Bruce J. Tonge

Background: Child behavioural and emotion regulation, and social communication; and parental confidence and mental health, all contribute to developmental outcomes for autistic children; however, there are limited programmes which integrate support across these domains. Methods: We report on a parallel, assessor-masked randomised controlled trial used to evaluate a brief, parent-led intervention, ParentWorks-Spectrum . Parents of 100 children aged 2–5 years with autism Level 2/3 and behavioural difficulties were randomly assigned (1:1) to ParentWorks-Spectrum ( n = 49) or Waitlist ( n = 51). ParentWorks-Spectrum involved 12–15 weekly 60- to 90-min online sessions of parenting intervention that covered three synergistic targets: child behavioural/emotional regulation, child social communication, and parental teamwork and mental health. Efficacy was assessed for primary (child conduct problems, Eyberg Child Behavior Inventory behavioural intensity and problem, and Social Responsiveness Scale, Second Edition autism features) and secondary (child social-emotional functioning and global functioning, parent sense of competence, parenting practices, mental health, and inter-parental conflict) outcomes. Results: At postintervention, there were moderate to large improvements in the Intervention ( n = 45) compared with the Waitlist group ( n = 46) on three of four primary outcome measures: conduct problems (diff = −0.91, 95% confidence interval = −1.55 to −0.26), Eyberg Child Behavior Inventory intensity (diff = −27.84, 95% confidence interval = −43.76 to −11.92), and Social Responsiveness Scale, Second Edition total (diff = −11.76, 95% confidence interval = −22.84 to −0.68). Effects were maintained at 3-month follow-up. Improvements were found for all but one secondary outcome and did not significantly differ for mothers versus fathers. Conclusions: A brief synergistic intervention delivered by telehealth that integrates child and parenting domains has benefits across core and associated autism features, and positive functioning in parents, including fathers. Trial registration: ANZCTR #12618001866291 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381133&isReview=true

Background: Schizotypal traits are considered to be clinical and cognitive features of Schizotypal Disorder in children (SDc). These traits are also seen in children and adolescents with high-functioning Autism Spectrum Disorder (ASD). This study examines the influence of schizotypal traits (and their severity) on the capacity of children with ASD to manage emotions, develop relationships with others, and adapt in school and family life. Methods: The Schizotypal traits of 63 children (6–12 years old) with High Functioning ASD were measured by the Melbourne Assessment of Schizotypy in Kids (MASK). Parents and teachers of the participating children completed the Child Behavior Checklist (CBCL) and Teachers’ Report Form (TRF) from the Achenbach System of Empirically Based Assessment and the Aberrant Behavior Checklist (ABC). Results: Overall, the results indicated correlations between the MASK scores and problems recorded by teachers, such as Internalizing problems (i.e., Anxious/Depressed, Withdrawn/Depressed, and Other problems score) according to TRF and Inappropriate speech scores, according to teacher’s ABC scales. Schizotypal traits impact the social, emotional, and behavioral functioning of children with ASD at home and school environments. Conclusions: The assessment of schizotypal traits in children with ASD provides critical information about a child’s functionality and cognitive development, also leading to the identification of potential cognitive-neuropsychological endophenotypes within ASD with characteristics of both Autism and Schizophrenia spectra. Τhe development of a valid assessment tool is required, as well as the design of targeted interventions to prevent the loss of functionality.

Background: Few studies have explored community participation for autistic adults, with or without intellectual disability. This study aims to investigate how autistic adults participate in the community, and the childhood and adulthood factors that predict community participation in adulthood.Method: Eighty‐four autistic adults (mean age 34 years; 67% with co‐occurring intellectual disability) initially recruited as children and adolescents, participated in the current study. Community participation frequency and variety were measured in adulthood. Childhood and adulthood predictors of community participation were investigated.Results: Participants engaged in the community an average of 18.2 times (range 0–49) over the previous 30‐day period, in an average of 6.3 different activities (range 0–13). Childhood and adulthood factors (autism symptoms, intellectual disability, living arrangements) were associated with community participation.Conclusion: Areas for additional support and resources were identified.

Male sex, early life chemical exposure and the brain aromatase enzyme have been implicated in autism spectrum disorder (ASD). In the Barwon Infant Study birth cohort (n = 1074), higher prenatal maternal bisphenol A (BPA) levels are associated with higher ASD symptoms at age 2 and diagnosis at age 9 only in males with low aromatase genetic pathway activity scores. Higher prenatal BPA levels are predictive of higher cord blood methylation across the CYP19A1 brain promoter I.f region (P = 0.009) and aromatase gene methylation mediates (P = 0.01) the link between higher prenatal BPA and brain-derived neurotrophic factor methylation, with independent cohort replication. BPA suppressed aromatase expression in vitro and in vivo. Male mice exposed to mid-gestation BPA or with aromatase knockout have ASD-like behaviors with structural and functional brain changes. 10-hydroxy-2-decenoic acid (10HDA), an estrogenic fatty acid alleviated these features and reversed detrimental neurodevelopmental gene expression. Here we demonstrate that prenatal BPA exposure is associated with impaired brain aromatase function and ASD-related behaviors and brain abnormalities in males that may be reversible through postnatal 10HDA intervention.

The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned.

Qualitative exploration of the experience of psychoanalytic psychotherapy complemented the quantitative evaluation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice‐weekly treatment was offered to adults for 2 years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low‐cost community service over 8 years. This paper is the second of two presenting the qualitative arm of the study, involving in‐depth narrative interviews with patients and psychotherapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of psychoanalytic psychotherapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psychotherapy and perspectives of both patients and psychotherapists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facilitative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psychotherapy may have affected the Implementation, Effectiveness and Maintenance of the program. The most notable facilitative factors emerging were the exploratory, insight‐oriented nature of the work, elements of the patient‐psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2‐year treatment, as both an expectation and a limit, probably inhibited program Reach, Adoption and overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implications for further investigation, are discussed.

The authors have withdrawn their manuscript owing to it needing further revision before publication, as well as errors in the author list. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.