Abstract
The study investigated whether EMDR is a feasible therapy for adults with ASD and a history of adverse events, and whether it is associated with reductions in symptoms of PTSD, psychological distress and autism. Participants received 6 to 8 weeks treatment as usual (TAU), followed by a maximum of 8 sessions EMDR added to TAU, and a follow-up of 6–8 weeks with TAU only. Results showed a significant reduction of symptoms of post-traumatic stress (IES-R: d = 1.16), psychological distress (BSI: d = 0.93) and autistic features (SRS-A: d = 0.39). Positive results were maintained at follow-up. The results suggest EMDR therapy to be a feasible and potentially effective treatment for individuals with ASD who suffer from the consequences of exposure to distressing events.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, DSM-5, fifth edition. Washington DC: American Psychiatric Association.
Asukai, N., Kato, H., Kawamura, N., Kim, Y., Yamamoto, K., & Kishimoto, J. (2002). Reliability and validity of the Japanese language version of the Impact of Event Scale-Revised (IES-R-J): Four studies of different traumatic events. Journal of Nervous and Mental Disease, 190, 175–182.
Barol, B. I., & Seubert, A. (2010). Stepping stones: EMDR treatment of individuals with intellectual and developmental disabilities and challenging behavior. Journal of EMDR Practice and Research, 4(4), 156–169. https://doi.org/10.1891/1933-3196.4.4.156.
Berg, K. L., Shiu, C. S., Acharya, K., Stolbach, B. C., & Msall, M. E. (2016). Disparities in adversity among children with autism spectrum disorder: A population-based study. Developmental Medicine & Child Neurology, 58(11), 1124–1131. https://doi.org/10.1111/dmcn.13161.
Beurs, E. de, & Zitman, F. G. (2006). De Brief Symptom Inventory (BSI): De betrouwbaarheid en validiteit van een handzaam alternatief voor de SCL-90. Maandblad Geestelijke Volksgezondheid, 61, 120–141.
Bisson, J., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD003388.
Bölte, S. (2012). The social responsiveness scale for adults: Initial results of a German cohort. Journal of Autism and Developmental Disorders, 42(9), 1998–1999.
Brenner, J., Pan, Z., Mazefsky, C., & Smith, K. A. (2017). Behavioral symptoms of reported abuse in children and adolescents with autism spectrum disorder in inpatient settings. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-017-3183-4.
Bruin, E. I. de, Ferdinand, R. F., Meester, S., De Nijs, P. F. A., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 7(37), 877–886.
Classen, C. C., Palesh, O. G., & Aggarwal, R. (2005). Sexual revictimization. A review of the empirical literature. Sage, 6(2), 103–129. https://doi.org/10.1177/1524838005275087.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.
Copeland, W. E., Keeler, G., Angold, A., & Costello, J. (2007). Traumatic events and post-traumatic stress. Arch Gen Psychiatry, 64(5), 577–584. https://doi.org/10.1001/archpsyc.64.5.577.
Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the impact of event scale-revised. Behavior Research and Therapy, 41, 1489–1496.
Culatta, E., Clay-Warner, J., Boyle, K. M., & Oshri, A. (2017). Sexual revictimization: A routine activity theory explanation. Journal of interpersonal violence. https://doi.org/10.1177/0886260517704962.
Cvetek, R. (2008). EMDR treatment of distressful experiences that fail to meet the criteria for PTSD. Journal of EMDR Practice and Research, 2, 2–14.
De Jaegher, H. (2013). Embodiment and sense-making in autism. Frontiers in Integrative Neuroscience. https://doi.org/10.3389/fnint.2013.00015.
De Jongh, A., Ernst, R., Marques, L., & Hornsveld, H. (2013). The impact of eye movements and tones on disturbing memories involving PTSD and other mental disorders. Journal of Behavior Therapy and Experimental Psychiatry, 44, 477–483.
De Jongh, A., Resick, P. A., Zoellner, L. A., van Minnen, A., Lee, C. W., Monson, C. M., Foa, E. B., Wheeler, K., Ten Broeke, E., Feeny, N., Rauch, S. A. M, Chard, K., Mueser, K. T., Sloan, D. M., van der Gaag, M., Rothbaum, B. O., Neuner, F., De Roos, C., Hehenkamp, L.M.J., Rosner, R., Bicanic, I.A.E. (2016). A critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33, 59–369. https://doi.org/10.1002/da.22469.
De Roos, C., Beer, R., De Jongh, A., & Ten Broeke, E. (2014). EMDR-protocol voor kinderen tot 18 jaar. In E. Ten Broeke, De A. Jongh & H. J. Oppenheim (third version, 2014). Praktijkboek EMDR: Casusconceptualisatie en specifieke patiëntengroepen [bijlage V]. Amsterdam: Harcourt.
DePrince, A. P. (2005). Social cognition and revictimization risk. Journal of Trauma & Dissociation, 6(1), 125–141. https://doi.org/10.1300/J229v06n01_08.
Derogatis, L. R. (1975a). Reliability and validity of the brief symptom inventory. In L. R. Derogatis (Ed.), The brief symptom inventory. Baltimore: Clinical Psychometric Research.
Engelhard, I. M., Hout, M. A., & van den Smeets, M. A. M. (2011). Taxing working memory reduces vividness and emotional intensity of images about the Queen’s Day tragedy. Journal of Behavior Therapy and Experimental Psychiatry, 42(1), 32–37.
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.
Frueh, B. C., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A., & Wells, C. (2006). Clinicians’ perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness. Psychiatric Services, 57(7), 1027–1031.
Grubaugh, A. L., Cusack, K. J., & Zinzow, H. M. (2008). Trumping Rules affect diagnoses of persons with severe mental illness. Psychiatric Services, 59(10), 1219–1220.
Hall-Lande, J., Hewitt, A., Mishra, S., Piescher, K., & LaLiberte, T. (2015). Involvement of children with autism spectrum disorder (ASD) in the child protection system. Focus on Autism and Other Developmental Disabilities, 30, 237–248.
Hofvander, B., Delorme, R., Chaste, P., Nyden, A., Wentz, E., … Leboyer, M. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, http://www.biomedcentral.com/1471-244X/9/35.
Kan, C. C., Geurts, H. M., van den Bosch, K., Forceville, E. J. M., van Manen, J., Schuurman, C. H., … van Duin, D. (2013). Multidisciplinaire richtlijn diagnostiek en behandeling van autismespectrumstoornissen bij volwassenen. Utrecht: De Tijdstroom.
Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3475–3486. https://doi.org/10.1007/s10803-015-2392-y.
Kerns, C. M., Newschaffer, C. J., Berkowitz, S. J., & Lee, B. K. (2017). Examining the association of autism and adverse childhood experiences in the national survey of children’s health: The important role events of income and co-occurring mental health conditions. Journal of Autism and Developmental Disorders, 47, 2275–2281. https://doi.org/10.1007/s10803-015-2392-y.
King, R. (2010). Complex post-traumatic stress disorder: Implications for individuals with autism spectrum disorders—Part I. Journal on Developmental Disabilities, 16(3), 91–100.
Kosatka, D., & Ona, C. (2014). Eye Movement desensitization and reprocessing in a patient with asperger’s disorder: Case report. Journal of EMDR Practice and Research, 8(1), 13–18.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
Lugnegård, T. U., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of asperger syndrome. Research in Developmental Disabilities, 32, 1910–1917.
Maïano, C., Normand, C. L., Salvas, M. C., Moullec, G., & Aimé, A. (2016). Prevalence of school bullying among youth with autism spectrum disorders: A systematic review and meta-analysis. Autism Research, 9, 601–615.
Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. A. (2005). The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse and Neglect, 29, 1359–1372.
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 527, 679–688.
Methar, M., & Mukaddes, N. M. (2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 539–546.
Mevissen, L. (2008). Eye movement desensitization and reprocessing (EMDR) behandeling bij mensen met een autismespectrumstoornis en stressklachten gerelateerd aan ingrijpende gebeurtenissen. Wetenschappelijk Tijdschrift Autisme, 3, 123–132.
Mevissen, L., Didden, R., & De Jongh, A. (2018). DITS-LVB Handleiding. Diagnostisch Interview Trauma en Stressoren—Licht Verstandelijke Beperking [DITS-MID Manual. Diagnostic Interview Trauma and Stressors—Mild Intellectual Disability]. Accare Child Study Center.
Mevissen, L., Didden, R., Korzilius, H., & De Jongh, A. (2016). Assessing posttraumatic stress disorder in children with mild to borderline intellectual disabilities. European Journal of Psychotraumatology, 7, 29786. https://doi.org/10.3402/ejpt.v7.29786.
Mevissen, L., Didden, R., Korzilius, H., & De Jongh, A. (2017). Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability: A multiple baseline across subjects study. Journal of Applied Research in Intellectual Disabilities. https://doi.org/10.1111/jar.12335.
Mevissen, L., Lievegoed, R., & de Jongh, A. (2011). EMDR treatment in people with mild ID and PTSD: 4 cases. Psychiatric Quarterly, 82, 43–57.
Mevissen, L., Lievegoed, R., Seubert, A., & De Jongh, A. (2012). PTSD treatment in people with severe intellectual disabilities: A case series. Developmental Neurorehabilitation, 15(3), 223–232.
Najavits, L. M. (2015). The problem of dropout from “gold standard” PTSD therapies. F1000Prime Reports. https://doi.org/10.12703/P7-43.
Nielsen, M. B., Tangenc, T., Idsoe, T., Matthiesen, S., & Magerøy, N. (2015). Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and meta-analysis. Aggression and Violent Behavior, 21, 17–24.
Noens, I., De la Marche, W., & Scholte, E. (2012). SRS-A Screeningslijst voor autismespectrum stoornissen bij volwassenen. Amsterdam: Hogrefe Uitgevers BV.
Olde, E., Kleber, R. J., van der Hart, O., & Pop, V. J. M. (2006). Childbirth and posttraumatic stress responses: A validation study of the Dutch Impact of Event Scale—revised. European Journal of Psychological Assessment, 22, 259–267.
Plana, I., Lavoie, M. A., Battaglia, M., & Achim, A. M. (2014). A meta-analysis and scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders. Journal of Anxiety Disorders, 28, 169–177.
Rigle, B. (2017). The relationship between adverse childhood events, resiliency and health among children with autism. Journal of Autism and Developmental Disorders, 47, 187–202. https://doi.org/10.1007/s10803-016-2905-3.
Roberts, L. A., Koenen, K. C., Lyall, K., Robinson, E. B., & Weisskopf, M. G. (2015). Association of autistic traits in adulthood with childhood abuse, interpersonal victimization and posttraumatic stress. Child Abuse & Neglect, 45, 135–142.
Roekel, G. H. van., Scholte, R. H. J., & Didden, H. C. M. (2010). Bullying among adolescents with autism spectrum disorders: Prevalence and perception. Journal of Autism and Developmental Disorders, 40, 63–73. https://doi.org/10.1007/s10803-009-0832-2.
Shapiro, F. (2007). EMDR, adaptive information processing and case conceptualization. Journal of EMDR Practice and Research, 1, 68–87.
Sourander, A., Gyllenberg, D., Brunstein Klomek, A., Sillanmäki, L., Ilola, A., & Kumpulainen, K. (2016). Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age. JAMA Psychiatry, 73(2), 159–165. https://doi.org/10.1001/jamapsychiatry.2015.2419.
Spinazzola, J., Blaustein, M., & Van der Kolk, B. A. (2005). Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples? Journal of Traumatic Stress, 18(5), 425–436.
Swift, J. K., & Greenberg, R. P. (2014). A treatment by disorder meta-analysis of dropout from psychotherapy. Journal of Psychotherapy Integration, 24(3), 193–207. https://doi.org/10.1037/a0037512.
Taylor, J. L., & Gotham, K. O. (2016). Cumulative life events, traumatic experiences, and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. Journal of Developmental Disorders, 8, 28. https://doi.org/10.1186/s11689-016-9160-y.
Van den Berg, L. J. M., Tollenaar, M. S., Spinhoven, P., Penninx, B. W. J. H., & Elzinga, B. M. (2017). A new perspective on PTSD symptoms after traumatic versus stressful life events and the role of gender. European Journal of Psychotraumatology. https://doi.org/10.1080/20008198.2017.1380470.
Weiss, D. S., & Marma, C. R. (1997). The impact of Event Scale—revised. In J. P. Wilson, J.P. & T. M. Keane (Eds.), Assessing psychological trauma and PTSD: A handbook for practitioners (pp. 399–411). New York: The Guilford Press.
Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology. Science and Practice, 17(4), 281–292.
World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. Geneva: WHO. Retrieved from http://www.who.int/mental_health/emergencies/stress_guidelines/en/.
Acknowledgments
We would like to acknowledge the contributions by the therapists in this study: Titia Arwerth, Barbara Kemps, Erik Kuiper, Noortje van Vliet, Jedidja Weegenaar (Dimence Institute of Mental Health); Nienke Boonstra (Altrecht Institute of Mental Health); Petra Spuijbroek (Riverduinen Institute of Mental Health); Uschi Koster; Erica Pijpers (both private practices in specialized mental health). We thank Arjan van Wijk (Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam) for his statistical analysis advice.
Author Contributions
Ella Lobregt-van Buuren conceived of the study, coordinated the study, performed the measurements and the statistical analysis, interpreted the data and drafted the manuscript; Bram Sizoo participated in the design, statistical analysis, interpretation of the data and helped to draft the manuscript; Liesbeth Mevissen participated in the design, trained and supervised the EMDR-therapists and helped to draft the manuscript; Ad de Jongh participated in the design, interpreted the data and helped to draft the manuscript. All authors read and approved the final manuscript.
Funding
The science committee of the Vereniging EMDR Nederland (VEN) and the Dokter Wittenbergstichting supported this study for €6000.
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Ad de Jongh receives income from published books on EMDR therapy and for the training of postdoctoral professionals in this method. The other authors declare that they have no conflict of interest.
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All procedures performed were in accordance with the ethical standards of the institutional research committee.
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Informed consent was obtained from all individual participants included in the study.
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Lobregt-van Buuren, E., Sizoo, B., Mevissen, L. et al. Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a Feasible and Potential Effective Treatment for Adults with Autism Spectrum Disorder (ASD) and a History of Adverse Events. J Autism Dev Disord 49, 151–164 (2019). https://doi.org/10.1007/s10803-018-3687-6
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DOI: https://doi.org/10.1007/s10803-018-3687-6