San Diego State University, San Diego, USA.
Child and Adolescent Services Research Center, San Diego, CA, USA.
Adm Policy Ment Health. 2021 Sep;48(5):857-883. doi: 10.1007/s10488-021-01133-7. Epub 2021 Apr 21.
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
患有自闭症谱系障碍（ASD）的年轻人有很高的并发心理健康需求，需要进行心理健康干预。鉴于 ASD 年轻人的独特临床特征，已经做出了重大努力来改编和测试针对这一人群的心理健康干预措施。然而，针对 ASD 年轻人测试的各种干预措施的改编特征描述有限，特别是在关注实施因素的情况下。此外，对于这些干预措施如何在社区服务中实施的了解也有限。本系统综述的目的是描述：（1）针对 ASD 年轻人并发心理健康状况的测试干预措施的类型；（2）针对 ASD 年轻人使用的心理健康干预措施的改编；（3）心理健康干预措施的实施策略、结果和决定因素，以便为将其转化为社区服务环境提供信息。对 83 篇测试针对 ASD 年轻人心理健康症状的干预措施的文章进行了综述，这些文章在分析中包含了实施因素。Stirman 等人（2013 年；2019 年）的 FRAME 改编、Powell 等人（2012 年；2015 年）的实施策略以及 Proctor 等人（2011 年）的实施结果分类学，分别用于描述针对 ASD 年轻人使用的改编的性质和类型以及所使用的实施策略、结果和决定因素（如果有的话）。在所检查的干预措施中，大多数（64.1%）最初是为针对青年心理健康问题而设计的，然后进行了改编，以便与 ASD 一起使用。最常见的改编包括干预内容的改编，特别是在保持核心功能的同时，增加了针对干预措施的元素，或者细化了干预措施的某些方面。有一半的文章描述了在干预测试期间使用的至少一种实施策略。在实施结果中，最常检查的是保真度和可接受性，有些还检查了适当性和可行性。19%的文章描述了这些实施结果的实施决定因素（即障碍/促进因素）。针对 ASD 的常见改编为未来的干预措施发展和培训社区治疗师提供了方向。需要进一步检查、规范和报告正在进行的改编和干预措施中的实施策略和结果，以促进将其转化为社区环境。讨论了未来研究的领域以及临床意义。
