DSpace Repository :: Browsing by Author "White, Susan W."

Browsing by Author "White, Susan W."

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Anxiety and Depression Reduction as Distal Outcomes of a College Transition Readiness Program for Adults with Autism
(Springer, 2021) Capriola-Hall, Nicole M.; Brewe, Alexis M.; Golt, Josh; White, Susan W.
Young adults with autism spectrum disorder (ASD) experience increased rates of anxiety and depression which can impact academic success. The Stepped Transition in Education Program for Students with ASD (STEPS) applies cognitive-behavioral principles to help young adults with ASD improve their adjustment to postsecondary education. We aimed to determine if STEPS had an effect on anxiety and depression. Treatment-seeking adults with ASD (n = 32; Mage = 19.74) were randomized to STEPS or transition as usual (TAU; i.e., waitlist control group). STEPS participants evinced significantly greater declines in depressive symptoms from pre-treatment to post-treatment compared to the waitlist. Anxiety symptoms did not significantly change. Results suggest that transition support for young people with ASD may improve mental health.
Anxiety in Children and Adolescents with Autism Spectrum Disorders
(Elsevier, 2009) White, Susan W.; Oswald, Donald; Ollendick, Thomas; Scahill, Lawrence
Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.
Anxiety in Youth with and without Autism Spectrum Disorder: Examination of Factorial Equivalence
(Elsevier, 2014) White, Susan W.; Lerner, Matthew D.; McLeod, Bryce D.; Wood, Jeffrey J.; Ginsburg, Golda S.; Kerns, Connor; Ollendick, Thomas; Kendall, Philip C.; Piacentini, John; Walkup, John; Compton, Scott
Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n = 109, Mage = 11.67 yrs, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n = 342, Mage = 11.25 yrs, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure’s established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.
Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span Current State of the Science and Future Directions
(WB Saunders, 2020) Beck, Kelly B.; Conner, Caitlin M.; Breitenfeldt, Kaitlyn E.; Northrup, Jessie B.; White, Susan W.; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama Tuscaloosa
Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.
Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions
(Elsevier, 2020) Beck, Kelly B.; Conner, Caitlin M.; Breitenfeldt, Kaitlyn E.; Northrup, Jessie B.; White, Susan W.; Mazefsky, Carla A.
Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.
Attention Bias Modification Treatment for Adolescents with Social Anxiety Disorder
(Elsevier, 2019) Ollendick, Thomas H.; White, Susan W.; Richey, John; Kim-Spoon, Jungmeen; Ryan, Sarah M.; Wieckowski, Andrea Trubanova; Coffman, Marika C.; Elias, Rebecca; Strege, Marlene V.; Capriola-Hall, Nicole; Smith, Maria
Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.
Attention Deployment to the Eye Region of Emotional Faces among Adolescents with and without Social Anxiety Disorder
(Springer, 2021) Capriola-Hall, Nicole N.; Ollendick, Thomas H.; White, Susan W.; University of Alabama Tuscaloosa; Virginia Polytechnic Institute & State University
Background Avoidance of the eye region, especially of faces showing anger, may maintain social anxiety symptoms by negatively reinforcing expectations and fears associated with social situations. Eye-tracking research, however, has yet to explicitly examine differences in attention allocation to the eye region of emotional faces among adolescents with social anxiety disorder (SAD). Methods Gaze patterns were explored in a sample of youth with and without SAD matched on age and sex. Results Adolescents with SAD were quicker to fixate, and maintained their initial gaze longer, to the eye region, regardless of emotion, relative to teens without SAD. Group-level differences also emerged for initial fixation duration directed to the eye region of angry faces (when compared with happy faces). Conclusions These findings suggest that vigilance to the eye region of faces, especially angry faces, (when compared with happy faces) is characteristic of adolescents with SAD. Adolescents with SAD seem drawn to the eye region, more so than teens without SAD.
Attention Modification to Attenuate Facial Emotion Recognition Deficits in Children with Autism: A Pilot Study
(Springer, 2020) Wieckowski, Andrea Trubanova; White, Susan W.
Diminished attending to faces may contribute to the impairments in emotion recognition and expression in autism spectrum disorder (ASD). The current study evaluated the acceptability, feasibility, and preliminary efficacy of an attention modification intervention designed to attenuate deficits in facial emotion recognition (FER). During the 10-session experimental treatment, children (n=8) with ASD watched dynamic videos of people expressing different emotions with the facial features highlighted to guide children’s attention. Children and their parents generally rated the treatment as acceptable and helpful. Although FER improvement was not apparent on task-based measures, parents reported slight improvements and decreased socioemotional problems following treatment. Results suggest that further research on visual attention retraining for ASD, within an experimental therapeutic program, may be promising.
Autism Goes to College: Understanding the Needs of a Student Population on the Rise
(Springer, 2018) Elias, Rebecca; White, Susan W.
Understanding the needs of adolescents and emerging adults with Autism Spectrum Disorder (ASD) with respect to transition to postsecondary education is critical to development of user-informed transition programming. Parents of adolescents and emerging adults with ASD (n = 52) and ADHD (n = 47) completed an online survey. Social interaction training and independent living training were services frequently requested by parents in the ASD group. Additionally, parents of postsecondary students with ASD endorsed distinct challenges with self-advocacy, managing emotions, and managing personal/adaptive skills relative to postsecondary students with ADHD. The profile of parent-reported difficulties and needed services compared to transition to postsecondary education for students with ASD is distinguishable from that for ADHD, suggesting individualized transition planning and in-college supports.
Autistic Traits, Substance Use, and Social Anxiety
(University of Alabama Libraries, 2022) Levy, Sera; Witte, Tricia; University of Alabama Tuscaloosa
The present study assessed the associations between autistic traits and the reporting of alcohol use motives, positive consequences of alcohol use, appeal of drug use, and problematic substance use among college students. Despite receiving little attention in the academic literature, autism spectrum disorder (ASD) and substance use disorder (SUD) as a dual diagnosis is seen in clinical populations. As social anxiety is commonly reported by both individuals with ASD and SUD, symptoms of social anxiety were thought to enhance the relationship between autistic traits and substance use, thus serving as a moderator. College students were recruited to complete an anonymous survey, and a total of 645 participants were included in the analyses. Findings revealed that autistic traits were significantly correlated with coping drinking motives and appeal of drug use. Additionally, there was a significant interaction between autistic traits and social anxiety for social drinking motives and alcohol use positive consequences such that there were significant negative associations at low levels of social anxiety for social motives, and at low and average social anxiety for alcohol use positive consequences. Results from this study suggest a noteworthy relationship between more autistic traits and the likelihood of reporting drinking alcohol for reasons to cope (i.e., alcohol helps when you feel depressed), as well as reporting drug use as appealing. Across all analyses, social anxiety did not appear as a moderator in the hypothesized direction, as so, future research should examine other potential moderators. Furthermore, findings should inform future research to explore why drug use may be more appealing to individuals with autistic traits than alcohol use.
Bridging Gaps and Enhancing Support: Stakeholder Perspectives on Optimizing a Transition Program for Autistic Youth and Young Adults
(Association for Behavioral and Cognitive Therapies, 2024) McClain, Amaya B.; Guyotte, Kelly W.; Powell, Nicole; White, Susan W.
Autistic adolescents and young adults face lower employment, education, and quality of life outcomes as compared to their nonautistic peers (Lawson et al., 2020; Nord et al., 2016). To address these issues, the Stepped Transition to Employment and Postsecondary Education Success (STEPS; White et al., 2017) program was developed to help students successfully transition into adulthood. Given the established effectiveness of STEPS (e.g., White et al., 2021), we sought input from community partners to reduce the gap between mental health and developmental disability support (Laxman et al., 2019; White et al., 2023) and to maximize the program's scalability and accessibility through the use of a community engagement framework. This study examined the perspectives of community stakeholders on different aspects of the program’s development, such as the barriers and facilitators to implementing STEPS and how to make the program more scalable and accessible for families, clinicians, and educators.
Brief Report: Creation of a Transition Readiness Scale for Adolescents with ASD
(Springer, 2023) Elias, Rebecca; Conner, Caitlin M.; White, Susan W.; University of Southern California; Children's Hospital Los Angeles; University of Pittsburgh; University of Alabama Tuscaloosa
The transition to postsecondary education is characterized by many changes for adolescents with autism spectrum disorder (ASD). A data-based understanding of a student's readiness for postsecondary education could help students, and their parents, better prepare for this life transition. The Transition Readiness Scale (TRS) was created to address this need. The TRS is a self/other-report questionnaire used to assess postsecondary readiness across behavioral, cognitive, and emotional domains among adolescents 15-18 years of age. The present study details measure development and provides preliminary psychometric properties in a sample of transition-aged youth with ASD. Results indicate strong internal consistency, adequate item-level analyses, and discriminant and concurrent validity. Future validation of the TRS in large-scale field testing is merited to inform clinical interpretation.
Brief Report: The Influence of Autism Severity and Depression on Self-Determination Among Young Adults with Autism Spectrum Disorder
(Springer, 2022) White, Susan W.; Smith, Isaac; Brewe, Alexis M.
Self-determination (SD) is linked to autonomy and better adult outcomes. Adults with autism spectrum disorder (ASD) are often less independent than cognitively matched peers. Given the frequency with which depression co-occurs in ASD and the established association between depression and SD, we sought to evaluate the influence of both ASD severity and depression on SD among cognitively able emerging adults with ASD. Emerging adults (n = 59) with ASD completed measures of SD, ASD severity, and depression. Both ASD severity and depression were moderately correlated with SD (r = − 0.473; − 0.423, respectively) and with each other (r = 0.625). After controlling for ASD severity, depression did not significantly predict SD. Strengthening SD should be considered in programming to promote independence.
Camouflaging in Autism: Examining Sex-Based and Compensatory Models in Social Cognition and Communication
(Wiley, 2021) Corbett, Blythe A.; Schwartzman, Jessica M.; Libsack, Erin J.; Muscatello, Rachael A.; Lerner, Matthew D.; Simmons, Grace Lee; White, Susan W.
Camouflaging refers to ways individuals with autism spectrum disorder (ASD), especially females, mask symptoms. Compensation occurs when a person's observed behavior appears more typical than what would be expected based on underlying ability and symptoms. The study explored camouflaging and compensation differences in 161 youth with ASD. Findings suggest sex-based differences with females showing better vocal expression. However, several compensation differences were observed with the High compensators showing stronger social communication and rapport. A more nuanced consideration of camouflaging using compensation models reveal subtle differences in underlying challenge and strength.
Caution When Screening for Autism among Socially Anxious Youth
(Springer, 2021) Capriola-Hall, Nicole N.; McFayden, Tyler; Ollendick, Thomas H.; White, Susan W.; University of Alabama Tuscaloosa; Virginia Polytechnic Institute & State University
Social anxiety disorder (SAD) is commonly comorbid with autism spectrum disorder (ASD). Here, in a sample of 86 children and adolescents (M-AGE = 12.62 years; 68.6% male), 28 of whom were diagnosed with ASD, 34 with SAD, and 24 with comorbid ASD and SAD, we compared parent-reported scores from the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber in Social Responsiveness Scale (SRS; Constantino and Gruber2012) to determine the sensitivity and specificity of the measure in cases of differential diagnosis between SAD and ASD. Results suggest that neither the subscales, nor the SRS-2 total score, consistently differed between ASD and SAD. Sensitivity and specificity analyses suggested that the SRS-2 total poorly discriminated ASD from SAD. When screening socially anxious youth for possible ASD, caution should be taken.
Change in Gaze-Based Attention Bias in Adolescents with Social Anxiety Disorder
(Taylor & Francis, 2019) White, Susan W.; Capriola-Hall, Nicole N.; Wieckowski, Andrea Trubanova; Ollendick, Thomas H.
Although attention bias (AB) toward threat has been associated with Social Anxiety Disorder (SAD), concerns regarding the ability of current measures to detect change in AB following treatment exist. We sought to examine change in bias, as measured via eye-tracking, in adolescents with SAD receiving either attention-bias modification training (ABMT) or attention-control training (ACT). Gaze-based AB was associated (r = −0.361) with symptoms of social anxiety prior to treatment, whereas there was no association between bias as measured via dot probe and social anxiety. Moreover, gaze-based bias to same-age face stimuli showed change following treatment. Large effects are seen for condition (ABMT or ACT) and for time, independent of treatment condition, in gaze-based AB to same-age stimuli. Findings suggest that further research on gaze-based bias, to assess stability over time outside of treatment and sensitivity to change following intervention, is warranted.
Characterizing the Relationship Among the Social Competence Elements in Autistic Adolescents
(Wiley, 2025) Key, Alexandra P.; McGonigle, Trey; Liu, Jinyuan; Muscatello, Rachael; Gable, Philip; White, Susan W.; Lerner, Matthew; Corbett, Blythe A.
Individuals with autism spectrum disorder have significant difficulties in social competence. This study provided empirical evaluation of the theoretical model by Kennedy and Adolphs (2012) positing that social competence relies on an interconnected network of four components: social brain, cognition, behavior and functioning. Data from 243 youth (69 female, 174 male), age 10–17 years, were used to test the hypothesized mediation effect of social cognition (Theory of Mind) from social brain (event-related potential markers of face perception and memory) to social behavior (Contextual Assessment of Social Skills) and functioning (Child Behavior Checklist). An additional analysis evaluated whether the structure of the social competence model varied based on the biological sex of the autistic participants. The findings support the conceptual model of social competence where the social brain’s contributions to social behavior and functioning are mediated by social cognition, with an additional direct path between the brain and behavior. The relationship among the four components of social competence is not significantly different for autistic males and females. Social competence is best represented as a network of direct and indirect connections among the neural, cognitive, and behavioral components. Thus, focusing on any single element is not sufficient for effective design of novel assessment and treatment approaches in autism. The findings also highlight the importance of self-initiated active engagement with social cues as a contributor to successful social behavior and functioning in autism.
Client-therapist alliance for adolescents and young adults with autism: relation to treatment outcomes and client characteristics
(University of Alabama Libraries, 2020-04) Brewe, Alexis Marie; White, Susan W.; University of Alabama Tuscaloosa
Adolescents and adults with autism spectrum disorder (ASD) experience difficulties with emotion regulation (ER), which has been associated with a host of co-occurring problems with mood, anxiety, and aggression. Although treatments targeting ER are available for individuals with ASD, there is a limited understanding of factors that lead to successful outcomes. The therapeutic alliance is considered important for outcomes in non-ASD samples; however, the process of alliance formation and its relation to treatment outcomes is unclear for clients with ASD. The present study aims to examine the trajectory of alliance formation across treatment, as well as examine whether alliance is related to treatment outcomes or specific within-person characteristics. Participants included adolescents and adults with ASD (n = 39, mean age = 15.28 years, age range = 12 to 21 years, 79.50% male) who completed a 16-week intervention designed to treat ER difficulties. Client-therapist alliance was measured at four timepoints throughout treatment using an observational measure of alliance and parents rated their child’s ER difficulties. Interrater reliability on observer-rated alliance was strong. Alliance formation significantly fluctuated throughout treatment. Overall alliance strength, as well as alliance early in treatment, predicted better treatment outcomes. Additionally, ASD symptom severity and co-occurring depression were related to alliance strength. The current study supports the importance of therapeutic alliance for clients with ASD and highlights a need for increased alliance formation during critical stages in treatment. Considerations for future research are discussed.
Cognitive Behaviour Therapy Versus a Counselling Intervention for Anxiety in Young People with High-Functioning Autism Spectrum Disorders: A Pilot Randomised Controlled Trial
(Springer, 2017-08-02) Murphy, Suzanne M.; Chowdhury, Uttom; White, Susan W.; Reynolds, Laura; Donald, Louisa; Gahan, Hilary; Iqbal, Zeinab; Kulkarni, Mahesh; Scrivener, Louise; Shaker-Naeeni, Hadi; Press, Dee A.
The use of cognitive-behavioural therapy (CBT) as a treatment for children and adolescents with autism spectrum disorder (ASD) has been explored in a number of trials. Whilst CBT appears superior to no treatment or treatment as usual, few studies have assessed CBT against a control group receiving an alternative therapy. Our randomised controlled trial compared use of CBT against person-centred counselling for anxiety in 36 young people with ASD, ages 12–18. Outcome measures included parent- teacher- and self-reports of anxiety and social disability. Whilst each therapy produced improvements in participants, neither therapy was superior to the other to a significant degree on any measure. This is consistent with findings for adults.
Community-Based Transition Support Programming for Autistic Emerging Adults
(University of Alabama Libraries, 2024) Brewe, Alexis; White, Susan W.
Becoming an independent adult is a critical life transition, characterized by new roles and responsibilities in employment, relationships, and education. For adolescents with Autism Spectrum Disorder (ASD), this transition is marked by unique challenges including unemployment/underemployment, social isolation, and difficulties living independently. Despite growing evidence of the utility of programs that prepare autistic individuals for adulthood, these programs are rarely adopted into routine clinical practice. The current study uses an implementation science approach to refine and test an existing, evidence-based transition support program, the Stepped Transition to Employment and Postsecondary Success program (STEPS) for community implementation. In Phase 1, qualitative feedback was sought from stakeholders (total n = 45; i.e., autistic adults, caregivers, and professionals involved in the adult transition process) on several barriers and facilitators to implementation of STEPS in the community. In Phase 2, STEPS was piloted with 12 autistic individuals aged 16-35 in a local community agency to examine program feasibility, acceptability, and initial clinical impact. Results supported feasibility of STEPS implementation, evidenced by 93% of treatment objectives being delivered as intended by the STEPS therapist and moderately strong therapeutic alliance (average rating = 3.29, possible range = 0-5) established with clients. Results also supported acceptability, evidenced by low attrition (91.67% retention rate), high session attendance (96.27% sessions attended as scheduled), high homework completion (84.10% homework completion), and high participant- and caregiver-reported program satisfaction (average ratings of >4 across all items, possible range 1-5). Results also partially support the clinical impact of STEPS, evidenced by clinically significant change and reliable improvement in participants' transition readiness, as well as secondary measures of adult functioning, self-knowledge, self-determination, and self-regulation. In Phase 3, participants from Phase 2 completed exit interviews to provide final input on STEPS content, which was used to prepare STEPS for community implementation. Findings informed future community implementation of STEPS, and produced a fully scalable, stakeholder-informed program that was developed to address implementation challenges and ready for community deployment. Future research could utilize innovative implementation approaches (i.e., hybrid effectiveness-implementation trials) to test strategies that might promote adoption and long-term sustainability of STEPS in communities.

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Browsing by Author "White, Susan W."

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