Investigating the factor structure of the child behavior checklist dysregulation profile in children and adolescents with autism spectrum disorder

The Strengths and Difficulties Questionnaire Dysregulation Profile Teacher-Report: Psychometric Properties and Associations with Aspects of School Experience

Emotional, cognitive, and behavioral dysregulation is a risk factor for severe outcomes, calling for reliable measures to assess it, including the Strengths and Difficulties Questionnaire Dysregulation Profile (SDQ-DP) defined by 5 or 15 items. This study explored for the first time the factor structure, internal consistency, and test-retest reliability of the SDQ-DPs teacher-report in a sample of Italian children (N = 1000; age 7-12 years). The gender invariance of the SDQ-DPs, construct validity, and associations with school variables were also evaluated. A first-order model for the SDQ-DP 5-item and a bifactor model for the SDQ-DP 15-item best fitted the data. Full measurement invariance across gender was confirmed only for the 15-item scale. Internal and test-retest reliabilities were weaker for the 5-item scale. Both SDQ-DPs were similarly associated with a measure of emotion regulation skills and some school variables. This study provides indications for a more conscious use of the two scales.

How are parental mental health and parenting practices associated with externalizing behaviors among young children with autism in China? A cross-sectional study and indirect effect analysis

Children with autism are more likely to exhibit externalizing behaviors than children without autism. A cross-sectional study was undertaken to investigate how parental mental health status and parenting practices contributed to the variance in externalizing behaviors among families of young children with autism in Chinese mainland, and whether parenting behaviors had any indirect effects on the relationship between parental mental health symptoms and externalizing behaviors. Data were drawn from the baseline assessment of a quasi-experimental study of a parent training program delivered to Chinese caregivers of children with autism aged 3 to 6 from diverse backgrounds (N = 111). Results showed that parental mental health symptoms and parenting behaviors explained the variance in child externalizing behaviors. Parental mental health problems and parental over-reactivity were linked to higher levels of child externalizing behaviors, whereas positive parenting was associated with less frequent externalizing behaviors. Positive parenting partially explained the relationship between parental mental health symptoms and externalizing behaviors. The findings of this study highlight the importance of actively attending to the psychological and parenting needs of caregivers in autism treatment programs. It points to the need for the development of culturally sensitive strategies to promote parental mental health and increase the use of positive parenting skills among parents of children with autism.

Dysregulation profile in children of ethnoracially diverse at-risk families: Factor structure and longitudinal correlates

The present work sought to confirm the factor structure and examine longitudinal strengths-based and mental health correlates of the dysregulation profile (DP) in children of at-risk fragile families of diverse ethnoracial backgrounds. The data came from the Fragile Families and Child Wellbeing Study (N = 2125 families). Mothers (Mage = 25.3) were mostly unmarried (74.6%), and children (51.4% boys) were identified as Black (47.0%), Hispanic (21.4%), White (16.7%), or multiracial or other backgrounds. Childhood DP was constructed using mother reports of the Child Behavior Checklist at age 9. Mothers' in-home parent-child interactions and depressive symptoms were assessed at child age 5. At age 15, children responded about their own mental health, social skills, and other strengths-focused outcomes. A bifactor DP structure fit well to the data, with the DP factor representing difficulties in self-regulation. Using SEM, we found that mothers who were more depressed and used less warm parenting at child age 5 had children who presented with higher DP at age 9. DP was in turn associated with less social skills, perseverance, optimism, and more anxiety, depression, and impulsivity at adolescence. Childhood DP appears to be relevant and applicable for at-risk, diverse families, and may also impede on children's future positive functioning.

Mapping the link between socio-economic factors, autistic traits and mental health across different settings

LAY ABSTRACT

Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings - in Europe and South Africa - to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.

The Child Behavior Check List Usefulness in Screening for Severe Psychopathology in Youth: A Narrative Literature Review

OBJECTIVE

This article will review the use of the CBCL to diagnose youth with psychopathological disorders focusing on: ADHD, Mood Disorders, Autism Spectrum disorders, and Disruptive Disorders.

METHOD

Using a narrative review approach, we investigate the usefulness of the CBCL as a screening tool to detect childhood onset psychopathology across different diagnostic syndromes.

RESULTS

The available literature supports the use of the CBCL for ADHD screening and as a measure of ADHD severity. While some studies support a specific profile linked with childhood bipolar disorder, replication studies for this profile found mixed results. The CBCL was also found to be useful in screening for patients presenting with Autism Spectrum Disorders, Conduct Disorder, and Childhood Bipolar Disorder all of which presents with more severely impaired scores.

CONCLUSION

The CBCL holds promise as a screening tool for childhood psychopathology.

Stepped-Care Cognitive Behavioral Therapy in Children on the Autism Spectrum with Co-occurring Anxiety

This trial examined stepped-care cognitive-behavioral treatment (CBT) among 96 autistic youth with co-occurring anxiety. Step 1 included an open trial of parent-led, therapist-guided bibliotherapy. Step 2 was family-based CBT for those who did not respond to Step 1 or maintenance for those who did. Eighteen participants (28%) who completed Step 1 responded. Responders reported significantly lower pre-treatment anxiety, internalizing symptoms, and functional impairment than non-responders. After Steps 1 and 2, 80% of completers (55% intent-to-treat) were responders. Anxiety, impairment, and ASD-related impairments significantly improved. Youth in maintenance experienced faster improvement through post-treatment, though there were no group differences at 3-month-follow-up. A stepped approach may help some individuals in Step 1, particularly those who are less anxious.

Self-Report Measurement of Well-Being in Autistic Adults: Psychometric Properties of the PERMA Profiler

Background

Studies of positive psychology and emotional well-being have broadened our understanding of mental health. However, mental health research involving autistic adults has been largely deficit-focused. Few studies have examined well-being using established positive psychological frameworks.

Methods

This study examined the psychometric characteristics of the PERMA Profiler, a 23-item questionnaire that measures well-being across five subscales (Positive emotion, Engagement, Relationships, Meaning, and Accomplishment), in a sample of 517 autistic adults ages 18-84 years (M = 39.5, standard deviation [SD] = 13.3). Reliability (internal consistency), structural validity (via confirmatory factor analysis including bifactor modeling), and concurrent validity were examined.

Results

The PERMA Profiler mean (SD) well-being score was 5.4 (SD = 1.7), which is notably lower than the mean of 7.0 previously found in nonautistic samples. Subscale scores were highest for Engagement (M = 6.8; SD = 1.9), followed by Accomplishment (M = 5.6; SD = 2.2), Relationships (M = 5.2; SD = 2.6), Meaning (M = 5.2; SD = 2.7), and Positive emotion (M = 5.0; SD = 2.4). Factor analyses revealed strong psychometrics (Cronbach's α = 0.93; Comparative Fit Index = 0.94; Tucker-Lewis Index = 0.97; root mean square error of approximation = 0.08; standardized root mean residual = 0.05) and superior fit of the bifactor model, supporting a general factor for conceptualizing well-being as opposed to a five-factor model. PERMA well-being and subscale scores were significantly correlated (p < 0.001) with mental health conditions and life satisfaction.

Conclusion

These findings support use of an adapted version of the PERMA Profiler in mental health research to evaluate well-being among autistic adults. Similar to studies with nonautistic populations, the Engagement measure may not capture the experiences of the autistic population and further refinement is needed. Follow-up research should represent a more diverse autistic population, collaborate with autistic coinvestigators, and explore potential correlates of well-being (such as social stigma) while using the PERMA Profiler.

Altered gut microbiota correlates with behavioral problems but not gastrointestinal symptoms in individuals with autism

BACKGROUND

Despite inconsistent results across studies, emerging evidence suggests that the microbial micro-environment may be associated with autism spectrum disorder (ASD). Geographical and cultural factors highly impact microbial profiles, and there is a shortage of data from East Asian populations. This study aimed to comprehensively characterize microbial profiles in an East Asian sample and explore whether gut microbiota contributes to clinical symptoms, emotional/behavioral problems, and GI symptoms in ASD.

METHODS

We assessed 82 boys and young men with ASD and 31 typically developing controls (TDC), aged 6-25 years. We analyzed the stool sample of all participants with 16S V3-V4 rRNA sequencing and correlated its profile with GI symptoms, autistic symptoms, and emotional/behavioral problems.

RESULTS

Autistic individuals, compared to TDC, had worse GI symptoms. There were no group differences in alpha diversity of species richness estimates (Shannon-wiener and Simpson diversity indices). Participants with ASD had an increased relative abundance of Fusobacterium, Ruminococcus torques group (at the genus level), and Bacteroides plebeius DSM 17135 (at the species level), while a decreased relative abundance of Ruminococcaceae UCG 013, Ervsipelotrichaceae UCG 003, Parasutterella, Clostridium sensu stricto 1, Turicibacter (at the genus level), and Clostridium spiroforme DSM 1552 and Intestinimonas butyriciproducens (at the species level). Altered taxonomic diversity in ASD significantly correlated with autistic symptoms, thought problems, delinquent behaviors, self dysregulation, and somatic complaints. We did not find an association between gut symptoms and gut microbial dysbiosis.

CONCLUSIONS

Our findings suggest that altered microbiota are associated with behavioral phenotypes but not GI symptoms in ASD. The function of the identified microbial profiles mainly involves the immune pathway, supporting the hypothesis of a complex relationship between altered microbiome, immune dysregulation, and ASD that may advance the discovery of molecular biomarkers for ASD.

Dysregulation in Children and Adolescents Presenting to a Multidisciplinary Autism Clinic

Research indicates that children with autism spectrum disorder (ASD) frequently exhibit dysregulation, which refers to poorly coordinated affective, behavioral, and cognitive responses to a given situation. We examined the characteristics of dysregulation in children presenting to a multidisciplinary ASD clinic for an ASD diagnostic evaluation. Sixty percent of children presenting for an ASD evaluation exhibited dysregulation. Dysregulation prevalence was higher in children without ASD versus with ASD (69% versus 56%). Severe dysregulation was higher in children without ASD (29% versus 16%). Both groups with severe dysregulation were equally likely to be taking psychiatric medications, however, children with ASD were less likely to be receiving therapy. These findings highlight the importance of implementing dysregulation screening and treatment protocols in ASD centers.

A Preliminary Psychometric Analysis of the Difficulties with Emotion Regulation Scale (DERS) Among Autistic Adolescents and Adults: Factor Structure, Reliability, and Validity

Emotion dysregulation is common among autistic people, yet few measures have received psychometric evaluation in this population. We examined the factor structure, reliability, and validity of a commonly-used measure of emotion dysregulation, the Difficulties with Emotion Regulation Scale (DERS), in a sample of 156 autistic adolescents and adults. Data were drawn from the NIH National Database for Autism Research (NDAR) and an author's existing dataset. Results demonstrated that the factor structure generally conformed to the original 6-factor model, with modifications. Reliability analyses revealed good-to-excellent internal consistencies. Validity analyses indicated that the DERS was positively associated with measures of anxiety, depression, and alexithymia. Our findings provide preliminary evidence for the utility of the DERS in a small autistic sample, with minor modifications.

Trajectories of Dysregulation in Children with Autism Spectrum Disorder

Objective: This study determined whether child and family environment factors are associated with differences in developmental trajectories of emotional and behavioral dysregulation in children with autism spectrum disorder (ASD).Method: Participants included 186 families of a child with ASD (5-12 years old at baseline; 86% male; 83% non-Hispanic Caucasian; 35% comorbid intellectual disability). At each of the four time points (each spaced 12 months apart), mothers and fathers within each family completed well-validated measures on their own mental health, their child's dysregulation, their parent-child relationship, and their parent couple relationship. Longitudinal multi-level modeling was used to describe trajectories of dysregulation across 3 years and test whether parent depression, closeness in the parent-child relationship, and positive parent dyadic coping were associated with differences in child trajectories.Results: On average, child dysregulation decreased across time. Closer mother-child and father-child relationship quality was associated with lower baseline dysregulation. More severe child restricted and repetitive behaviors, fewer maternal depression symptoms, and more positive parent dyadic coping were associated with declines in child dysregulation over time.Conclusions: On average, children with ASD become less dysregulated across time. However, there is important variability in dysregulation trajectories of children with ASD. Children with ASD who have a high (versus low) severity of restricted and repetitive behaviors appear to be at risk for greater dysregulation. The family environment, and specifically a closer parent-child relationship, better maternal mental health, and more positive couple coping, may contribute to a pattern of improved child regulation across time in ASD.

Understanding, Assessing, and Intervening with Emotion Dysregulation in Autism Spectrum Disorder: A Developmental Perspective

This article provides a comprehensive review of emotion dysregulation (ED) in individuals with autism spectrum disorder (ASD). The authors describe ED from a developmental perspective, and highlight how aberrations in social development and a restricted-repetitive repertoire of behaviors, render individuals with ASD more vulnerable to ED. The article also summarizes how ED in children and adolescents with ASD has been measured and conceptualized in research and clinic settings. Evidence-based pharmacologic and cognitive behavioral interventions targeting ED in ASD are summarized, with a focus on how such approaches are tailored to the developmental needs of individuals with ASD.

Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions

Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.

Parent-Teacher Disagreement on Ratings of Behavior Problems in Children with ASD: Associations with Parental School Involvement Over Time

ASD symptomology and behavioral problems pose challenges for children with ASD in school. Disagreement between parents and teachers in ratings of children's behavior problems may provide clinically relevant information. We examined parent-teacher disagreement on ratings of behavior problems among children with ASD during the fall and spring of the school year. When child, teacher, and class characteristics were considered simultaneously, only ASD symptom severity predicted informant disagreement on internalizing and externalizing behavior problems. We also examined associations between informant disagreement and parent school involvement. Cross-lagged panel analyses revealed that higher informant disagreement on children's behavior problems in the fall predicted lower parent school involvement in the spring, suggesting that greater informant agreement may foster parental school involvement over time.

Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions

Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.