Individuals with autism spectrum disorder (ASD) show deficits in social and emotional reciprocity, which often include empathic responding. The younger siblings of children with ASD (high-risk siblings) are at elevated risk for ASD and for subclinical deficits in social-emotional functioning. Higher levels of empathy in high-risk siblings during the second and third years of life predict fewer ASD symptoms and likelihood of diagnosis. We conducted a multi-method investigation of empathic responding to an examiner’s accident in 30 low-risk and 48 high-risk siblings with (n=12) and without ASD outcomes (n=36) at 4–6 years of age. Empathic responding was measured through behavioral observation and parent report. Prosocial behavior did not differ by ASD outcome. Children with ASD exhibited lower levels of personal distress than high-risk and low-risk siblings without ASD. Per parent report, high-risk siblings without ASD demonstrated higher levels of empathic responding than low-risk children, while the ASD group did not differ from children without ASD on this measure. Higher levels of observed empathic concern, but not prosocial behavior, were associated with lower Social Affect scores on the ADOS in high-risk children. Results suggest that ASD diagnosis and symptoms are associated with reduced emotional responsiveness to an adult’s distress, but not associated with deficits in prosocial behavior at preschool age. Results do not support the idea that empathic responding is negatively impacted in a broader autism phenotype. Findings extend previous research by suggesting that empathy may be a protective factor in the social-emotional development of children with familial risk for ASD. Lay summary We examined empathic responding to an adult’s accident in children with and without familial risk for ASD at 4–6 years of age. Results suggest that ASD diagnosis and symptoms are associated with reduced emotional responsiveness to an adult’s distress, but not with deficits in helping behavior at preschool age. Findings do not support the idea that deficits in empathic responding are part of a broader autism phenotype.

Routine outcome monitoring (ROM) is the practice of using self-or other report measures to inform treatment by monitoring client symptoms and treatment progress while providing feedback to clinicians and clients. Although ROM has been found to improve therapeutic outcomes and reduce early termination and is considered an evidence-based practice, this essential process is underutilized by clinicians due to philosophical and practical implementation barriers. To improve clinician knowledge and utilization, there have been several recent calls for the study of ROM education and training practices. This paper describes a multiyear study of standardized ROM implementation in a psychology training clinic following a process model. We discuss features of the model and the implementation process including procedures, barriers, facilitators, and outcomes. While initially there were barriers to ROM implementation consistent with the literature, the use of an implementation framework along with evaluation (e.g., clinician feedback, client surveys) helped to address these barriers and improve ROM implementation, resulting in high utilization and compliance rates. The discussion highlights lessons learned and identified facilitators to help aid successful ROM implementation within a training setting.

Many children with autism spectrum disorder (ASD) exhibit difficulties with negative affect. Cognitive behavioural therapy (CBT) has been successfully adapted for individuals with ASD to treat these difficulties. In a wait-list control study, for example, group analyses showed promising results for young children with ASD using a developmentally adapted group CBT approach. This report examined response to group CBT in terms of individual-level change in young children with ASD. Eighteen children with ASD, aged 5–7 years, and their respective parents participated in treatment. Parents completed pre- and post-treatment measures of negative affect and related behaviours. Treatment responders and non-responders were grouped based on significant treatment outcomes as assessed by statistically significant change for lability/negativity and 20% decrease in intensity, duration or frequency of emotional outbursts. Results indicated that 67% of children met criteria as a treatment responder, showing meaningful improvement in at least two outcome measures. No significant group differences emerged for initial characteristics before treatment. Wilcoxon signed rank tests determined pre-/post-treatment change in parental confidence for each treatment responder group. Results indicated statistically significant increase for the treatment responder group in parent-reported confidence in their own ability and in their child's ability to manage the child's anger and anxiety, but these results were not significant for the treatment non-responder group. Results provide additional evidence that CBT can significantly decrease expressions of anger/anxiety in children with ASD as young as 5 years, yet also suggest need for further improvement.

As reported prevalence and public awareness of Autism Spectrum Disorder (ASD) have grown in recent years, clinicians will likely see increased referrals for suspected ASD. The current study sought to elucidate factors associated with referral for possible ASD, as well as diagnostic outcome among youth referred for suspected ASD. Youth referred for psychological evaluations at an outpatient clinic (N = 69, 6-18 years, 48 male) were categorized into four groups: referred for suspected ASD and diagnosed as such, referred for ASD and not diagnosed as such, not referred for ASD but diagnosed as such, and neither referred for nor diagnosed with ASD. Approximately half of cases referred for suspected ASD did not meet diagnostic criteria. A significant effect of group was found for cognitive ability and anxiety. Youth receiving ASD diagnoses, regardless of whether they were referred for suspected ASD, demonstrated lower cognitive ability than children not receiving ASD diagnoses. Youth neither referred for nor diagnosed with ASD demonstrated lower anxiety than those who were referred and diagnosed. Maternal education significantly differed among the four groups. Although group differences are seen for youth cognitive ability, anxiety, and maternal education, we found no clear indicators differentiating referrals that were "accurate" (i.e., those diagnosed with ASD) and those that were not (i.e., those who did not receive ASD diagnosis). Comorbidity was high in all groups, including those referred primarily for ASD assessment, underscoring the importance of comprehensive assessment regardless of specificity of the referral.

Few psychological interventions exist to target executive function difficulties in children and adolescents. The current study modified the Unstuck and On Target! intervention protocol for use in an outpatient clinic setting with a diagnostically diverse group of participants. Participants engaged in a 10-week child and parent group treatment with assessment measurement at pre- and post-treatment. Assessments consisted of parent-report questionnaires, clinician-administered tasks, and treatment fidelity ratings. Results suggest that the modified intervention was delivered with high fidelity and is feasible and acceptable in a transdiagnostic sample. Although preliminary, efficacy appears promising and suggests that parent-rated executive function, as well as behavioral and emotional challenges, are amenable to change as a result of intervention participation. The results imply that the modified intervention has merit, and should be further explored within the context of larger studies.