Project ID NS-MH2024_34


Co Supervisor 1A Institute of Psychiatry, Psychology & Neuroscience, School of Academic Psychiatry, Department of Child & Adolescent PsychiatryWebsite

Co Supervisor 1B Institute of Psychiatry, Psychology & Neuroscience, School of Academic Psychiatry, Department of Psychological MedicineWebsite

Developing mechanistically informed interventions to improve flexible thinking and symptoms of co-occurring psychiatric conditions experienced by autistic young people

Autistic people are at high risk of experiencing co-occurring anxiety and depression. Current approaches to treating mental health in autism focus on adapting interventions for the neurotypical population which target symptoms rather than underlying mechanisms. In this project we will take a different approach by developing an intervention which targets cognitive inflexibility, a transdiagnostic mechanism associated with multiple domains of mental health difficulties in autism. Cognitive Remediation Therapy (CRT) is an existing intervention which has been used with different patient groups to improve flexibility. CRT has shown promise in improving these cognitive difficulties in those with anorexia nervosa and autistic features (Dandil et al, 2020) and with further adaptation could be used with autistic young people.

The project has three key aims:
1) To use the existing literature of adapted interventions for autism and input from autistic youth and their parents to adapt CRT for use with autistic youth.
2) To establish the acceptability of adapted CRT by conducting a proof-of-principle pilot study with approximately twenty autistic young people.
3) To gather preliminary outcome data on CI, anxiety and depression, and other key measures such as functional outcomes.

There will also be opportunities to work with existing datasets to conduct complex analysis exploring other potential mechanisms/treatment targets. This could take up more / less of the PhD depending on the candidates interests.

Key skills to be learnt:
• Translation/ clinical research
• Co-design of psychological interventions
• Intervention study design / clinical trials
• Fundamental and complex statistical analyses – options include longitudinal modeling, structural equation modelling and network analysis.

Key objectives:
Year 1: Literature review; co-design work with autistic youth; ethical approvals; data-based project.
Year 2: Data collection; statistics training
Year 3: Data collection; attend annual CRT conference in NYC.
Year 4: Writing for publication; thesis submission; public/service user engagement training; present at international autism conference (INSAR).

Representative Publications

Ozsivadjian, A., Hollocks, M. J., Magiati, I., Happé, F., Baird, G., & Absoud, M. (2021). Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. Journal of child psychology and psychiatry, 62(6), 715-724.

Lei, J., Charman, T., Leigh, E., Russell, A., Mohamed, Z., & Hollocks, M. J. (2022). Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta?analysis. Autism Research.

Hollocks, M. J., Leno, V. C., Chandler, S., White, P., Yorke, I., Charman, T., … & Simonoff, E. (2022). Psychiatric conditions in autistic adolescents: longitudinal stability from childhood and associated risk factors. European child & adolescent psychiatry, 1-12.

Tchanturia K, Doris E, Fleming C (2014) Effectiveness of cognitive remediation and emotion skills training (CREST) for anorexia nervosa in group format: A naturalistic pilot study European Eating Disorders Review. 22(3):200-5; doi: 10.1002/erv.2287 (95; 4.4; 80).

Dandil, Y., Smith, K., Adamson, J., & Tchanturia, K. (2020). Individual cognitive remediation therapy benefits for patients with anorexia nervosa and high autistic features. European Eating Disorders Review, 28(1), 87-91.

Kinnaird E, Tchanturia K (2021) Looking beneath the surface: distinguishing between common features in autism and anorexia nervosa; Journal of Behavioral and Cognitive Therapy., 5.8 20)