Does Treatment Stigma Among Autistic Adolescents and Guardians of Autistic Adolescents Affect the Effectiveness of Cognitive Behavioral Therapy? An Observational Study

Does Treatment Stigma Among Autistic Adolescents and Guardians of Autistic Adolescents Affect the Effectiveness of Cognitive Behavioral Therapy? 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An Observational Study Emiko Oshita, Fumiyo Oshima, Minako Hongo, Siqing Guan, Yusuke Nitta, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1385134/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study explores how treatment stigma of Autistic adolescents, and their guardians affects the effectiveness of cognitive behavioral therapy (CBT) interventions. Methods The intervention group in the randomization consisted of Autistic adolescents, n = 23 (16 boys, 7 girls, mean age 12.8 years) and their guardians, n = 23 (1 male, 22 females, mean age 44.8 years). Their questionnaire data were used. The changes in the Barriers to Access to Care Evaluation scale version 3 (BACEv3) before the intervention and other tests after the intervention were analyzed using Spearman's rank correlation coefficient. Results The Spearman's rank correlation coefficient analysis showed that the BACEv3 of Autistic adolescents did not correlate with the change in any of the scales. Guardians' BACEv3 was significantly correlated with Autistic adolescents’ Autistic traits knowledge of Autism Spectrum Disorder characteristics and communication of adaptive behavior. Conclusions The results suggest that the presence of treatment stigma in Autistic adolescents does not affect CBT interventions. It was also suggested that guardianship treatment stigma did not reduce the effectiveness of CBT interventions for Autistic adolescents. These findings will help us to understand the role of treatment stigma in CBT interventions for Autistic adolescents and their guardians. Trial registration: University Hospital Medical Information Network (UMIN 000029851). Registered January 6, 2018. Background Autism Spectrum Disorder (ASD) is a group of neurodevelopmental disorders characterized primarily by "impaired interpersonal communication" and "limited and repetitive behavioral patterns"[ 1 ]. This heterogeneity ranges across the full range of IQ and language functioning, diverse communication, social, and behavioral deficits [ 2 ]. Autistic adolescents may have poor adaptive behaviors even when they have normal cognitive abilities [ 3 – 7 ]. Therefore, even cases of high cognitive ability require diagnosis and support [ 8 ]. Stigma refers to prejudice against "undesirable kinds of attributes" [ 9 ]. Treatment stigma, in particular, refers to prejudice and discrimination against receiving treatment and support [ 10 ] and is a factor that inhibits help-seeking from treatment and support agencies [ 11 ]. The longer treatment stigma exists and extended treatment and support are refused, the worse the outcome is likely to be [ 12 ]. In a study on the relationship between autism and stigma, researchers in Japan developed and implemented an awareness program to reduce public stigma about disability; the program resulted in reduced stigma and improved knowledge [ 13 ]. Online classes on ASD improved college students' knowledge of ASD and reduced stigma against it [ 14 , 15 ]. However, these studies were solely about public stigma of ASD. Therefore, it is worthwhile to examine the impact of treatment stigma. Cognitive Behavioral Therapy (CBT) has been shown to be effective for both children and adults with ASD [ 16 – 18 ]. For example, it has been suggested that CBT reduces anxiety symptoms in young people and those with ASD [ 19 – 21 ], decreases symptoms of depression and stress [ 22 ], and is effective in treating comorbid Obsessive Compulsive Disorder in youth and adults with ASD [ 23 ]. The Program for Education and Enrichment of Relationship Skills (PEERS) for Young Adults led to an improvement in the social skills of adolescents and young adults [ 24 – 26 ]. Psychoeducation about disability has been shown to increase knowledge and positive attitudes toward disability [ 27 ]. Psychoeducational programs that teach Autistic adolescents about their disability increase knowledge and awareness of ASD [ 28 ]. The stigma around ASD undermines the mental health and quality of life of the guardians of Autistic adolescents as well [ 29 – 31 ]. A decrease in guardianship treatment stigma also contributes to improved parental mental health [ 32 , 33 ]. Following such research, we developed Aware and Care for my Autistic Traits (ACAT), a program that integrates CBT and psychoeducation to promote understanding of ASD for diagnosed adolescents and their guardians, and implemented it for two years starting in 2018 [ 34 ]. The results showed that the intervention group of children with ASD had significantly improved awareness and mental health, and reduced treatment stigma. ASD awareness significantly improved in the guardian intervention group as well, compared to the control group (Oshima et al., in submission). The purpose of this study is to determine whether the treatment stigma of Autistic adolescents and their guardians who participated in the ACAT clinical trial as the intervention group affects the effectiveness of the intervention in the trial. Two hypotheses were formulated in this study. (1) The higher the treatment stigma of autistic adolescents, the less CBT can improve AS traits and adaptive behavior. (2) The higher the treatment stigma of the guardians, the less the effects of CBT on the guardians of the autistic adolescents can be improved. Methods This study used data from the ACAT clinical trial (Oshima et al., in submission) with six weeks psychosocial education program by CBT at Chiba University. The intervention group in the randomization consisted of Autistic adolescents, n = 23 (16 boys, 7 girls; mean age 12.8 ± 2.2 years) and their guardians, n = 23 (one male, 22 females; mean age 44.8 ± 6.1 years). Eligibility and exclusion criteria were as follows. Demographic characteristics of participants are summarized in Table 1 and Table 2 . [Table 1 near here] [Table 2 near here] Relevant standards Autistic adolescents: 1) Those who have been diagnosed and notified by a psychiatrist that their primary diagnosis is ASD and who also meet the criteria for ASD on either the Autism Diagnostic Observation Schedule (ADOS-2) or Autism Diagnostic Interview-Revised (ADI-R); 2) A verbal IQ of 90 or higher on the Wechsler Intelligence Test; 3) The Strengths and Difficulties Questionnaires (SDQ) with a score of moderate (Some need) or higher; 4) The applicant must be between 10 and 17 years of age at the time of obtaining consent, and one parent or guardian must be able to participate in the CBT. Guardians of Autistic adolescents: Those whose guardians did not meet the diagnostic criteria for mental illness in the Japanese version of the Brief Structured Interview for Mental Illness. Exclusion Criteria: Organic brain disorder (including dementia), psychotic disorder, bipolar disorder, drug dependence, or other mental severe disorder complicated by psychosis, imminent suicide risk, antisocial behavior, or significant progressive physical illness. Endpoints used in this study The Autism Knowledge Quiz-Child (AKQ-C) and Autism Knowledge Quiz-Guardians/Parents (AKQ-P) [ 28 ], which is a five-item structured interview that measures understanding of ASD characteristics and 15 sections of the item knowledge quiz. Both child self-administered and guardian self-administered questions were asked to be answered. The Barriers to Access to Care Evaluation scale version 3 (BACEv3) [ 10 ] is a 30-item questionnaire that measures treatment stigma related to mental health and has a four-point scale ranging from "not at all" to "quite a bit." Children and guardians were each asked to respond. The Depression Self-Rating Scale for Children (DSRS-C) [ 35 ] is an 18-item self-assessment questionnaire for depression in children. The children were asked to rate their level of depression by answering "always," "sometimes," and "never.” The Strengths and Difficulties Questionnaire (SDQ) [ 36 ] is a self-administered questionnaire designed to comprehensively assess adjustment and mental health status from early childhood through adolescence. The questionnaire consists of 25 items, each of which requires a response of "yes," "somewhat yes," or "no." The rating is divided into three levels: “low need,” “some need,” and “high need.” Guardians were asked to fill in the form. In the Vineland Adaptive Behavior Scales Second Edition (Vineland-II) [ 37 ], children’s adaptive behavior is graded in four domains: "communication domain," "daily skill domain," "sociality domain," and "motor skills.” Three domains were graded except for "motor skills," where the evaluation target was up to 6 years old. A semi-structured interview was conducted with the guardians. The 12-item General Health Questionnaire (GHQ-12) [ 38 ] is a self-administered questionnaire that measures the presence of mental and physical problems in the health of the child from the first day of the child's life to the present and consists of 12 items to be answered using a four- point scale: "less than usual", "no more than usual", "rather more than usual", "or much more than usual". Guardians were asked to respond. The Parenting Resilience Elements Questionnaire (PREQ) [ 39 ] of guardians with developmental disabilities is a self-administered questionnaire that measures the strength of nurturing resilience, with 16 items answered using a seven-point scale ranging from "not at all true" to "very true." Guardians were asked to respond. Analysis method For hypothesis (1), the change in BACEv3 at pretest and the change in other tests at posttest in Autistic adolescents was calculated by Spearman rank correlation coefficients for the intervention group and the control group were calculated. For hypothesis (2), the change in guardians' BACEv3 at Pre and the change in other tests at Post were calculated by Spearman rank correlation coefficients were calculated for the intervention and control groups, respectively. All these analyses were performed using SPSS Statistics Version 27.0 (IBM Armonk, New York, USA). The p-value was set at .05 to determine significance. Results As a result of the hypothesis analysis (1), BACEv3 of Autistic adolescents in the intervention group was not correlated with the amount of change in any scale. As a result of the analysis of hypothesis (2), BACEv3 of guardians in the intervention group was significantly correlated with the AS traits knowledge of ASD and communication of adaptive behavior. There was a positive (r = 0.681, p < 0.01) and moderate correlation between baseline guardians' BACEv3 and the amount of change in AKQ-C "knowledge." There was a negative (r = 0.534, p < 0.05) and moderate correlation between baseline guardians' BACEv3 and the amount of change in Vineland II "communication" (receptive/expressive language, reading and writing) (Table 3 ). [Table 3 near here] Discussion The purpose of this study was to determine whether the treatment stigma of Autistic adolescents and their guardians affected the effectiveness of the ACAT intervention. The Spearman's rank correlation coefficient analysis showed that the BACEv3 of Autistic adolescents did not correlate with the change in any of the scales. Guardians' BACEv3 was significantly correlated with Autistic adolescents’ knowledge of ASD characteristics and communication of adaptive behavior. The study examined two hypotheses. The first hypothesis is that the higher the treatment stigma of autistic adolescents, the less CBT can improve autistic traits and adaptive behavior. Based on previous studies by Corrigan et al. (2004) and Gulliver et al. (2010), we predicted that high treatment stigma in Autistic adolescents would reduce the effect of CBT intervention, but in the present study, high treatment stigma in Autistic adolescents was uncorrelated with the amount of change in intervention. Therefore, this hypothesis was rejected. Thus, at least for Autistic adolescents, the individual's treatment stigma was not expected to affect treatment effectiveness. Secondly, the higher the treatment stigma of the guardians, the less the effects of CBT on the guardians of the autistic adolescents can be improved. Although there were changes in measures related to Autistic adolescents among guardians in the intervention group, there were no significant differences in the amount of change in measures related to guardians. This suggests that guardianship treatment stigma did not affect the guardians' intervention. Contrary to the prediction that high guardianship treatment stigma would reduce CBT effectiveness for guardians and Autistic adolescents, Autistic adolescents in the intervention group showed an increase in knowledge of ASD. This may be due to the high treatment stigma of the guardians, which may have led to a less open discussion of ASD between guardians and children. Furthermore, the Autistic adolescents’ knowledge at the pre-intervention time point may have been low to begin with. Additionally, there was a decrease in communication (receptive/expressive language, reading, and writing) of the Autistic adolescents. This may be because the guardians’ lack of knowledge prior to the intervention may have led them to overestimate their assessment of the Autistic adolescents and evaluate them as if they were neurotypical children. One factor that may have contributed to the lack of association between guardians' treatment stigma and changes in the intervention was that the BACEv3 is a measure of self-treatment stigma, and therefore the child's intervention, the ACAT, may not have been correctly reflected on the ACAT. A recently reported study has shown that treatment stigma prevents people from seeking help [ 11 ]; however, this study suggests that treatment stigma does not have an impact. Notably, people already undergoing treatment participated in the original study [ 34 ]. Therefore, it can be said that the study showed that high treatment stigma does not affect the intervention only for those who are undergoing treatment. An environment where treatment and support are appropriately and easily connected is important for children with ASD and their parents, who have high treatment stigma. It would be good if there were a mechanism or system that allows everyone to easily connect to welfare and clinical services for support and treatment. If the findings from the past and future research can be part of the construction of such a system, even those with high treatment stigma who are not receiving support may be able to access support. Limitations The participants in this study were Autistic adolescents and guardians who actively avoided or did not receive treatment or support, as the study dealt with treatment stigma while participating in an intervention trial. Regarding guardianship treatment stigma, we did not measure guardians' treatment stigma. It may be necessary to examine treatment stigma for Autistic adolescents and their guardians who are not receiving assistance in the future. In addition, because we used data from an intervention trial, the number of samples was relatively small, and there is a need to reanalyze the results with a more significant number of samples. Conclusions Even when Autistic adolescents had treatment stigma, there was no change between high treatment stigma and the effect of the intervention, suggesting that treatment stigma had no effect. Even when guardians' treatment stigma was high, CBT interventions for Autistic adolescents increased knowledge, suggesting that it also did not reduce the effectiveness of the intervention for Autistic adolescents. List Of Abbreviations ACAT Aware and Care for my Autistic Traits ADI-R Autism Diagnostic Interview-Revised ADOS-2 Autism Diagnostic Observation Schedule ASD Autism Spectrum Disorder AKQ-C Autism Knowledge Quiz-Child AKQ-P Autism Knowledge Quiz-Guardians/Parents BACEv3 Barriers to Access to Care Evaluation scale version 3 CBT Cognitive Behavioral Therapy DSRS-C Depression Self-Rating Scale for Children GHQ-12 General Health Questionnaire PREQ Parenting Resilience Elements Questionnaire SDQ Strength and Difficulties Questionnaire Vineland-II Vineland Adaptive Behavior Scales Second Edition Declarations Ethics approval and consent to participate : This study used data from ACAT clinical trial. It was approved by the Chiba University Clinical Research Ethics Review Committee (CRB3180015, No. G29027). All methods were carried out in accordance with the Declaration of Helsinki. This clinical trial has been registered with the University Hospitals Medical Information Network (UMIN 000029851). Written Consent has been obtained from a parent or legally authorized representative. Consent forms were submitted by each of the participating parents and children. Consent for publication : Not applicable. Availability of data and materials : The data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : The study was supported by the special research grant (No. 2017 S-1) of the Association of Japanese Clinical Psychology, which is a non-profit association for clinical psychology in Japan. The funders had no role in the design of the study; collection, analysis, and interpretation of the data; or in writing the manuscript. Author’s contributions : EO and SG analyzed data from Autistic adolescents and their guardians on the impact of CBT intervention on treatment stigma; YN and MH interpreted the data; EO contributed to writing the manuscript; FO was involved in all aspects of the preparation of the paper. ES was the general supervisor. All authors read and approved the final manuscript. Acknowledgments : Not applicable. References American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders 5Ed Dsm-5. 5th ed. Washington, D.C: Amer Psychiatric Pub Inc; 2013. Jones W, Klin A. Heterogeneity and Homogeneity Across the Autism Spectrum: The Role of Development. J Am Acad Child Adolesc Psychiatry. 2009;48:471–3. Klin A, Saulnier CA, Sparrow SS, Cicchetti DV, Volkmar FR, Lord C. Social and Communication Abilities and Disabilities in Higher Functioning Individuals with Autism Spectrum Disorders: The Vineland and the ADOS. J Autism Dev Disord. 2007;37:748–59. Kenworthy L, Case L, Harms MB, Martin A, Wallace GL. Adaptive Behavior Ratings Correlate With Symptomatology and IQ Among Individuals With High-Functioning Autism Spectrum Disorders. J Autism Dev Disord. 2010;40:416–23. Volker MA, Lopata C, Smerbeck AM, Knoll VA, Thomeer ML, Toomey JA, et al. BASC-2 PRS Profiles for Students with High-Functioning Autism Spectrum Disorders. J Autism Dev Disord. 2010;40:188–99. Kanne SM, Gerber AJ, Quirmbach LM, Sparrow SS, Cicchetti DV, Saulnier CA. The Role of Adaptive Behavior in Autism Spectrum Disorders: Implications for Functional Outcome. J Autism Dev Disord. 2011;41:1007–18. Pugliese CE, Anthony L, Strang JF, Dudley K, Wallace GL, Kenworthy L. Increasing Adaptive Behavior Skill Deficits From Childhood to Adolescence in Autism Spectrum Disorder: Role of Executive Function. J Autism Dev Disord. 2015;45:1579–87. Tillmann J, San José Cáceres A, Chatham CH, Crawley D, Holt R, Oakley B, et al. Investigating the factors underlying adaptive functioning in autism in the EU-AIMS Longitudinal European Autism Project. Autism Res. 2019;12:645–57. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Reissue edition. New York: Touchstone; 1986. Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012;12:36. Salaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: a cross-sectional survey. Br J Gen Pract. 2016;66:e686–92. Marshall M. Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-Episode Patients: A Systematic Review. ARCH GEN PSYCHIATRY. 2005;62:9. Torii M, Umeda M, Someki F, Kondo T, Ogawa H, Shikibe Y, et al. Survey of stigma towards Neurodevelopmental Disabilities in High School Students and Effectiveness of the Online Education Program of Understanding Neurodevelopmental Disabilities. Bull Grad Sch Hum Dev Enviroment. 2021;14:69–77. (in Japanese) Gillespie-Lynch K, Brooks PJ, Someki F, Obeid R, Shane-Simpson C, Kapp SK, et al. Changing College Students’ Conceptions of Autism: An Online Training to Increase Knowledge and Decrease Stigma. J Autism Dev Disord. 2015;45:2553–66. Someki F, Torii M, Brooks PJ, Koeda T, Gillespie-Lynch K. Stigma associated with autism among college students in Japan and the United States: An online training study. Res Dev Disabil. 2018;76:88–98. Weston L, Hodgekins J, Langdon PE. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2016;49:41–54. Maddox BB, Miyazaki Y, White SW. Long-Term Effects of CBT on Social Impairment in Adolescents with ASD. J Autism Dev Disord. 2017;47:3872–82. Spain D, Happé F. How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study. J Ration-Emotive Cogn-Behav Ther. 2020;38:184–208. Sung M, Ooi YP, Goh TJ, Pathy P, Fung DSS, Ang RP, et al. Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial. Child Psychiatry Hum Dev. 2011;42:634–49. White SW, Ollendick T, Albano AM, Oswald D, Johnson C, Southam-Gerow MA, et al. Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder. J Autism Dev Disord. 2013;43:382–94. Wood JJ, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E, et al. Cognitive Behavioral Therapy for Early Adolescents With Autism Spectrum Disorders and Clinical Anxiety: A Randomized, Controlled Trial. Behav Ther. 2015;46:7–19. McGillivray JA, Evert HT. Group Cognitive Behavioural Therapy Program Shows Potential in Reducing Symptoms of Depression and Stress Among Young People with ASD. J Autism Dev Disord. 2014;44:2041–51. Russell AJ, Jassi A, Fullana MA, Mack H, Johnston K, Heyman I, et al. COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL: Research Article: CBT for OCD for Adults with ASD. Depress Anxiety. 2013;30:697–708. Gantman A, Kapp SK, Orenski K, Laugeson EA. Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study. J Autism Dev Disord. 2012;42:1094–103. Laugeson EA, Frankel F, Gantman A, Dillon AR, Mogil C. Evidence-Based Social Skills Training for Adolescents with Autism Spectrum Disorders: The UCLA PEERS Program. J Autism Dev Disord. 2012;42:1025–36. Schohl KA, Van Hecke AV, Carson AM, Dolan B, Karst J, Stevens S. A Replication and Extension of the PEERS Intervention: Examining Effects on Social Skills and Social Anxiety in Adolescents with Autism Spectrum Disorders. J Autism Dev Disord. 2014;44:532–45. Nussey C, Pistrang N, Murphy T. How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder: A review of psychoeducational approaches in TS and ADHD. Child Care Health Dev. 2013;39:617–27. Gordon K, Murin M, Baykaner O, Roughan L, Livermore-Hardy V, Skuse D, et al. A randomised controlled trial of PEGASUS, a psychoeducational programme for young people with high-functioning autism spectrum disorder. J Child Psychol Psychiatry. 2015;56:468–76. Werner S, Shulman C. Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables. Res Dev Disabil. 2013;34:4103–14. Papadopoulos C, Lodder A, Constantinou G, Randhawa G. Systematic Review of the Relationship Between Autism Stigma and Informal Caregiver Mental Health. J Autism Dev Disord. 2019;49:1665–85. Shepherd D, Landon J, Goedeke S, Meads J. Stress and distress in New Zealand parents caring for a child with autism spectrum disorder. Res Dev Disabil. 2021;111:103875. Chan KKS, Lam CB. Trait Mindfulness Attenuates the Adverse Psychological Impact of Stigma on Parents of Children with Autism Spectrum Disorder. Mindfulness. 2017;8:984–94. Lodder A, Papadopoulos C, Randhawa G. Stigma of living as an autism carer: a brief psycho-social support intervention (SOLACE). Study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud. 2019;5:34. Oshima F, William M, Takahashi N, Tsuchiyagaito A, Kuwabara H, Shiina A, et al. Cognitive-behavioral family therapy as psychoeducation for adolescents with high-functioning autism spectrum disorders: Aware and Care for my Autistic Traits (ACAT) program study protocol for a pragmatic multisite randomized controlled trial. Trials. 2020;21:814. Birleson P, Hudson I, Buchanan DG, Wolff S. Clinical evaluation of a self-rating scale for depressive disorder in childhood (Depression Self-Rating Scale). J Child Psychol Psychiatry. 1987;28:43–60. Goodman R. The Strengths and Difficulties Questionnaire: A Research Note. J Child Psychol Psychiatry. 1997;38:581–6. Sparrow SS, Cicchetti DV, Balla DA. Vineland Adaptive Behavior Scales–Second Edition (Vineland–II). 2nd edition. Minneapolis: NCS Pearson Inc; 2005. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;:4. Suzuki K, Kobayashi T, Moriyama K, Kaga M, Hiratani M, Watanabe K, et al. Development and Evaluation of a Parenting Resilience Elements Questionnaire (PREQ) Measuring Resiliency in Rearing Children with Developmental Disorders. PLOS ONE. 2015;10:e0143946. Tables Table 1 . Demographic for Autistic adolescents of COMB/TAU groups （from Original study） Demographic variables Total ｎ＝45(N%) TAU group n=22(Row%) ＣＯＭＢgroup n = 23(Row%) Test ｐ-value Sex/ Gender ｐ＝.5589 Male 33 17(51.5) 16(48.5) Female 12 5(41.7) 7(58.3) School attendance ｐ＝.295 Everyday 29 14(48.3) 15 (51.7) Less than one-third of the semester 1 1(10.0) 0 ( 0.0) No attendance 13 5(38.5) 8 (61.5) Non-student 2 2(100.0) 0(0.0) Academic background (%) p =.139 Primary- high school students 43(95.6) 20(46.5) 23 (53.3) Junior high school graduates 2(4.4) 2(100.0) 0(0.0) Total years of education p =.0541 Mean ( SD ) 8.0( SD 2.2 ) 8.6( SD 1.9) 7.3( SD 2.3) Support and Consideration at school p =.117 Support classes 5(11.1) 1(20.0) 4(80.0) Special classes 2(4.4) 0(0.0) 2(100.0) Consideration 2(4.4) 2(100.0) 0(0.0) Non-Support・Consideration 36(80.0) 19(52.8) 17(47.2) Age at diagnosis -year p =.878 Mean ( SD ) 10.3( SD 4.1) 10.4( SD 4.9) 10.2( SD 3.3) Complications p =.668 Without 26(57.8) 12(46.2) 14(53.8) With 19(42.2) 10(52.6) 9(47.4) Table 2 . Demographic for Guardians of COMB/TAU group (from Original study） Demographic variables Total ｎ＝45(N%) TAU group n=22(Row5) ＣＯＭＢgroup n = 23(Row%) Test ｐ-value Sex/ Gender ｐ＝.3226 Father 1(2.2) 0(0.0) 1(100.0) Mother 44(97.8) 22(50.0) 22(50.0) Total years of education p =.3075 Mean ( SD ) 14.3( SD 1.6) 14.6( SD 1.4) 14.1( SD 1.8) Total years of work p =.1874 Mean ( SD ) 14.4( SD 8.2) 12.7( SD 8.4) 16.0( SD 7.8) Current employment status ｎ（％） p =.0981 No 17(37.0) 11(64.7) 6(35.3) Reason: Homemaker 11(64.7) 6(35.3) Yes 28(62.2) 11(39.3) 17(60.7) Full-time employment 13(46.4) 5(38.5) 8(61.5) Part-time employment 15(51.7) 6(40.0) 9(60.0) Household income n(%) p=.5311 4000000 yen* level or less 6(13.4) 4(66.7) 2(33.3) 5000000 yen – 8000000yen level 25(55.6) 13(52.0) 12(48.0) 9000000 yen level or more 14(31.0) 5(35.7) 9(64.3) Support for parents n (%) p =.4773 Non-use 37(82.2) 18(48.6) Use 8(17.8) 5(62.5) Past medical history p =.7655 No 36(80.0) 18(50.0) Yes 9(20.0) 5(55.6) *1US dollar = 115 Japanese Yen(JPY) Table 3 . Correlations between BACEv3 and Pre-Post changes in other measures for guardians and autistic adolescents’ pre-intervention Variation Pre to post Baseline Intervention group Autistic adolescents BACEv3 Guardians of autistic adolescents BACEv3 Frequency n Autistic adolescents AKQ-C strength . 094 -.036 21 AKQ-C weak -.251 -.103 21 AKQ-C knowledge -.288 .681** 18 SDQ -.170 -.205 21 DSRSC -.333 .204 21 Vineland II Communication . 102 -.534* 21 Vineland II Daily living .209 -.390 21 Vineland II Social .204 .048 21 Guardians of autistic adolescents AKQ-P strength -.085 -.125 21 AKQ-P weak -.022 -.186 21 AKQ-P knowledge -.316 .326 19 GHQ-12 -.412 .158 21 PREQ .253 -.050 21 Process variables were calculated by comparing BACEv3 pre-intervention with the amount of change in scores before and after the intervention. Statistical significance was evaluated by Spearman's correlation coefficient. ** p<.01, * p<.05 AKQ-C, Autism Knowledge Quiz-Child; AKQ-P, Autism Knowledge Quiz-Guardians; SDQ, Strengths and Difficulties Questionnaire; DSRSC, Depression Self-Rating Scale for Children; Vineland II, Vineland Adaptive Behavior Scale Second Edition; GHQ, The 12-item General Health Questionnaire; PREQ, Parenting Resilience Elements Questionnaire. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1385134","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":88806703,"identity":"7cbc22b3-73cd-41c8-9f02-b5083bba873a","order_by":0,"name":"Emiko Oshita","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABH0lEQVRIie2RMUvDQBiGv+PkpsOsXxbzFy4EYhbrX7kQ6FSqkKWDBEFIl+KcEql/QSh0PgnE5cA1YyGrQ0AomYpxCFhJtKNgnunluIf3vu8ABgb+IlapnLpGabQH2AZy2+eMZUgWnjTbC0coE/EObCaF+q70IZS219ccp87LXVnBLLLMuWIINyOgaXeNeI5DJ/EwdHXuIujMTrlslDwA8qC6lYxuBOfob4oJAxIrsoKrHQJTQBLZreRwXnOG/vrxjVYkji5XxrZp2f+g6BPhfCpPyAFJTP0Um4c1db2KWTBpLxcYoh67KHUWLJMt9fz7gPfNclpQJao6mhrzrKyqWXSRvEpSVLvRmd2zsUPkl8Dt5AjjEOvXTx0YGBj4J3wAiqlczDn0fEsAAAAASUVORK5CYII=","orcid":"","institution":"Osaka University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Emiko","middleName":"","lastName":"Oshita","suffix":""},{"id":88806704,"identity":"bb36b1bd-c11f-4143-8cea-4dadb1e2dc8e","order_by":1,"name":"Fumiyo Oshima","email":"","orcid":"","institution":"Osaka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fumiyo","middleName":"","lastName":"Oshima","suffix":""},{"id":88806705,"identity":"328302ea-93a9-4b66-bee3-d54bfd658064","order_by":2,"name":"Minako Hongo","email":"","orcid":"","institution":"Osaka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Minako","middleName":"","lastName":"Hongo","suffix":""},{"id":88806706,"identity":"814aecec-bead-45b7-9007-cdf0473a7600","order_by":3,"name":"Siqing Guan","email":"","orcid":"","institution":"Chiba University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Siqing","middleName":"","lastName":"Guan","suffix":""},{"id":88806707,"identity":"ff7f5559-a79c-481d-90a3-817db6c3281a","order_by":4,"name":"Yusuke Nitta","email":"","orcid":"","institution":"Chiba University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yusuke","middleName":"","lastName":"Nitta","suffix":""},{"id":88806708,"identity":"4f595d74-3dc4-404b-9710-c98293224bf8","order_by":5,"name":"Eiji Shimizu","email":"","orcid":"","institution":"Osaka University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eiji","middleName":"","lastName":"Shimizu","suffix":""}],"badges":[],"createdAt":"2022-02-22 12:59:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1385134/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1385134/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19807454,"identity":"0f833c27-5971-40a3-b91e-2ce6b0f66557","added_by":"auto","created_at":"2022-03-31 07:14:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":273476,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1385134/v1/e6c5af1a-a3d9-40fd-98c2-8fa4aca6efbf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDoes Treatment Stigma Among Autistic Adolescents and Guardians of Autistic Adolescents Affect the Effectiveness of Cognitive Behavioral Therapy? An Observational Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAutism Spectrum Disorder (ASD) is a group of neurodevelopmental disorders characterized primarily by \"impaired interpersonal communication\" and \"limited and repetitive behavioral patterns\"[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This heterogeneity ranges across the full range of IQ and language functioning, diverse communication, social, and behavioral deficits [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Autistic adolescents may have poor adaptive behaviors even when they have normal cognitive abilities [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, even cases of high cognitive ability require diagnosis and support [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Stigma refers to prejudice against \"undesirable kinds of attributes\" [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Treatment stigma, in particular, refers to prejudice and discrimination against receiving treatment and support [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and is a factor that inhibits help-seeking from treatment and support agencies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The longer treatment stigma exists and extended treatment and support are refused, the worse the outcome is likely to be [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a study on the relationship between autism and stigma, researchers in Japan developed and implemented an awareness program to reduce public stigma about disability; the program resulted in reduced stigma and improved knowledge [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Online classes on ASD improved college students' knowledge of ASD and reduced stigma against it [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, these studies were solely about public stigma of ASD. Therefore, it is worthwhile to examine the impact of treatment stigma.\u003c/p\u003e \u003cp\u003eCognitive Behavioral Therapy (CBT) has been shown to be effective for both children and adults with ASD [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. For example, it has been suggested that CBT reduces anxiety symptoms in young people and those with ASD [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], decreases symptoms of depression and stress [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and is effective in treating comorbid Obsessive Compulsive Disorder in youth and adults with ASD [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The Program for Education and Enrichment of Relationship Skills (PEERS) for Young Adults led to an improvement in the social skills of adolescents and young adults [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePsychoeducation about disability has been shown to increase knowledge and positive attitudes toward disability [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Psychoeducational programs that teach Autistic adolescents about their disability increase knowledge and awareness of ASD [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The stigma around ASD undermines the mental health and quality of life of the guardians of Autistic adolescents as well [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. A decrease in guardianship treatment stigma also contributes to improved parental mental health [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Following such research, we developed Aware and Care for my Autistic Traits (ACAT), a program that integrates CBT and psychoeducation to promote understanding of ASD for diagnosed adolescents and their guardians, and implemented it for two years starting in 2018 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The results showed that the intervention group of children with ASD had significantly improved awareness and mental health, and reduced treatment stigma. ASD awareness significantly improved in the guardian intervention group as well, compared to the control group (Oshima et al., in submission).\u003c/p\u003e \u003cp\u003eThe purpose of this study is to determine whether the treatment stigma of Autistic adolescents and their guardians who participated in the ACAT clinical trial as the intervention group affects the effectiveness of the intervention in the trial. Two hypotheses were formulated in this study. (1) The higher the treatment stigma of autistic adolescents, the less CBT can improve AS traits and adaptive behavior. (2) The higher the treatment stigma of the guardians, the less the effects of CBT on the guardians of the autistic adolescents can be improved.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study used data from the ACAT clinical trial (Oshima et al., in submission) with six weeks psychosocial education program by CBT at Chiba University. The intervention group in the randomization consisted of Autistic adolescents, n\u0026thinsp;=\u0026thinsp;23 (16 boys, 7 girls; mean age 12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 years) and their guardians, n\u0026thinsp;=\u0026thinsp;23 (one male, 22 females; mean age 44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1 years). Eligibility and exclusion criteria were as follows. Demographic characteristics of participants are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e[Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e near here]\u003c/p\u003e\n\u003cp\u003e[Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e near here]\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eRelevant standards\u003c/h2\u003e\n \u003cp\u003eAutistic adolescents: 1) Those who have been diagnosed and notified by a psychiatrist that their primary diagnosis is ASD and who also meet the criteria for ASD on either the Autism Diagnostic Observation Schedule (ADOS-2) or Autism Diagnostic Interview-Revised (ADI-R); 2) A verbal IQ of 90 or higher on the Wechsler Intelligence Test; 3) The Strengths and Difficulties Questionnaires (SDQ) with a score of moderate (Some need) or higher; 4) The applicant must be between 10 and 17 years of age at the time of obtaining consent, and one parent or guardian must be able to participate in the CBT.\u003c/p\u003e\n \u003cp\u003eGuardians of Autistic adolescents: Those whose guardians did not meet the diagnostic criteria for mental illness in the Japanese version of the Brief Structured Interview for Mental Illness. Exclusion Criteria: Organic brain disorder (including dementia), psychotic disorder, bipolar disorder, drug dependence, or other mental severe disorder complicated by psychosis, imminent suicide risk, antisocial behavior, or significant progressive physical illness.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003eEndpoints used in this study\u003c/h2\u003e\n \u003cp\u003eThe Autism Knowledge Quiz-Child (AKQ-C) and Autism Knowledge Quiz-Guardians/Parents (AKQ-P) [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], which is a five-item structured interview that measures understanding of ASD characteristics and 15 sections of the item knowledge quiz. Both child self-administered and guardian self-administered questions were asked to be answered. The Barriers to Access to Care Evaluation scale version 3 (BACEv3) [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e] is a 30-item questionnaire that measures treatment stigma related to mental health and has a four-point scale ranging from \u0026quot;not at all\u0026quot; to \u0026quot;quite a bit.\u0026quot; Children and guardians were each asked to respond. The Depression Self-Rating Scale for Children (DSRS-C) [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e] is an 18-item self-assessment questionnaire for depression in children. The children were asked to rate their level of depression by answering \u0026quot;always,\u0026quot; \u0026quot;sometimes,\u0026quot; and \u0026quot;never.\u0026rdquo; The Strengths and Difficulties Questionnaire (SDQ) [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e] is a self-administered questionnaire designed to comprehensively assess adjustment and mental health status from early childhood through adolescence. The questionnaire consists of 25 items, each of which requires a response of \u0026quot;yes,\u0026quot; \u0026quot;somewhat yes,\u0026quot; or \u0026quot;no.\u0026quot; The rating is divided into three levels: \u0026ldquo;low need,\u0026rdquo; \u0026ldquo;some need,\u0026rdquo; and \u0026ldquo;high need.\u0026rdquo; Guardians were asked to fill in the form. In the Vineland Adaptive Behavior Scales Second Edition (Vineland-II) [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e], children\u0026rsquo;s adaptive behavior is graded in four domains: \u0026quot;communication domain,\u0026quot; \u0026quot;daily skill domain,\u0026quot; \u0026quot;sociality domain,\u0026quot; and \u0026quot;motor skills.\u0026rdquo; Three domains were graded except for \u0026quot;motor skills,\u0026quot; where the evaluation target was up to 6 years old. A semi-structured interview was conducted with the guardians. The 12-item General Health Questionnaire (GHQ-12) [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e] is a self-administered questionnaire that measures the presence of mental and physical problems in the health of the child from the first day of the child\u0026apos;s life to the present and consists of 12 items to be answered using a four- point scale: \u0026quot;less than usual\u0026quot;, \u0026quot;no more than usual\u0026quot;, \u0026quot;rather more than usual\u0026quot;, \u0026quot;or much more than usual\u0026quot;. Guardians were asked to respond. The Parenting Resilience Elements Questionnaire (PREQ) [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e] of guardians with developmental disabilities is a self-administered questionnaire that measures the strength of nurturing resilience, with 16 items answered using a seven-point scale ranging from \u0026quot;not at all true\u0026quot; to \u0026quot;very true.\u0026quot; Guardians were asked to respond.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003eAnalysis method\u003c/h2\u003e\n \u003cp\u003eFor hypothesis (1), the change in BACEv3 at pretest and the change in other tests at posttest in Autistic adolescents was calculated by Spearman rank correlation coefficients for the intervention group and the control group were calculated.\u003c/p\u003e\n \u003cp\u003eFor hypothesis (2), the change in guardians\u0026apos; BACEv3 at Pre and the change in other tests at Post were calculated by Spearman rank correlation coefficients were calculated for the intervention and control groups, respectively.\u003c/p\u003e\n \u003cp\u003eAll these analyses were performed using SPSS Statistics Version 27.0 (IBM Armonk, New York, USA). The p-value was set at .05 to determine significance.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAs a result of the hypothesis analysis (1), BACEv3 of Autistic adolescents in the intervention group was not correlated with the amount of change in any scale. As a result of the analysis of hypothesis (2), BACEv3 of guardians in the intervention group was significantly correlated with the AS traits knowledge of ASD and communication of adaptive behavior. There was a positive (r\u0026thinsp;=\u0026thinsp;0.681, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and moderate correlation between baseline guardians\u0026apos; BACEv3 and the amount of change in AKQ-C \u0026quot;knowledge.\u0026quot; There was a negative (r\u0026thinsp;=\u0026thinsp;0.534, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and moderate correlation between baseline guardians\u0026apos; BACEv3 and the amount of change in Vineland II \u0026quot;communication\u0026quot; (receptive/expressive language, reading and writing) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e[Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e near here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to determine whether the treatment stigma of Autistic adolescents and their guardians affected the effectiveness of the ACAT intervention. The Spearman's rank correlation coefficient analysis showed that the BACEv3 of Autistic adolescents did not correlate with the change in any of the scales. Guardians' BACEv3 was significantly correlated with Autistic adolescents\u0026rsquo; knowledge of ASD characteristics and communication of adaptive behavior. The study examined two hypotheses. The first hypothesis is that the higher the treatment stigma of autistic adolescents, the less CBT can improve autistic traits and adaptive behavior. Based on previous studies by Corrigan et al. (2004) and Gulliver et al. (2010), we predicted that high treatment stigma in Autistic adolescents would reduce the effect of CBT intervention, but in the present study, high treatment stigma in Autistic adolescents was uncorrelated with the amount of change in intervention. Therefore, this hypothesis was rejected. Thus, at least for Autistic adolescents, the individual's treatment stigma was not expected to affect treatment effectiveness. Secondly, the higher the treatment stigma of the guardians, the less the effects of CBT on the guardians of the autistic adolescents can be improved. Although there were changes in measures related to Autistic adolescents among guardians in the intervention group, there were no significant differences in the amount of change in measures related to guardians. This suggests that guardianship treatment stigma did not affect the guardians' intervention.\u003c/p\u003e \u003cp\u003eContrary to the prediction that high guardianship treatment stigma would reduce CBT effectiveness for guardians and Autistic adolescents, Autistic adolescents in the intervention group showed an increase in knowledge of ASD. This may be due to the high treatment stigma of the guardians, which may have led to a less open discussion of ASD between guardians and children. Furthermore, the Autistic adolescents\u0026rsquo; knowledge at the pre-intervention time point may have been low to begin with. Additionally, there was a decrease in communication (receptive/expressive language, reading, and writing) of the Autistic adolescents. This may be because the guardians\u0026rsquo; lack of knowledge prior to the intervention may have led them to overestimate their assessment of the Autistic adolescents and evaluate them as if they were neurotypical children. One factor that may have contributed to the lack of association between guardians' treatment stigma and changes in the intervention was that the BACEv3 is a measure of self-treatment stigma, and therefore the child's intervention, the ACAT, may not have been correctly reflected on the ACAT. A recently reported study has shown that treatment stigma prevents people from seeking help [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; however, this study suggests that treatment stigma does not have an impact. Notably, people already undergoing treatment participated in the original study [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, it can be said that the study showed that high treatment stigma does not affect the intervention only for those who are undergoing treatment.\u003c/p\u003e \u003cp\u003eAn environment where treatment and support are appropriately and easily connected is important for children with ASD and their parents, who have high treatment stigma. It would be good if there were a mechanism or system that allows everyone to easily connect to welfare and clinical services for support and treatment. If the findings from the past and future research can be part of the construction of such a system, even those with high treatment stigma who are not receiving support may be able to access support.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe participants in this study were Autistic adolescents and guardians who actively avoided or did not receive treatment or support, as the study dealt with treatment stigma while participating in an intervention trial. Regarding guardianship treatment stigma, we did not measure guardians' treatment stigma. It may be necessary to examine treatment stigma for Autistic adolescents and their guardians who are not receiving assistance in the future. In addition, because we used data from an intervention trial, the number of samples was relatively small, and there is a need to reanalyze the results with a more significant number of samples.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEven when Autistic adolescents had treatment stigma, there was no change between high treatment stigma and the effect of the intervention, suggesting that treatment stigma had no effect. Even when guardians' treatment stigma was high, CBT interventions for Autistic adolescents increased knowledge, suggesting that it also did not reduce the effectiveness of the intervention for Autistic adolescents.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAware and Care for my Autistic Traits\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADI-R\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutism Diagnostic Interview-Revised\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADOS-2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutism Diagnostic Observation Schedule\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutism Spectrum Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAKQ-C\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutism Knowledge Quiz-Child\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAKQ-P\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAutism Knowledge Quiz-Guardians/Parents\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBACEv3\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBarriers to Access to Care Evaluation scale version 3\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCognitive Behavioral Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDSRS-C\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDepression Self-Rating Scale for Children\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGHQ-12\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral Health Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePREQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eParenting Resilience Elements Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSDQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrength and Difficulties Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVineland-II\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVineland Adaptive Behavior Scales Second Edition\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: This study used data from ACAT clinical trial. It was approved by the Chiba University Clinical Research Ethics Review Committee (CRB3180015, No. G29027). All methods were carried out in accordance with the Declaration of Helsinki. This clinical trial has been registered with the University Hospitals Medical Information Network (UMIN 000029851). Written Consent has been obtained from a parent or legally authorized representative. Consent forms were submitted by each of the participating parents and children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The study was supported by the special research grant (No. 2017 S-1) of the Association of Japanese Clinical Psychology, which is a non-profit association for clinical psychology in Japan. The funders had no role in the design of the study; collection, analysis, and interpretation of the data; or in writing the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e: EO and SG analyzed data from Autistic adolescents and their guardians on the impact of CBT intervention on treatment stigma; YN and MH interpreted the data; EO contributed to writing the manuscript; FO was involved in all aspects of the preparation of the paper. ES was the general supervisor. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders 5Ed Dsm-5. 5th ed. Washington, D.C: Amer Psychiatric Pub Inc; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones W, Klin A. Heterogeneity and Homogeneity Across the Autism Spectrum: The Role of Development. J Am Acad Child Adolesc Psychiatry. 2009;48:471\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlin A, Saulnier CA, Sparrow SS, Cicchetti DV, Volkmar FR, Lord C. Social and Communication Abilities and Disabilities in Higher Functioning Individuals with Autism Spectrum Disorders: The Vineland and the ADOS. J Autism Dev Disord. 2007;37:748\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenworthy L, Case L, Harms MB, Martin A, Wallace GL. Adaptive Behavior Ratings Correlate With Symptomatology and IQ Among Individuals With High-Functioning Autism Spectrum Disorders. J Autism Dev Disord. 2010;40:416\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolker MA, Lopata C, Smerbeck AM, Knoll VA, Thomeer ML, Toomey JA, et al. BASC-2 PRS Profiles for Students with High-Functioning Autism Spectrum Disorders. J Autism Dev Disord. 2010;40:188\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanne SM, Gerber AJ, Quirmbach LM, Sparrow SS, Cicchetti DV, Saulnier CA. The Role of Adaptive Behavior in Autism Spectrum Disorders: Implications for Functional Outcome. J Autism Dev Disord. 2011;41:1007\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePugliese CE, Anthony L, Strang JF, Dudley K, Wallace GL, Kenworthy L. Increasing Adaptive Behavior Skill Deficits From Childhood to Adolescence in Autism Spectrum Disorder: Role of Executive Function. J Autism Dev Disord. 2015;45:1579\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTillmann J, San Jos\u0026eacute; C\u0026aacute;ceres A, Chatham CH, Crawley D, Holt R, Oakley B, et al. Investigating the factors underlying adaptive functioning in autism in the EU-AIMS Longitudinal European Autism Project. Autism Res. 2019;12:645\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoffman E. Stigma: Notes on the Management of Spoiled Identity. Reissue edition. New York: Touchstone; 1986.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012;12:36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: a cross-sectional survey. Br J Gen Pract. 2016;66:e686\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarshall M. Association Between Duration of Untreated Psychosis and Outcome in Cohorts of First-Episode Patients: A Systematic Review. ARCH GEN PSYCHIATRY. 2005;62:9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorii M, Umeda M, Someki F, Kondo T, Ogawa H, Shikibe Y, et al. Survey of stigma towards Neurodevelopmental Disabilities in High School Students and Effectiveness of the Online Education Program of Understanding Neurodevelopmental Disabilities. Bull Grad Sch Hum Dev Enviroment. 2021;14:69\u0026ndash;77. (in Japanese)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillespie-Lynch K, Brooks PJ, Someki F, Obeid R, Shane-Simpson C, Kapp SK, et al. Changing College Students\u0026rsquo; Conceptions of Autism: An Online Training to Increase Knowledge and Decrease Stigma. J Autism Dev Disord. 2015;45:2553\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomeki F, Torii M, Brooks PJ, Koeda T, Gillespie-Lynch K. Stigma associated with autism among college students in Japan and the United States: An online training study. Res Dev Disabil. 2018;76:88\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeston L, Hodgekins J, Langdon PE. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2016;49:41\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaddox BB, Miyazaki Y, White SW. Long-Term Effects of CBT on Social Impairment in Adolescents with ASD. J Autism Dev Disord. 2017;47:3872\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpain D, Happ\u0026eacute; F. How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study. J Ration-Emotive Cogn-Behav Ther. 2020;38:184\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung M, Ooi YP, Goh TJ, Pathy P, Fung DSS, Ang RP, et al. Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial. Child Psychiatry Hum Dev. 2011;42:634\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite SW, Ollendick T, Albano AM, Oswald D, Johnson C, Southam-Gerow MA, et al. Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder. J Autism Dev Disord. 2013;43:382\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood JJ, Ehrenreich-May J, Alessandri M, Fujii C, Renno P, Laugeson E, et al. Cognitive Behavioral Therapy for Early Adolescents With Autism Spectrum Disorders and Clinical Anxiety: A Randomized, Controlled Trial. Behav Ther. 2015;46:7\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGillivray JA, Evert HT. Group Cognitive Behavioural Therapy Program Shows Potential in Reducing Symptoms of Depression and Stress Among Young People with ASD. J Autism Dev Disord. 2014;44:2041\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRussell AJ, Jassi A, Fullana MA, Mack H, Johnston K, Heyman I, et al. COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL: Research Article: CBT for OCD for Adults with ASD. Depress Anxiety. 2013;30:697\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGantman A, Kapp SK, Orenski K, Laugeson EA. Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study. J Autism Dev Disord. 2012;42:1094\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaugeson EA, Frankel F, Gantman A, Dillon AR, Mogil C. Evidence-Based Social Skills Training for Adolescents with Autism Spectrum Disorders: The UCLA PEERS Program. J Autism Dev Disord. 2012;42:1025\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchohl KA, Van Hecke AV, Carson AM, Dolan B, Karst J, Stevens S. A Replication and Extension of the PEERS Intervention: Examining Effects on Social Skills and Social Anxiety in Adolescents with Autism Spectrum Disorders. J Autism Dev Disord. 2014;44:532\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNussey C, Pistrang N, Murphy T. How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder: A review of psychoeducational approaches in TS and ADHD. Child Care Health Dev. 2013;39:617\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGordon K, Murin M, Baykaner O, Roughan L, Livermore-Hardy V, Skuse D, et al. A randomised controlled trial of PEGASUS, a psychoeducational programme for young people with high-functioning autism spectrum disorder. J Child Psychol Psychiatry. 2015;56:468\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerner S, Shulman C. Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables. Res Dev Disabil. 2013;34:4103\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadopoulos C, Lodder A, Constantinou G, Randhawa G. Systematic Review of the Relationship Between Autism Stigma and Informal Caregiver Mental Health. J Autism Dev Disord. 2019;49:1665\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShepherd D, Landon J, Goedeke S, Meads J. Stress and distress in New Zealand parents caring for a child with autism spectrum disorder. Res Dev Disabil. 2021;111:103875.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan KKS, Lam CB. Trait Mindfulness Attenuates the Adverse Psychological Impact of Stigma on Parents of Children with Autism Spectrum Disorder. Mindfulness. 2017;8:984\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLodder A, Papadopoulos C, Randhawa G. Stigma of living as an autism carer: a brief psycho-social support intervention (SOLACE). Study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud. 2019;5:34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOshima F, William M, Takahashi N, Tsuchiyagaito A, Kuwabara H, Shiina A, et al. Cognitive-behavioral family therapy as psychoeducation for adolescents with high-functioning autism spectrum disorders: Aware and Care for my Autistic Traits (ACAT) program study protocol for a pragmatic multisite randomized controlled trial. Trials. 2020;21:814.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirleson P, Hudson I, Buchanan DG, Wolff S. Clinical evaluation of a self-rating scale for depressive disorder in childhood (Depression Self-Rating Scale). J Child Psychol Psychiatry. 1987;28:43\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodman R. The Strengths and Difficulties Questionnaire: A Research Note. J Child Psychol Psychiatry. 1997;38:581\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSparrow SS, Cicchetti DV, Balla DA. Vineland Adaptive Behavior Scales\u0026ndash;Second Edition (Vineland\u0026ndash;II). 2nd edition. Minneapolis: NCS Pearson Inc; 2005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;:4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki K, Kobayashi T, Moriyama K, Kaga M, Hiratani M, Watanabe K, et al. Development and Evaluation of a Parenting Resilience Elements Questionnaire (PREQ) Measuring Resiliency in Rearing Children with Developmental Disorders. PLOS ONE. 2015;10:e0143946.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Demographic for Autistic adolescents of COMB/TAU groups （from Original study）\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eDemographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eｎ＝45(N%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003eTAU group\u003c/p\u003e\n \u003cp\u003en=22(Row%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003eＣＯＭＢgroup\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n = 23(Row%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003cp\u003eｐ-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eSex/ Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003eｐ＝.5589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e \u0026nbsp;33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e17(51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;16(48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e 7(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eSchool attendance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003eｐ＝.295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Everyday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;14(48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 15 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Less\u0026nbsp;than\u0026nbsp;one-third\u0026nbsp;of the semester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e1(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0 ( 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e No\u0026nbsp;attendance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e5(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp; Non-student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eAcademic background (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003ep =.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003ePrimary- high school students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;43(95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e20(46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 23 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp; Junior high school graduates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eTotal years of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003ep =.0541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eMean (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e8.0(\u003cem\u003eSD\u0026nbsp;\u003c/em\u003e2.2\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e8.6(\u003cem\u003eSD\u003c/em\u003e 1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 7.3(\u003cem\u003eSD\u003c/em\u003e 2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eSupport and Consideration at school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003ep =.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Support classes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e5(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eSpecial classes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e2(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Consideration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e2(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Non-Support・Consideration\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e36(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e19(52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;17(47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eAge at diagnosis -year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003ep =.878\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eMean (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e10.3(\u003cem\u003eSD\u003c/em\u003e 4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e10.4(\u003cem\u003eSD\u003c/em\u003e 4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e \u0026nbsp;10.2(\u003cem\u003eSD\u0026nbsp;\u003c/em\u003e3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003ep =.668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e Without\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e26(57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e12(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;14(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"31.632653061224488%\"\u003e\n \u003cp\u003e With\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.346938775510203%\"\u003e\n \u003cp\u003e19(42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e10(52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.387755102040817%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 9(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Demographic for Guardians of COMB/TAU group (from Original study）\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eDemographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eｎ＝45(N%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003eTAU group\u003c/p\u003e\n \u003cp\u003en=22(Row5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003eＣＯＭＢgroup\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n = 23(Row%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003cp\u003eｐ-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eSex/ Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eｐ＝.3226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;Father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e \u0026nbsp; 1(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e44(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e22(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e \u0026nbsp;22(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eTotal years of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep =.3075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eMean (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e14.3(\u003cem\u003eSD\u003c/em\u003e 1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e14.6(\u003cem\u003eSD\u003c/em\u003e 1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 14.1(\u003cem\u003eSD\u003c/em\u003e 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eTotal years of work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep =.1874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e Mean (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e14.4(\u003cem\u003eSD\u003c/em\u003e 8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e12.7(\u003cem\u003eSD\u003c/em\u003e 8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e16.0(\u003cem\u003eSD\u003c/em\u003e 7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eCurrent employment status\u003c/p\u003e\n \u003cp\u003eｎ（％）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep =.0981\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eNo \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 17(37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e 6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eReason: Homemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e Yes \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e28(62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;11(39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;17(60.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eFull-time employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 13(46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e5(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 8(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003ePart-time employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 15(51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e6(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 9(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eHousehold income n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep=.5311\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e4000000 yen* level or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e6(13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e4(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e5000000 yen \u0026ndash; 8000000yen level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e25(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e13(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e12(48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e9000000 yen level or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e14(31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e5(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e9(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003eSupport for parents \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep =.4773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e Non-use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 37(82.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8(17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003ePast medical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ep =.7655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 36(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;9(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;5(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*1US dollar = 115 Japanese Yen(JPY)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Correlations between BACEv3 and Pre-Post changes in other measures for guardians and autistic adolescents\u0026rsquo; pre-intervention\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" width=\"46.464646464646464%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePre to post\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"53.535353535353536%\"\u003e\n \u003cp\u003eBaseline Intervention group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.61538461538461%\"\u003e\n \u003cp\u003eAutistic adolescents BACEv3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"40.38461538461539%\"\u003e\n \u003cp\u003eGuardians of\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eautistic adolescents\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBACEv3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp\u003eAutistic adolescents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eAKQ-C strength \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e. 094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.649484536082475%\"\u003e\n \u003cp\u003e-.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eAKQ-C weak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eAKQ-C knowledge \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;.681**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eSDQ \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eDSRSC \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eVineland II Communication \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e. 102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.534*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eVineland II Daily living\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eVineland II Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp\u003eGuardians of autistic adolescents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eAKQ-P strength \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e-.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.649484536082475%\"\u003e\n \u003cp\u003e-.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eAKQ-P weak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eAKQ-P knowledge \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003eGHQ-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e-.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"38.095238095238095%\"\u003e\n \u003cp\u003ePREQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e-.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.476190476190476%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eProcess variables were calculated by comparing BACEv3 pre-intervention with the amount of change in scores before and after the intervention.\u003c/p\u003e\n\u003cp\u003eStatistical significance was evaluated by Spearman\u0026apos;s correlation coefficient.\u003c/p\u003e\n\u003cp\u003e** p\u0026lt;.01, * p\u0026lt;.05\u003c/p\u003e\n\u003cp\u003eAKQ-C, Autism Knowledge Quiz-Child; AKQ-P, Autism Knowledge Quiz-Guardians; SDQ, Strengths and Difficulties Questionnaire; DSRSC, Depression Self-Rating Scale for Children; Vineland II, Vineland Adaptive Behavior Scale Second Edition; GHQ, The 12-item General Health Questionnaire; PREQ, Parenting Resilience Elements Questionnaire.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-1385134/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1385134/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\u003cp\u003eThis study explores how treatment stigma of Autistic adolescents, and their guardians affects the effectiveness of cognitive behavioral therapy (CBT) interventions.\u003c/p\u003e\u003cp\u003eMethods\u003c/p\u003e\u003cp\u003eThe intervention group in the randomization consisted of Autistic adolescents, n = 23 (16 boys, 7 girls, mean age 12.8 years) and their guardians, n = 23 (1 male, 22 females, mean age 44.8 years). Their questionnaire data were used. The changes in the Barriers to Access to Care Evaluation scale version 3 (BACEv3) before the intervention and other tests after the intervention were analyzed using Spearman's rank correlation coefficient.\u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003eThe Spearman's rank correlation coefficient analysis showed that the BACEv3 of Autistic adolescents did not correlate with the change in any of the scales. Guardians' BACEv3 was significantly correlated with Autistic adolescents’ Autistic traits knowledge of Autism Spectrum Disorder characteristics and communication of adaptive behavior.\u003c/p\u003e\u003cp\u003eConclusions\u003c/p\u003e\u003cp\u003eThe results suggest that the presence of treatment stigma in Autistic adolescents does not affect CBT interventions. It was also suggested that guardianship treatment stigma did not reduce the effectiveness of CBT interventions for Autistic adolescents. These findings will help us to understand the role of treatment stigma in CBT interventions for Autistic adolescents and their guardians.\u003c/p\u003e\u003cp\u003eTrial registration: University Hospital Medical Information Network (UMIN 000029851). Registered January 6, 2018.\u003c/p\u003e","manuscriptTitle":"Does Treatment Stigma Among Autistic Adolescents and Guardians of Autistic Adolescents Affect the Effectiveness of Cognitive Behavioral Therapy? An Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-10 15:38:04","doi":"10.21203/rs.3.rs-1385134/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d45190ac-ab03-44ff-929d-2bd51f05f7a5","owner":[],"postedDate":"March 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-03-31T07:14:21+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-10 15:38:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1385134","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1385134","identity":"rs-1385134","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}