Faculty of Health

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Open Access
Plugged in: Electronics use in youth and young adults with Autism Spectrum Disorder
(Sage Publishing, 01/01/2016) MacMullin, Jennifer A.; Lunsky, Yona; Weiss, Jonathan
Although electronic technology currently plays an integral role for most youth, there are growing concerns of its excessive and compulsive use. The current study documents patterns and impact of electronics use in individuals with Autism Spectrum Disorder (ASD) compared to typically developing peers. Participants included 172 parents of typically developing individuals and 139 parents of individuals with an ASD diagnosis, ranging in age from 6 to 21 years. Parents completed an online survey of demographics and the frequency, duration, and problematic patterns of electronics use in their youth and young adults. Individuals with ASD were reported to use certain electronics more often in the last month and on an average day, and had greater compulsive Internet and video game use than individuals without ASD. Across both samples, males used video games more often than females. Compared to parents of individuals without ASD, parents of individuals with ASD were significantly more likely to report that electronics use was currently having a negative impact. The implications of problematic electronics use for individuals with ASD are discussed.
Open Access
Bullying Experiences among Children and Youth with Autism Spectrum Disorders
(Springer US, 01/02/2012) Cappadocia, M. Catherine; Weiss, Jonathan; Pepler, Debra
Few studies have investigated bullying experiences among children diagnosed with autism spectrum disorders (ASD); however, preliminary research suggests that children with ASD are at greater risk for being bullied than typically developing peers. The aim of the current study was to build an understanding of bullying experiences among children with ASD based on parent reports by examining rates of various forms of bullying, exploring the association between victimization and mental health problems, and investigating individual and contextual variables as correlates of victimization. Victimization was related to child age, internalizing and externalizing mental health problems, communication difficulties, and number of friends at school, as well as parent mental health problems. Bullying prevention and intervention strategies are discussed.
Open Access
Altered anterior visual system development following early monocular enucleation
(Elsevier Inc., 01/11/2013) Kelly, Krista; McKetton, Larissa; Schneider, Keith; Gallie, Brenda; Steeves, Jennifer
Purpose Retinoblastoma is a rare eye cancer that generally occurs before 5 years of age and often results in enucleation (surgical removal) of the cancerous eye. In the present study, we sought to determine the consequences of early monocular enucleation on the morphological development of the anterior visual pathway including the optic chiasm and lateral geniculate nucleus. Methods A group of adults who had one eye enucleated early in life due to retinoblastoma was compared to binocularly intact controls. Although structural changes have previously been reported in late enucleation, we also collected data from one late enucleated participant to compare to our early enucleated participants. Measurements of the optic nerves, optic chiasm, optic tracts and lateral geniculate nuclei were evaluated from T1 weighted and proton density weighted images collected from each participant. Results The early monocular enucleation group exhibited overall degeneration of the anterior visual system compared to controls. Surprisingly, however, optic tract diameter and geniculate volume decreases were less severe contralateral to the remaining eye. Consistent with previous research, the late enucleated participant showed no asymmetry and significantly larger volume decreases in both geniculate nuclei compared to controls. Conclusions The novel finding of an asymmetry in morphology of the anterior visual system following long-term survival from early monocular enucleation indicates altered postnatal visual development. Possible mechanisms behind this altered development include recruitment of deafferented cells by crossing nasal fibres and/or geniculate cell retention via feedback from primary visual cortex. These data highlight the importance of balanced binocular input during postnatal maturation for typical anterior visual system morphology.
Open Access
Factors associated with caregiver burden among parents of individuals with ASD: Differences across intellectual functioning
(Wiley, 02/09/2014) Vogan, Vanessa; Lake, Johanna; Weiss, Jonathan; Robinson, Suzanne; Tint, Ami; Lunsky, Yona
Symptoms of autism spectrum disorder (ASD) persist into adolescence and adulthood, when access to health services and supports become difficult. Consequently, most adolescents and adults with ASD remain reliant on their families for support, often resulting in caregiver burden among parents. This study aims to investigate factors associated with burden in parents of adolescents and young adults with ASD, and to understand how these factors differ across varying levels of intellectual functioning. Of the 297 parents sampled, ASD severity, externalizing behaviors, medical comorbidity, and parent age predicted burden in parents of adolescents and young adults with ASD and an intellectual disability (ID), whereas an inability to pay for services predicted burden in parents of individuals with ASD and no ID. Factors associated with caregiver burden differed among individuals with and without ID and were not limited to symptom severity or mental health problems, but also extended to system factors.
Open Access
Comparative Effects of Mindfulness and Support and Information Group Interventions for Parents of Adults with Autism Spectrum Disorder and Other Developmental Disabilities
(Springer US, 03/04/2017) Lunsky, Yona; Hastings, Richard; Weiss, Jonathan; Palucka, Anna M.; Hutton, Sue; White, Karen
This study evaluated two community based interventions for parents of adults with autism spectrum disorder and other developmental disabilities. Parents in the mindfulness group reported significant reductions in psychological distress, while parents in the support and information group did not. Reduced levels of distress in the mindfulness group were maintained at 20 weeks follow-up. Mindfulness scores and mindful parenting scores and related constructs (e.g., self-compassion) did not differ between the two groups. Results suggest the psychological components of the mindfulness based group intervention were effective over and above the non-specific effects of group processes and informal support.
Open Access
Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain
(Dove Medical Press Ltd., 04/03/2013) Pagé, M. Gabrielle; Stinson, Jennifer; Campbell, Fiona; Issac, Lisa; Katz, Joel
Background: The goals of this study were to examine the trajectory of pediatric chronic postsurgical pain (CPSP) over the first year after surgery and to identify acute postsurgical predictors of CPSP. Methods: Eighty-three children aged 8–18 years (mean 13.8, standard deviation 2.4) who underwent major orthopedic or general surgery completed pain and pain-related psychological measures at 48–72 hours, 2 weeks (pain anxiety and pain measures only), and 6 and 12 months after surgery. Results: Results showed that 1 year after surgery, 22% of children developed moderate to severe CPSP with minimal functional disability. Children who reported a Numeric Rating Scale pain-intensity score $ 3 out of 10 two weeks after discharge were more than three times as likely to develop moderate/severe CPSP at 6 months and more than twice as likely to develop moderate/severe CPSP at 12 months than those who reported a Numeric Rating Scale pain score , 3 (6-month relative risk 3.3, 95% confidence interval 1.2–9.0 and 12-month relative risk 2.5, 95% confidence interval 0.9–7.5). Pain unpleasantness predicted the transition from acute to moderate/severe CPSP, whereas anxiety sensitivity predicted the maintenance of moderate/severe CPSP from 6 to 12 months after surgery. Conclusions: This study highlights the prevalence of pediatric CPSP and the role played by psychological variables in its development/maintenance. Risk factors that are associated with the development of CPSP are different from those that maintain it.
Open Access
Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review
(Dove Medical Press Limited, 05/01/2015) Burns, Lindsay, C.; Ritvo, Sarah, E.; Ferguson, Meaghan, K.; Clarke, Hance; Seltzer, Ze'ev; Katz, Joel
Background: Total knee arthroplasty (TKA) is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant predictor of chronic pain persisting $3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates. Conclusion: This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery.
Open Access
Priority service needs and receipt across the lifespan for individuals with autism spectrum disorder
(Wiley, 06/04/2017) Lai, Jonathan; Weiss, Jonathan
Individuals with Autism Spectrum Disorder (ASD) have a range of health, community, and social support needs across the lifespan that create age-speciﬁc challenges in navigating service sectors. In this study, we set out to identify the priority needs of individuals with ASD across the lifespan, and the factors that predict receiving priority services. Participants included 3,317 individuals with ASD from a Canada-wide online caregiver survey, stratiﬁed into ﬁve age groups(preschool, elementary school age, adolescence, emerging adulthood, adulthood). Priority receipt was calculated as a ratio of current services that corresponded to individualized priority need. Age-stratiﬁed Poisson regression analyses were used to identify the sociodemographic, clinical and systemic predictors of priority receipt. Results indicate that the distribution of priority need varied by age, except for social skills programming, which was a high across all groups.The number of high and moderate priority needs diversiﬁed with age. Overall, 30% of individuals had none of their priority needs met and priority receipt decreased with age. Systemic factors were most consistently related to priority receipt across the lifespan. Understanding patterns and correlates of priority needs and use that currently exist in different age groups can inform policies to improve service access.
Open Access
Phantom limb pain
(Elsevier, 08/11/1997) Katz, Joel
Traditional methods of postoperative analgesia do not provide adequate control of pain, in part because they focus on treating the patient only after the pain is well entrenched. Despite recent advances in the management of postoperative pain, up to 60% of patients continue to report moderate to severe pain shortly after surgery. 1 Patients are ordinarily transported to the recovery room, in considerable pain, where they receive high doses of morphine in an attempt to bring the pain under control. ...
Open Access
Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury
(Dove Medical Press Ltd., 09/01/2013) Rosenbloom, Brittany N; Khan, Sobia; McCartney, Colin JL; Katz, Joel
Background: Persistent pain and psychological distress are common after traumatic musculoskeletal injury (TMsI). Individuals sustaining a TMsI are often young, do not recover quickly, and place a large economic burden on society. Objectives: The aim of this systematic review is to determine (1) the incidence of persistent pain following TMsI, (2) the characteristics of pain, characterized by injury severity and type, and (3) risk and protective factors associated with persistent pain following TMsI. Methods: A systematic search of electronic databases (MEDLINE®, PubMed®, Embase, and PsycINFO®) was conducted for prospective, interventional, or noninterventional studies measuring the incidence of pain associated with TMsI. Results: The search revealed 4388 studies. Eleven studies examined persistent pain and met inclusion criteria. Pain was assessed using a validated measure of pain intensity or pain presence in six studies. Persistent pain was reported by all studies at variable time points up to 84 months postinjury, with wide variation among studies in pain intensity (ie, from mild to very severe) and pain incidence at each time point. The incidence of pain decreased over time within each study. Two studies found significant relationships between injury severity and persistent pain. Frequently cited predictive factors for persistent pain included: symptoms of anxiety and depression, patient perception that the injury was attributable to external sources (ie, they were not at fault), cognitive avoidance of distressing thoughts, alcohol consumption prior to trauma, lower educational status, being injured at work, eligibility for compensation, pain at initial assessment, and older age. Conclusion and implications: The evidence from the eleven studies included in this review indicates that persistent pain is prevalent up to 84 months following traumatic injury. Further research is needed to better evaluate persistent pain and other long-term posttraumatic outcomes.
Open Access
Keeping an eye on pain: investigating visual attention biases in individuals with chronic pain using eye-tracking methodology
(Dovepress, 10/08/2016) Fashler, Samantha, R.; Katz, Joel
Attentional biases to painful stimuli are evident in individuals with chronic pain, although the directional tendency of these biases (ie, toward or away from threat-related stimuli) remains unclear. This study used eye-tracking technology, a measure of visual attention, to evaluate the attentional patterns of individuals with and without chronic pain during exposure to injury-related and neutral pictures. Individuals with (N=51) and without chronic pain (N=62) completed a dot-probe task using injury-related and neutral pictures while their eye movements were recorded. Mixed-design analysis of variance evaluated the interaction between group (chronic pain, pain-free) and picture type (injury-related, neutral). Reaction time results showed that regardless of chronic pain status, participants responded faster to trials with neutral stimuli in comparison to trials that included injury-related pictures. Eye-tracking measures showed within-group differences whereby injury-related pictures received more frequent fixations and visits, as well as longer average visit durations. Between-group differences showed that individuals with chronic pain had fewer fixations and shorter average visit durations for all stimuli. An examination of how biases change over the time-course of stimulus presentation showed that during the late phase of attention, individuals with chronic pain had longer average gaze durations on injury pictures relative to pain-free individuals. The results show the advantage of incorporating eye-tracking methodology when examining attentional biases, and suggest future avenues of research.
Open Access
Pain-related psychological correlates of pediatric acute post-surgical pain
(Dove Medical Press Ltd., 12/11/2012) Pagé, M. Gabrielle; Stinson, Jennifer; Campbell, Fiona; Issac, Lisa; Katz, Joel
Background: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP) and predictors of functional disability 2 weeks after hospital discharge. Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4) years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery. Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness. Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.
Open Access
Implicit versus explicit associative learning and experimentally induced placebo hypoalgesia
(Dove Medical Press Ltd., 14/02/2011) Martin-Pichora, Andrea L; Mankovsky-Arnold, Tsipora D.; Katz, Joel
The present study examined whether 1) placebo hypoalgesia can be generated through implicit associative learning (ie, conditioning in the absence of conscious awareness) and 2) the magnitude of placebo hypoalgesia changes when expectations about pain are made explicit. The temperature of heat pain stimuli was surreptitiously lowered during conditioning trials for the placebo cream and the magnitude of the placebo effect was assessed during a subsequent set of trials when the temperature was the same for both placebo and control conditions. To assess whether placebo hypoalgesia could be generated from an implicit tactile stimulus, a 2 2 design was used with direction of cream application as one factor and verbal information about which cream was being applied as the second factor. A significant placebo effect was observed when participants received verbal information about which cream was being applied but not following implicit conditioning alone. However, 87.5% of those who showed a placebo response as the result of implicit conditioning were able to accurately guess the order of cream application during the final trial, despite a lack of awareness about the sensory manipulation and low confidence in their ratings, suggesting implicit learning in some participants. In summary, implicit associative learning was evident in some participants but it was not sufficient to produce a placebo effect suggesting some level of explicit expectation or cognitive mediation may be necessary. Notably, the placebo response was abolished when expectations were made explicit, suggesting a delicate interplay between attention and expectation.
Open Access
Thriving in Youth with Autism Spectrum Disorder and Intellectual Disability
(Springer US, 15/03/2015) Weiss, Jonathan; Burnham Riosa, Priscilla;
Most research on mental health in individuals with autism spectrum disorder (ASD) and intellectual disability (ID) has focused on deficits. We examined individual (i.e., sociocommunicative skills, adaptive behavior, functional cognitive skills) and contextual (i.e., home, school, and community participation) correlates of thriving in 330 youth with ID and ASD compared to youth with ID only, 11–22 years of age (M = 16.74, SD = 2.95). Youth with ASD and ID were reported to thrive less than peers with ID only. Group differences in sociocommunicative ability and school participation mediated the relationship between ASD and less thriving. Research is needed to further elucidate a developmental-contextual framework that can inform interventions to promote mental health and wellness in individuals with ASD and ID.
Open Access
Transdiagnostic Case Conceptualization of Emotional Problems in Youth with ASD: An Emotion Regulation Approach
(John Wiley & Sons, 15/12/2014) Weiss, Jonathan
Youth with autism spectrum disorder often struggle to cope with co-occurring anxiety, depression, or anger, and having both internalizing and externalizing symptoms is a common clinical presentation. A number of authors have designed cognitive-behavioral interventions to address transdiagnostic factors related to multiple emotional problems, although none have applied this focus to youth with ASD. The current review article describes how a transdiagnostic emotion regulation framework may inform cognitive-behavioral interventions for youth with ASD, which until now have focused almost exclusively on anxiety. Research is needed to empirically test how a transdiagnostic intervention can address the processes of emotion regulation and assist youth with ASD to cope with their emotional disorders.
Open Access
Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder
(Springer International Publishing AG, 16/04/2015) Thomson, Kendra; Burnham Riosa, Priscilla; Weiss, Jonathan
Children with autism spectrum disorder (ASD) often present with comorbid psychopathology including problems with emotion regulation. The goal of the present research was to investigate the feasibility of a multicomponent manualized cognitive behavior therapy treatment program for improving emotion regulation in youth with ASD 8 to 12 years of age. Thirteen males and their parents participated in the intervention, reporting high satisfaction with the activities and program overall, and attending all sessions. Preliminary outcomes regarding emotion regulation and psychopathology, and feasibility of the intervention, are summarized and discussed.
Open Access
Access barriers to services by immigrant mothers of children with autism in Canada
(17/01/2017) Khanlou, Nazilla; Haque, Nasim; Mustafa, Nida; Vazquez, Luz Maria; Mantini, Anne; Weiss, Jonathan
Equal access for autism services remains suboptimal for diverse groups. In Canada,little is known about the barriers immigrant mothers face accessing services and support for their children with developmental disabilities. In this qualitative study, 21 immigrant mothers of children with Autism, from a diverse ethno cultural background, were interviewed inToronto, Canada. We apply House’s (1981) four domains of social support to analyze findings.Structural support challenges, such as delays in diagnosis, fragmented and dispersed services were common, followed by instrumental challenges due to loss of social ties and stigma. Lack of expected support from partners, and negative perceptions of services, were identified as emotional and perceptive challenges. Focused attention is required to address inequalities within the context of current access pathways for autism.
Open Access
Depression in youth with autism spectrum disorders: The role of ASD vulnerabilities and family-environmental stressors
(Taylor & Francis Group, 17/03/2015) Fung, Stephanie; Weiss, Jonathan; Lunsky, Yona
Individuals with Autism Spectrum Disorders (ASD) are at an increased risk of mental health problems, with depression being one of the most common presenting issues. The current study used a diathesis-stress model to investigate stressors [parent distress and negative life events (NLE)] and vulnerabilities (youth age and intellectual functioning) as predictors of depressive symptoms in youth with ASD. Parents of youth with ASD (N=91; ages 7 to 25 years) completed online questionnaires about demographic variables, distress, NLE, and youth depression. High parent distress and exposure to 3 or more NLE were associated with symptoms of depression in individuals with ASD. Also, youth with ASD who were younger, or who were noted to have average or above intellectual functioning, were reported to have higher depression levels than other individuals with ASD. None of the vulnerabilities were found to moderate the relationships between stressors and depression.
Open Access
Perceptions of seniors with heart failure regarding autonomous zero-effort monitoring of physiological parameters in the smart-home environment
(Elsevier: Heart and Lung, 17/05/2017) Grace, Sherry L.; Taherzadeh, Golnoush; Sung Jae Chang, Isaac; Boger, Jennifer; Arcelus, Amaya; Mak, Susanna; Chessex, Caroline; Mihailidis, Alex
Background: Technological advances are leading to the ability to autonomously monitor patient’s health status in their own homes, to enable aging-in-place. Objectives: To understand the perceptions of seniors with heart failure (HF) regarding smart-home systems to monitor their physiological parameters. Methods: In this qualitative study, HF outpatients were invited to a smart-home lab, where they completed a sequence of activities, during which the capacity of 5 autonomous sensing modalities was compared to gold standard measures. Afterwards, a semi-structured interview was undertaken. These were transcribed and analyzed using an interpretive-descriptive approach. Results: Five themes emerged from the 26 interviews: (1) perceptions of technology, (2) perceived benefits of autonomous health monitoring, (3) disadvantages of autonomous monitoring, (4) lack of perceived need for continuous health monitoring, and (5) preferences for autonomous monitoring. Conclusions: Patient perception towards autonomous monitoring devices was positive, lending credenceto zero-effort technology as a viable and promising approach.
Open Access
More than meets the eye: visual attention biases in individuals reporting chronic pain
(Dove Medical Press Limited, 19/09/2014) Fashler, Samantha, R.; Katz, Joel
The present study used eye-tracking technology to assess whether individuals who report chronic pain direct more attention to sensory pain-related words than do pain-free individuals. A total of 113 participants (51 with chronic pain, 62 pain-free) were recruited. Participants completed a dot-probe task, viewing neutral and sensory pain-related words while their reaction time and eye movements were recorded. Eye-tracking data were analyzed by mixed-design analysis of variance with group (chronic pain versus pain-free) as the between-subjects factor, and word type (sensory pain versus neutral) as the within-subjects factor. Results showed a significant main effect for word type: all participants attended to pain-related words more than neutral words on several eye-tracking parameters. The group main effect was significant for number of fixations, which was greater in the chronic pain group. Finally, the group by word type interaction effect was significant for average visit duration, number of fixations, and total late-phase duration, all greater for sensory pain versus neutral words in the chronic pain group. As well, participants with chronic pain fixated significantly more frequently on pain words than did pain-free participants. In contrast, none of the effects for reaction time were significant. The results support the hypothesis that individuals with chronic pain display specific attentional biases toward pain-related stimuli and demonstrate the value of eye-tracking technology in measuring differences in visual attention variables.