Conceptual Model

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Shochet, Ian M., Saggers, Beth R., Carrington, Suzanne B., Orr, Jayne A.,Wurfl, Astrid M., Duncan, Bonnie, & Smith, Coral L..(2016)The Cooperative Research Centre for Living with Autism (Autism CRC)conceptual model to promote mental health for adolescents with ASD.Clinical Child and Family Psychology Review, 19(2), pp. 94-116.

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https://doi.org/10.1007/s10567-016-0203-4

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Title

The Cooperative Research Centre for Living with Autism (Autism CRC) Conceptual Model to Promote Mental Health for Adolescents with ASD

Authors

▪ Professor Ian M. Shochet 1 2, 1 Queensland University of Technology, School of Psychology and Counselling, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Dr Beth R. Saggers 1 2, 1 Queensland University of Technology, School of Cultural and Professional Learning, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Professor Suzanne B. Carrington 1 2, 1 Queensland University of Technology, School of Cultural and Professional Learning, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Dr Jayne A. Orr 1 2, 1 Queensland University of Technology, School of Psychology and Counselling, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Ms Astrid M. Wurfl 1 2, 1 Queensland University of Technology, School of Psychology and Counselling, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Ms Bonnie M. Duncan 1 2, 1 Queensland University of Technology, School of Psychology and Counselling, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

▪ Ms Coral L. Smith 1 2, 1 Queensland University of Technology, School of Psychology and Counselling, 2Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.

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Address for all authors

Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia

Corresponding author

Dr Jayne A. Orr School of Psychology and Counselling Queensland University of Technology Victoria Park Road Kelvin Grove QLD 4059 Australia

Telephone: +61 7 3138 4921 Fax: +61 7 3138 0322

Email: jayne.orr@qut.edu.au

Acknowledgments

This research is supported by the Cooperative Research Centre for Living with Autism (Autism CRC under Project No. 2.029, awarded to Professor Ian Shochet and Dr Beth Saggers. The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Program.

Compliance with Ethical standards

All procedures performed in studies involving human participants will be in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

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Abstract

Despite an increased risk of mental health problems in adolescents with Autism Spectrum Disorder (ASD), there is limited research on effective prevention approaches for this population. Funded by the Cooperative Research Centre for Living with Autism, a theoretically and empirically supported school-based preventative model has been developed to alter the negative trajectory and promote wellbeing and positive mental health in adolescents with ASD. This conceptual paper provides the rationale, theoretical, empirical and methodological framework of a multilayered intervention targeting the school, parents, and adolescents on the spectrum. Two important interrelated protective factors have been identified in community adolescent samples, namely the sense of belonging (connectedness) to school, and the capacity for self and affect regulation in the face of stress (i.e., resilience). We describe how a confluence of theories from social psychology, developmental psychology and family systems theory, along with empirical evidence (including emerging neurobiological evidence) supports the interrelationships between these protective factors and many indices of wellbeing. However, the characteristics of ASD (including social and communication difficulties, and frequently difficulties with changes and transitions, and diminished optimism and self-esteem) impair access to these vital protective factors. The paper describes how evidenced-based interventions at the school level for promoting inclusive schools (using the Index for Inclusion), and interventions for adolescents and parents to promote resilience and belonging (using the Resourceful Adolescent Program (RAP)), are adapted and integrated for adolescents with ASD. This multisite proof of concept study will confirm whether this multilevel school-based intervention is promising, feasible and sustainable.

The Cooperative Research Centre for Living with Autism (Autism CRC) Conceptual Model to

Promote Mental Health for Adolescents with ASD

Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) as occurring across a spectrum of severity of pervasive deficits that appear in early childhood and endure across the lifespan, with individuals varying greatly in terms of symptom expression and level of functioning. Core symptoms include persistent impairments in social communication (e.g., limited verbal and nonverbal communication, poor eye contact, difficulty understanding others’ body language), persistent deficits in reciprocal social interaction (e.g., difficulties in developing and maintaining relationships), and at least two patterns of restricted, repetitive behaviour (e.g., unusual repetitive speech, unusual object use, ritualised behaviour, excessive rigidity, fixated interests, heightened or diminished reactivity to sensory input). Other common symptoms include intellectual impairment, language impairment (e.g., delayed language production and/or comprehension), motor deficits (e.g., unusual gait or clumsiness), self-injurious behaviour (e.g., head banging), neuro-cognitive or social-cognitive impairments (e.g., limited theory of mind skills, abstraction and generalization difficulties, executive function deficits), challenging behaviours, disturbed sleep, and comorbidities with psychiatric disorders such as depression and anxiety.

The number of children diagnosed with ASD is increasing, most likely due to broadened diagnostic criteria, enhanced awareness of the disorder, and improved services and education policies (Fombonne, 2005; Williams, Macdermott, Ridley, Glasson, & Wray, 2008). Prevalence of ASD in 8 year old children in the USA was estimated in 2010 as 1:68 (Centres for Disease Control and Prevention [CDC], 2014), while prevalence in 5 to 9 year old children in Australia was estimated in 2012 as 1:100 (Australian Bureau of Statistics, 2012). Furthermore, the rise in prevalence is greater in individuals without intellectual disability (CDC, 2014).

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As there is no known cure for ASD, treatment-as-usual aims to facilitate skill acquisition, and improve learning, functional skills and quality of life (Anagnostou et al., 2014). Although significant improvements in verbal intelligence and language communication skills have been realised with intensive applied behaviour analysis (ABA) treatment (based on operant conditioning principles) in preschool-aged children (Reichow, 2012), treatment for children entering adolescence (referred to as young adolescents from hereon) tends to address comorbidities rather than core ASD symptoms (Anagnostou et al., 2014). Despite recommendations that interventions targeting mental wellbeing in adolescents with ASD should aim to enhance adaptive functioning across home, school and social settings (Francis, 2005), treatment of many young adolescents with ASD consists primarily of psychotropic medication prescribed to reduce ASD symptoms (Ching & Pringsheim, 2012; Jesner, Aref-Adib, & Coren, 2007; Malow et al., 2012). Atypical antipsychotics (Risperidone and Aripiprazole) have been found to decrease irritability, impulsive aggression, and repetitive behaviours (Aman et al., 2015; Owen et al., 2009), a noradrenergic reuptake inhibitor (Atomoxetine) has shown small effects for diminishing hyperactivity and increasing attention (Harfterkamp et al., 2012), and Melatonin has been found to improve sleep initiation and duration (Rossignol & Frye, 2011). Evidence-based psychosocial treatment programs for young adolescents with ASD frequently take the form of social skills training (often offered in group format) to target improved social functioning (e.g., Reichow & Volkmar, 2011; Wang & Spillane, 2009), and behaviour therapy and cognitivebehavioural therapy (CBT) to reduce symptoms from psychiatric comorbidities (e.g., Ho, Stephenson, & Carter, 2013; Kreslins, Robertson, & Melville, 2015; Scarpa, White, & Attwood, 2013).

Concerning prognosis, untreated ASD rarely resolves (Matson & Horovitz, 2010; Matson, Mahan, Hess, Fodstad, & Neal, 2010; Moss, Magiati, Charman, & Howlin, 2008). The majority of children diagnosed with ASD experience substantial social and adaptive functioning difficulties in adolescence and adulthood (APA, 2013; Joshi et al., 2010). As the prevalence of ASD is increasing, and at a greater rate in individuals without intellectual disability (CDC, 2014), and deficits of ASD endure across the lifespan and are complicated by psychosocial difficulties that emerge in adolescence (APA, 2013), there is an increasing need for interventions that promote mental health and adaptive functioning in young adolescents with ASD (Francis, 2005).

Drawing on the best available research and theory, this review describes a conceptual model for a multilevel, school-based, positive mental health approach to promote optimal functionality. We identify the specific biopsychosocial challenges for young adolescents, the protective factors that are most likely to provide the best leverage for change, and propose a model of intervention. While the focus of the review is largely on the promotion of mental health (and particularly on the importance of depression), the selected protective factors and proposed interventions also address functionality and wellbeing. We note that the two-continua model of mental health proposes that mental wellbeing and mental ill-health are separate but related factors, rather than opposite ends of the mental illness spectrum, such that individuals with a mental disorder are able to experience some level of subjective wellbeing (Keyes, 2005a). In this regard we also recognise that there is a growing body of research that focuses on quality of life for adolescents with ASD (e.g., Lee, Harrington, Louie, & Newschaffer, 2008; Sheldrick, Neger, Shipman, & Perrin, 2012; Tavernor, Barron, Rodgers, & McConachie, 2013; van Heijst & Geurts, 2015). While these issues are addressed in the presentation of the conceptual model, a comprehensive review of the quality of life literature is beyond the scope of this study.

Psychosocial Challenges of Early Adolescence

Young adolescents are typically required to navigate increasingly complex peer relationships while dealing with the transition to secondary school that often involves larger schools, bigger classes,

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multiple educators and increasing academic demands (Benner, 2011). Further, their vulnerability to significant decreases in self-esteem at this developmental stage may diminish their capacity to cope with such challenges (Wigfield, Eccles, MacIver, Reuman, & Midgley, 1991).

The risk of internalising psychopathology increases in adolescence: depression and anxiety are two of the most common mental health disorders experienced by children and adolescents (Farrell & Barrett, 2007), with both clinical and subclinical presentations in youth associated with heightened risk of recurrent episodes in adulthood (Copeland, Shanhan, Costello, & Angold, 2009). However, while anxiety disorders tend to emerge in childhood around 6 years of age, the incidence of depression increases significantly after early adolescence (Lewinsohn , Rohde, Seely, Klein, & Gotlib, 2000), with a recent national estimate finding a median age of onset of 13 years, and 14.3% of adolescents meeting diagnostic criteria for a depressive disorder (Merikangas et al., 2010). Depressive symptoms in early adolescence can reduce the quality and quantity of relationships in familial, educational and wider social settings; heighten the risk of social withdrawal and the display of antisocial behaviour towards others; erode capacity for coping; decrease levels of self-care and adaptive functioning; and increase levels of self-injury and the risk of suicidal ideation (Ghaziuddin, Ghaziuddin, & Greden, 2002; Matson & Nebel-Schwalm, 2007; Stewart, Barnard, Pearson, Hasan, & O’Brien, 2006; White & Roberson-Nay, 2009). To maximise treatment efficacy, prevention programs intervene in the developmental period immediately preceding the age of peak incidence; hence many anxiety prevention programs target children, while depression prevention programs focus on early adolescence (see Gladstone, Beardslee, & O’Connor, 2011 for review).

Additional Psychosocial Challenges Experienced by Young Adolescents with ASD

Young adolescents with ASD tend to experience the developmental challenges associated with the transition to adolescence as more challenging than do their neurotypical peers, and are consequently even more at risk of developing comorbid depression (Brereton, Tonge, & Einfeld, 2006; Mayes, Calhoun, Murray, & Zahid, 2011; McPheeters, Davis, Navarre, & Scott, 2011). The social and emotional difficulties experienced by young adolescents with ASD can lead to heightened stress and conflict in the family system (Ghaziuddin et al., 2002). This stress and conflict can have a detrimental effect on parental mental health (Zablotsky, Boswell, & Smith, 2012) and the adolescent’s wider support network (Ghaziuddin et al., 2002; Matson & Nebel-Schwalm, 2007). In addition, depression in young adolescents with ASD often persists into adulthood (Sterling, Dawson, Estes, & Greenson, 2008) which, in combination with the young adult’s ASD deficits, continues to impact negatively at the individual and family level (e.g., Eaves & Ho, 2008; Marriage, Wolverton, & Marriage, 2009).

The increased vulnerability for developing depression in young adolescents with ASD can be understood by considering recent neurobiological findings in conjunction with the expression of the social interaction and affect regulation difficulties that young adolescents with ASD experience. An analysis of 586 cross-sectional and longitudinal MRI brain scans in ASD and neurotypical individuals aged 12 months to 50 years found increased neuron loss and reduced volume in brain regions responsible for social, communication and emotion abilities in adolescents with ASD compared to neurotypical adolescents (Courchesne, Campbell, & Solso, 2011). Furthermore, instead of improving (as occurs in neurotypical adolescents), executive functions which underlie the metacognitive abilities required for adaptive social functioning decline in young adolescents with ASD (Rosenthal et al., 2013). In their two-hit model of autism, Picci and Scherf (2014) propose that neural reorganisation, pubertal hormones, and increasing social demands of adolescence inflict a second insult on the already compromised and vulnerable social neural system of the young adolescent

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with ASD which perpetuates difficulties with social interaction and diminishes motivation to develop and maintain peer friendships.

The social interaction difficulties experienced by young adolescents with ASD, combined with the increasing social demands of early adolescence, increase their likelihood of disengaging from others which impedes the development and maintenance of relationships with peers and teachers. This in turn leads to withdrawal and social isolation, and removes opportunities for developing social skills through exposure to peer modelling and practise, thereby further diminishing social skills and leading to loneliness (Bauminger, Shulman, & Agam, 2003; Downs & Smith, 2004; Humphrey & Symes, 2010; White, Oswald, Ollendick, & Scahill, 2009; White & Roberson-Nay, 2009). Further, difficulties with social interaction, along with the expression of the core ASD symptamology (e.g., repetitive and restricted behaviours and thoughts, lack of assertiveness, heightened behavioural reactions, rigidity, hypersensitivity) increase the likelihood of peer rejection, with close to 50% of young adolescents with ASD falling victim to bullying (e.g., Cappadocia, Weiss, & Pepler, 2012; Sterzing, Shattuck, Narendorf, Wagner, & Cooper, 2012). The damaging effects of bullying are often intensified in young adolescents with ASD due to their social isolation which precludes support from peers, and their difficulties with communication and self-expression that reduce the likelihood that they will seek help from an adult (Humphrey & Symes, 2010).

The majority of young adolescents with ASD struggle with affect regulation (Samson, Huber, & Gross, 2012). Affect regulation is an important aspect of adolescents’ emotional and social development and is facilitated by the adoption of coping strategies such as problem solving and cognitive reappraisal that help the young person to manage negative mood and anxiety, and to cope in frustrating or stressful personal and social situations (e.g., McRae et al., 2012; Silvers et al., 2012).

Recruiting these coping strategies requires perspective taking abilities, executive functioning, and cognitive linguistic abilities (e.g., Jahromi, Bryce, & Swanson, 2013; Losh & Capps, 2006; Samson et al., 2012). However, young adolescents with ASD typically have deficits in theory of mind that hamper their perspective taking (Samson et al., 2012), deficits in executive functions that diminish the ability to supress ruminative thoughts and to switch between unhelpful and more helpful cognitive strategies (Hofmann, Schmeichel, & Baddeley, 2012; Jahromi et al., 2013), and deficits in cognitive linguistic processes (e.g., Losh & Capps, 2006). Hence, they rely more heavily on maladaptive emotion regulation strategies such as avoidance and venting (Jahromi, Meek, & Ober-Reynolds, 2012), defense and crying (Konstantareas & Stewart, 2006), averted eye contact (Dalton et al., 2005), and suppression (Samson, Hardan, Podell, Phillips, & Gross, 2015).

These difficulties present unique challenges for schools, teachers and educational outcomes.Students with ASD are four times more likely than their neurotypical peers to require learning and social support services (Mandell, Walrath, Manteuffel, Sgro, & Pinto-Martin, 2005), which coupled with their social and emotional difficulties, can limit their social, emotional and educational trajectory (Humphrey & Lewis, 2008). In a recent study, teachers rated students with ASD as exhibiting significantly higher levels of oppositional and aggressive behaviour, attention difficulties, and symptoms of depression and anxiety than their neurotypical peers; and also rated 54% as underachieving academically compared to 8% of their typically developing peers (Ashburner, Ziviani, & Rodger, 2010). Therefore, teachers experience students with ASD in mainstream classes as struggling to maintain their attention and regulate their emotions and behaviour, and as underperforming relative to their level of ability, despite receiving a range of specialist support services in the classroom.

Importantly, the difficulties with connectedness and affect regulation that may contribute to

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depression do not translate to less depression for higher functioning adolescents with ASD. In fact, depression appears to be more prevalent in higher functioning than lower functioning adolescents with ASD (54% vs. 42%) (Mayes, Calhoun, Murray, Ahuja, & Smith, 2011). Compared to lower functioning adolescents with ASD, higher functioning adolescents tend to be more interested in social interaction (Ozonoff, Dawson, & McPartland, 2002), and also have greater insight into their core ASD deficits, especially their difficulties with social competency (Mazurek & Kanne, 2010). They are more aware of past unsuccessful attempts to develop social relationships (Gotham, Bishop, Brunswasser & Lord, 2014; Hedley & Young, 2006), and are more likely to experience distress when attempts at social connectedness fail (Sterling et al., 2008) and to perceive their peers as less accepting of them (Williamson, Craig, & Slinger, 2008). Hence, they tend to experience greater loneliness triggered by a lack of (or poor quality) friendships (Bauminger et al., 2003; Whitehouse, Durkin, Jaquet, & Ziatas, 2009). In addition, they are more likely to have a maladaptive attributional style characterised by a tendency to internalise and assume responsibility for negative events (Barnhill & Myles, 2001), and to view themselves as less capable than others (Humphrey & Lewis, 2008; Humphrey & Symes, 2010). These factors combine to diminish optimism, lower self-esteem, and increase the risk of developing depression in higher functioning adolescents with ASD (Barnhill & Myles, 2001; Fung, Lunsky, & Weiss, 2015; Solomon, Miller, Taylor, Hinshaw, & Carter, 2012; Tantum, 2000).

An important life task that emerges during the transition from secondary schooling to adulthood, and that is impacted on by depression, is engaging in tertiary education and/or becoming employed (Taylor & Seltzer, 2011). Depression reduces the likelihood of engaging in and remaining in tertiary education (see Mojtabai et al., 2015 for review), and reduces job-search persistence and the likelihood of becoming employed (Wanberg, Glomb, Song, & Sorenson, 2005) which exacerbates the risk of developing depression, and reduces employment prospects even further (Paul & Moser, 2009).

A longitudinal study that followed high-functioning adults with ASD (N = 72) over 12 years found that, although the majority had engaged in tertiary education and/or employment during this period, only 25% were able to remain in education or employment over time (Taylor, Henninger, & Mailick, 2015). Hence, preventing depression in young adolescents with ASD will most likely have farreaching consequences that buffer the individual against the significant challenges of young adulthood.

Preventing Depression in Young Adolescents

Many programs targeting depression in neurotypical adolescents have been developed and trialled with some success at both the prevention and treatment level (Clarke et al., 2001; Garber, Webb, & Horowitz, 2009; Landback et al., 2009; Shochet et al., 2001; Stice, Shaw, Bohon, Marti, & Rohde, 2009; Young, Mufson, & Gallop, 2010). Prevention programs can be classified as universal (provided to everyone in a population), selective (provided to at-risk subgroups of the general population), or indicated (provided to those experiencing symptoms of the difficulties targeted by the prevention program) (Mrazek & Haggerty, 1994). Concerning prevention, a number of programs designed to promote resilience, such as the Penn Resilience Program (PRP; Gillham, Brunwasser, & Freres, 2008) and the Resourceful Adolescent Program (RAP; Shochet, Holland, & Whitefield, 1997a) have been implemented on a universal or indicated basis. A series of meta-analyses suggest that these programs tend to show greater efficacy when targetting adolescents at risk (e.g., Merry et al. 2011; Stice et al., 2009).

Notwithstanding the increased risk of mental health problems in adolescents with ASD, there is limited research on effective depression prevention or early intervention approaches tailored for this population (Ghaziuddin et al., 2002; Stewart et al., 2006). In children, a small study trialled an

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enhanced curriculum that focused on building skills in emotion recognition, executive functioning, communication, and problem solving in boys with ASD aged 8 to 12 years, and found that participants had improved emotion awareness and some non-significant changes in reported levels of depression (Solomon, Goodlin-Jones, & Anders, 2004). Two recent studies have trialled CBT for depression in older adolescents: a non-randomised, small (N = 26), group-based CBT program with individuals with ASD aged 15 – 25 years achieved a reduction in self-reported depressed mood, negative thoughts, and stress relative to waitlist control (McGillivray & Evert, 2014); and a small pilot RCT that compared a depression treatment program with treatment as usual in 20 adolescents with ASD (Mage = 15.75 years) found a significant reduction in mean pre- and post- depression scores in the intervention group (Santomauro, Sheffield, & Sofronoff, 2015). However, there are no evidenced based interventions for prevention and early intervention of depression for young adolescents with ASD. A strength-focused resilience model aimed at promoting protective factors offers some direction in this regard.

Factors that Protect Against Depression

Diverse definitions of terminology are used in the field of resilience, wellbeing and mental health. We follow the developmental psychopathology definition of resilience as a dynamic process that consists of positive adaptation despite significant adversity (Luthar, Cicchetti, & Becker, 2000), and we recognise that living with a neurodevelopmental disorder such as ASD constitutes significant adversity that requires a resilience process. Research has consistently indicated that resilience is inhibited by risk factors, and is promoted by protective factors (Alvord & Grados, 2005; Benzies & Mychasiuk, 2009; Fergus & Zimmerman, 2005) which are processes that alter the effects of adversity so as to achieve a positive rather than negative outcome (Luthar et al., 2000).

Resilience work with adolescents focuses on strengths rather than deficits in order to understand healthy development despite exposure to risk. A particular focus may be to build upon social skills for enhancing relationships and self-efficacy for health promotion behaviour. Currently there is little research that explores the use of strength-based programs to promote wellbeing and 12 prevent depression in adolescents with ASD by building their resilience. Two important interrelated factors that are vital for wellbeing and positive mental health, and that protect against the development of depression by building resilience, have been identified in community adolescent samples. These protective factors are the sense of belonging, and the capacity for self and affect regulation in the face of stress.

Sense of belonging. A sense of belonging represents the extent of feeling part of one or more social groups (Quinn & Oldmeadow, 2013). The innate psychological drive to belong to social groups (Baumeister & Leary, 1995) and its importance for forming meaningful relationships and secure attachments with others is explored in social psychology, developmental psychology and family systems theory (e.g., Bowlby, 1969; Bronfenbrenner, 1989; Fiske, 2004; Kerr & Bowen, 1988; Reeve, Deci, & Ryan, 2004; Titelman, 2014). Forming social connections is a particularly important task during adolescent development because such connections form the foundation for long-lasting interpersonal bonds (Baumeister & Leary, 1995), enable adolescents to internalise values endorsed by significant others (Reeve et al., 2004), and contribute to the adolescent’s developing sense of identity or self-concept (Schachter & Rich, 2011). A sense of belonging has been found to protect against psychopathology and stress (Baumeister & Leary, 1995), to buffer the effects of depression (Anderman, 2002; Cockshaw & Shochet, 2010; Sargent, Williams, Hagery, Lynch-Sauer, & Hoyle, 2002), and to promote academic success, high self-esteem, positive affect, optimism, life satisfaction, hope and future expectations (e.g., Bonny, Britto, Klostermann, Hornung, & Slap, 2000;

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You et al.,2008).

Conversely, the sense of not belonging (or a thwarted sense of belonging) has been associated with loneliness (Chipuer, 2001; Mellor, Stokes, Firth, Hayash, & Cummins, 2008); anxiety, depression, emotional distress, negative affect, substance use and suicide (e.g., Anderman, 2002; Carter, McGee, Taylor, & Willliams, 2007; Lee & Robbins, 1998; Shochet, Dadds, Ham, & Montague, 2006; Shochet, Homel, Cockshaw, & Montgomery, 2008; Witherspoon, Schotland, Way, & Hughes, 2009). For example, a longitudinal study of Australian adolescents (N = 2678) found that a thwarted sense of belonging in Year 8 was associated with a heightened risk from Year 10 onwards of anxiety and depressive symptoms, substance use, and diminished academic achievement (Bond et al., 2007).

Congruent with the need to belong, Sociometer Theory (Leary & Baumeister, 2000; Leary & Downs, 1995) from social psychology emphasises the importance of perceived relational value and suggests that an innate psychological apparatus, the sociometer, continuously scans the environment for interpersonal signals to inform an aggregate impression of one’s level of social acceptance or rejection (i.e., perceived belongingness). An impression of low relational value is consciously experienced as feelings of social disapproval and rejection which diminish self-esteem and contribute to the development of depressive symptoms, even in the absence of real rejection or actual reduced acceptance (Leary, 2005). Sociometer Theory is backed by neuroimaging research that has found that lower self-esteem increases activity in brain regions associated with processing rejection and acceptance (Eisenberger, Inagaki, Muscatell, Byrne Haltom, & Leary, 2011).

In line with Sociometer Theory, a thwarted sense of belonging has been identified as the immediate antecedent of a depressive response in several interpersonal theories of depression (Coyne, 1976; Joiner & Metalsky, 2001) that are integrated in the social-cognitive interpersonal process model (Sacco & Vaughan, 2006). This model proposes that depression is maintained by reciprocal interpersonal transactions: one’s perception that cues from others are indicative of diminished relational value results in a perception of diminished self-esteem which triggers an increased need for validation, giving rise to behaviours aimed at securing confirmation of an intact relational bond. Such behaviours include excessive reassurance seeking and self-denigration which are experienced as aversive by others and, in turn, elicit criticism, rejection and non-genuine support.

School belonging, in the form of school connectedness, is the extent to which students feel valued and cared for by their school community as a result of their sense of belonging and relatedness to others in their school community (Ciani, Middleton, Summers, & Sheldon, 2010; Osterman, 2000). A link has been found between school connectedness and positive outcomes such as peer support, teacher support, interest in studies and higher academic achievement (Anderman, 2002; Monahan, Oesterle, & Hawkins, 2010). Whitlock (2006) contends that perceptions of school connectedness vary throughout the adolescent years in response to developmental changes and needs. Recent research has found evidence of relationships between school connectedness and mental health, with lower connectedness associated with an increase in depressive symptoms, lower self-esteem, diminished optimism, and greater paranoid tendencies which together hinder approaching others with openness and trust, thereby perpetuating a threat-focused cycle and reducing chances for social connectedness which could lead to social withdrawal and loneliness (e.g., Anderman, 2002; Chapman, Buckley, Sheehan, & Shochet, 2013; Frydenberg, Care, Freeman, & Chan, 2009; Kidger, Araya, Donovan, & Gunnell, 2012; Shochet et al., 2006; Shochet & Smith, 2012).

Importantly, belonging and school connectedness is the strongest single correlate of depression uncovered to date and tends to be the most proximal. Shochet et al. (2006) measured the relationship between school connectedness and general wellbeing, depression and anxiety symptomology in adolescents aged 12 to 14 in a large prospective study (N = 2022) at two points

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of time across 14 schools. The mean concurrent correlation between school connectedness and depressive symptoms was not only high (r = -.67) but was also greater than reported in other belonging and connectedness studies. This strong relationship has been confirmed in a cross-sectional study (r = -.70, N = 153; Shochet et al., 2008), and a longitudinal study that followed Australian students (N = 3459) transitioning to high school over a 2-year period (Lester, Waters, & Cross, 2013). Further, in Shochet et al.’s (2006) prospective study, school connectedness predicted future depressive symptoms for boys and girls, and future anxiety symptoms for girls, at 1-year follow-up even after controlling for prexisting mental health symptomology, while mental health symptoms did not significantly predict future school connectedness. These findings support the theoretical position that belonging is the immediate antecedent of depressive and anxiety symptoms and not vice-versa, and is consistent with the existence of an innate mechanism to monitor relational value posited by Sociometer Theory. School connectedness has been found to predict wellbeing as well. Recent longitudinal research measured wellbeing and connectedness once a year for 3 years in a considerable adolescent sample (N = 1774) and found that high levels of school and family connectedness significantly predicted high levels of wellbeing in subsequent years (Jose, Ryan, & Pryor, 2012).

Capacity for self and affect regulation. Self-regulation is an important component of resilience, and is the process by which the self modifies its inner states in a goal-directed manner to override unhelpful impulses, responses or behaviour with a more helpful, adaptive response (Baumeister, Schmeichel, & Vohs, 2007). Models of adolescent brain development offer an explanation for self-regulation instability found in early adolescence. These models propose that cognitive control is required for self-regulation, and that while cortical regions subserving cognitive control and subcortical regions associated with self-regulation processing mature in a more or less parallel fashion in childhood and late adolescence, maturation of each region proceeds at a different rate in early adolescence, giving rise to heightened impulsivity and risk taking, and difficulties resisting temptation and unhelpful peer influence (e.g., Casey et al., 2010; Dahl, 2001; Steinberg, 2008).

Affect regulation can be conceptualised as a process triggered by self-regulation that monitors and moderates internal feeling states to enhance mental health and wellbeing (Eisenberg, Fabes, Guthrie, & Reiser, 2000; Fledderus, Bohlmeijer, Smit, & Westerhof, 2010). Emotions can be distinguished from affect. Emotions tend to be triggered by specific objects and give rise to behavioural responses related to these objects, while affect (e.g., low mood) tends to be more diffuse and to last longer than emotions (Gross, 2013). Adolescents tend to react more strongly than adults to emotion-eliciting situations (e.g., Stroud et al., 2009), experience negative and mixed emotions more frequently (e.g., Riediger, Schmiedek, Wagner, & Lindenberger, 2009; Riediger, Wrzus, & Wagner, 2014), and experience more lability in their emotional states (e.g., Larson, Moneta, Richards, & Wilson, 2002).

Emotion regulation refers to shaping the experience and expression of emotions and appears to increase adolescents’ ability to cope with developmental challenges, with available evidence linking enhanced emotion regulation skills to greater peer acceptance, reduced risk of experiencing bullying by peers, higher social competence, increased prosocial behaviour, better academic achievement, and fewer internalizing and externalizing problems (e.g., Buckley & Saarni, 2009; McLaughlin, Hatzenbuehler, Mennin, & Nolen-Hoeksema, 2011; Silk et al., 2007; Yap, Allen, & Sheeber, 2007). Further, emotion regulation difficulties have been associated with mental health problems, including depression, anxiety and stress (e.g., Eftekhari, Zoellner, & Vigil, 2009; Moore, Zoellner, & Mollenholt, 2008; Saxena, Dubey, & Pandey, 2011), and limited use of emotion regulation strategies has been found to decrease levels of wellbeing (e.g., Haga, Kraft, & Corby, 2009; Hopp, Troy, & Mauss, 2011; Saxena et al., 2011).

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Interrelated protective factors. The protective factors of connectedness and self and affect regulation have been found to be linked in a reciprocal manner, in that the greater the capacity for self and affect regulation, the greater the experience of connectedness, and vice versa. Self and affect regulation have been found to lead to more adaptive social interactions, and positive social interactions with others have been found to generate a sense of belonging and connectedness (Gross, 2002, 2015; Zhao & Zhao, 2015). Gross (2002, 2015) found that those who used the maladaptive emotion regulation strategy of suppression experienced poorer social support because doing so deprived others of social cues that would otherwise help to trigger reciprocal concern, and also required considerable cognitive effort which diminished attention and response to reciprocal social cues. In contrast, those who used the adaptive emotion regulation strategy of reappraisal experienced greater social support because they were more liked which led to a decrease in negative emotions. Similarly, Zhao and Zhao (2015) found that school connectedness mediated the relationship between emotion regulation and depression amongst 504 secondary school students in China, with adolescents who used suppression feeling less connected and experiencing more depressive symptoms, and those who used reappraisal feeling more connected and experiencing fewer depressive symptoms.

Also, experiencing a sense of belonging and having valuable connections to others may facilitate self and affect regulation (Beckes & Coan, 2011; DeWall et al., 2011; Roberts & Burleson, 2013) which in turn is a protective factor against depression. Roberts and Burleson (2013) explored the roles of social connection and emotion regulation in 316 females and found that stronger social connectedness lead to more effective emotion regulation and fewer self-reported depressive symptoms. Attachment Theory (Bowlby & Ainsworth, 1992) can be conceptualised as a connectedness and self and affect regulation theory. According to Attachment Theory, infants may be securely attached to a primary caregiver who shows consistent and responsive care, or insecurely attached when subjected to inconsistent and ambiguous care, with childhood attachment styles thought to be emulated in future relationships throughout the lifespan. Attachment Theory posits that attachment behaviours enable children to regulate affect and relieve distress. Securely attached individuals develop a positive belief of self-worth and a belief that others are able to help alleviate distress which allows for the development of functional emotion regulatory strategies, while insecurely attached individuals develop negative beliefs and often recruit the maladaptive emotion regulation strategies of worry and rumination when experiencing distressing attachment cues (Malik, Wells, & Wittkowski, 2015).

The findings of belonging and connectedness interacting with self and affect regulation are strengthened by neuroscience research. Studies have found that affiliative relationships operate via oxytocin-endorphin systems and are physiologically soothing, which reduces threat sensitivities and emotion reactivity (Carter, 1998; Cozolino, 2007; Depue & Morrone-Strupinsky, 2005; Panksepp, 1998).

Therefore, there is a need to build the two protective factors of school connectedness and self and affect regulation in young adolescents to protect against the development of depression. Improving young adolescents’ self and affect regulation increases their ability to negotiate difficult interpersonal situations, thereby contributing to improved interpersonal relations (Finkel & Fitzsimons, 2011; Shochet & Ham, 2003; Vohs & Finkel, 2006). Also, improved self and affect regulation augments the capacity for school connectedness by enriching peer relationships (Buckley & Saarni, 2009), and increasing perceptions of school support (Anderman, 2002).

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Conceptual Model for Promoting Mental Health of Adolescents with ASD in Schools

In line with the two-continua model of mental health (Keyes, 2005a) it should be possible to promote flourishing wellbeing and mental health in young adolescents who live with the developmental challenge of ASD by focusing on connectedness and affect regulation. Recall that the core symptoms of ASD (which include impairments in social communication, deficits in reciprocal social interaction, and patterns of restricted, repetitive behaviour) (APA, 2013), along with affect regulation difficulties (Dalton et al., 2005; Jahromi et al., 2012; Konstantareas & Stewart, 2006; Samson et al., 2015), and frequently difficulties with transitions, diminished optimism, and lower self-esteem (Barnhill & Myles, 2001; Solomon et al., 2012) impair access to the vital protective factors of school connectedness and the capacity for self and affect regulation in the face of stress (Downs & Smith, 2004; Humphrey & Symes, 2010; White & Roberson-Nay, 2009).

The schooling system offers an influential support network for young adolescents (Stewart, 2008; Stewart, Sun, Patterson, Lemerle, & Hardie, 2004). School-based preventative intervention programs, which are available as a component of the curriculum, are accessible, affordable, sustainable, and have been supported empirically (Corrieri et al., 2014). Educational policies and procedures also make the school a suitable location for interventions. Inclusive education policies in Australia require support for students with ASD in mainstream classes and include a whole school approach to support students’ curriculum needs, as well as their social and emotional needs (Humphrey & Symes, 2010; Ministerial Council on Education, Employment, Training and Youth Affairs, 2008). A range of studies has highlighted that having a sense of belonging for students with ASD has a positive impact on their school experiences, and ultimately on their success in the school environment (Humphrey, 2008; O’Rourke & Houghton, 2008; Osborne & Reed, 2011; Sciutto, Richwine, Mentrikoski, & Niedzwiecki, 2012). Thus, interventions at the school level aimed at promoting school connectedness and affect regulation are consistent with both educational needs and mental health outcomes, and should be supported and encouraged within the school context.

Although there is limited research, it would seem that support in the form of effective schoolbased interventions should operate at multiple ecological levels to support young adolescents with ASD, as well as their parents/caregivers (referred to as parents from hereon), teachers and the school system (Howlin, 2000). An established, strength-focused, evidence-based program that is devised to increase capacity for relationships and to promote self and affect regulation in young adolescents is the Resourceful Adolescent Program (RAP; Shochet, Holland, & Whitefield, 1997a). RAP consists of three interventions that are delivered in a group format: the Resourceful Adolescent Program for Adolescents (RAP–A), the Resourceful Adolescent Program for Parents (RAP–P), and the Resourceful Adolescent Program for Teachers (RAP–T). In addition, RAP–T can be augmented with the Index for Inclusion (Booth & Ainscow, 2002), a process that operates at the school systems level to support the development of a school culture, policy and practice that promotes school connectedness.

A theoretically and empirically supported school-based preventative model has been developed to alter the negative trajectory and to promote wellbeing and positive mental health in young adolescents with ASD. The School Connectedness Conceptual Model (see Figure 1) operates within a holistic, collaborative framework for intervening at multiple levels by addressing the reciprocally related protective factors of affect regulation and school connectedness to improve the wellbeing of adolescents with ASD. In service of this, adaptations of the three RAP interventions have been made specifically to promote protective factors for young adolescents with ASD.

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Figure 1. The conceptual school-based model for promoting mental health and wellbeing in young adolescents with ASD.

At the adolescent level RAP–A–ASD, the ASD adaptation of the RAP–A intervention, targets underlying intrapsychic and interpersonal skills to improve affect regulation and interpersonal relationships and connectedness. RAP–P–ASD, an adaptation of the RAP–P intervention, aims to enhance connectedness and affect regulation at the family systems level, to increase parent efficacy in managing emotional reactivity from their young adolescents, to promote adolescents’ capacity for affect regulation, and to improve parent-adolescent attachment (which predicts school connectedness). The whole school level intervention utilises the framework and process from the Index for Inclusion (Booth & Ainscow, 2002) along with RAP–T–ASD, an adaptation of RAP–T. The whole school level intervention aims to trigger a shift in school culture, policy and practice; and to assist teachers, support, and administration staff to foster a more inclusive school environment and to promote greater school connectedness and resilience in young adolescents with ASD. It is expected that this holistic approach will harness the reciprocal relationship between belonging and self and affect regulation. Greater connectedness and inclusiveness should produce more equanimity and affective stability, and vice versa. This in turn should impact on both wellbeing and mental health. A detailed description of the background, rationale and content of the interventions at each level follows.

At the adolescent level. RAP–A–ASD (Shochet, Mackay, & Wurfl, 2011), the adapted version of RAP–A (Shochet, Holland, & Whitfield, 1997a, 1997b), has been developed to reduce and prevent depression and improve self efficacy in high-functioning young adolescents with ASD. RAP–A is designed to be delivered in a group format on a weekly basis across 11 weeks (Shochet et al., 2001; Shochet & Ham, 2003; Shochet et al., 1997a, 1997b; Shochet & Osgarby, 1999). RAP–A purposefully avoids using deficit orientated words such as “depression” and “mental illness”, adopting instead a strength-based focus that reinforces existing personal strengths and builds skills for selfregulation,

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understanding social support networks, perspective taking, preventing and managing conflict, and interpersonal relationships to foster mental health and wellbeing (Fergus & Zimmerman, 2005; Shochet & Osgarby, 1999). This emphasis on positive language and skills is relatively unique for a mental health intervention, and aims to empower adolescents who engage in the program (Shochet et al., 2011). Based on the metaphor of the children’s story of the Three Little Pigs, in which only the house made of bricks withstood the attacks of the Big Bad Wolf, each week participants identify “resource bricks” such as “personal strength” bricks and “keeping calm” bricks. Session content and process are described in a Group Leader’s Manual (Shochet et al., 1997a), and each participant receives a Participant Workbook (Shochet et al., 1997b).

RAP–A is based on integral elements of CBT and Interpersonal Psychotherapy (IPT), both of which are supported as effective, evidence-based interventions for treating depression in young people (e.g., Clarke et al., 2001; Merry, McDowell, Wild, Bir, & Cunliffe, 2004; Rivet-Duval, Heroit, & Hunt, 2011). The cognitive-behavioural elements of RAP–A are designed to increase self and affect regulation and include stress management using self-management and self-relaxation strategies; cognitive restructuring; the identification and challenging of negative or distorted thinking and the development of positive self-talk; and problem solving strategies based on defining problems, identifying and evaluating solutions, and implementing the chosen solution step by step. The interpersonal components of RAP–A are drawn from IPT for depression (Mufson, Moreau, Weissman, & Klerman, 1993) and are designed to promote connectedness by encouraging participants to establish and draw on support networks; and to develop skills that reduce interpersonal conflict by applying an understanding of others’ perspectives in maintaining peace, and promoting harmony. RAP–A is designed to be implemented as part of the school curriculum to prevent depression in adolescents aged 12 to 15, is used widely throughout Australia, and has been implemented successfully in schools internationally (Shochet & Ham, 2004).

RAP–A can be delivered in a universal, selected or indicated format, and has proven to be effective and efficacious at a universal level (Merry et al., 2004) and is also purported to be suitable as a selective intervention (Millear, Liossis, Shochet, Biggs, & Donald, 2008; Muris, Bogie, & Hoogsteder, 2001; Shochet et al., 2001). RAP–A has gathered empirical support for its efficacy in reducing symptoms of depression in adolescent samples across a number of randomised controlled trials (RCTs). For example, Shochet et al. (2001) investigated the program’s efficacy in 260 students in Year 9 from Brisbane secondary schools, and noted a significant decrease in hopelessness and depressive symptomology at both post-intervention and at 10-month follow up. Another study of adolescents aged 13 to 15 (N = 392) in New Zealand compared the efficacy of the program delivered by teachers relative to placebo-control, with adolescents in the treatment condition showing significantly greater improvements in depressive symptomology relative to the control group, which was maintained at 18 months post-intervention (Merry et al., 2004). Furthermore, the program has been shown to be useful for all adolescents, not only those specifically at risk for depression, and is aimed to prevent the development of future mental health problems (Merry et al., 2004; Shochet et al., 2001; Shochet & Osgarby, 1999). A recent qualitative analysis of 109 Year 9 students’ beliefs about what they gained from RAP–A revealed that the mechanism of change in the depression prevention intervention might well be improved self and affect regulation (Shochet, Montague, Smith, & Dadds, 2014).

RAP–A–ASD has been designed to be implemented on an individual basis, rather than in groups, while retaining the 11-week structure of RAP–A. The individual treatment format is adopted to reduce the risk of social demands interfering with the ability of the young adolescent with ASD to engage in the program content. Interestingly, a recent meta-analysis of the effectiveness of anxiety interventions in youth with ASD found individual therapy to be more effective than group therapy

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(Kreslins et al., 2015). In addition, RAP–A–ASD incorporates added components to target difficulties that adolescents with ASD typically experience. Examples of such components include a social story to target theory of mind deficits (Gray & White, 2002), and computerised sessions (iRAP) to increase the engagement of adolescents with ASD by using interactive activities and video segments that model behaviours and emotions that children with ASD find difficult to distinguish. An accompanying RAP–A–ASD guidelines manual for facilitators has been developed to increase awareness of ASD characteristics that manifest in adolescents with ASD, including theory of mind deficits, variations in sensory processing, special interests, verbal and non-verbal communication, difficulties with structure and change, and physical environment considerations. The content of each session of RAP–A–ASD is described in Table 1.

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Table 1

RAP-A-ASD Program Content

Session Key message Content 1. Getting to know We’re interested in you! Let’s

work together as a team.Use fun-based activities to build rapport and gauge participant’s interactive capacity and turn-taking ability. Introduce the program using a social story.

2. Building self-esteem Parents are important in supporting the development of adolescents with autism.

Introduce the importance of regulating self-esteem. Introduce a tool to monitor self-esteem (“selfenometer”). Explore strengths and resources using concrete prompts.

3. Introduction to the RAP model

Our body clues and our self-talk affect the way we feel and behave.

Introduce RAP model with iRAP computer program. Provide a CBT based description of the link between behaviour, body clues, self-talk and emotions. Introduce concept of risky and resourceful responses.

4. Keeping calm Be a detective. Find your body clues and keep calm.

Explore body signals related to positive and negative feelings using iRAP. Develop strategies to relax and manage stress.

5. Self-talk I am what I think. Introduce cognitive restructuring with the assistance of a movie clip. Generate positive self-talk.

6. Thinking resourcefully

You can change your thinking. Understand and identify self-talk. Practice challenging negative self-talk and developing positive self-talk.

7. Finding solutions to problems

There are solutions to my problems.

Learn a step-by-step problem solving model and apply it in interpersonal situations.

8. Identifying and accessing support networks

There is always help at hand. Use fun-based activities to learn about developing a support network, and seeking help to maintain emotional wellbeing.

9. Considering the other person’s perspective

There are two sides to every story. Take time out, stop and think.

Promote perspective taking and empathy for others. Develop strategies to prevent escalation of conflict.

10. Keeping the peace and making the peace

Keep the peace and make the peace.

Develop strategies to promote harmonious relationships and to get connected. Develop strategies to prevent or manage conflict with care givers and significant others.

11. Putting it all together Being a resourceful adolescent really works! Let’s celebrate!

Review program content, evaluate program, deliver personal positive feedback, and celebrate.

A small school-based RCT of young people with ASD aged 10 to 13 years (N = 30) compared RAP–A–ASD with support as usual. Outcomes showed initial support for RAP–A–ASD as a program that assists adolescents with ASD to develop affect regulation skills (Mackay, 2013). Qualitative

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exploration of participants’ experience of the RAP–A–ASD program, and parent and teacher observations of participants during and after their involvement, revealed greater capacity in participants for affect regulation and enhanced social communication and engagement skills. These findings are pertinent considering this population’s increased tendency to experience intense emotions and to have difficulty managing these emotions, and their difficulties with social interaction and communication that impact on making and maintaining relationships (APA, 2013; Humphrey & Lewis, 2008; Kanne, Christ, & Riersen, 2009; Konstantareas & Stewart, 2006; White & Roberson- Nay, 2009).

At the parent level. Important family-based factors have been found to buffer adolescents from depression, including age-appropriate secure attachment to parents, parental expressions of caring and warmth, and supporting adolescents to develop increasing autonomy while maintaining close parental relationships (see Restifo & Bögels, 2009 for review). RAP–P–ASD is the ASD adapted form of RAP–P, a strengths-based, non-blaming resilience-building program which targets family protective factors such as increasing family harmony and preventing conflict. RAP–P is offered through schools to all parents of adolescents engaged in RAP–A, and is usually delivered as a series of three workshops of two to three hours’ duration. The first session facilitates identification of existing parental strengths, and identification and management of parental stress to enhance calm and effective parenting. The second session provides information about adolescent development, strategies for promoting adolescent self-esteem, and strategies for balancing independence and attachment issues. The final session covers strategies to promote family harmony and manage conflict (Shochet, Holland, Osgarby, & Whitefield, 1998).

RAP–P is based on an integration of cognitive-behavioural theory, Bowen Family Systems Theory (Kerr & Bowen, 1988; Titelman, 2014) and knowledge from developmental psychology of the maturational changes that occur naturally during adolescence. RAP–P draws on cognitive-behavioural strategies for stress management, cognitive restructuring, and management and prevention of conflict, and introduces parents to cognitive-behavioural principles related to self-managed change in behaviours and emotions. From the family systems perspective, RAP–P focuses on the intergenerational effects of parental levels of differentiation of self on the adolescent and the inter relationships between differentiation, stress, and conflict. Those displaying good differentiation of self are able to separate their rational and emotional functioning on the intrapersonal and interpersonal level, and to maintain both a sense of belonging to family and a sense of separateness and individuality which boosts their mental health and wellbeing. Those who are undifferentiated become highly anxious and emotionally reactive both intrapersonally and in relationships, and are less able to self-soothe in times of conflict and stress. Developmentally, the growing need for autonomy in adolescence requires simultaneous closeness and separation from parents, with family conflict less likely when parents are able to feel soothed rather than anxious while their adolescents differentiate.

RAP–P aims to improve attachment between parents and adolescents, and to enhance parent and adolescent differentiation of self, by augmenting parents’ existing strengths, helping parents to boost their own self-regulation and parental self-efficacy, and helping parents to manage their negative emotional over-reactions to their adolescents and their adolescents’ emotional over-reactions to them. RAP–P addresses family-based risk factors for adolescent depression, including unresolved and emotionally heated parent-adolescent conflict and parental overprotection. Also, RAP–P develops protective factors, including family harmony, support for growing independence coupled with ongoing appropriate attachment, and conflict management (Restifo & Bögels, 2009). Thus, although RAP–P is influenced by a family systems perspective, the thrust again is to improve self and affect regulation at the family level and to maintain positive parent-adolescent relationships.

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Research has also indicated that parent attachment predicts school connectedness which in turn predicts depressive symptoms (Shochet et al., 2008). Thus, the RAP–P intervention at the family level that fosters parent-adolescent relationships may have a direct influence on promoting school connectedness as well.

A recent study demonstrated that RAP–P may be particularly effective when used with selective populations to help parents to manage their stress and to maintain empathy for their adolescents in difficult circumstances. This study, a RCT of suicidal adolescents and their parents in an Australian outpatient clinic (N = 48), compared a family intervention that included RAP–P plus routine care with routine care only. The RAP–P component consisted of four, rather than three, 2-hour sessions with the adolescents’ parents. An initial session was added that provided psychoeducation about suicidal behaviour, practical strategies to minimise self-injurious behaviour, and information about support services. At post-treatment RAP–P was associated with greater improvement in family functioning (i.e., adolescent-parent relationships and parental self and affect regulation), greater reductions in adolescents’ suicidal behaviour, and greater reductions in adolescent psychiatric disability with gains maintained at 6-month follow-up. Changes in adolescent suicidality were largely mediated by the improvement in family functioning which appeared to be the mechanism of change (Pineda & Dadds, 2013).

RAP–P–ASD (see Table 2) has been designed to be delivered as a series of four workshops, instead of following the three workshop format of RAP–P. It is hoped that this expansion will provide parents with additional time and space to discuss the unique challenges of parenting young adolescents with ASD.

Table 1

RAP-P-ASD Program Content

Session Key message Content 1. Parents are people

too!Parents/caregivers do a great job and deserve a pat on the back!

Caregivers identify their strengths. Explore the effects of stress and conclude that the best parenting is done when feeling calm.

2. What makes teenagers tick?

Parents/caregivers are important in supporting adolescents’ development.

Discuss stress management strategies. Increase caregiver understanding of adolescent development, priorities and stress by helping them to recall their own adolescence. Explore role of belongingness and strategies to promote belongingness for their adolescents.

3. Consolidating family connectedness

Parents/caregivers always have an important role in their adolescents’ lives.

Explore the idea of independence and attachment. Discuss promoting harmony and valuing differences.

4. Promoting positive family relationships

Positive family relationships increase self-esteem and well-being for all!

Explore successful ways of preventing and managing conflict. Caregivers reflect on their values and positive times with their adolescents.

At the school and teacher level. For a school to achieve a more inclusive culture that supports the social and learning needs of adolescents with ASD and promotes school connectedness, a whole of school approach is required whereby school staff at all levels commit to inclusive teaching

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and curriculum, and consider ways of working together in their own school community. The Index for Inclusion is a process that operates at the school systems level to support the development of a school culture, policy and practice where all people are valued and treated with respect for their varied knowledge and experience (Booth & Ainscow, 2002) thereby contributing to school connectedness (Shochet et al., 2006).

The Index for Inclusion has been used successfully in a range of international contexts to support the review and development of inclusive policy, culture and practice in ministries of education, education regions and school community levels (Carrington, Bourke, & Dharan, 2012; Carrington & Robinson, 2006). The Index for Inclusion is implemented by a committee at each school that consists of school staff, parents, students and researchers. The Index for Inclusion process includes five phases: getting started with the Index, finding out about the school, producing an inclusive school development plan, implementing priorities, and reviewing the Index process. The committee recruits activities to help the school to identify its unique areas of priority for including young adolescents with ASD in the school culture; collects qualitative data about inclusion from school staff, parents, and students using prespecified questions in interviews, focus groups, and questionnaires; and analyses the data and reviews the school’s progress towards inclusivity in order to develop and refine an informed inclusion plan for the school. Examples of activities that may be recruited include reviewing documents underlying the school curriculum, culture, policy and practices to determine the extent to which they support inclusive education, and to identify goals for change; exploring stereotypes that may be present in the school community in order to prompt a shift to a strengths rather than deficits focus; considering the meaning of equity and equality in an inclusive school; encouraging students to share their experiences, aspirations and suggestions for their own learning; and planning and prioritising future goals for inclusivity (Booth & Ainscow, 2002). The idiosyncratic social, behavioural, cognitive and sensory characteristics with which young adolescents with ASD may present can result in significant and unique challenges for teachers working with young adolescents with ASD in inclusive classrooms (Ashburner et al., 2010; Carrington & Graham, 1999; Carrington & Harper-Hill, 2015; Little & Evans, 2012; Lock & Bullard, 2004). Therefore, teachers require support for working with this population (Humphrey & Lewis, 2008; Renty & Roeyers, 2006). Carrington and Graham (1999) elaborate on examples of changes and adaptations that schools and teachers may make when working with young adolescents with ASD.

Students’ difficulties with rigidity and coping with unpredictability mean that teachers need to strive to provide students with a predictable and structured routine, to provide advance warning of departures from this routine, and to provide opportunities to incorporate individuals’ special interests into their learning. Further, students who struggle to persevere with tasks they perceive to be challenging need teachers to break tasks down into smaller units, and to provide regular feedback and redirection. Also, students presenting with difficulties with attention and concentration, or with sensory overload difficulties, require teachers to consider a seating plan that minimises distractions and methods of screening out extraneous noise. Moreover, as most young adolescents with ASD have a literal understanding of language, teachers need to use explicit and concise language that is free of irony and idioms in order to facilitate effective communication in the classroom. As well, teachers require knowledge of behavioural strategies that can be recruited to manage difficult behaviours both in and outside the classroom. Finally, as many young adolescents with ASD have difficulty identifying their feelings, and may fail to acknowledge that they are experiencing low mood, teachers need to be cognisant of behavioural changes that may suggest depression e.g., increased disorganisation, inattentiveness, isolation, fatigue, and/or emotional lability.

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Students on the spectrum have provided insights into the factors which influence their sense of belonging and success at school, and have endorsed access to supportive teachers and positive relationships with peers most frequently (Saggers, 2015; Saggers, Hwang, & Mercer, 2011). The Index for Inclusion framework of action learning in a school community can be enhanced by incorporating RAP–T–ASD, a condensed version of the Resourceful Adolescent Program for Teachers (RAP–T), a program designed to assist teachers with the micro-skills to foster school connectedness. A pilot study involving 70 teachers in which key RAP–T elements were presented was well accepted, and participant evaluations were consistently high (Shochet & Ham, 2004). The key message of RAP–T–ASD is that teachers are the unsung heroes: they play a crucial role in promoting school connectedness. RAP–T–ASD has four goals. The first goal is to increase teachers’ recognition of the importance and value of school connectedness in both educational functioning and mental health and wellbeing. The second goal is to provide an outline of the key elements of school connectedness (warm relationships, student inclusion and a sense of belonging, the identification and encouragement of students’ strengths, and equity and fairness), and to impart strategies for enhancing these elements in everyday teaching. The third goal is to help teachers to manage their own stress. The fourth goal is to provide teachers with resources and strategies for incorporating school connectedness in the teaching curriculum.

The Research Initiative

Despite an increased risk of mental health problems in adolescents with ASD, there is limited research to date on effective prevention or early intervention approaches in this population. Many studies exploring interventions for adolescents with ASD have failed to use random assignment, to adopt standard intervention protocols, or to ensure treatment adherence, all of which limit the rigour and generalisabilty of research findings (National Initiative for Autism: Screening and Assessment, 2003). In addition, there is a lack of research that explores the effective promotion of known factors that protect against the development of depression in young adolescents with ASD. Therefore, there is a need to develop and trial selective interventions aimed at preventing depression in adolescents with ASD so as to determine the best evidence-based practice for the treatment and support of this population (Francis, 2005), and to do so using an inclusive intervention approach that involves parents, teachers, and other professionals committed to supporting adolescents (Howlin, 2000).

The Cooperative Research Centre for Living with Autism (Autism CRC) is the world’s first national, cooperative research effort focused on ASD, and is funded for 8 years by the Australian Federal Government, and by cash and in-kind support from Autism CRC participants. This high priority research initiative aims to improve the accuracy of ASD diagnosis to facilitate early intervention; to optimise educational environments throughout Australia so as to provide students with ASD with the most appropriate opportunities to develop socially, behaviourally and academically, and to provide teachers and health professionals of young people with ASD with the most effective strategies to manage complex behaviours; and to identify the ongoing needs of adults with ASD (Autism CRC, 2016).

A project funded by the Autism CRC, henceforth known as the School Connectedness Project, will implement and evaluate a multilevel, indicated, selective, evidence-based intervention that is preventative in nature and targets the school system, teachers, parents, and adolescents with ASD. The intervention will use the Index for Inclusion framework at the school level (and will also draw on the RAP–T–ASD intervention for teachers), and will use RAP–A–ASD and RAP–P–ASD at the adolescent and parent levels respectively. This project has two aims. The first aim is to assist young adolescents with ASD to have a greater sense of connectedness to their peers, teachers, school

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and parents, and to have greater self and affect regulation, so as to improve their wellbeing and mental health. The second aim is to determine whether operating at multiple ecological levels using a schoolbased intervention is feasible and can result in a sustainable, primary prevention program.

The Planned Intervention

To test the School Connectedness Conceptual Model, a 3-year multisite proof of concept study using a mixed methods design will pilot and evaluate the school connectedness program. The study will aim to determine whether a targeted, school-based intervention that operates at multiple ecological levels to simultaneously increase the capacity for school connectedness and self and affect regulation in young adolescents with ASD can be integrated in the school culture and implemented in the school environment as a sustainable, primary prevention program. The proof of concept phase is an important step in intervention research because it provides a cost-effective method of determining whether an intervention can realise a clinically significant improvement in a small, select sample. Should a clinically significant outcome eventuate, this would justify proceeding with a more rigorous and costly randomised trial with more representative samples.

Participants. Given that the incidence of depression increases significantly after early adolescence (Lewinsohn et al., 2000; Merikangas et al., 2010), the participants will be 30 adolescents with ASD aged 12 to 14 years, and their parents and teachers, to provide sufficient data to detect reliable change (Jacobson & Truax, 1991), and to maximise the program effects on promoting adolescent wellbeing and preventing adolescent depression. Middle schools are rare in Australia, with the majority of schools classified as either primary schools (preparatory (± 5 years of age) to year 6 (±11 years of age)) or secondary schools (year 7 (± 12 years of age) to year 12 (± 17 years of age). Hence, adolescents in the first two years of secondary school will be targeted. Participants will be sourced in the first instance from approximately six to nine urban schools in South East Queensland, Australia with generalisation probes to be conducted with replication studies in rural Western Australia and New South Wales. As the RAP program is suitable for higher-functioning adolescents, students with an intellectual impairment will not be invited to participate.

Procedure. The program will draw on elements of the Index for Inclusion, and the ASD adaptation of RAP for the adolescents (RAP–A–ASD), parents (RAP–P–ASD) and teachers (RAP–T– ASD). To implement the Index for Inclusion, a small committee consisting of relevant school staff (e.g., special education teachers, administrative staff, year-level coordinators), parents, students, and at least two members from the research team will be formed at each participating school. A series of collaborative meetings will be held with the committee, using materials from the Index for Inclusion for discussion, and focusing on school culture and inclusion of young adolescent students with ASD so that the school can identify its unique areas of priority, and identify the data required to be collected from school staff, students, and parents to tap these areas of priority. Data will be collected using surveys and interviews developed from the questions and indicators in the Index for Inclusion. Following data collection, further committee meetings will be held to analyse and discuss the results and to develop an informed plan for the school. Ongoing meetings will be held in order to review the school’s progress and to evaluate the utility of the Index for Inclusion process. The RAP–T–ASD program will be delivered as an optional, single 2-hour workshop attended by teachers, administrators and support staff at each of the participating schools to provide training to assist school personnel in the promotion of school connectedness. This school-level process is expected to run for a school calendar year.

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Registered provisional psychologists enrolled in the postgraduate program in Educational and Developmental Psychology at the Queensland University of Technology in Brisbane, Australia will be trained in the implementation of RAP–A–ASD. The adolescent participants will each complete the RAP–A–ASD program in 11 to 15 one-on-one 50 minute weekly sessions with one of the project’s provisional psychologists, during school time, on school premises. Project staff will conduct RAP–P– ASD with the parents of participating adolescents in four two-and-a-half-hour weekly group sessions.

Evaluation. As a proof of concept study this is not a randomised controlled trial. However, the use of reliable change statistical procedures (Jacobson & Truax, 1991) will enable us to examine responsiveness (or otherwise) to various components of the interventions for approximately 30 young adolescents with ASD. A mixed-methods design that gathers quantitative data using questionnaires, and qualitative data using semi-structured interviews and focus groups will be used. To explore the effect of the RAP program, questionnaires that tap mental health and wellbeing, and parent-adolescent relationships will be administered to each adolescent participant, his or her parents, and the teacher deemed to have the most in-depth knowledge of the adolescent on five separate occasions across 18 months. The questionnaires that will be used include the Psychological Sense of School Membership Scale (Goodenow, 1993), an 18-item measure of school connectedness; the Coping Self-Efficacy Scale (Chesney, Neilands, Chambers, Taylor, & Folkman, 2006), a 26-item measure of one’s confidence in performing coping behaviours when faced with life challenges; the Strengths and Difficulties Questionnaire (Goodman, 1997), a 25-item measure of child and adolescent wellbeing; the second edition of the Children’s Depression Inventory (Kovacs, 2011), a 17-item measure of child and adolescent depressive symptoms; the Family Assessment Device (Epstein, Baldwin, & Bishop, 1983), a 60-item measure of family characteristics; the Mental Health Continuum Short-form (Keyes, 2005b), a 14- item measure of wellbeing; and the Anxiety Scale for Children with Autism Spectrum Disorder (Rodgers et al., 2016), a 24-item measure of anxiety in children and adolescents with ASD. In addition, semi-structured interviews to gauge the impact of the RAP intervention will be conducted with participants (students, parents, and teachers) one month post-completion, and at 3-month follow up. Questions that tap domains relating to participants’ experience of the program, their memory of concepts and strategies that they learned from the program and instances when they have used these, and changes that they have noticed in themselves and in others will be asked.

To explore the effect of the Index for Inclusion process, and the experience of members of the Index for Inclusion school committee, questionnaires that tap school connectedness and semistructured interviews will gather data from all members of the school committee, and will focus on their experience of the School Connectedness project and their perceptions of the responsiveness (or otherwise) of the other stakeholders in the project. In addition, qualitative analyses of open questions and interviews using a phenomenological constant comparison approach will be undertaken to identify themes unique to specific stakeholders and common to all stakeholder groups. Adopting this phenomenological approach will allow researchers to describe the lived experiences of individuals about a phenomenon as described by participants (Cresswell, 2014). Data will be analysed using constant comparative methods in order to reconstruct and understand the experiences of the participants (Glaser, 1992). This analysis will allow for comparison between participants, participant groups and school communities, thereby enabling us to triangle the qualitative data.

Anticipated outcomes. It is hoped that the intervention will yield a prototype of the School Connectedness Program that can be integrated in the school culture and implemented in the

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school environment as a sustainable, primary prevention program. Furthermore, it is hoped that the intervention will yield evidence that improving the capacity for school connectedness and self and affect regulation reduces depressive symptoms and other mental health problems (e.g., anxiety) and enhances emotional wellbeing in young adolescents with ASD. In addition, it is hoped that the intervention will yield an improved understanding of the factors influencing school connectedness for young adolescents with ASD.

It is anticipated that participants will come from lower and middle class families. Also, it is anticipated that there will be more male than female participants because ASD is diagnosed four times more frequently in males (APA, 2013). In line with some evidence in the depression literature that, in the early years of secondary school, females benefit to a greater extent from teacher support than do males (Pössel, Rudasill, Sawyer, Spence, & Bjerg, 2013), it is possible that females will realise greater outcomes than will males but the evidence for this is not well established. Although neurotypical adolescents will not be completing the RAP–A–ASD program, it is hoped that qualitative data derived from the Index for Inclusion process will provide information about shifts in acceptance of an inclusive school culture in neurotypical adolescents, as well as changes in their own school connectedness.

Conclusion

It is important to develop empirically supported interventions to alter the negative developmental trajectory of people living with ASD, and to promote positive mental health and wellbeing. The young adolescent period is a particularly important time when adolescents with ASD face a greater risk for developing mental health problems such as depression. School-based interventions hold considerable promise to promote a more positive trajectory. A growing body of theory and research points to the vital role of belonging and school connectedness as an important protective factor for mental health and wellbeing. At the same time, the capacity for self and affect regulation in the face of stress and negative life events accords a process of resilience that can promote wellbeing and mental health. These two protective factors can be theoretically and empirically linked and are reciprocally related. Theories from social psychology, developmental psychology and family systems theory, along with empirical evidence (including emerging neurobiological evidence) support the interrelationships between these protective factors and many indices of wellbeing. A multilayered approach at the individual, family and school level provides the best opportunity to harness these reciprocal protective factors.

We now have very preliminary evidence of resilience interventions (informed both by CBT and IPT) that look promising for promoting affect regulation and connectedness at the individual level. Parent interventions can play an important role in helping parents to assist their adolescents with ASD to navigate their challenging teenage years with greater composure, affect regulation and connectedness. Although these parent interventions have not been trialled with adolescents with ASD, they have been successfully delivered with other high risk populations (e.g., suicidal adolescents). Finally, at the school level we now have a well-defined action research process to promote greater inclusiveness and school connectedness. It is important to test whether such a multilayered intervention can work synergistically to improve the mental health and wellbeing outcomes of adolescents living with ASD. The Autism CRC conceptual model is currently being subjected to a proof of concept analysis across multiple sites in Australia. We expect this positively focused multilevel school-based approach to be a promising, feasible and sustainable approach for improving the lives of adolescents living with ASD.

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References

Alvord, M. K., & Grados, J. J. (2005). Enhancing resilience in children: A proactive approach. Professional Psychology: Research and Practice, 36, 238-245. doi: 10.1037/0735-7028.36.3.238

Aman, M., Rettiganti, M., Nagaraja, H. N., Hollway, J. A., McCracken, J., McDougle, C. J., ...Vitiello, B. (2015). Tolerability, safety, and benefits of risperidone in children and adolescents with autism: 21-month follow-up after 8-week placebo-controlled trial. Journal of Child and Adolescent

Psychopharmacology, 25, 482-493. doi:10.1089/cap.2015.0005

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Anagnostou, E., Zwaigenbaum, L., Szatmari, P., Fombonne, E., Fernandez, B. A., Woodbury-Smith, M., … Scherer, S. W. (2014). Autism spectrum disorder: Advances in evidence-based practice. Canadian

Medical Association Journal, 186, 509-519. doi:10.1503/cmaj.121756

Anderman, E. M. (2002). School effects on psychological outcomes during adolescence. Journal of

Educational Psychology, 94, 795–809. doi: 10.1037//0022-0663.94.4.795

Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: Capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorders, 4, 18–27. doi: 10.1016/j.rasd.2009.07.002

Australian Bureau of Statistics. (2012). 4428.0 - Autism in Australia. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4428.0Main%20Features32012?o pendocument&tabname=Summary&prodno=4428.0&issue=2012&num=&view=

Autism CRC. (2016). Austism CRC. Retrieved from http://autismcrc.com.au

Barnhill, G. P., & Myles, B. S. (2001). Attributional style and depression in adolescents with asperger syndrome. Journal of Positive Behavior Interventions, 3, 175-182. doi:10.1177/109830070100300305

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497-529. doi:10.1037/0033- 2909.117.3.497 7777651

Baumeister, R. F., Schmeichel, B. J., & Vohs, K. D. (2007). Self-regulation and the executive function: The self as controlling agent. In A. W. Kruglasnki & E. Higgins (Eds.), Social psychology: Handbook of

basic principles (2nd ed.) (pp. 516–539). New York, NY: Guilford Press.

Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism & Developmental Disorders, 33, 489-507. doi:10.1023/A:1025827427901

Beckes, L., & Coan, J. A. (2011). Social baseline theory: The role of social proximity in emotion and economy of action. Social and Personality Psychology Compass, 5, 976-988. doi:10.1111/j.1751-9004.2011.00400.x

Benner, A. D. (2011). The transition to high school: Current knowledge, future directions. Educational

Psychology Review, 23, 299-328. doi:10.1007/s10648-011-9152-0

Benzies, K., & Mychasiuk, R. (2009). Fostering family resiliency: A review of the key protective factors. Child & Family Social Work, 14, 103-114. doi: 10.1111/j.1365-2206.2008.00586.x

26

Bond, L., Butler, H., Thomas, L., Carlin, J., Glover, S., Bowes, G., & Patton, G. (2007). Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. Journal of Adolescent Health, 40(4), e9–e18. doi:10.1016/j.jadohealth.2006.10.013

Bonny, A. E., Britto, M. T., Klostermann, B. K., Hornung, R. W., & Slap, G. B. (2000). School disconnectedness: Identifying adolescents at risk. Pediatrics, 106, 1017–1021. doi:10.1542/peds.106.5.1017

Booth, T. & Ainscow, M. (2002). Index for Inclusion. Bristol, United Kingdom: Centre for Studies on Inclusive Education.

Bowlby, J. (1969). Attachment and loss: Attachment. London, United Kingdom: Hogarth Publishers.

Bowlby, J., & Ainsworth, M. (1992). The origins of attachment theory. Developmental Psychology, 28, 759-775. doi:10.1037/0012-1649.28.5.759

Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and

Developmental Disorders, 36, 863– 870. doi:10.1007/s10803-006-0125-y

Bronfenbrenner, U. (1989). Ecological systems theory. In R. Vasta (Ed.), Annals of child development (pp. 187–248). Greenwich, CT: JAI Press Inc.

Buckley, M., & Saarni, C. (2009). Emotion regulation: Implications for positive youth development. In R. Gilman, E. S. Huebner, & M. J. Furlong (Eds.), Handbook of positive psychology in schools (pp. 107–118). New York, NY: Routledge.

Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying experiences among children and youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 266–277. doi:10.1007/s10803-011-1241-x

Carrington, S. B., & Harper-Hill, K. (2015). Teaching children who have a diagnosis of autism spectrum disorder. Professional Voice - Teaching, 10(3), 48-53.

Carrington, S. B., & Robinson, R. (2006). Inclusive school community: Why is it so complex? International Journal of Inclusive Education, 10, 323-334. doi: 10.1080/13603110500256137

Carrington, S. B., Bourke, R., & Dharan, V. (2012). Using the index for inclusion to develop inclusive school communities. In S. B. Carrington, & J. MacArthur (Eds.), Teaching in inclusive school

communities (pp. 341-366). Brisbane, Australia: John Wiley & Sons.

Carrington, S., & Graham, L. (1999). Asperger’s syndrome: Learner characteristics and teaching strategies. Special Education Perspectives, 8, 15-23.

Carter, C. S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendorinlogy, 23, 779–818.doi: 10.1016/s0306-4530(98)00055-9

Carter, M., McGee, R., Taylor, B., & Williams, S. (2007). Health outcomes in adolescence: Associations with family, friends and school engagement. Journal of Adolescence, 30, 51–62. doi:10.1016/j.adolescence.2005.04.002

Casey, B. J., Jones, R. M., Levita, L., Libby, V., Pattwell, S. S., Ruberry, E. J., … Somerville, L. H. (2010). The storm and stress of adolescence: Insights from human imaging and mouse genetics. Developmental Psychobiology, 52, 225-235. doi:10.1002/dev.20447

27

Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years - Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report: Surveillance Summaries, 63(2), 1-22.

Chapman, R. L., Buckley, L., Sheehan, M., & Shochet, I. M. (2013). School-based programs for increasing connectedness and reducing risk behavior: A systematic review. Educational Psychology

Review, 25, 95–114. doi: 10.1007/s10648-013-9216-4

Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. British Journal of Health Psychology, 11, 421-437. doi:10.1348/135910705x53155

Ching, H., & Pringsheim, T. (2012). Aripiprazole for autism spectrum disorders (ASD). Cochrane

Database of Systematic Reviews, 2012(5), 1-43. doi: 10.1002/14651858.cd009043

Chipuer, H. M. (2001). Dyadic attachments and community connectedness: Links with youths’ loneliness experiences. Journal of Community Psychology, 29, 429–446. doi: 10.1002/jcop.1027.abs

Ciani, K. D., Middleton, M. J., Summers, J. J., & Sheldon, K. M. (2010). Buffering against performance classroom goal structures: The importance of autonomy support and classroom community. Contemporary Educational Psychology, 35, 88–99. doi: 10.1016/j.cedpsych.2009.11.001

Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., … Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127-1134. doi:10.1001/archpsyc.58.12.1127

Cockshaw, W. D., & Shochet, I. (2010). The link between belongingness and depressive symptoms: An exploration in the workplace interpersonal context. Australian Psychologist, 45, 283-289. doi: 10.1080/00050061003752418

Copeland, W. E., Shanahan, L., Costello, E. J., & Angold, A. (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry, 66, 764–772. doi: 10.1001/archgenpsychiatry.2009.85

Corrieri, S., Heider, D., Conrad, I., Blume, A., König, H., & Riedel-Heller, S. G. (2014). Schoolbased prevention programs for depression and anxiety in adolescence: A systematic review. Health

Promotion International, 29, 427-441.doi: 10.1093/heapro/dat001

Courchesne, E., Campbell, K., & Solso, S. (2011). Brain growth across the life span in autism: Agespecific changes in anatomical pathology. Brain Research, 1380, 138–145. doi: 10.1016/j.brainres.2010.09.101

Coyne, J. C. (1976). Towards an interactional description of depression. Psychiatry, 39, 28–40.

Cozolino, L. (2007). The neuroscience of human relationships: Attachment and the developing

brain. New York, NY: Norton.

Cresswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). London, United Kingdom: Sage.

Dahl, R. E. (2001). Affect regulation, brain development, and behavioral/emotional health in adolescence. CNS Spectrums, 6, 60–72.

Dalton, K. M., Nacewicz, B. M., Johnstone, T., Schaefer, H. S., Gernsbacher, M.A., & Goldsmith, H. H. (2005). Gaze fixation and the neural circuitry of face processing in autism. Nature Neuroscience, 8, 519–526. doi:10.1038/nn1421

28

Depue, R. A., & Morrone-Strupinsky, J. V. (2005). A neurobehavioral model of affiliative bonding: Implications for conceptualizing a human trait of affiliation. Behavioral Brain Science, 28, 313–350. doi: 10.1017/s0140525x05000063

DeWall, C. N., Twenge, J. M., Koole, S. L., Baumeister, R. F., Marquez, A., & Reid, M. W. (2011). Automatic emotion regulation after social exclusion: Tuning to positivity. Emotion, 11, 623- 636. doi:10.1037/a0023534

Downs, A., & Smith, T. (2004). Emotional understanding, cooperation, and social behavior in highfunctioning children with autism. Journal of Autism and Developmental Disorders, 34, 625- 635. doi:10.1007/s10803-004-5284-0

Eaves, L. C., & Ho, H. H. (2008).Young adult outcome of autism spectrum disorders. Journal of

Autism and Developmental Disorders, 38, 739–747. doi: 10.1007/ s10803-007-0441-x

Eftekhari, A., Zoellner, L. A., & Vigil, S. A. (2009). Patterns of emotion regulation and psychopathology. Anxiety Stress Coping, 22, 571–586. doi:10.1080/10615800802179860

Eisenberg, N., Fabes, R. A., Guthrie, I. K., & Reiser, M. (2000). Dispositional emotionality and regulation: Their role in predicting quality of social functioning. Journal of Personality and Social

Psychology, 78, 136-157. doi:10.1037/0022-3514.78.1.136

Eisenberger, N. I., Inagaki, T. K., Muscatell, K. A., Byrne Haltom, K. E., & Leary, M. R. (2011). The neural sociometer: Brain mechanisms underlying state self-esteem. Journal of Cognitive Neuroscience, 23, 3448-3455. doi:10.1162/jocn_a_00027

Epstein, N. E., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171-180. doi: 10.1111/j.1752-0606.1983.tb01497.x.

Farrell, L. J., & Barrett, P. M. (2007). Prevention of childhood emotional disorders: Reducing the burden of suffering associated with anxiety and depression. Child and Adolescent Mental Health,

12, 58–65. doi: 10.1111/j.1475-3588.2006.00430.x

Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399-419. doi: 10.1146/annurev.publhealth.26.021304.144357

Finkel, E. J., & Fitzsimons, G. M. (2011). The effects of social relationships on self-regulation. In K. D. Vohs, & R. F. Baumeister (Eds.), Handbook of self-regulation: Research, theory, and applications (2nd ed.) (pp. 390–406). New York, NY: Guilford Press.

Fiske, S. T. (2004). Social beings: A core motives approach to social psychology. Hoboken, NJ: Wiley.

Fledderus, M., Bohlmeijer, E. T., Smit, F., & Westerhof, G. J. (2010). Mental health promotion as a new goal in public mental health care: A randomized controlled trial of an intervention enhancing psychological flexibility. American Journal of Public Health, 100, 2372-2378. doi:10.2105/AJPH.2010.196196

Fombonne, E. (2005). The changing epidemiology of autism. Journal of Applied Research in

Intellectual Disabilities, 18, 281-294. doi:10.1111/j.1468-3148.2005.00266.x

Francis, K. (2005). Autism interventions: A critical update. Developmental Medicine & Child

Neurology, 47, 493-499. doi:10.1111/j.1469-8749.2005.tb01178.x

29

Frydenberg, E., Care, E., Freeman, E., & Chan, E. (2009). Interrelationships between coping, school connectedness and wellbeing. Australian Journal of Education, 53, 261-276. doi: 10.1177/000494410905300305

Fung, S., Lunsky, Y., & Weiss, J. A. (2015). Depression in youth with autism spectrum disorder: The role of ASD vulnerabilities and family-environmental stressors. Journal of Mental Health Research in

Intellectual Disabilities, 8, 120-139. doi:10.1080/19315864.2015.1017892

Garber, J., Webb, C. A., & Horowitz, J. L. (2009). Prevention of depression in adolescents: A review of selective and indicated programs. In S. Nolen-Hoeksema, & L. M. Hilt (Eds.), Handbook of

depression in adolescents (pp. 619-659). New York, NY: Routledge/Taylor & Francis Group.

Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism & Developmental Disorders, 32, 299-306.

Gillham, J. E., Brunwasser, S. M., & Freres, D. R. (2008). Preventing depression in early adolescence: The Penn Resiliency Program. In J. R. Z. Abela & B. L. Hankin (Eds.), Handbook of depression in

children and adolescents (pp. 309 –322). New York, NY: Guilford Press

Gladstone, T. R. G., Beardslee, W. R., & O’Connor, E. E. (2011). The prevention of adolescent depression. Psychiatric Clinics of North America, 34, 35-52. doi:10.1016/j.psc.2010.11.015

Glaser, B. G. (1992). Basics of grounded theory analysis. Mill Valley, CA: Sociology Press.

Goodenow, C. (1993). The psychological sense of school membership among adolescents: Scale development and educational correlates. Psychology in the Schools, 30, 79–90. doi:10.1002/1520-6807(199301)30:13.0.CO;2-X

Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child

Psychology and Psychiatry, 38, 581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x

Gotham, K., Bishop, S. L., Brunwasser, S., & Lord, C. (2014). Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent–adult ASD sample. Autism Research,

7, 381-391. doi:10.1002/aur.1377

Gray, C., & White, A. (2002). My social stories book. London, United Kingdom: Jessica Kingsley Publishers.

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291. doi: 10.1017/s0048577201393198

Gross, J. J. (2013). Handbook of emotion regulation (2nd ed.). New York, NY: Guilford Publications.

Gross, J. J. (2015). The extended process model of emotion regulation: Elaborations, applications, and future directions. Psychological Inquiry, 26, 130-137. doi: 10.1080/1047840X.2015.989751

Haga, S. M., Kraft, P., & Corby, E. (2009). Emotion regulation: Antecedents and outcomes of cognitive reappraisal and expressive suppression in cross-cultural samples. Journal of Happiness

Studies, 10, 271–291. doi:10.1007/s10902-007-9080-3

Harfterkamp, M., van de Loo-Neus, G., Minderaa, R. B., van der Gaag, R., Escobar, R., Schacht, A., … Hoekstra, P. J. (2012). A randomized double-blind study of atomoxetine versus placebo for attention-deficit/hyperactivity disorder symptoms in children with autism spectrum disorder. Journal of the

American Academy of Child and Adolescent Psychiatry, 51, 733-741. doi:10.1016/j.jaac.2012.04.011

30

Hedley, D., & Young, R. (2006). Social comparison processes and depressive symptoms in children and adolescents with asperger syndrome. Autism, 10, 139-153. doi:10.1177/1362361306062020

Ho, B. P. V., Stephenson, J., & Carter, M. (2013). Cognitive-behavioral approach for children with autism spectrum disorders: A meta-analysis. Review Journal of Autism and Developmental

Disorders, 1, 18-33. doi:10.1007/s40489-013-0002-5

Hofmann, W., Schmeichel, B. J., & Baddeley, A. D. (2012). Executive functions and self-regulation. Trends in Cognitive Sciences, 16, 174-180. doi:10.1016/j.tics.2012.01.006

Hopp, H., Troy, A. S., & Mauss, I. B. (2011). The unconscious pursuit of emotion regulation: Implications for psychological health. Cognition and Emotion, 25(3), 532–545. doi:10.1080/02699931.2010.532606

Howlin, P. (2000). Autism and intellectual disability: Diagnostic and treatment issues. Journal of the

Royal Society of Medicine, 93, 351-355.

Humphrey, N. (2008). Autistic spectrum disorder and inclusion: Including pupils with autistic spectrum disorders in mainstream schools. Support for Learning, 23, 41-47. doi: 10.1111/j.1467-9604.2007.00367.x

Humphrey, N., & Lewis, S. (2008). `Make me normal’: The views and experiences of pupils on the autistic spectrum in mainstream secondary schools. Autism, 12, 23-46. doi: 10.1177/1362361307085267

Humphrey, N., & Symes, W. (2010). Perceptions of social support and experience of bullying among pupils with autistic spectrum disorders in mainstream secondary schools. European Journal of

Special Needs Education, 25, 77-91. doi: 10.1080/08856250903450855

Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19. doi:10.1037/0022-006X.59.1.12

Jahromi, L. B., Bryce, C. I., & Swanson, J. (2013). The importance of self-regulation for the school and peer engagement of children with high-functioning autism. Research in Autism Spectrum Disorders,

7, 235–246. doi: 10.1016/ j.rasd.2012.08.012

Jahromi, L. B., Meek, S. E., & Ober-Reynolds, S. (2012). Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. Journal of Child

Psychology and Psychiatry, 53, 1250–1258. doi:10.1111/ j.1469-7610.2012.02560.x

Jesner, O. S., Aref-Adib, M., & Coren, E. (2007). Risperidone for autism spectrum disorder. Cochrane

Database of Systematic Reviews, 2007(1), 1-24. doi: 10.1002/14651858.CD005040.pub2.

Joiner, T. E., & Metalsky, G. I. (2001). Excessive reassurance seeking: Delineating a risk factor involved in the development of depressive symptoms. Psychological Science, 12, 371–387. doi: 10.1111/1467-9280.00369

Jose, P. E., Ryan, N., & Pryor, J. (2012). Does social connectedness lead to a greater sense of wellbeing in adolescence? Journal of Research on Adolescence, 22, 235–251. doi:10.1111/j.1532- 7795.2012.00783.x

Joshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., … Biederman, J. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361–1370. doi: 10.1007/s10803-010-0996-9

31

Kanne, S., Christ, S., & Reiersen, A. (2009). Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders, 39, 827- 833. doi: 10.1007/s10803-008-0688-x

Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen Theory. New York, NY: Norton.

Keyes, C. L. M. (2005a). Mental health and/or mental illness? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548.doi: 10.1037/0022-006X.73.3.539

Keyes, C. L. M. (2005b). The subjective well-being of America’s youth: Toward a comprehensive assessment. Adolescent and Family Health, 4, 3–11.

Kidger, J., Araya, R., Donovan, J., & Gunnell, D. (2012). The effect of the school environment on the emotional health of adolescents: A systematic review. Pediatrics, 129, 925-949. doi: 10.1542/peds.2011-2248

Konstantareas, M. M., & Stewart, K. (2006). Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism & Developmental Disorders, 36, 143-154. doi: 10.1007/s10803-005-0051-4

Kovacs, M. (2011). Children’s Depression Inventory (2nd ed.). North Tonawanda, NY: Multi-Health Systems Inc.

Kreslins, A., Robertson, A. E., & Melville, C. (2015). The effectiveness of psychosocial interventions for anxiety in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health, 9, 1-12. doi:10.1186/s13034-015-0054-7

Landback, J., Prochaska, M., Ellis, J., Dmochowska, K., Kuwabara, S., Gladstone, T., … Van Voorhees, B. (2009). From prototype to product: Development of a primary care/internet based depression prevention intervention for adolescents (CATCH-IT). Community Mental Health Journal, 45, 349-354. doi: 10.1007/s10597-009-9226-3

Larson, R., Moneta, G., Richards, M. H., & Wilson, S. (2002). Continuity, stability, and change in daily emotional experience across adolescence. Child Development, 73, 1151–1165. doi: 10.1111/1467-8624.00464

Leary, M. R. (2005). Sociometer theory and the pursuit of relational value: Getting to the root of self esteem. European Review of Social Psychology, 16, 75-111. doi: 10.1080/10463280540000007

Leary, M. R., & Baumeister, R. F. (2000). The nature and function of self-esteem: Sociometer theory. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 32, pp.1– 62). San Diego, CA: Academic Press.

Leary, M. R., & Downs, D. L. (1995). Interpersonal functions of the self-esteem motive: Self-esteem as a sociometer. In M. Kernis (Ed.), Efficacy, agency and self-esteem (pp. 123–144). New York, NY: Plenum.

Lee, L., Harrington, R. A., Louie, B. B., & Newschaffer, C. J. (2008). Children with autism: Quality of life and parental concerns. Journal of Autism and Developmental Disorders, 38, 1147-1160. doi:10.1007/s10803-007-0491-0

32

Lee, R. M., & Robbins, S. B. (1998). The relationship between social connectedness and anxiety, selfesteem, and social identity. Journal of Counseling Psychology, 45, 338–345. doi:10.1037//0022-0167.45.3.338

Lester, L., Waters, S., & Cross, D. (2013). The relationship between school connectedness and mental health during the transition to secondary school: A path analysis. Australian Journal of Guidance

and Counselling, 23, 157-171.doi: 10.1017/jgc.2013.20

Lewinsohn, P. M., Rohde, P., Seeley, J. R., Klein, D. N., & Gotlib, I. H. (2000). Natural course of adolescent major depressive disorder in a community sample: Predictors of recurrence in young adults. American Journal of Psychiatry, 157, 1584-1591. doi:10.1176/appi.ajp.157.10.1584

Little, C., & Evans, D. (2012). Conceptualizing social inclusion within teacher education. In C. Forlin (Ed.), Future directions for teacher education for inclusion (pp. 141–150), London, United Kingdom: Routledge.

Lock, R. H., & Bullard, H. R. (2004). Ensure the successful inclusion of a child with asperger syndrome in the general education classroom. Intervention in School and Clinic, 39, 176- 180. doi:10.1177/10534512040390030801

Losh, M., & Capps, L. (2006). Understanding of emotional experience in autism: Insights from the personal accounts of high-functioning children with autism. Developmental Psychology, 42, 809–818. doi:10.1037/0012–1649.42.5.809

Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543-562. doi:10.1111/1467-8624.00164

Mackay, B. (2013). Preventing depression and promoting wellbeing in children with Autistic

Spectrum Disorder: A mixed methods evaluation of a school-based resilience intervention.

Unpublished doctoral dissertation, Queensland University of Technology, Australia.

Malik, S., Wells, A., & Wittkowski, A. (2015). Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review. Journal of Affective

Disorders, 172, 428-444. doi:10.1016/j.jad.2014.10.007

Malow, B. A., Byars, K., Johnson, K., Weiss, S., Bernal, P., Goldman, S. E., … Glaze, D. G. (2012). A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders. Pediatrics, 130, S106. doi: 10.1542/peds.2012-0900I

Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. (2005). Characteristics of children with autistic spectrum disorders served in comprehensive community-based mental health settings. Journal of Autism and Developmental Disorders, 35, 313-321. doi:10.1007/s10803-005-3296-z

Marriage, S., Wolverton, A., & Marriage, K. (2009). Autism spectrum disorder grown up: A chart review of adult functioning. Journal of the Canadian Academy of Child and Adolescent Psychiatry,

18, 322–328.

Matson, J. L., & Horovitz, M. (2010). Stability of autism spectrum disorders symptoms over time. Journal of Developmental and Physical Disabilities, 22, 331-342. doi:10.1007/s10882-010- 9188-y

Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28, 341-352. doi:10.1016/j.ridd.2005.12.004

33

Matson, J. L., Mahan, S., Hess, J. A., Fodstad, J. C., & Neal, D. (2010). Progression of challenging behaviors in children and adolescents with autism spectrum disorders as measured by the autism spectrum disorders-problem behaviors for children (ASD-PBC). Research in Autism Spectrum

Disorders, 4, 400-404. doi:10.1016/j.rasd.2009.10.010

Mayes, S. D., Calhoun, S. L., Murray, M. J., & Zahid, J. (2011). Variables associated with anxiety and depression in children with autism. Journal of Developmental and Physical Disabilities, 23, 325–337. doi: 10.1007/s10882-011-9231-7

Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5, 474–485. doi: 10.1016/j.rasd.2010.06.012

Mazurek, M. O., & Kanne, S. M. (2010). Friendship and internalizing symptoms among children and adolescents with ASD. Journal of Autism and Developmental Disorders, 40, 1512-1520. doi:10.1007/s10803-010-1014-y

McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism

and Developmental Disorders, 44, 2041-2051. doi:10.1007/s10803-014- 2087-9

McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and

Therapy, 49, 544–554. doi: 10.1016/j.brat.2011.06.003

McPheeters, M. L., Davis, A., Navarre, J. R., & Scott, T. A. (2011). Family report of ASD concomitant with depression or anxiety among US children. Journal of Autism and Developmental Disorders, 41, 646–653. doi:10.1007/s10803- 010-1085-9

McRae, K., Gross, J. J., Weber, J., Robertson, E. R., Sokol-Hessner, P., Ray, R. D., … Ochsner, K. N. (2012). The development of emotion regulation: An fMRI study of cognitive reappraisal in children, adolescents and young adults. Social Cognitive and Affective Neuroscience, 7, 11-22. doi:10.1093/scan/nsr093

Mellor, D., Stokes, M., Firth, L., Hayash, Y., & Cummins, R. (2008). Need for belonging, relationship satisfaction, loneliness, and life satisfaction. Personality and Individual Differences, 45, 213- 218. doi: 10.1016/j.paid.2008.03.020

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent

Psychiatry, 49, 980–989. http://doi.org/10.1016/j.jaac.2010.05.017

Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2011). Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), 1409- 1685.doi:10.1002/14651858.CD003380.pub3.

Merry, S., McDowell, H., Wild, C. J., Bir, J., & Cunliffe, R. (2004). A randomized placebo-controlled trial of a school-based depression prevention program. Journal of the American Academy of Child and

Adolescent Psychiatry, 43, 538-547. doi: 10.1097/00004583-200405000-00007

Millear, P., Liossis, P., Shochet, I. M., Biggs, H., & Donald, M. (2008). Being on PAR: Outcomes of a pilot trial to improve mental health and wellbeing in the workplace with the promoting adult resilience (PAR) program. Behaviour Change, 25, 215-228. doi:10.1375/bech.25.4.215

34

Ministerial Council on Education, Employment, Training and Youth Affairs. (2008). Melbourne

declaration on educational goals for young Australians. Canberra, Australia: Author.

Mojtabai, R., Stuart, E. A., Hwang, I., Eaton, W. W., Sampson, N., & Kessler, R. C. (2015). Longterm effects of mental disorders on educational attainment in the national comorbidity survey ten-year follow-up. Social Psychiatry and Psychiatric Epidemiology, 50, 1577-1591. doi:10.1007/s00127-015-1083-5

Monahan, K. C., Oesterle, S., & Hawkins, J. D. (2010). Predictors and consequences of school connectedness: The case for prevention. The Prevention Researcher, 17(3), 3-6. doi: 10.1037/e597072010-002

Moore, S., Zoellner, L., & Mollenholt, N. (2008). Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behaviour Research and Therapy, 46, 993–1000. doi:10.1016/j.brat.2008.05.001

Moss, J., Magiati, I., Charman, T., & Howlin, P. (2008). Stability of the Autism Diagnostic Interview- —Revised from pre-school to elementary school age in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1081-1091. doi:10.1007/s10803-007-0487-9

Mrazek, P., & Haggerty, P. (1994). Reducing risk for mental disorders: Frontiers for preventive

intervention research. Washington, DC: National Academy Press.

Mufson, L., Moreau, D., Weissman, M. M., & Klerman, G. L. (1993). Interpersonal psychotherapy for adolescent depression. In G. L. Klerman & M. M. Weissman (Eds.), New applications of interpersonal

psychotherapy (pp. 130-166). Washington, DC: American Psychiatric Association Press.

Muris, P., Bogie, N., & Hoogsteder, A. (2001). Effects of an early intervention group program for anxious and depressed adolescents: A pilot study. Psychological Reports, 88, 481-482. doi: 10.2466/pr0.88.2

National Initiative for Autism: Screening and Assessment. (2003). National Autism Plan for Children (NAPC). Retrieved from http://books.google.com.au/books?id=N6bwxrFrOUC& printsec=frontcover&dq=National+Autism+Plan+for+Children&hl=en&sa=X&ei= NaeRUY7nLsTliAfk5YGYAg&ved=0CDQQ6AEwAA

O’Rourke, J., & Houghton, S. (2008). Perceptions of secondary school students with mild disabilities to the academic and social support mechanisms implemented in regular classrooms. International Journal of Disability, Development and Education, 55, 227–237. doi: 10.1080/10349120802268321

Osborne, L., & Reed, P. (2011). School factors associated with mainstream progress in secondary education for included pupils with Autism Spectrum Disorders. Research in Autism Spectrum

Disorders, 5, 1253–1263. doi: 10.1016/j.rasd.2011.01.016

Osterman, K. F. (2000). Students’ need for belonging in the school community. Review of

Educational Research, 70, 323–367. doi: 10.2307/1170786

Owen, R., Sikich, L., Marcus, R. N., Corey-Lisle, P., Manos, G., McQuade, R. D., … Findling, R. L. (2009). Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics, 124, 1533-1540. doi:10.1542/peds.2008-3782

Ozonoff, S., Dawson, G., & McPartland, J. (2002), A parent’s guide to asperger syndrome and

highfunctioning autism. New York, NY: Guilford Press.

Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emotions.

Oxford, United Kingdom: Oxford University Press.

35

Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of

Vocational Behavior, 74, 264–282. doi: 10.1016/j.jvb.2009.01.001

Picci, G., & Scherf, K. S. (2014). A two-hit model of autism: Adolescence as the second hit. Clinical

Psychological Science, 3, 349-371. doi:10.1177/2167702614540646

Pineda, J., & Dadds, M. R. (2013). Family intervention for adolescents with suicidal behavior: A randomized controlled trial and mediation analysis. Journal of the American Academy of Child and

Adolescent Psychiatry, 52, 851-862. doi:10.1016/j.jaac.2013.05.015

Pössel, P., Rudasill, K. M., Sawyer, M. G., Spence, S. H., & Bjerg, A. C. (2013). Associations between teacher emotional support and depressive symptoms in Australian adolescents: A 5-year longitudinal study. Developmental Psychology, 49, 2135-2146. doi:10.1037/a0031767

Quinn, S., & Oldmeadow, J. A. (2013). Is the ‘I’ generation a ‘we’ generation? Social networking use among 9- to 13-year-olds and belonging. British Journal of Developmental Psychology, 31, 136-142. doi:10.1111/bjdp.12007 23331112

Reeve, J., Deci E. L., & Ryan R. M. (2004). Self-determination theory. A dialectical framework for understanding sociocultural influences on student motivation. In D.M. McInerney & S. Van Etten (Eds.), Research on sociocultural influences on motivation and learning: Big theories revisited (vol. 4, pp. 31 -59). Greenwich, CT: Information Age Press.

Reichow, B. (2012). Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 512-520. doi:10.1007/s10803-011-1218-9

Reichow, B., & Volkmar, F. R. (2011). Introduction to evidence-based practices in autism: Where we started. In B. Reichow, P. Doehring, D. V. Cicchetti., & F. R. Volkmar (Eds.), Evidence-Based practices

and treatments for children with autism (pp. 3-24). New York, NY: Springer.

Renty, J., & Roeyers, H. (2006). Satisfaction with formal support and education for children with autism spectrum disorder: The voices of the parents. Child: Care, Health and Development, 32, 371-385. doi:10.1111/j.1365-2214.2006.00584.x

Restifo, K., & Bögels, S. (2009). Family processes in the development of youth depression: Translating the evidence to treatment. Clinical Psychology Review, 29, 294-316. doi:10.1016/j.cpr.2009.02.005

Riediger, M., Schmiedek, F., Wagner, G., & Lindenberger, U. (2009). Seeking pleasure and seeking pain: Differences in pro- and contrahedonic motivation from adolescence to old age. Psychological

Science, 20, 1529–1535. doi: 10.1111/j.1467-9280.2009.02473.x

Riediger, M., Wrzus, C., & Wagner, G. G. (2014). Happiness is pleasant, or is it? Implicit representations of affect valence are associated with contrahedonic motivation and mixed affect in daily life. Emotion, 14, 950-961. doi:10.1037/a0037711

Rivet-Duval, E., Heriot, S., & Hunt, C. (2011). Preventing adolescent depression in Mauritius: A universal school-based program. Child and Adolescent Mental Health, 16(2), 86-91. doi:10.1111/j.1475-3588.2010.00584.x

Roberts, N. A., & Burleson, M. H. (2013). Processes linking cultural ingroup bonds and mental health: The roles of social connection and emotion regulation. Frontiers in Psychology, 4, 52-70. doi:10.3389/fpsyg.2013.00052

36

Rodgers, J., Wigham, S., McConachie, H., Freeston, M., Honey, E., & Parr, J. R. (2016). Development of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD). Autism Research, doi:10.1002/aur.1603

Rosenthal, M., Wallace, G. L., Lawson, R., Wills, M. C., Dixon, E., Yerys, B. E., & Kenworthy, L. (2013). Impairments in realworld executive function increase from childhood to adolescence in autism spectrum disorders. Neuropsychology, 27, 13–18. doi: 10.1037/a0031299

Rossignol, D. A., & Frye, R. E. (2011). Melatonin in autism spectrum disorders: A systematic review and meta-analysis. Developmental Medicine & Child Neurology, 53, 783-792. doi:10.1111/j.1469-8749.2011.03980.x

Sacco, W. P., & Vaughan, C. A. (2006). Depression and the response of others: A social-cognitive interpersonal process model. In T. E. Joiner, J. S. Brown, & J. Kistner (Eds.), The interpersonal, social

and cognitive nature of depression (pp. 101– 132). Mahwah, NJ: Lawrence Erlbaum.

Saggers, B. (2015). Student perceptions: Improving the educational experiences of high school students on the autism spectrum. Improving Schools, 18, 35-45. doi: 10.1177/1365480214566213

Saggers, B., Hwang, Y., & Mercer, L. K. (2011). Your voice counts: Listening to the voice of high school students with Autism Spectrum Disorder. Australasian Journal of Special Education, 35, 173–190. doi: 10.1375/ajse.35.2.173

Samson, A. C., Hardan, A. Y., Podell, R. W., Phillips, J. M., & Gross, J. J. (2015). Emotion regulation in children and adolescents with autism spectrum disorder. Autism Research, 8, 9-18. doi:10.1002/aur.1387

Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotional reactivity and regulation in adults with autism spectrum disorders. Emotion, 12, 659–665. doi:10.1037/a0027975

Santomauro, D., Sheffield, J., & Sofronoff, K. (2015). Depression in adolescents with ASD: A pilot RCT of a group intervention. Journal of Autism and Developmental Disorders, 46, 572-588. doi:10.1007/s10803-015-2605-4

Sargent, J., Williams, R. A., Hagerty, B., Lynch-Sauer, J., & Hoyle, K. (2002). Sense of belonging as a buffer against depressive symptoms. Journal of the American Psychiatric Nurses Association, 8, 120-129. doi: 10.1067/mpn.2002.127290

Saxena, P., Dubey, A., & Pandey, R. (2011). Role of emotion regulation difficulties in predicting mental health and well-being. SIS Journal of Projective Psychology and Mental Health, 18, 147-154.

Scarpa, A., White, S. W., & Attwood, T. (2013). Cognitive-behavioral interventions for children and

adolescents with high-functioning autism spectrum disorders. New York, NY: Guilford Publications.

Schachter, E. P., & Rich Y. (2011). Identity education: A conceptual framework for educational researchers and practitioners. Educational Psychologist, 46, 222 -238. doi:10.1080/00461520.2011.614509

Sciutto, M., Richwine, S., Mentrikoski, J., & Niedzwiecki, K. (2012). A qualitative analysis of the school experiences of students with asperger syndrome. Focus on Autism and Other Developmental

Disabilities, 27, 177-188. doi: 10.1177/1088357612450511

Sheldrick, R. C., Neger, E. N., Shipman, D., & Perrin, E. C. (2012). Quality of life of adolescents with autism spectrum disorders: Concordance among adolescents’ self-reports, parents’ reports, and parents’ proxy reports. Quality of Life Research, 21, 53-57. doi:10.1007/s11136-011-9916-5

37

Shochet, I. M., & Ham, D. (2003). The resourceful adolescent project: A universal approach to preventing adolescent depression through promoting resiliance and family well-being in Australia. In I. Katz, & J. Pinkerton (Eds.), Evaluating family support: Thinking internationally, thinking critically (pp. 271-290). West Sussex, United Kingdom: John Wiley & Sons.

Shochet, I. M., & Ham, D. (2004). Universal school-based approaches to preventing adolescent depression: Past findings and future directions of the resourceful adolescent program. International

Journal of Mental Health Promotion, 6, 17-25. doi:10.1080/14623730.2004.9721935

Shochet, I. M., & Osgarby, S. M. (1999). The resourceful adolescent project: Building psychological resilience in adolescents and their parents. The Australian Educational and Developmental

Psychologist, 16, 46-65.

Shochet, I. M., & Smith, C. L. (2012). Enhancing school connectedness to prevent violence and promote wellbeing. In S. R. Jimerson, A. B. Nickerson, M. J. Mayer, & M. J. Furlong (Eds.), Handbook

of school violence and school safety: International research and practice (pp. 475- 486). London, United Kingdom: Routledge.

Shochet, I. M., Dadds, M. R., Ham, D., & Montague, R. (2006). School connectedness is an underemphasized parameter in adolescent mental health: Results of a community prediction study. Journal of Clinical Child and Adolescent Psychology, 35, 170-179. doi: 10.1207/s15374424jccp3502_1

Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H., & Osgarby, S. M. (2001). The efficacy of a universal school-based program to prevent adolescent depression. Journal of Clinical

Child Psychology, 30, 303-315. doi: 10.1207/s15374424jccp3003_3

Shochet, I. M., Holland, D., & Whitefield, K. (1997a). Resourceful Adolescent Program: Group leader’s

manual. Brisbane, Australia: School of Psychology and Counselling, Queensland University of Technology.

Shochet, I. M., Holland, D., & Whitefield, K. (1997b). Resourceful Adolescent Program: Participant’s

workbook. Brisbane, Australia: School of Psychology and Counselling, Queensland University of Technology.

Shochet, I. M., Holland, D., Osgarby, S. M., & Whitefield, K. (1998). The Resourceful family project:

Parent program. Brisbane, Australia: Griffith University.

Shochet, I. M., Homel, R., Cockshaw, W. D. & Montgomery, D. (2008). How do school connectedness and attachment to parents interrelate in predicting adolescent depressive symptoms? Journal of

Clinical Child and Adolescent Psychology, 37, 676−681. doi:10.1080/15374410802148053

Shochet, I. M., Mackay, B., & Wurfl, A. (2011). Resourceful Adolescent Program: Autism spectrum

disorders supplement. Brisbane, Australia: School of Psychology and Counselling, Queensland University of Technology.

Shochet, I. M., Montague, R., Smith, C., & Dadds, M. (2014). A qualitative investigation of adolescents’ perceived mechanisms of change from a universal school-based depression prevention program. International Journal of Environmental Research and Public Health, 11, 5541-5554, doi:10.3390/ijerph110x0000x

Silk, J. S., Vanderbilt-Adriance, E., Shaw, D. S., Forbes, E. E., Whalen, D. J., Ryan, N. D., & Dahl, R. E. (2007). Resilience among children and adolescents at risk for depression: Mediation and moderation across social and neurobiological contexts. Development and Psychopathology, 19, 841-865. doi:10.1017/S0954579407000417

38

Silvers, J. A., McRae, K., Gabrieli, J. D. E., Gross, J. J., Remy, K. A., & Ochsner, K. N. (2012). Agerelated differences in emotional reactivity, regulation, and rejection sensitivity in adolescence. Emotion, 12, 1235–1247. doi:10.10037/a0028297

Solomon, M., Goodlin-Jones, B. L., & Anders, T. (2004). A social adjustment enhancement intervention for high functioning autism, asperger’s syndrome, and pervasive developmental disorder NOS. Journal of Autism and Developmental Disorders, 34, 649-668. doi:10.1007/s10803-004-5286-y

Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S. P., & Carter, C. S. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism

and Developmental Disorders, 42, 48-59. doi:10.1007/s10803-011-1215-z

Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental

Review, 28, 78–106. doi: 10.1016/j.dr.2007.08.002

Sterling, L., Dawson, G., Estes, A., & Greenson, J. (2008). Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of Autism and

Developmental Disorders, 38, 1011-1018. doi:10.1007/s10803-007-0477-y

Sterzing, P. R., Shattuck, P. T., Narendorf, S. C., Wagner, M., & Cooper, B. P. (2012). Bullying involvement and autism spectrum disorders: Prevalence and correlates of bullying involvement among adolescents with an autism spectrum disorder. Archives of Pediatrics & Adolescent

Medicine, 166, 1058-1064. doi:10.1001/archpediatrics.2012.790

Stewart, D. E. (2008). Implementing mental health promotion in schools: A process evaluation. International Journal of Mental Health Promotion, 10, 32-41. doi: 10.1080/14623730.2008.9721755

Stewart, D. E., Sun, J., Patterson, C., Lemerle, K. & Hardie, M.W. (2004). Promoting and building resilience in primary school communities: Evidence from a comprehensive ‘health promoting school’ approach. International Journal of Mental Health Promotion, 6, 26-31. doi: 10.1080/14623730.2004.9721936

Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and asperger syndrome: A review. Autism, 10, 103-116. doi: 10.1177/1362361306062013

Stice, E., Shaw, H., Bohon, C., Marti, N., C., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486-503. doi:10.1037/A0015168

Stroud, L. R., Foster, E., Papandonatos, G. D., Handwerger, K., Granger, D. A., Kivlighan, K. T., & Niaura, R. (2009). Stress response and the adolescent transition: Performance versus peer rejection stressors. Development and Psychopathology, 21, 47-68. doi:10.1017/S0954579409000042

Tantam, D. (2000). Psychological disorder in adolescents and adults with asperger syndrome. Autism, 4, 47-62. doi:10.1177/1362361300004001004

Tavernor, L., Barron, E., Rodgers, J., & McConachie, H. (2013). Finding out what matters: Validity of quality of life measurement in young people with ASD. Child: Care, Health and Development, 39, 592-601. doi:10.1111/j.1365-2214.2012.01377.x

Taylor, J. L., & Seltzer, M. M. (2011). Employment and post-secondary educational activities for young adults with autism spectrum disorders during the transition to adulthood. Journal of Autism and

Developmental Disorders, 41, 566-574. doi:10.1007/s10803-010-1070-3

39

Taylor, J. L., Henninger, N. A., & Mailick, M. R. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19, 785–793. doi: 10.1177/1362361315585643

Titelman, P. (Ed.). (2014). Differentiation of self: Bowen family systems theory. New York, NY: Routledge. van Heijst, B. F., & Geurts, H. M. (2015). Quality of life in autism across the lifespan: A metaanalysis. Autism, 19, 158-167. doi:10.1177/1362361313517053

Vohs, K. D., & Finkel, E. J. (2006). Self and relationships: Connecting intrapersonal and interpersonal

processes. New York, NY: Guilford Press.

Wanberg, C. R., Glomb, T. M., Song, Z., & Sorenson, S. (2005). Job-search persistence during unemployment: A 10-wave longitudinal study. Journal of Applied Psychology, 90, 411–430. doi: 10.1037/0021-9010.90.3.411

Wang, P., & Spillane, A. (2009). Evidence-based social skills interventions for children with autism: A meta-analysis. Education and Training in Developmental Disabilities, 44, 318-342.

White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1006-1013. doi: 10.1007/s10803-009-0713-8.

White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216-229. doi: 10.1016/j.cpr.2009.01.003.

Whitehouse, A. J. O., Durkin, K., Jaquet, E., & Ziatas, K. (2009). Friendship, loneliness and depression in adolescents with asperger’s syndrome. Journal of Adolescence, 32, 309-322. doi:10.1016/j.adolescence.2008.03.004

Whitlock, J. L. (2006). Youth perceptions of life at school: Contextual correlates of school connectedness in adolescence. Applied Developmental Science, 10, 13-29. doi: 10.1207/s1532480xads1001_2

Wigfield, A., Eccles, J. S., MacIver, D., Reuman, D. A., & Midgley, C. (1991). Transitions during early adolescence: Changes in children’s domain-specific self-perceptions and general selfesteem across the transition to junior high school. Developmental Psychology, 27, 552–565. doi: 10.1037//0012-1649.27.4.552

Williams, K., Macdermott, S., Ridley, G., Glasson, E. J., & Wray, J. A. (2008). The prevalence of autism in Australia. Can it be established from existing data? Journal of Paediatrics and Child Health, 44, 504-510. doi: 10.1111/j.1440-1754.2008.01331.x.

Williamson, S., Craig, J., & Slinger, R. (2008). Exploring the relationship between measures of selfesteem and psychological adjustment among adolescents with asperger syndrome. Autism, 12, 391-402. doi:10.1177/1362361308091652

Witherspoon, D., Schotland, M., Way, N., & Hughes, D. (2009). Connecting the dots: How connectedness to multiple contexts influences the psychological and academic adjustment of urban youth. Applied Developmental Science, 13, 199–216. doi:10.1080/10888690903288755

Yap, M. B., Allen, N. B., & Sheeber, L. (2007). Using an emotion regulation framework to understand the role of temperament and family processes in risk for adolescent depressive disorders. Clinical

Child and Family Psychology Review, 10, 180–196. doi: 10.1007/s10567-006-0014-0

40

You, S., Furlong, M. J., Felix, E., Sharkey, J. D., Green, J. G., & Tanigawa, D. (2008). Relations among school connectedness, hope, life satisfaction, and bully victimization. Psychology in the Schools, 45, 446–460. doi:10.1002/pits.20308

Young, J. F., Mufson, L., & Gallop, R. (2010). Preventing depression: A randomized trial of interpersonal psychotherapy-adolescent skills training. Depression and Anxiety, 27, 426-433. doi:10.1002/da.20664

Zablotsky, B., Boswell, K., & Smith, C. (2012). An evaluation of school involvement and satisfaction of parents of children with autism spectrum disorders. American Journal on Intellectual and

Developmental Disabilities, 117, 316-330. doi:10.1352/1944-7558-117.4.316

Zhao, Y., & Zhao, G. (2015). Emotion regulation and depressive symptoms: Examining the mediation effects of school connectedness in Chinese late adolescents. Journal of Adolescence, 40, 14- 23. doi: 10.1016/j.adolescence.2014.12.009

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