Coherence of Representations Regarding the Child, Resolution of the Child's Diagnosis and Emotional Availability: A Study of Arab-Israeli Mothers of Children with ASD

Effects of adverse childhood experiences on observed parenting and children's behavior problems among Jewish and Arab Muslim families in Israel

Research points to the substantial impact of parents' exposure to adverse childhood experiences (ACEs) on parents and their children. However, most studies have been conducted in North America, and research on ACEs effects on observed parenting or on intergenerational transmission of ACE effects is limited. We therefore studied families from diverse ethnocultural backgrounds in Israel and examined whether mothers' ACEs hampered maternal sensitivity and the quality of the home environment and whether mothers' psychological distress mediated these links. We also explored whether mothers' ACEs predicted children's behavior problems indirectly through maternal psychological distress and whether maternal sensitivity and the home environment attenuated this mediating path. Participants were 232 mothers (Mchild age = 18.40 months, SD = 1.76; 63.36% non-ultra-Orthodox Jewish, 17.24% ultra-Orthodox Jewish, 19.40% Arab Muslim). Results showed mothers' ACEs were directly associated with decreased maternal sensitivity. Mothers' ACEs were indirectly associated with more behavior problems in children through mothers' higher psychological distress, and maternal sensitivity moderated this indirect link; it was significant only for mothers who showed lower sensitivity. Findings emphasize the significant role ACEs play in early mother-child relationships. The importance of including ACE assessment in research and practice with families of infants and toddlers is discussed.

Does hope mediate the relationship between parent's resolution of their child's autism diagnosis and parental stress

Introduction

Resolution of a child's diagnosis, the process of accepting and adjusting to the reality of a child's significant diagnosis, has been often associated with decreased parental stress. Hope, a potential buffer against psychological distress, has been suggested as a potential explanation for this relationship. However, the mediating role of hope in the relationship between resolution of diagnosis and parental stress has not been explored.

Methods

This study aimed to examine whether four types of hope (child, parental, societal, denial of diagnosis) mediated the relationship between resolution to an autism diagnosis and reduced parental stress. Participants included 73 parents (Mage = 43.22, SD = 7.69, female 97.3%) of autistic children (Mage  = 11.15, SD = 4.56, male = 67.1%).

Results

Resolution to diagnosis was negatively and significantly correlated with resolution to diagnosis, as well as child, parental and societal hope. These three hopes were also significantly and negatively correlated with parental stress. Importantly, when controlling for level of support and autism awareness, parental hope mediated the relationship between resolution to diagnosis and parental stress. Denial of diagnosis was not correlated with resolution or parental stress but did have significant but weak associate with the other hopes.

Discussion

These findings suggest that hope based on parent's abilities to support their child and be supported themselves play an important role in parental stress once parents are more resolved to their child's diagnosis. Supporting parents to manage factors associated with supporting their child's needs, may benefit parents of autistic children.

Integrating attachment and linguistic perspectives on the coherence of narratives regarding close relationships: A qualitative illustration

In this multidisciplinary study, we offer an integrative view on the coherence of narratives regarding close relationships. We show how coherence, as conceptualized by attachment researchers, is manifested in discursive syntactic structure, as conceptualized by linguists. To illustrate this correspondence, we use narratives of six mothers about their adolescent child and their relationship. Narratives were elicited with the widely used Five Minute Speech Sample (FMSS) procedure and were coded according to the FMSS-coherence manual, tapping their clarity, consistency, and multidimensionality. In addition, the syntactic constructions employed by mothers were analyzed. FMSS were segmented into Clause Packages (CPs). Within CPs, overt syntactic markers, such as 'because,' as well as unmarked thematic and pragmatic relations, such as new vs. given information, were categorized as reflecting different levels of integration between clauses. As we demonstrate, mothers whose narratives were rated as more coherent employed more integrated CPs. We conclude by discussing the multi-layered nature of coherence. We consider how a multidisciplinary approach to coherence can enrich the understanding of personal narratives and open a new direction for research of close relationships as well as inform functional analyses of the linguistic expression of coherence.

Coherence of Parental Representations Following Therapy for Autistic Children

Autistic children experience high rates of mental health challenges, and links have been found between child mental health and the parent-child relationship. As parents of autistic children are often actively involved in their child's treatment, it is important to consider aspects of the parent-child relationship within this context. The present study investigated changes in a component of the parent-child relationship, the coherence of parental representations, following participation in a 10-week cognitive behavioural therapy intervention designed to address autistic children's mental health challenges. Relationships were examined between coherence and child characteristics (i.e., autism symptoms, mental health), and associations with child treatment outcomes (i.e., mental health). Participants included 81 children (89% boys) aged 8 to 13 years and their parents (85% mothers) aged 35 to 54 years. Baseline levels of coherence were related to children's mental health symptoms but not autism symptoms. Although there were no significant changes in overall coherence across therapy, subscale-level improvements (i.e., concern, acceptance) emerged. Changes in coherence across therapy were linked with children's post-intervention behavioural symptoms and were approaching significance for internalizing problems, but were not associated with externalizing problems. It is critical to investigate factors that shape the coherence of parents' representations of their children, as this may provide insight into potential targets for intervention. Ascertaining whether participation in therapy improves parental coherence, and consequently child treatment outcomes, can advocate for parent-involved therapy, which will ultimately benefit the well-being of autistic children.

Maternal Reaction and Psychological Coping After Diagnosis of Congenital Heart Disease

OBJECTIVES

A diagnosis of congenital heart disease (CHD) during fetal life or infancy can be devastating for parents, resulting in significant psychological stressors. The goals of this study were to (1) assess maternal resolution and adaptation to a new diagnosis of CHD, (2) explore how maternal resolution and adaptation relates to psychological well-being and (3) evaluate whether specific illness parameters impact resolution status.

METHODS

This cross-sectional study evaluated resolution to diagnosis in the first 6 months of life for mothers of children with CHD. Mothers completed a Reaction to Diagnosis Interview (RDI) and psychological surveys assessing stress, depression, and coping skills. The RDI invites parents to discuss the diagnosis, changes in their thoughts and feelings since the diagnosis, and reflections on why they think they have a child with a medical condition. A chart review of the child recording illness parameters was also performed.

RESULTS

Thirty-six mothers participated in this study. Twelve of their children had a prenatal diagnosis of CHD (33.3%). Seventeen mothers (47.2%) were unresolved to the diagnosis of CHD in their child, regardless of the timing or severity of the diagnosis. Twenty-four participants (68.6%) had significant or highly significant life stress and 9 participants (25.7%) had clinical concerns or met criteria for Post-Traumatic Stress Disorder. Nineteen mothers (55.9%) were at risk for clinical depression. Mothers unresolved to the diagnosis had higher rates of post-traumatic stress than those resolved to the diagnosis (47.1% vs. 10.5%, p = 0.03). Mothers of infants with a prenatal diagnosis of CHD reported significantly lower rates of life stress despite higher severity of heart defects (p = 0.02).

CONCLUSIONS FOR PRACTICE

Mothers of infants with CHD have similar proportions of resolution to diagnosis compared to mothers of children with other chronic diseases. They experience a high rate of symptoms of life stress, post-traumatic stress and clinical depression. Symptoms of post-traumatic stress are higher in mothers unresolved to the diagnosis. Identification of those at highest risk for poor adaptation to the diagnosis may allow for targeted psychological support services for those most vulnerable.

Diving into the Resolution Process: Parent's Reactions to Child's Diagnosis

This research presents an in-depth observation of parental resolution regarding a child's diagnosis with special needs to help counsellors understand the complexities of parental coping. Sixty-two parents of children with Autism Spectrum Disorder/Intellectual Developmental Delay participated in a Reaction to the Diagnosis Interview and a semi-structured interview. Categorical analysis revealed that 59.7% of the parents had reached resolution, with approximately 40% emotional orientation, 40% cognitive orientation, and 20% proactive orientation. Content analysis revealed three themes: emotions-feelings of guilt, shame, and emotional breakdown; thoughts-fear of stigma and concern for the child's future; actions-concealment, seeking support, and attempts to reject the results of the diagnosis. Whereas most parents were diagnosed as having reached resolution, the content analysis still found complex subject matter suggesting lack of resolution. Research findings show that counsellors should identify the intricate emotional dynamics of parents coping while being cautious of premature coping categorization.

Emotional availability in mothers and their children with spinal muscular atrophy type 1 who require augmentative and alternative communication: a mixed-methods pilot study

Emotional availability in parent-child interactions fosters children's socioemotional development. Little is known about the emotional availability of parents and children with profound motor disabilities and complex communication needs or the contributions of augmentative and alternative communication (AAC) to emotional availability. To begin addressing these gaps, this pilot study focused on three mothers and their children with spinal muscular atrophy Type 1 who could not speak and required AAC. The study used a mixed-methods design. Mother-child interactions were rated using the Emotional Availability Scales. Semi-structured in-depth interviews with the mothers were qualitatively analyzed. Emotional availability in mother-child dyads was adequate. In the interviews, mothers addressed significant challenges but described mainly typical parent-child relationships and adaptive child and mother coping attributable to the use of AAC. Results suggest that emotional availability is possible and can be facilitated by AAC, even with children with profound motor disabilities and limited ability to communicate needs and desires. The findings highlight the importance of targeting children's socioemotional needs and parent-child emotional availability in AAC interventions with families of children with profound motor disabilities.

Narrative coherence across the transition to parenthood: Primiparous parents' representations of their child in relation to parental sensitivity

Narrative coherence reflects parents' ability to provide a believable, clear, relevant, and internally consistent story about their child. Parents demonstrating more narrative coherence have been theorized to show higher parental sensitivity, but this has not been examined in a normative sample, nor across the transition to parenthood, and only once in fathers. The aim of this study was to examine stability and change in narrative coherence across the transition to parenthood in mothers and fathers, as well as the relation between pre- and postnatal narrative coherence and postnatal parental sensitivity. The sample consisted of 105 primiparous expecting parents. Narrative coherence was measured at 36-weeks pregnancy and when the child was 4 months old, using the Five Minute Speech Sample procedure. Parental sensitivity was observed in three episodes. Results demonstrated that narrative coherence was moderately stable (correlations) across the transition to parenthood in fathers only. Both mothers' and fathers' narrative coherence improved over time. Furthermore, mothers and fathers were overall equally coherent, and maternal and paternal narrative coherence were positively interrelated during pregnancy only. Lastly, our findings showed weak evidence for the theorized link between narrative coherence and parental sensitivity: only postnatal narrative coherence predicted paternal sensitivity, only during free play. Our findings give new insight in the development of narrative coherence across the transition to parenthood, and how it relates to actual parenting. More research is needed to confirm our findings and further explore this topic.

Parents' resolution of their child's diagnosis: A scoping review

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

Emotional availability in dyads of nursing aide - resident with dementia: Old tool, new perspective

Objectives

This study examined the emotional availability of nursing aide-resident with dementia dyads in a long-term care-facility. Emotional availability refers to the nursing aide’s sensitivity toward the resident, structuring their interactions in a non-intrusive and non-hostile manner and the resident’s responsiveness to and involvement of the nursing aide. The study evaluated the reciprocity in the emotional availability of nursing aides and the residents and examined whether emotional availability varies with the level of difficulty of taking care of the residents and with the context of the interaction.

Method

The study was conducted in three wards in one long-term care-facility. Twenty nursing aides and 40 residents took part in the study. Each nursing aide was videotaped during feeding, structured and unstructured interactions, with two residents, one that was nominated by the head nurse as difficult to take care of and one that was nominated as easy to take care of. The interactions were coded using the emotional availability scales.

Results

Linear mixed-effect model analyses indicated that higher emotional availability of nursing aides was related to higher emotional availability of the residents. Nursing aides’ emotional availability did not vary between “difficult” and “easy” residents or across the three interaction contexts. “Difficult” residents involved their nursing aides less than “easy” residents.

Discussion

The study documented the reciprocal nature of the interaction between nursing aides and residents with dementia. It suggests that nursing aides have an important role in promoting residents’ responsiveness and involvement.

Factors associated with parental resolution of a child's autism diagnosis: A systematic review

BACKGROUND

Receiving a child's autism diagnosis can be stressful; as such, parent resolution contributes to the wellbeing and development of healthy parent-child relationships. In other significant childhood diagnoses (e.g., cerebral palsy, diabetes), the degree to which parents adjust to (a) their child's diagnosis and (b) their changes in expectations concerning their child's development and capacity (referred to as resolution to diagnosis), has been associated with improved outcomes including facilitating parent-child relationships and improved parental wellbeing. Given potential benefits to parent and child, and the heterogenous nature of autism, examining the unique factors associated with resolution to diagnosis is important. In this systematic review we identified factors that support or inhibit parental resolution to their child receiving a diagnosis of autism.

METHODS

We completed a systematic review following PRISMA guidelines of peer-reviewed studies from 2017 to 2022, that investigated parental resolution or acceptance of an autism diagnosis. Papers including "acceptance" needed to encompass both accepting the diagnosis and the implications regarding the child's abilities. We searched six databases (Scopus, Web of Science, MEDLINE, PsycINFO, ProQuest), with additional papers located following review of reference lists.

RESULTS

Fourteen papers with 592 participants that investigated parental resolution or acceptance of an autism diagnosis, were included. We identified six common factors that facilitate or inhibit parental resolution and acceptance of an autism diagnosis including: symptom severity; religion, belief, and culture; knowledge and uncertainty; negative emotions (i.e., denial, shame, guilt); positive emotions; and support. Greater resolution was associated with improved "attunement and insightfulness" in the parent-child relationship.

LIMITATION

The review was limited by the small number of studies meeting inclusion criteria. Second, the quality of included studies was mixed, with over half of the studies being qualitative and only one randomized control trial (RCT) identified.

CONCLUSION

Parental resolution can have an impact on parent's perception of their child's capabilities and impact the parent-child relationship. We identified six categories that aid in inhibiting or promoting resolution to diagnosis. Despite taking a broad approach on the definition of resolution, the low number of studies identified in the review indicates a need for more research in this area.

SYSTEMATIC REVIEW REGISTRATION

http://www.crd.york.ac.uk/PROSPERO/, PROSPERO [ID: CRD42022336283].

A Systematic Scoping Review of Social, Educational, and Psychological Research on Individuals with Autism Spectrum Disorder and their Family Members in Arab Countries and Cultures

Cultural dimensions of autism spectrum disorder (ASD) are relatively unexplored in the research literature. The current study is a systematic scoping review describing social, educational, and psychological research focused on individuals with ASD and their family members in Arab countries and cultures. Seventy studies met eligibility criteria. Most of the studies were from Jordan, Saudi Arabia, and Lebanon. Most of the identified research addressed three major domains: the prevalence of ASD and diagnosis issues, the experiences and outcomes for Arab caregivers of individuals with ASD, and social and communication behaviour of Arab individuals with ASD. There were significant gaps in research evidence base, including research on interventions and on ASD services. Overall, the included research was appraised as being of weak quality.

The reaction to diagnosis questionnaire: a preliminary validation of a new self-report measure to assess parents' resolution of their child's diagnosis

Parents' resolution of their child's diagnosis is associated with parental sensitivity and secure child attachment. The Reaction to Diagnosis Interview (RDI) is the accepted measure for assessing resolution, but its administration and coding are time and labor intensive. This study examined the psychometric properties of the Reaction to Diagnosis Questionnaire (RDQ), a new self-report measure that assesses resolution. 75 mothers of children diagnosed with Cerebral Palsy or Developmental Delay completed the RDI and the RDQ and reported on family characteristics. The RDQ showed good internal consistency. Mothers who were classified as resolved using the RDI had higher RDQ scores compared with mothers who were classified as unresolved. The networks of associations of the RDI and the RDQ with family characteristics were similar, although formal equivalence testing could not be performed. The RDQ may be a promising time- and cost-effective tool. Nevertheless, more research is needed to further establish its validity.