Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes

'It wasn't the strategies on their own': Exploring caregivers' experiences of accessing services in the development of interventions for autistic people with intellectual disability

LAY ABSTRACT

Many autistic individuals with intellectual disability experience anxiety, and for those who use few or no words, anxiety may present as behaviour that challenges, such as self-injury and avoiding anxiety-provoking situations. Families report difficulty accessing support from services for autistic individuals experiencing anxiety. Moreover, once receiving support, effective interventions for autistic people with intellectual disability are limited. We completed individual and group discussions with 16 caregivers of autistic people with intellectual disability, to (a) explore their experiences of accessing services for anxiety and/or behaviour that challenges for their child; and (b) understand what matters to caregivers when developing interventions that have been designed for them and the autistic individual with intellectual disability that they support. Caregivers reported that services, in their experience, did not deliver the support that they expected, and that they often needed to 'fight' for support. Caregivers considered services and families working together, the inclusion of peer support, and families being offered interventions that are flexible to individual circumstances to be important. These considerations are valuable for clinicians and researchers developing interventions and aiming to improve outcomes for autistic people with intellectual disability and their families.

Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.

Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children With Developmental Delays

Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.

Developmental links between executive function and emotion regulation in early toddlerhood

Developmental associations between poor executive function (EF) and problem behaviors in toddlerhood indicate that the interplay between cognition and affect begins very early in life (Hughes, Devine, Mesman, & Blair, 2020). However, very few longitudinal studies of toddlers have included direct measures of both EF and emotion regulation (ER). In addition, while models of ER highlight the importance of situational contexts (e.g., Miller, McDonough, Rosenblum, Sameroff, 2005), existing work is limited by a heavy reliance on lab-based observations of mother-child dyads. Addressing these twin gaps, the current study of 197 families included video-based ratings of ER in toddlers' dyadic play with both mothers and fathers at each of two time-points (14- and 24-months), with parallel measures of EF being gathered in each home visit. Our cross-lagged analyses showed that EF at 14 months predicted ER at 24 months, but this association was limited to observations of toddlers with mothers. It was also asymmetric: ER at 14 months did not predict EF at 24 months. These findings support co-regulation models of early ER and highlight the predictive utility of very early individual differences in EF.

Evaluating in the Real-World Educational Intervention to Improve Interference Control in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) present deficiencies in interference control processes. The main aim of this pilot study was to analyze the efficacy of an educational intervention designed to optimize the interference control of eight ASD children, attending to their ASD severity level. A mixed-methods approach grounded in systematic observation and nomothetic/follow-up/multidimensional observational designs was used. An observation instrument was developed to code data, which were grouped according to the ASD severity level (Group 1, requires support; Group 2, requires substantial support) and were analyzed using a lag sequential analysis. The results show that, although both groups progressed during the intervention and could have continued to improve, each group evolved differently. Group 1 performed relatively well from the onset and increased and developed their interference control strategies throughout the intervention, while Group 2, despite also acquiring new interference control strategies, took more time to show improvements. One month after the intervention ended, both groups were unable to consolidate the strategies learned. A mixed-methods approach allowed for real interference control deficits in ASD children to be captured in a natural context. To conclude, it would be necessary to lengthen this intervention and adapt it to the needs of each group.