychologists need more formal training and experience in meeting the needs of individuals identified with autism.
  • Singer (2008) surveyed 199 school psychologists regarding the frequency with which they were called upon to provide services to students with an autism spectrum disorder (ASD); services they actually provided to those students; and their perceptions of the training and experience they had pertaining to the assessment and treatment of ASD. Additionally, the study surveyed 72 graduate programs in school psychology to determine the extent to which these programs prepared new school psychologists to work with children who have ASD. A majority of respondents (64%) reported using only brief screening instruments to identify students. Although able to identify the “red flag” indicators of ASD, very few school psychologists perceived their training as adequate. Only 12.6 % of respondents indicated that they had sufficient coursework in ASD and only 21% indicated that they had sufficient practicum experience. Just 15% indicated that their overall training with ASD was “completely adequate.” Only 5 of the 72 (16.9%) school psychology programs surveyed offered a specific course in ASD; most indicating that the topic was addressed in other courses. According to the author, the survey data suggest that school psychologists lack adequate knowledge about evidence-based instruments and procedures available to screen, assess, and intervene for ASD.
  • Pearson (2008) surveyed a group of Pennsylvania school psychologists regarding their training, knowledge and evaluation practices when assessing and diagnosing ASD. The aim of the study was to determine the extent to which school psychologists are prepared to meet the rapidly increasing demand for using best practice procedures when assessing and diagnosing ASD. An electronic survey was sent to 1,159 certified school psychologists with 243 completed surveys returned. Survey results found the majority of respondents indicated that they rely on the use of brief screening instruments and do not use or recommend "gold standard" instruments with students suspected of having ASD. Only 32.2% of the respondents reported they were very much prepared to recommend an IDEA classification of Autism. Less than 5% of the school psychologists surveyed received formal training in ASD at graduate institutions or internships. The overwhelming majority of school psychologists surveyed believed there is  a need for more training for school psychologists concerning the characteristics of ASD, best practice in the assessment of ASD, and differentiating ASD from other developmental or coexisting disorders.
  • Small (2012) used an online survey of 100 members of the Massachusetts School Psychology Association (MSPA) to obtain information pertaining to demographics, participants' experiences with the ASD population, participants' knowledge of ASD, as well as their use, competency, and feelings of usefulness of various assessment techniques and treatments/interventions. The results indicated that overall, school psychologists demonstrated adequate knowledge of ASD, felt competent conducting assessments, and reported that the assessment tools were useful. School psychologists spent less time on treatment/intervention and while they considered many of the treatments/interventions helpful, they did not feel competent implementing them. The results suggest that school psychologists need more training in ASD, especially regarding treatments/interventions, at the pre-service level through graduate school training and experiences (e.g., practica and internships), as well as at the practitioner level through professional development opportunities.
As more and more children are being identified with ASD and placed in general education classrooms, school psychologists will play an ever increasingly important role in identification and intervention, as well as offer support, information, consultation, and recommendations to teachers, school personnel, administration, and families. Therefore, it is essential that they be knowledgeable about evidence-based assessment and intervention strategies for this population of students.  Despite the limitations inherent in survey research, the data from these studies suggest that school psychologists are not adequately prepared to provide evidence-based assessment and intervention services to children with ASD. The survey research illustrates a significant discrepancy between best practice (evidence-based) parameters and reality when it comes to the practice of school psychology and ASD in the schools (Aiello & Ruble, 2017). 

Federal statutes require that school districts ensure that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. Although surveys indicate sufficient knowledge of the signs and symptoms associated with ASD, there is a critical need for school psychologists to be trained and develop competency in evidence-based assessment and identification practices with children who have or may have an ASD. For example, Aiello & Ruble (2017) found a majority of survey respondents reported using brief screening measures such the GARS and/or GADS in assessment and identification, both of which are not recommended for use in decision-making (Brock, 2004; Norris, M., & Lecavalier, 2010; Pandolfi, Magyar & Dill, 2010; Wilkinson, 2010, 2017). In contrast, evidence-based tools such as the ADOS, ADI-R, CARS, and SCQ were used less a third of the time in ASD assessment. Thus, while evidence-based instruments are available for the reliable, thorough assessment of students with ASD, school psychologists either do not have access or lack sufficient training to make them a part of their practice in the schools.
Because the knowledge base in ASD is changing so rapidly, it is imperative that school psychologists remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. School psychologists can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about best practice assessment and intervention /treatment approaches. 

Recommendations culled from the survey findings include the following: (a) school psychologists need more in-depth, formal training complete with supervision and consultation; (b) school psychology training programs should focus more energy on teaching intervention strategies for students with autism and include a separate course in ASD as part of the curriculum; (c) increase the use of more psychometrically sound autism instruments such as the ADOS and ADI-R in schools to provide better identification and more complete intervention strategies; (d) consider resident ASD specialists within the school and train teams of school professionals to work as a unit with the autism-related cases to ensure that the personnel are well-trained and have the experience necessary to conduct reliable and valid assessments and treatment planning; (e) provide training for all school psychologists on best practice guidelines for screening and assessment of ASD and identify measures with and without empirical support; and (g) develop closer relationships with ASD experts and service providers in the community. School districts may also want to consider levels of training, levels of education, and years of experience when assigning school psychologists who work with children who have ASD.  Finally, the National Association of School Psychologists (NASP) may consider developing guidelines and recommendations regarding the minimal competencies needed in order to work with special populations such as students with ASD.

Key References and Further Reading
Aiello, R., & Ruble, L. A. (2011, February). Survey of school psychologists’ autism knowledge, training, and experiences. Poster presented at the annual convention of the National Association of School Psychologists, San Francisco, CA.

Aiello, R., Ruble, L., & Esler, A. (2017). National Study of School Psychologists’ Use of Evidence-Based Assessment in Autism Spectrum Disorder. Journal of Applied School Psychology33(1), 67-88. DOI: 10.1080/15377903.2016.1236307
Brock, S. E. (2004). The identification of autism spectrum disorders: A primer for the school psychologist. California State University, Sacramento, College of Education, Department of Special education, Rehabilitation, and School Psychology.
Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.
Pandolfi V., Magyar C. I., & Dill C. A. (2010). Constructs assessed by the GARS-2: factor analysis of data from the standardization sample. Journal of Autism & Developmental Disorders, 40, 1118-30. 
Pearson, L. M. (2008). A survey of Pennsylvania school psychologists' training, knowledge and evaluation practice for assessing and diagnosing autism spectrum disorders. PCOM Psychology Dissertations. Paper 112.
Rasmussen, J. E. (2009). Autism: Assessment and intervention practices of school psychologists and the implications for training in the united states. Ball State University). ProQuest Dissertations and Theses, 192. UMI Number: 3379197
Small, S. H. (2012). Autism spectrum disorders (ASD): Knowledge, training, roles and responsibilities of school psychologists. University of South Florida). ProQuest Dissertations and Theses, 220. ISBN: 9781267519658 UMI Number 3308958
Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London & Philadelphia: Jessica Kingsley Publishers.

Wilkinson LA  (2013) School Psychologists Need More Training in Providing Services to Students with Autism Spectrum Disorders (ASD). Autism 3: e117. doi:10.4172/2165-7890.1000e117

Wilkinson, L.A. (Ed.). (2014). Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. Washington, DC: American Psychological Association.
Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London & Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Wednesday, February 7, 2018

Alexithymia, Empathy, and Autism

Alexithymia, Empathy, and Autism

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impairment in (a) reciprocal social interaction and communication and (b) restricted and/or repetitive behaviors or interests. These delays or atypicality in social development, communication, neurocognition, and behavior vary in severity of symptoms, age of onset, and association with other disorders. However, it is deficits in social relatedness that are the major source of impairment and the core-defining feature of ASD, regardless of cognitive or language ability. This includes difficulties in communicating with others, processing and integrating emotional information, establishing and maintaining reciprocal social relationships, taking another person's perspective, and inferring the interests of others .
An important aspect of social relatedness is the ability to empathize with the feelings of others. Empathy involves two major components: a cognitive component (e.g., theory of mind (ToM), perspective taking, or mindreading) and an affective component (emotional processing) which allows us to share the feelings of others. The affective component of sympathy involves having an appropriate emotional reaction to another person’s thoughts and feelings. When engaged in affective empathy, we vicariously experience the emotional states of others, understanding that our feelings are not ours but rather those of the other individual (Baron-Cohen, 2008).

While autism has been shown to be associated with a deficit in perspective taking (cognitive empathy or ToM), it is much less clear to what degree individuals with ASD also experience deficits in affective empathy. In fact, it is uncertain whether the empathy deficit commonly attributed to individuals with autism is a result of the disorder itself, or if it is a consequence of a comorbid (coexisting) subclinical condition known as alexithymia. Alexithymia is characterized by difficulties in identifying, describing, and processing one's own feelings, often marked by a lack of understanding of the feelings of others, and difficulty distinguishing between feelings and the bodily sensations of emotional arousal (Kooiman, Spinhoven, & Trijsburg, 2002). It is especially important to note that Alexithymia does not constitute a clinical diagnosis and is best conceptualized as a dimensional personality trait that is normally distributed in the general population (estimates of 10%). However, there is evidence to suggest that it is associated with an increased risk of psychopathology. For example, several studies indicate that even in childhood, alexithymia and problems in the domain of emotion processing are positively related to internalizing problems such as depression and anxiety.
Although alexithymia is not a core feature of autism, recent studies have found varying degrees of this trait in 50 to 85% of individuals with ASD (Hill, Berthoz, & Frith, 2004). The alexithymia trait appears to have the following properties: (a) it is more common in individuals with ASD than in the general population (b) it is more common in parents of individuals with ASD than in parents of individuals with another developmental disabilities, (c) it is stable over time in ASD, and (d) problems in the domain of emotion awareness are positively related to depression, anxiety, somatic complaints, worry and rumination (Rieffe et al., 2011). There is also evidence to suggest that the alexithymia trait might be part of the broader autism phenotype and a significant component of the emotion processing difficulties experienced by people with ASD (Szatmari et al., 2008). 

Although individuals with ASD experience alexithymia at much higher rates than the general population, autism and alexithymia appear to be distinct, unrelated, and overlapping conditions in which alexithymia seems to influence affective empathy. Therefore, the empathy deficits typically observed in autism may be due to the large comorbidity between alexithymic traits and autism, rather than representing an essential feature of the social impairments in autism (Bird et al., 2010).  

Research also indicates that alexithymia is linked to interoceptive difficulties in ASD. Interoception is known as the awareness of one’s body or the sense of the condition of the body.  The system of interoception relates to how we perceive feelings from our bodies that determine our mood, sense of wellbeing and emotions. Awareness of, and sensitivity to, internal physiological sensations is fundamental to how we conceptualize our affective experiences. There has been increasing theoretical interest in the possibility that interoception may be altered in ASD. It has been speculated that impaired interoception leads to the socioemotional deficits which are a diagnostic feature of the condition. However, research now indicates that alexithymia, not autism, is associated with atypical interoception. For example, Shah et al., 2016 examined the relative impact of autism and alexithymia on interoception and concluded that interoceptive impairments should not be considered a feature of ASD, but instead due to co-occurring alexithymia.
Future Research

An obvious question for future research relates to the prevalence of high levels of alexithymia in ASD compared to neurotypical individuals and how to explain the high comorbidity between alexithymia and ASD. Is alexithymia a neuroanatomical structural consequence or is the result of a neurobiological impairment, or is it a distinctive personality trait of individuals with ASD? Does the level of alexithymia predict symptom severity in ASD? Would interoceptive training be therapeutic for individuals with co-occurring alexithymia? Although not a feature of autism, would alexithymia be a useful diagnostic marker for ASD? Because alexithymia is associated with increased risk of psychopathology (e.g., anxiety and depression), should a measure of alexithymia be included in an assessment battery for ASD? As with most autism research, there are more questions than answers.
Key References
Baron-Cohen, S. (2008). Autism and Asperger syndrome: The facts. New York: Oxford University Press.
Bird, G., Silani, G., Brindley, R., White, S., Frith, U., & Singer, T. (2010).  Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133, 1515-1525.
Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.
Kooiman, C.G., Spinhoven, P. & Trijsburg, R.W. (2002). The assessment of alexithymia: A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20, Journal of Psychosomatic Research, 53, 1083-1090.
Rieffe, C., Oosterveld, P., Meerum Terwogt, M., Mootz, S., van Leeuwen, E., & Stockmann, L. (2011). Emotion regulation and internalizing symptoms in children with autism spectrum disorders, Autism, 15, 655-670.

Shah, P., Hall, R., Catmur, C., & Bird, J. (2016). Alexithymia, not autism, is associated with impaired interoception. Cortex, 81, 215-220.
Silani, G., Bird, G., Brindley, R., Singer, T., Frith, C., Frith, U. (2008). Levels of emotional awareness and autism: An fMRI study. Soc Neuroscience, 3, 97-112.
Szatmari, P., Georgiades, S., Duku, E., Zwaigenbaum, L., Goldberg, J., & Bennett, T. (2008). Alexithymia in Parents of Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 38, 1859-1865.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

© Lee A. Wilkinson, PhD

Saturday, February 3, 2018

Polypharmacy in Autism Treatment

Medication Treatment for Autism 

Prescription medications do not address the core symptoms of autism and are not considered to be "first-line" interventions or treatment for children with autism spectrum disorder (ASD). At present, early, intensive, and behaviorally-based interventions are considered the benchmark interventions for autism. Pharmacologic interventions are often considered for maladaptive behaviors such as aggression, self-injurious behavior, repetitive behaviors, sleep disturbance, anxiety, mood lability, irritability, hyperactivity, inattention, destructive behavior, or other disruptive behaviors in children with autism. 

The most commonly prescribed medications are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil; stimulants such as Concerta, Metadate, Methylin, Ritalin, and Adderall, and atypical neuroleptics such as Risperidone (Risperdal) and Aripiprazole (Abilify), both with FDA approved labeling for the symptomatic (aggression and irritability) treatment of children and adolescents with ASD. Although Methylphenidate (Ritalin) has been reported to be effective for reducing hyperactivity in some autistic children, it has not found to be effective for treating restricted or repetitive behavior or irritability (Huffman et al., 2011). Some marginal evidence of benefit has been reported for various SSRIs in the treatment of restricted, repetitive behaviors, but more study is needed (Huffman et al., 2011; Warren et al., 2011). Although Risperdal and Abilify have been reported by caregivers to reduce problem behaviors such as irritability, hyperactivity, tantrums, abrupt changes in mood, emotional distress, aggression, repetitive behaviors, and self-injury, the risk of adverse (side) effects is considered to be quite high (Warren et al., 2011).

Research indicates increasing rates of psychotropic use and the simultaneous use of multiple psychotropic medications (polypharmacy) with autistic children. A research study involving a large sample of children with ASD found 64% used psychotropic medications and 35% had evidence of polypharmacy (Spencer et al., 2013). Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy. Although co-occurring problems such as hyperactivity, inattention, aggression, and anxiety or depression, may respond to a medication regimen, as well as relieve family stress and enhance adaptability, there are general concerns about these medications. For example, there is a lack of evidence clearly documenting the safety or effectiveness of psychotropic treatment during childhood. Likewise, there is a paucity of information about the safety and effectiveness of psychotropic polypharmacy and potential interactions between and among medications that may affect individuals with complex conditions, including autism (Spencer et al., 2013). 

Further research is needed to assess the value of these medications when weighed against their potential for harm. Likewise, there is an immediate need to develop standards of care around the prescription of psychotropic medications based on the best available evidence and a coordinated, multidisciplinary approach to improving the health and quality of life of children with autism and their families. Because clinicians and school-based professionals may not be aware of the extent and effects of psychotropic use and polypharmacy when working with autistic children, they should collaborate with parents, primary care providers, and others to carefully obtain medication histories and monitor treatment effects.
Adapted from Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools (Second Edition). London and Philadelphia: Jessica Kingsley Publishers.
Key References and Further Reading
Huffman, L. C., Sutcliffe, T. K., Tanner, I. S. D., & Feldman, H. M. (2011). Management of symptoms in children with autism spectrum disorders: A comprehensive review of pharmacologic and complementary-alternative medicine treatments. Journal of Developmental and Behavioral Pediatrics, 32, 56-68. Available from

LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: a review. P & T: a peer-reviewed journal for formulary management40(6), 389-97.
Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., Azocar, F., & Jain, A. (2013).  Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics, 132, 833–840.
Warren, Z., Veenstra-VanderWeele, J., Stone, W., Bruzek, J. L., Nahmias, A. S., Foss-Feig, J. H…McPheeters, M. (2011). Therapies for children with autism spectrum disorders. Comparative Effectiveness Review, Number 26. AHRQ Publication No. 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality. Available from
Wilkinson, L. A. (2017). Best practice in treatment and intervention. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 136-137). London and Philadelphia: Jessica Kingsley Publishers.
Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also 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. His latest award-winning book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2018 Lee A. Wilkinson, PhD

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