Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder

Impacts of Caregiving for Individuals with Autism in Low-Resource Settings, a Report from the Kurdistan Region of Iraq

Caring for children with different developmental trajectories brings various challenges, which are often exacerbated in low-resource settings. International research has shown that raising a child with autism strongly impacts family caregivers, particularly mothers. There is a dearth of information regarding caregiving for individuals with autism in the Kurdistan Region of Iraq (KRI) and for fathers as well as mothers. This study examined the similarities and differences in caregiving for mothers and fathers of a child with autism in KRI using validated rating scales to measure various aspects of their general well-being. Over two years, a sample of 118 parents of individuals with autism (81 mothers and 37 fathers) self-completed the rating scales, which were further discussed through individual interviews with service personnel mainly known to them. The findings indicated that mothers and fathers were similarly impacted. Although there were no statistically significant differences in the ratings of their general health, sources of stress, family functioning, and satisfaction with caregiving, the majority of parents had elevated ratings on all the measures. In addition, parents who rated their children higher on the Aberrant Behavior Checklist had significantly higher scores on their general health issues and were less satisfied with their caregiving role. Parents of female individuals with autism were also significantly more stressed compared to the male individuals with autism and parents of children who received a diagnosis before three years of age, reported fewer behavioral problems with their child compared to the parents who received a diagnosis when the child was older. In this sample, mothers and fathers seem to be similarly impacted by caring for a child with autism, which is contrary to findings from other countries. However, in this region, family bonds between couples and the wider family may have had an influence which further cross-cultural research in low-resource settings could help elucidate, notwithstanding the challenges this poses. The findings have policy implications for health authorities in the KRI to improve the support provided to both mothers and fathers who care for children with autism, which presently is rarely available to them.

Emotions and difficulties experienced by parents of children with autism: A qualitative study

RATIONALE

This study was performed to determine the difficulties experienced by the parents of children with autism.

METHODS

A qualitative method was used to determine the difficulties experienced by the parents. The sample of the study consisted of parents with 24 children with autism who met the inclusion criteria. The data were analysed by the MAXQDA qualitative data analysis programme in accordance with Colaizzi's seven-stage method.

RESULTS

Total of 5 themes and 29 codes were gathered in line with the data obtained from the interviews. Five main themes of the interviews emerged; emotions experienced by parents; adaptation to family life; difficulty in social relationships; limited opportunity for entertainment/activity and financial difficulty. Parents whose income were less than or equal to their expenses particularly stated that they had economic difficulties in the transportation of their children to places such as hospitals/schools/special education.

CONCLUSION

In accordance with the findings of this study, it was determined that almost all of the parents with a child diagnosed with autism experienced sadness, denial, shock, depression, self-blame in the period when their children were first diagnosed, and later accepted the disease. In addition, it was detected that parents had difficulties in family relations, social relations, entertainment/activity and economic aspects.

Implementing a Positive Behavior Support Program for Young Children with Autism in Public Agencies: A Social Validity Evaluation from Parents, Practitioners, and Administrators

Challenging behaviors in young children with autism and intellectual disabilities pose significant barriers to learning and inclusion. The Prevent-Teach-Reinforce for Young Children (PTR-YC) program is an evidence-based intervention that addresses these behaviors according to Positive Behavior Intervention Support principles. It is essential to assess the social validity of an intervention, when implemented into a public service system, to ensure sustainability and relevance to stakeholders. The present study aimed to document the social validity of PTR-YC from the point of view of three key informants: parents, practitioners, and administrators. Sixty-one participants were interviewed about their experience with PTR-YC (9 administrators, 31 practitioners, and 20 families). Semi-structured interviews assessed three fundamental components of social validity (Wolf, 1978): (a) social relevance of intervention goals, (b) social appropriateness of intervention procedures, and (c) social importance of intervention effects. Participants' responses were subjected to thematic analysis. Intervention goals, namely family participation in the clinical process, strategies that focuses on prevention, and teaching alternative adaptive behaviors, were identified as relevant. Participants appreciated the program's clear, structured, and turnkey clinical process, its parent-practitioner collaboration, and its consistency with practices already in place in the field. Positive instrumental outcomes (e.g., knowledge, competencies, self-efficacy) and ultimate outcomes (e.g., decrease in challenging behavior) of the intervention were reported on children, families, and practitioners. This study represents the first in-depth evaluation of the social validity of PTR-YC in specialized public services for autism and demonstrates its appropriateness for universal implementation in this sector.

Relationship Between Change in Participation and Later Mental Health Problems in Children

BACKGROUND

Participation in everyday activities is beneficial for mental health. However, little is known about the extent to which changes in children's participation are associated with later mental health.

OBJECTIVES

To investigate the association between changes in the frequency and involvement in home, school, and community activities and subsequent mental health problems in children. Methodology: We recruited 242 school-aged children. Their parents completed the Participation and Environment Measure for Children and Youth twice, and after 2 years, they completed the Strengths and Difficulties Questionnaire.

RESULTS

After controlling for demographic factors, hierarchical regression analysis revealed that reductions in children's involvement in home and community activities were significantly associated with elevated levels of externalizing and internalizing problems. Furthermore, an increase in children's involvement in school activities showed significant relationships with better mental health outcomes.

CONCLUSION

These findings inform participation-based interventions for occupational therapists aimed at mitigating children's future mental health problems.

ProVIA-Kids - outcomes of an uncontrolled study on smartphone-based behaviour analysis for challenging behaviour in children with intellectual and developmental disabilities or autism spectrum disorder

Introduction

Challenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB.

Methods

A total of 18 caregivers (M = 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4-11 years (M = 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale.

Results

We observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood.

Discussion

ProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period.

Registration

The study was registered at https://www.drks.de (ID = DRKS00029039) on May 31, 2022.

The correlation between brain structure characteristics and emotion regulation ability in children at high risk of autism spectrum disorder

As indicated by longitudinal observation, autism has difficulty controlling emotions to a certain extent in early childhood, and most children's emotional and behavioral problems are further aggravated with the growth of age. This study aimed at exploring the correlation between white matter and white matter fiber bundle connectivity characteristics and their emotional regulation ability in children with autism using machine learning methods, which can lay an empirical basis for early clinical intervention of autism. Fifty-five high risk of autism spectrum disorder (HR-ASD) children and 52 typical development (TD) children were selected to complete the skull 3D-T1 structure and diffusion tensor imaging (DTI). The emotional regulation ability of the two groups was compared using the still-face paradigm (SFP). The classification and regression models of white matter characteristics and white matter fiber bundle connections of emotion regulation ability in the HR-ASD group were built based on the machine learning method. The volume of the right amygdala (R2 = 0.245) and the volume of the right hippocampus (R2 = 0.197) affected constructive emotion regulation strategies. FA (R2 = 0.32) and MD (R2 = 0.34) had the predictive effect on self-stimulating behaviour. White matter fiber bundle connection predicted constructive regulation strategies (positive edging R2 = 0.333, negative edging R2 = 0.334) and mother-seeking behaviors (positive edging R2 = 0.667, negative edging R2 = 0.363). The emotional regulation ability of HR-ASD children is significantly correlated with the connections of multiple white matter fiber bundles, which is a potential neuro-biomarker of emotional regulation ability.

Are a Child's Autistic Traits, Behavioural Difficulties, Prosocial Behaviour and Temperament Predictors of Parental Self-Efficacy and Satisfaction? A Study on Parents of Autistic and Neurotypical Children Aged 7-11 Years

The aim of the study was to evaluate the significance of the severity of autistic traits, behavioural difficulties, prosocial behaviour and temperamental characteristics in children for parental self-efficacy and parental satisfaction in two groups of parents: parents of autistic children, and parents of neurotypical children. Data come from 145 parents of autistic children and 239 parents of neurotypical children. Using hierarchical multiple regression analyses, the analysis explored the role of child characteristics in prediction of parental self-efficacy and parental satisfaction. The regression model tested explained 21% variation in parental self-efficacy and 27% variation in parental satisfaction in parents of autistic children and 3% of variation of results with respect to parental self-efficacy and 17% variation in parental satisfaction in parents of neurotypical children. In both groups, parental self-efficacy and parental satisfaction were negatively correlated with such child characteristics as severity of behavioural difficulties, severity of autistic traits and emotionality as also positively related to the child's prosocial behaviour. These findings may suggest that particularly useful mental health prevention programs for parents should combine two elements: developing parents' abilities of effectively coping with children's behavioural difficulties and working on attribution processes and negative convictions about parenthood.

Parent-led Communication Therapy for Young Bilingual Autistic Children: A Scoping Review

A scoping review of the literature was undertaken using JBI guidelines to map the evidence of parent-led therapy (PLT) for young autistic children (≤ 6 years) raised in bilingual environments. Reviewers used Covidence to screen located sources. Sixteen papers met inclusion criteria. A strong acceleration of reports of PLT for young autistic children measured in bilingual environments was observed, with 93.8% of papers (n = 15) published since 2015. Reporting of participants' language environments (home language(s)/L1s and societal language(s)/L2s) was inconsistent. A large majority of these studies, 87.5% (n = 14) were conducted in North America or in collaboration with a North American institution. Diverse PLT programs and methodologies were identified. There is variation in demographic information collected and outcomes reported. Evidence gaps in the literature are identified and the value of undertaking systematic review on this topic is considered. This scoping review points to the necessity of further empirical research and practice that centres parents in early and specific support for autistic children raised in bilingual environments. Suggestions for improving reporting standards of language profiles are provided.

Caregivers of Children with Autism Spectrum Disorders: The Role of Guilt Sensitivity and Support

Background/Objectives: Burden Syndrome, also known as Caregiver Syndrome, particularly affects those who serve in the role of informal caregiver in the presence of family members with conditions. The ABCX dual model examines the impact on the caregiver of the diagnosis of autism spectrum disorder (ASD) on the family. This model considers the severity of the stressor (A), the additional demands of life stress (aA), the family's internal resources (B), the family's external resources (bB), the family's assessment of the situation (C), coping strategies (cC), and outcome (X). The purpose of the present study is to investigate the relationships between resilience, guilt, and burden of care in caregivers of children with ASD. Methods: Various assessment instruments were used, including the "Caregiver Burden Inventory" to measure burden, the "Brief Resilience Scale" to assess resilience, the "Guilt Sensitivity Questionnaire" to examine guilt sensitivity, and the "DA.L.I.A." to collect information on parent and child characteristics. A total of 80 parents/caregivers participated in the research, including 53 women (Age M = 41.72; SD = 7.8) and 27 men (Age M = 43.35; SD = 6.29). Results: The findings indicate that individuals' resilience to stressful events correlates negatively with burden, a developmental subtype. However, guilt seems not to play a significant role in the overall perception of burden. In contrast, it was found that the use of informal supports is associated with higher levels of guilt and emotional burden, whereas the use of formal supports is correlated with higher emotional burden, but not higher perceptions of guilt. Conclusions: This study provides important information about the support needed by caregivers and suggests how to address emotional burdens to prevent burnout and support families with children with ASD.

Quality of Life and Its Associated Correlates of Parents of Children on the Autism Spectrum in Singapore

This cross-sectional study aimed to assess Quality of life (QoL) of parents of children on the autism spectrum in Singapore and identify its associated factors. Parents of children (age ≥ 5 years) completed the Quality of Life in Autism scale which measures parental self-rated QoL (higher scores denote greater QoL), and the perceived impact of the child's autism-related behaviors on parents (higher scores denote lesser impact). Information on the child's degree of autism (measured by the Social Responsiveness Scale, second edition [SRS-2]), community and social participation and cognitive and adaptive functioning were also obtained. Participants were 86 parents with mean child age 6.3 years (SD 1.0). Univariate analysis results revealed greater participation in community and social events to be two modifiable factors associated with higher parental QoL. However, these factors were not found to be significant in the multivariate model. Higher autism features (represented by higher parent-rated SRS scores) was associated with a greater perceived impact of the child's behaviors by parents in both univariate and multivariate analyses. Of note, child's cognitive or adaptive skills were not significantly associated with either QoL measure. Equipping parents to handle autism-related behaviors can be useful to reduce their impact on parental QoL. Facilitating community participation for these children may positively influence caregiver QoL as well.

Parenting stress, coping strategies and social support for mothers of preschool children with autism spectrum disorder in the Republic of Croatia

Parents of children with autism spectrum disorder (ASD) report experiencing more parenting stress than parents of children with typical development or other developmental disorders. Eighty mothers of preschool children with ASD completed questionnaires with the purpose of exploring the extent and characteristics of parenting stress and the possibility of predicting parenting stress based on the mother's coping strategies, perceived social and professional support, the severity of the child's symptoms, and certain sociodemographic characteristics. The results show that 19% of the mothers had clinically significant parental stress. Most of the mothers experienced increased stress levels related to the following: poor interactions with their children (34%), the child's demandingness (27%), and their personal ability to cope with parental distress (20%). The predictors significantly explained 42.8% of the variance in total parental stress, with support from friends and severity of the child's symptoms being significant unique contributors.

Factors Impacting Parental Quality of Life in Preschool Children on the Autism Spectrum

This study examined connections between parental quality of life (QoL) and features of children (autism severity, cognitive ability, behavioral profile, and sociodemographic factors). Parents of 97 children attending an autism-specific preschool completed the Quality of Life in Autism, Vineland Adaptive Behavior Scales and Child Behavior Checklist. The Autism Diagnostic Observation Schedule and Mullen Scales of Early Learning were also administered. Reduced restrictive/repetitive behavior and higher socialization and play/leisure scores were associated with better parental QoL. Better behavioral regulation and attention also predicted better QoL, as did stronger communication and reduced internalising behaviours. Findings indicate that a child's level of autism specific traits, adaptive functioning and behavioral profile has greater impact on parental QoL than cognitive level.

Mother and child mental health over time in children with Autism and/or ADHD in the Longitudinal Study of Australian Children

This study utilised a longitudinal population-based study to explore mother and child mental health trajectories over time from child age 0 to 14 years, between children with ASD, ADHD, or ASD + ADHD. It explored whether a bidirectional relationship between mother psychological distress and child emotional and behavioural problems (EBPs) existed. The birth cohort from the Longitudinal Study of Australian Children was used. Child EBPs were assessed using the Strengths and Difficulties Questionnaire; and mother emotional distress using the Kessler K6. Generalised estimating equations and structured equation modelling was used to understand changes over time, differences between groups and bidirectional relationships. As expected, children with ASD, ADHD or ASD + ADHD had higher EBPs than children without, and their mothers had higher levels of psychological distress across most time points, but with differing trajectories. Mothers of children with ASD (with or without ADHD) showed increasing psychological distress over time, while mothers of children with ADHD had reducing distress. The bidirectional relationship between mother and child mental health found in children without diagnoses was only partially present in children with ASD/ADHD. Findings highlight support needs and discuss implications for transactional models of parent/child emotional problems in children with neurodevelopmental disorders.

A Double-Blind Randomised Controlled Trial of Prebiotic Supplementation in Children with Autism: Effects on Parental Quality of Life, Child Behaviour, Gastrointestinal Symptoms, and the Microbiome

PURPOSE

Modifying gut bacteria in children with autism may influence behaviour, with potential to improve family functioning. We conducted a randomised controlled trial to assess the effect of prebiotics on behaviour, gastrointestinal symptoms and downstream effects on parental quality of life.

METHOD

Children with autism (4-10yrs) were randomised to 2.4 g/d of prebiotic (GOS) or placebo for six weeks. Pre and post stools samples were collected, and validated questionnaires used to measure change in social and mealtime behaviours, GI symptoms and pQOL. Linear mixed models evaluated group differences for behavioural variables, and Mann Whitney U tests were used to compare change between-groups for GI symptoms, differential abundance of genera and alpha diversity of the microbiome.

RESULTS

Thirty-three parent-child dyads completed the trial. No group difference was seen for behavioural variables but both groups improved significantly from baseline. There was a medium effect size between groups for GI symptoms (d = 0.47) and pQOL (d = 0.44) driven by greater improvements in the prebiotic group. Bifidobacterium increased threefold following prebiotics (1.4-5.9%, p < 0.001) with no change in controls. Supplements were well tolerated, compliance with dose 94%.

CONCLUSION

Prebiotics modify levels of Bifidobacterium and prove well tolerated but in this instance, resulted in only marginal effects on GI symptoms and pQOL. A larger sample of children with more severe symptoms could help to determine the potential of prebiotics in autism.

TRIAL REGISTRATION

https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000615189 .

Effects of service dogs on children with ASD's symptoms and parents' well-being: On the importance of considering those effects with a more systemic perspective

The integration of a service dog can have numerous benefits for children with Autism Spectrum Disorder (ASD). However, although integration takes place within a family, little is known about the dynamics of these benefits on the family microsystem. Thus, the aim of our study was to propose a more systemic perspective, not only by investigating the benefits of SD integration, but also by exploring the relationships between improvements in children with ASD, parents' well-being, parenting strategies and the quality of the child-dog relationship. Twenty parent-child with ASD dyads were followed before, as well as 3 and 6 months after service dog integration. At each stage, parents completed an online survey which included: the Autism Behavior Inventory (ABI-S), the State-Trait Anxiety Inventory (STAI-Y), the Parenting Stress Index Short Version (PSI-SF), the Monash Dog Owner Relationship Scale (MDORS) and the Parenting Styles and Dimensions Questionnaire (PSDQ). First, repeated measure one-way ANOVAs revealed that both children's ASD symptoms and parents' anxiety decreased significantly after service dog integration. Additionally, Spearman correlations revealed that the more ASD symptoms decreased, the more parent's anxiety and parenting stress also decreased. Second, the quality of the child-dog relationship appeared to contribute to those benefits on both children's ASD symptoms and parents' well-being. Interestingly, parenting strategies seemed to adapt according to these benefits and to the quality of the child-dog relationship. Through a more systemic perspective, this study highlighted that the integration of a service dog involved reciprocal and dynamic effects for children with ASD and their parents, and shed new light on the processes that may underlie the effects of a service dog for children with ASD.

Psychological Symptoms in Parents Who Experience Child-to-Parent Violence: The Role of Self-Efficacy Beliefs

Previous research suggests that parents involved in child-to-parent violence (CPV) experience shame, judgment, and a lack of social support, often accompanied by feelings of self-blame and helplessness as well as a deterioration in their perception of self-efficacy and their parenting skills. All of these factors may impact parents' mental health. However, there is a research gap concerning the consequences of CPV among parents. Therefore, the objective of this study was to examine the relationship between CPV and psychological symptoms (i.e., depression, anxiety, hostility, obsessive-compulsive, interpersonal sensitivity, and somatization) in parents based on their perceptions of self-efficacy. The sample was composed of 354 participants: 177 parents (83.1% mothers) and their 177 children (53.4% boys; Mage = 13.27). CPV was reported by both parents and their children. In addition, parents reported their self-efficacy beliefs and psychological symptoms. The results showed that CPV was negatively associated with parents' psychological symptomatology, except for somatization. Moreover, self-efficacy beliefs explain part of the indirect association between CPV behaviors and psychological symptoms in parents. Overall, our findings provide evidence for the potential impact of CPV on mental health in parents and suggest the relevance of reinforcing their self-efficacy beliefs.

Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak

Objective

Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD.

Method

A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview.

Results

Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p < 0.01), social withdrawal (r = 0.439, p < 0.01), stereotypic behaviour (r = 0.392, p < 0.01), hyperactivity/non-compliance (r = 0.467, p < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour (r = 0.182, p = 0.007), medication use (eta = 0.187, p = 0.005), Social Welfare Department registration (eta = 0.138, p = 0.036), and the presence of siblings with ASD (eta = 0.130, p = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden.

Conclusion

Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers.

Psychometric Properties of the Greek Version of the Autism Parenting Stress Index (APSI) among Parents of Children with Autism Spectrum Disorder

(1) Background: This study aimed to validate the Greek version of the Autism Parenting Stress Index (APSI) among parents of children with ASD. (2) Methods: The translated version was administered to 113 parents (Male: 12, Female: 101, 39.24 years old, SD 6.70, age range, 25-58) of children diagnosed with ASD and 127 parents (Male: 24, Female: 103, 41.08 years old, SD 6.22, age range: 27-56) of typically developing children. (3) Results: Significant differences between the APSI total scores and three domains between groups were observed. Although the initial factor structure could not be replicated, the APSI's internal consistency was excellent (a = 0.914), with a high positive item-total correlation (0.900-0.917). The APSI's test-retest reliability was excellent, showing an ICC equal to 0.922 [95%, CI: 0.900-0.940]. The APSI's total score cut-off point was equal to 12.00 (AUC 0.845, p < 0.001) with a sensitivity of 0.839 and 1-specificity of 0.220. A principal component analysis of the 13 items, using varimax rotations, identified three factors, which explained approximately 45.8% of the overall variance. (4) Conclusions: The Greek version of the APSI exhibited discriminant validity for measuring parents of children with ASD. Greek health professionals can use it to assess the stress experienced by parents of children with ASD.

A review of the use of psychotropic medication to address challenging behaviour in neurodevelopmental disorders

Engagement in challenging behaviour (e.g., aggression, self-injury) is reported to occur in neurodevelopmental disorders such as intellectual disabilities (ID), autism spectrum disorder (ASD), and fragile X syndrome (FXS). Common interventions to address these behaviours include both behavioural and pharmacological approaches. Although psychotropic medications are commonly used to address challenging behaviour in ID, ASD, and FXS, demonstration of the effectiveness of treatment is limited. Furthermore, research examining interaction effects between psychotropic medication, challenging behaviour, and environmental events within specific neurodevelopmental disorders such as ID, ASD, and FXS is scarce. The purpose of this chapter is to provide an overview of challenging behaviour within ID, ASD, and FXS and of the effectiveness of psychotropic medication as an intervention for challenging behaviour within these neurodevelopmental disorders. Finally, research examining how psychotropic medication may impact the relationship between challenging behaviour and environmental events is reviewed.

Challenging Behavior and Parental Depression: The Effects of Everyday Stressors and Benefit Finding for Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder present with challenging behaviors that can impact caregivers by increasing parental perceived stress and risk for depression. However, positive coping strategies have also been identified as protective factors for parents of children with ASD. The present study examined parental perceived daily stressors and positive coping strategies (i.e., benefit finding) as mediators to depression for parents of children with ASD. A latent profile analysis identified three classes of behavior severity for children with ASD. Across all classes, higher levels of perceived daily stressors predicted increased parental depression, while benefit finding predicted lower parental depression. Results support interventions that increase positive coping strategies to decrease levels of depression in parents of children with ASD.

Supporting the wellbeing of caregivers of children on the autism spectrum: A qualitative report on experiences of attending group dance movement psychotherapy

Caregivers of children on the autism spectrum can carry a significant amount of practical, psychological, and social demands and responsibilities that are highly stressful. A group Dance Movement Psychotherapy (DMP) was offered to facilitate the wellbeing of caregivers. In this article, we explore the experiences of the therapeutic processes and outcomes of the intervention from the perspectives of caregivers, the therapist, and the researcher/co-facilitator.

METHOD

Four clusters of caregivers of children on the autism spectrum (N = 20 Mean age = 39.25 years) took part in five group DMP sessions lasting 90 minutes delivered across two special educational needs settings. Twenty reflective focus groups took place in total, with each taking place at the end of each DMP session. Participants were invited to capture their experiences through arts-based drawings, while therapist and participating researcher/co-facilitator kept session-based notes and arts-based reflections. These arts-based and verbal data were grouped to generate themes.

RESULTS

Six overarching themes emerged from the arts-based and verbal data with multiple subthemes that describe the contribution of DMP towards promoting caregivers' wellbeing and identified key challenges in implementing the intervention. These themes are: (1) Beholding within and around; (2) Reflecting and reinforcing strengths; (3) Exchanging views; (4) Looking back and carrying forward; (5) Core benefits; and (6) Challenges to engage in DMP.

CONCLUSION

Caregivers talked about their experience of participating in the DMP groups as positive and acknowledged the helpful and challenging aspects of taking part in DMP intervention. They appreciated the creative and expressive nature of the intervention to promote their emotional and social wellbeing. The challenges identified in the study indicate that further awareness is needed within school environments about the contribution arts therapies can make towards establishing appropriate and sustainable interventions for caregivers.

Parenting stress in autism: do children's characteristics still count more than stressors related to the COVID-19 pandemic?

Parents of children with autism spectrum disorders (ASD) experience higher levels of stress than parents of typically-developing (TD) children, due to differences in their children's emotional functioning. The COVID-19 pandemic exacerbated the cognitive and practical demands on vulnerable populations and their families. The aim of this study was to examine parenting stress levels in parents of children ASD and TD children, considering the children's emotional functioning (i.e., anxiety and cognitive emotion regulation strategies), and stressful life events deriving from the COVID-19 pandemic. The study involved 64 parent-child dyads comprising children from 7 to 16 years old, divided into two groups: 32 (26 M) children and adolescents with ASD but no intellectual disability, and 32 (26 M) with typical development. Our results show that parents of children with ASD reported higher levels of stress, but factors relating to the child and the context had a different influence on parenting stress in the ASD and TD groups. The higher level of parenting stress in the ASD group seemed to relate more to the children's emotional characteristics, while the TD group was more affected by the unpredictable stressful events prompted by COVID-19. Families' mental health should be considered a core aspect of supporting parents having to deal with both their child's emotional adjustment and the challenges of the COVID-19 pandemic.

Self-forgiveness, Guilt, Shame, and Parental Stress among Parents of Children with Autism Spectrum Disorder

A mixed-method approach was used to explore and compare self-forgiveness, guilt, shame, and parental stress in parents of children with autism spectrum disorder (ASD) and parents of neurotypical (NT) children. The data were obtained by the Heartland Forgiveness Scale (Thompson et al., 2005), Guilt and Shame Experience Scale (Maliňáková et al., 2019), Parental Stress Scale (Berry & Jones, 1995) and by open-ended questions. The research sample consisted of 143 parents of children with ASD and 135 parents of NT children from Slovakia. The regression analysis confirmed that guilt, shame, and self-forgiveness explained 23% of the variance in parental stress, while the only significant negative predictor was self-forgiveness. Furthermore, shame mediated the pathway between self-forgiveness and parental stress in parents of children with ASD. Parents of children with ASD experience more shame than parents of NT children. The qualitative analysis obtained a more comprehensive understanding of both groups. Parents of children with ASD mostly experienced shame in regard to their child's inappropriate behavior or it being misunderstood by society, while parents of NT children mostly did not feel ashamed of their parenting. Acceptance, social support, religious beliefs, and love from the child were the most often mentioned factors helping self-forgiveness in parents of children with ASD. We highlight the importance of self-forgiveness as a potential coping mechanism for parental stress and suggest focusing on negative aspects of shame in parents of children with ASD.

Adaptation of Parents Raising a Child with ASD: The Role of Positive Perceptions, Coping, Self-efficacy, and Social Support

This study explored the adaptation of parents raising a child with an Autism Spectrum Disorder (ASD) specifically the contributory role of positive perceptions, coping, self-efficacy, and social support. One hundred and thirty-six parents of children with a diagnosis of ASD completed a battery of self-report questionnaires via an online survey. Using multiple regression analyses positive perceptions, adaptive coping, self-efficacy, and social support were each a significant contributor to one or more positive adaptation outcomes. Multiple moderated regression analysis found no evidence that these factors were significant moderators between behavioural problems and parental adaptation. The implications of these findings in supporting parents raising a child with ASD are outlined.

Parent couple conflict and emotional and behavioral problems in youth with autism: Longitudinal investigation of bidirectional effects

Families of youth with autism spectrum disorder (ASD) are vulnerable to maladaptive psychosocial experiences, including elevated youth emotional and behavioral problems (EBPs) and poor parent couple relationship outcomes. Yet, the extent to which these family psychosocial experiences are intertwined has been given little research attention. The present study longitudinally investigated the bidirectional associations between parent couple conflict (PCC) and youth EBPs in 188 families of children and adolescents with ASD (initially aged 5 to 12 years) across four time points (T1, T2, T3, T4), each spaced 12 months apart. Mother- and father-report of youth EBPs and PCC were entered into a cross-lagged panel model. After adjusting for youth age and intellectual disability status and parent education and couple relationship length, the results indicated that father-report of PCC predicted increased youth EBPs 12 months later (T1→T2 and T2→T3). In addition, father-report of youth EBPs predicted increased PCC 12 months later (T3→T4). Mother-report did not demonstrate cross-lagged effects. The findings suggest that fathers' perceptions of PCC and youth emotional and behavioral functioning are transactionally related, highlighting the need for family-wide interventions.

Knowledge, attitudes, and associated factors of caregivers towards children with autism spectrum disorder in East Coast Peninsular Malaysia

Background

Caregivers are directly involved in managing the daily basic needs of children with autism spectrum disorder (ASD). The knowledge and attitudes of these caregivers are important to achieving success in their roles. Thus, this study aimed to determine what constitutes good knowledge, attitudes, and associated factors among caregivers toward children with ASD.

Methods

A cross-sectional study was conducted among 128 caregivers of children with ASD in Kota Bharu, Kelantan from May to August 2020, using convenience sampling. Validated questionnaires were used to assess the knowledge and attitudes toward children with ASD. The data were analyzed using SPSS version 24. Descriptive statistics and simple and multiple logistic regression analyses were then performed.

Results

The response rate was 100%. The proportion of good knowledge and attitudes toward children with ASD among caregivers was 85.1% and 88.3%, respectively. Factors significantly associated with good knowledge were being female (OR (95% CI) 2.79 [0.99-7.90]) and ASD children being non-first-born children (OR (95% CI) 0.41 [0.15-1.12]). Factors significantly associated with good attitudes were age of 30 years and older (OR (95% CI) 0.13 [0.03-0.62]) and caregiver having other children with other types of learning difficulties (OR (95% CI) 0.15 [0.04, 0.52]).

Conclusions

The proportion of caregivers with good knowledge of ASD and good attitudes toward children with ASD was high. The caregiver's age and sex, the position of the ASD child among the siblings, and the presence of other types of learning disorders in the family need to be considered when managing children with ASD.

Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder - Study protocol for the ProVIA trial

Background

Challenging behaviour (CB) comprises various forms of aggressive and problematic behaviours frequently occurring in children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD). CB often arises from impaired communication or problem solving skills. It is often met with coercive measure due to a lack of alternative strategies on the part of the caregiver, while it also impacts on the caregivers due to the exposure to physical harm and high levels of stress. Within the ProVIA project we developed a smartphone-based tool for caregivers of children with IDD and/or ASD to prevent and modify CB. The ProVIA app systematically helps caregivers to identify specific causes of CB and provides individualised practical guidance to prevent CB and consecutive coercive measures, thus aiming to improve the health and well-being of the children and caregivers.

Methods

In this uncontrolled open trial we will enrol N = 25 caregivers of children aged 3-11 years with a diagnosis of IDD and/or ASD. Participants will use the ProVIA-Kids app for 8 weeks. During the intervention phase, participants will conduct behaviour analyses after each instance of CB. The app will summarise the identified putative causes for the CB in each situation, and provide recommendations regarding the handling and prevention of CB. Furthermore, the app will aggregate data from all available behaviour analyses and identify the most relevant (i.e., most frequently reported) risk factors. Measurement points are at baseline (T0), after the intervention (T1) and 12 weeks after the end of the intervention (follow-up; T2). The primary outcome is the absolute change in parental stress (EBI total scale) between T0 and T1. Further aspects of interest are changes in CB severity and frequency, caregiver mood, satisfaction with the parenting role (EFB-K total scale) and experienced parenting competence (FKE total scale). Pre-post comparisons will be analysed with paired sample t-tests.

Discussion

ProVIA is pioneering structured behaviour analysis via smartphone, assessing predefined causes of CB and providing feedback and recommendations. If this approach proves successful, the ProVIA-Kids app will be a valuable tool for caregivers to prevent CB and improve their own as well as the children's quality of life.

Trial registration

The study is registered at https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (registered May 31, 2022).

Parental stress and dyadic adjustment among parents of children with ASD: Moderating effects of dyadic coping and perceived social support

BACKGROUND

Previous studies examining the association between child behavior problems and parental stress have reported mixed results.

AIM

This study aimed to explore the associations between child behavior problems and parental stress as well as parental stress and dyadic adjustment, and the moderating roles of stress communication, perceived partner supportive dyadic coping, and perceived social support in the relationship between parental stress and dyadic adjustment.

METHODS AND PROCEDURES

Data were derived from 233 parents with at least one child with ASD from Iran.

OUTCOMES AND RESULTS

The results demonstrated that child behavior problems were positively associated with parental stress whereas parental stress was negatively associated with dyadic adjustment. Furthermore, stress communication, perceived partner supportive dyadic coping, and perceived social support moderated the relationship between parental stress and dyadic adjustment.

CONCLUSIONS

The current findings may attract the attention of clinicians and professionals who work with parents of children with ASD on the effect of stress and how to manage stress on these parents' dyadic adjustment.

Association between child behavioural problems and parenting stress in autism spectrum disorders: the role of parenting self-efficacy

Introduction: The present study build on previous research that found a bidirectional relation of parenting stress and negative behavioural outcomes in children with Autism Spectrum Disorders. Aim: To investigate the mediating role of parenting self-efficacy in the relationship of parenting stress and children's behavioural and emotional problems. Materials and methods: The sample included 32 young children and their families. Sociodemographic and clinical data were collected. Hierarchical regression analysis revealed direct and indirect mediating effects. Results: Parenting self-efficacy mediated the relationship between parenting stress and children's behavioural and emotional problems in fathers only. Conclusions: We discuss potential ways targeted parenting self-efficacy intervention can support fathers. Results contribute to gain father-informed knowledge in, a research branch generally focused on mothers.

Parenting Stress in Mothers of Children and Adolescents with Down Syndrome

Parenting stress has deleterious effects on parents, children, and overall family functioning. Parents of children with intellectual disability, including Down Syndrome (DS), show higher levels of parenting stress than parents of typically developing children. This research aimed to (i) evaluate parenting stress levels in a group of mothers of youths with DS using a parent-report questionnaire, (ii) identify children’s individual and clinical features associated with maternal stress, and (iii) identify specific situational life/demographics factors related to maternal stress. Seventy-eight youths with DS underwent a neuropsychological evaluation, whereas mothers completed questionnaires for the assessment of parenting stress and of the child’s emotional and behavioral problems. We found that Parent–Child Difficult Interaction was the domain with the highest percentage of clinical scores (39.7%). Both internalizing and externalizing problems correlated with maternal stress, as well as autistic symptoms. The levels of maternal stress were not associated with any socio-demographic variable. After controlling for child-related correlates of maternal stress and for mothers’ age and education level, unemployed mothers exhibited higher levels of parental distress than employed mothers. The present study highlights that unemployment is related with parenting stress and potentially amenable to policy interventions supporting parents in combining work and family care.

Parental Stress and Children’s Self-Regulation Problems in Families with Children with Autism Spectrum Disorder (ASD)

Background: Increased parental stress is strongly related to the severity of autism spectrum disorder (ASD) symptomatology. Parents’ coping strategies and social support issues add to the complexity of this relationship. Aim: The present study investigated the relationship between self-regulation skills and parenting stress in parents of nonverbal children with ASD. Methods and procedure: The Parenting Stress Index–Short Form (PSI-SF) was administered to 75 families, and self-regulation scores on a Motor Behavior Checklist for children (MBC) were recorded by students’ class teachers (level of functioning-behavioral problems). In addition, interviews were conducted with a focus group of six parents (four mothers and two fathers) to explore the underline factors of parental stressin-depth. Results: Correlation analyses revealed that parenting stress was positively correlated with elevated scores on MBC children’s self-regulation subscale. On the other hand, parenting stress was negatively correlated with the level of social functional support reported. Qualitative data were analyzed using transcripts, revealing additional stressors for families and parents, and resulting in recommendations to overcome these factors. Conclusions and implications: Aiming at developing strategies to improve self-regulation skills in nonverbal children with ASD may be particularly important in reducing parental stress for families having nonverbal children with autism and other developmental disabilities. Parents’ stressors and suggestions during interviews are also discussed.

Adaptive Behavior, Emotional/Behavioral Problems and Parental Stress in Children With Autism Spectrum Disorder

Background: The aim of our study was to compare adaptive skills, emotional/behavioral problems, and parental stress among children with different severity levels of Autism Spectrum Disorder (ASD) symptoms. Methods: This study included a sample of 88 subjects with ASD (mean age = 6.00 ± 2.70). All subjects underwent standardized neuropsychological tests for the assessment of symptoms of the autism spectrum (Autism Diagnostic Observation Schedule-Second Edition), adaptive level (The Vineland Adaptive Behavior Scales, Survey Interview, 2nd edition), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form-PSI-SF). Non-parametric statistical methods (Kruskal-Wallis test and Mann-Whitney U-test for post hoc analysis) and linear regression analysis were used in this study. Results: Children who had higher severity levels of ASD symptoms had less adaptive functioning; younger children showed more severe symptoms of ASD; older children had better communication skills. The presence of greater adaptive difficulties was related to a greater presence of internalizing problems. An increase in parental stress levels was related to an higher severity of ASD symptoms, fewer adaptive skills, and a greater presence of internalizing and externalizing problems. Conclusion: This study suggests that the adaptive behavior should be considered in order to planning a habilitation intervention in children with autism. It is also important to monitor emotional/behavioral problems and parental stress levels in order to provide parenting support and improve the family quality of life.

Autistic Mothers of Autistic Children: A Preliminary Study in an Under-Researched Area

Background

Much research exists on the mental health and well-being of parents of autistic children; however, parents who are themselves autistic have received little attention in the literature. We aimed to compare parenting stress and family outcomes in mothers who do, and do not, identify as being autistic.

Methods

We matched 20 mothers who identified as being autistic to 20 mothers who do not identify as being autistic on variables associated with parental well-being: child externalizing behaviors, score on the Social Communication Questionnaire, child adaptive functioning, family income, and child and maternal age. All mothers had at least one autistic child. Outcome variables were family outcomes (Family Outcome Survey-Revised) and parenting stress (Parent Stress Index 4-Short Form). Paired t-tests were used to compare scores between the two samples.

Results

There were no statistical differences in achievement of family outcomes between the autistic and nonautistic mothers. The small effect size on Family Outcome 4 may suggest that autistic mothers develop stronger support networks, but as a statistical comparison for this item nonsignificant, this should be interpreted with caution. Autistic and nonautistic mothers reported equally high levels of parenting stress.

Conclusions

Further research with larger samples is required to explore this under-researched area. Such research would be of value to understand any interaction between parental and child autism characteristics, well-being, and parenting. This could then inform development of supports, which can be tailored for each child's family.

Lay summary

Why was this research done?: Despite decades of research exploring the well-being and mental health of parents of autistic children, the experience of autistic adults with autistic children has not been researched in detail. In fact, we could find less than five research studies on the topic.What was the purpose of the study?: We wanted to do some preliminary work in the area and look at whether parent well-being or family outcomes are similar or different between autistic and nonautistic mothers of autistic children.What did the researchers do?: We are part of a team of researchers working on a larger study on a different topic. As part of this study, we asked parents about their own experiences and well-being, which included questions on whether or not the parents identify as autistic. This meant that within this larger study, there were the data to look at parent and family outcomes and see if they differ depending on whether or not the mothers themselves identified as being autistic.To do this, we went to the large data set and first identified the mothers who identified as being autistic; this was 20 mothers. Then, one of the researchers (M.S.) carefully matched the 20 autistic mothers to 20 mothers who did not identify as autistic (nonautistic mothers) on a number of areas that previous research has linked with parent and family well-being and outcomes. Trying to make the two groups as similar as possible in the areas shown to impact parent and family outcomes means that we can be more confident that any differences between the two groups are due to the one thing that is purposeful: whether or not the mothers were autistic.What were the results of the study?: We found that in general, parent well-being and family outcomes did not differ between the two groups.What were the potential weaknesses of the study?: The small sample size and the lack of detailed knowledge around parental relationship status and ethnicity mean that it is not possible to assume that these results represent the wider population. We also cannot be sure that mothers who identified as nonautistic were definitely not autistic (i.e., they may have been autistic but as yet undiagnosed).How will these findings help autistic adults now or in the future?: We hope that this study will be a platform to inspire future research in this area, using different research methods (interviews, questionnaires) to learn from the lived experience of autistic mothers. This can provide a way for nonautistic parents, researchers, and professionals to learn from the experience and skills of autistic mothers and potentially inform future practice.

Parenting Stress and Social Style in Mothers and Fathers of Children with Autism Spectrum Disorder: A Cross-Cultural Investigation in Italy and Japan

Parents of children with autism spectrum disorder (ASD) face unique challenges, which may affect parenting functioning. However, little is known about gender and cultural variations in parenting stress and styles in these families. The aims of this study were to investigate: (1a) the differences in parenting stress and (1b) social style between Italian and Japanese mothers and fathers of children with ASD; (2) the predictive role of culture, sociodemographic, and child's characteristics on parenting stress; (3) the predictors of the social parenting style, including parenting stress dimensions. The study involved 92 Italians and 89 Japanese parents of school-age children (5-12 years) with ASD who completed the Parenting Stress Index and the Parenting Style Questionnaire. Results revealed that Japanese parents showed higher parenting stress and less engagement in social style than Italians. Across cultures, mothers used more social style than fathers. Being Japanese and having a child with greater ASD severity predicted higher levels of parenting stress. We also found that country, parent's gender, and stress related to the dysfunctional interaction were significant predictors of parenting social style. Our findings highlight the importance of a cross-cultural approach to better understand the experiences and needs of mothers and fathers of children with ASD.

The characteristics and factors of the internalizing and externalizing behaviours of children at high risk for autism spectrum disorder

BACKGROUND

The behavioral characteristics of children with autism spectrum disorder (ASD) are not only affected by their disease, but also by their parenting environment. HR-ASD has the risk of developing internalization and externalization problems. How the early development of these behavioral problems is affected by parent-child interaction is worth exploring. We tested whether parent-child interactions and parenting characteristics were associated with behavioural problems during the infant periods.

METHODS

This study collected data from 91 infants at high risk for ASD and 68 matched typically developing (TD) infants, about their internalizing and externalizing behavioural problems and engagement states (i.e. positive, negative, and parent-child interactions), using free play paradigm. Parent measures were assessed using the Broad Autism Phenotypic Questionnaire (BAPQ) and Parenting Stress Index Short Form (PSI-SF) questionnaire. The core symptoms of ASD were assessed using the the Autism Diagnostic Observational Schedule (ADOS).

RESULTS

During free play, infants in the HR-ASD group showed more internalizing (P < 0.001) and externalizing (P < 0.05) behaviours and less positive engagement (P < 0.01) than the TD group. In the regression analysis, we found that parenting stress had an impact on the infants' externalizing behaviours (△R2 = 0.215). Parent negative engagement had an impact on the infants' internalizing behaviours (△R2 = 0.451).

CONCLUSIONS

The present study revealed that children at high risk for ASD exhibited more severe internalizing and externalizing behavioural problems than TD group. The parent negative engagement is associated with behavioural problems. The findings on the contribution of parents' factors to behavioural problems suggests that the parenting stress and parent-child interactions are important factors for mitigating behavioural problems.

Stress in Egyptian parents of children with developmental disabilities. The moderating effect of social support

BACKGROUND

Research shows that parents of children with developmental disabilities (DDs) are at increased risk for elevated stress. Child adaptive functioning as well as social supports are key factors influencing stress in parents. However, few studies have examined the interaction between these variables and their contribution to perceived stress especially in Egyptian parents.

AIMS

The present study investigated the relationship between parenting stress, child adaptive functioning, and social supports. It also examined the moderating role of social support in the relationship between child adaptive functioning and stress in Egyptian parents of children with DDs.

METHOD

Sixty-four Egyptian parents of children with DDs completed assessment measures of parenting stress, child adaptive functioning, and social supports.

RESULTS

Parenting stress was negatively associated with child adaptive functioning and informal social supports. However, there was no association between parenting stress and formal social supports. In addition, level of informal social support had a moderating effect on the relationship between child adaptive functioning and level of parenting stress.

CONCLUSIONS

The findings highlight the importance of interventions that reduce child-related stressors, particularly low adaptive functioning. Programs that address parenting stress and promote effective informal and formal social supports are crucial to help parents cope with stress.

Parental Quality of Life and Involvement in Intervention for Children or Adolescents with Autism Spectrum Disorders: A Systematic Review

Previous research has examined several parental, child-related, and contextual factors associated with parental quality of life (QoL) among parents with a child or an adolescent with autism spectrum disorders (ASD); however, no systematic review has examined the relationship between parental QoL and parental involvement in intervention. To fill this gap, a systematic review was conducted using four electronic databases and checked reference lists of retrieved studies. Records were included in the systematic review if they presented original data, assessed parental QoL, and involvement in intervention for children or adolescents with ASD, were published in peer-reviewed journals between 2000 and 2020, and were written in English. Among the 96 screened full-texts, 17 articles met the eligibility criteria. The selected studies included over 2000 parents of children or adolescents with ASD. Three categories of parental involvement (i.e., none, indirect, direct) were identified, which varied across studies, although most had direct parental involvement. The results from this review show that increased parental involvement in the intervention for children or adolescents with ASD may be one way to promote their QoL. However, further research specifically focused on parental involvement during the intervention for children and adolescents with ASD is warranted.

The relationship between the stress experienced by parents and cyberchondria during the pandemic process

Purpose

The purpose of this paper is to examine the relationship between the stress experienced by parents during the pandemic and their cyberchondria. The research was carried out in a descriptive and cross-sectional manner.

Design/methodology/approach

The sample of the research: living in Turkey and has created 432 parents with at least one child between the ages of 6 and 15. Participant information form, parental stress scale and cyberchondria scale were used in the study. Data were collected through online surveys between July 1, 2020, and August 31, 2020.

Findings

In the study, when the scores obtained from the Parental Stress Scale and the Cyberchondria Scale were compared with the demographic characteristics, a significant difference was found between gender, age, marital status, education level, economic status, number of children and presence of chronic diseases (p < 0.05). It was determined that there is a significant difference between the responses of the parents regarding the pandemic process and the Parental Stress Scale and the Cyberchondria Scale (p < 0.05). A positive significant correlation was found between the Parental Stress Scale and the total and subdimensions of the Cyberchondria Scale (p < 0.05).

Research limitations/implications

The research was carried out with only parents with children between the ages of 6 and 15, but it reveals the stress and cyberchondria of the parents during the pandemic.

Originality/value

The results obtained reflect the factors affecting the stress and cyberchondria levels experienced by parents during the pandemic process. Also, as the stress of the parent's increases, it has seen that the level of cyberchondria increases in parallel.

Parental Stress and Disability in Offspring: A Snapshot during the COVID-19 Pandemic

Parenting a child with a disability, such as neurodevelopmental disorders and genetic syndromes, implies a high level of stress. During the COVID-19 outbreak—as a period implying additional challenges—few studies have specifically investigated caregivers’ distress among neurodevelopmental disabilities. The objective of the study is to investigate whether during the COVID-19 pandemic, the level of parental stress differs between four disability groups including neurodevelopmental disorders (autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD)) and genetic syndromes (Rett syndrome (RTT), Sotos syndrome (SS)) in comparison to families with typical development offspring (TD). In total, 220 Italian parents of children affected by neurodevelopmental disabilities (74 ASD, 51 ADHD, 34 SS, 21 RTT, 40 TD; age M 9.4 ± SD 4.2) underwent a standardized evaluation for stress related to parenting through the self-report questionnaire, Parental Stress Index-Short Form (PSI-SF). The main findings show greater levels of parental stress—mainly linked to child behavioral characteristics rather than parental sense of competence—in parents of children affected by a disability in comparison to children with typical development. This study highlights the need to support not only individuals with special needs but also their own caregivers: core figures in the management and outcome of children disorders.

Predictors of parenting stress in parents of children diagnosed with autism spectrum disorder: a scoping review

Introduction

Identifying the predictors of parenting stress in parents of children with autism spectrum disorder is crucial to provide the best health-care services.

Main text

The scoping review was conducted. Search engines (EBSCO, Springer, PubMed, Ovid, Google Scholar, and Science Direct) were used to collate published studies between the years 2009 and 2020. Keywords used were parenting stress, parental stress, predictors of parenting stress, Autism disorder, Autism, and scoping review. Primary screening of the titles and abstracts of 1039 articles was conducted. The secondary screening of 348 articles resulted in 27 articles included in this review. The reviewed articles revealed core symptoms of the disorder, namely, behavior problems, and socio-communication impairments strongly linked with the high level of parenting stress.

Conclusion

This scoping review is the initial step toward encouraging future efforts to provide supportive interventions for parents of children with autism spectrum disorder.

The Role of Family Accommodation of RRBs in Disruptive Behavior Among Children with Autism

Family accommodation refers to changes in families' behavior aimed at reducing children's psychopathology-related distress (Shimshoni et al. in Indian J ournal of Psychiatry 61(Suppl 1):S93-S103, 2019). Family accommodation of RRBs occurs frequently in families of children with autism, is linked to greater symptom severity (Feldman et al. in J Autism Dev Disord 49(9):3602-3610, 2019), and is unexplored in the context of disruptive behaviors. This study examined child and parent factors associated with disruptive behavior in children with autism. Parents (N = 90; age 2-9 years) reported on children's autism symptomatology, adaptive functioning, and disruptive behavior, alongside parenting stress and family accommodation of RRBs. Such accommodation contributed significantly to predicting disruptive behavior. These findings indicate that parent behavior is associated with the expression of disruptive behavior in this sample, highlighting potential intervention targets for children with autism.

TrASDition Training: An online parental training for transition-age youth with autism spectrum disorder

Transition to the adult age represents a rather challenging period of life for youth with Autism Spectrum Disorder (ASD) and for their families. Given the actual lack of integrated healthcare systems for autistic young-adults, enhancing parental skills could represent a feasible program to improve skills preparatory for transition in adult life. The online approach, providing easy access to services which otherwise would burden a daily family organization, already strenuous for a family with an autistic person, can represent an innovative way of delivering intervention. Therefore, we developed an online psychoeducational parental training, named TrASDition Training, with a 6 months duration, addressed to parents of autistic youth with and without Intellectual Disability during the transition age. The aim of this study was to longitudinally evaluate the impact of the online parental training on the adaptive functioning, on the repetitive and problematic behaviors of ASD youth (n = 23) and on parental stress. After 6 months of Training, we found a significant improvement in adaptive functioning of ASD participants and a reduction of parental stress.

Clinical and individual features associated with maternal stress in young adolescents with autism spectrum disorder

Parents of people with autism spectrum disorder experience both negative stressful and positive events. Several clinical and socio-demographic features of children on the autism spectrum have been associated with parenting stress in their families. However, there have been few studies that focus on adolescents and the role of cognitive impairment has rarely been addressed. The main aim of the present research is to explore associations between autism symptoms, cognitive impairment, emotional and behavioral problems, socio-demographic features, and maternal stress in a sample of young adolescents with Autism Spectrum Disorder with and without cognitive impairment. Cognitive impairment and emotional and behavioral problems are associated with maternal stress, while autism symptoms seem to play a minor role. Maternal education and occupation are only associated with maternal stress in the group with cognitive impairment, while maternal age is stress-associated in the group of adolescents without cognitive impairment. Age-related implications for intervention and future research directions are discussed. LAY SUMMARY: Parents of individuals on the autism spectrum are exposed to both negative stressful and enriching experiences during their parenthood. While the influence of several child characteristics and socio-demographic features on parental stress during childhood has been widely explored in past studies, studies on teenagers are limited. The aim of the present research is to explore the influence of several characteristics on maternal stress levels in families with teenagers on the autism spectrum. We found that cognitive impairment and emotional and behavioral problems are associated with maternal stress, while autism symptoms seem to play a minor role. Socio-demographic features are not associated with maternal stress. Broadly speaking, the subjective perception of parental distress in both groups is less related to teenagers' characteristics then the perception of having a difficult interaction with the teenagers. We divided our participants into two groups (one group with cognitive impairment and the other group without). We found that mothers of teenagers with cognitive impairment are generally more stressed compared to the other group. Furthermore, we confirm that emotional and behavioral problems seem to play a major role in maternal stress (especially in the group without cognitive impairment), while autism symptoms seem to play a minor role. Furthermore, we found that maternal education/occupation and maternal age are associated with maternal stress in the group with and the group without cognitive impairment respectively. This research highlights the association between several variables and stress in mothers of adolescents on the spectrum. Results are discussed in the framework of previous findings highlighting the lack of adequate care and support services for families, especially for those of adolescents on the spectrum with cognitive impairment.

Neuropsychological Profile, Emotional/Behavioral Problems, and Parental Stress in Children with Neurodevelopmental Disorders

Background: The aim of our study was to trace a specific neuropsychological profile, to investigate emotional-behavioral problems and parental stress in children with Autism Spectrum Disorder Level 1/High functioning (ASD-HF), Specific Learning Disorders (SLD) and Attention Deficit/Hyperactivity Disorder (ADHD) disorders and to highlight similarities and differences among the three groups. Methods: We retrospectively collected the data from a total of 62 subjects with ASD-HF (n = 19) ADHD (n = 21), SLD (n = 22) and 20 typical development. All the participants underwent neuropsychological standardized test for the evaluation of cognitive profile (Wechsler Intelligence Scale for Children Fourth Edition—WISC-IV), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form—PSI-SF). The scores of the ASD-HF, ADHD, and SLD groups were compared using non-parametric statistic methods (Kruskall–Wallis H test and U Mann–Whitney for post-hoc analysis). Results: The ASD-HF group were significantly higher in all areas of the WISC-IV than the other two clinical groups. The SLD group performed significantly lower than ASD-HF in Working Memory Index. The SLD group showed lower scores on the somatic problems subscale than the other two groups. In the Difficult Child subscale of the PSI-SF, parents of ADHD children scored lower than the mothers of SLD subjects and higher than the fathers of SLD subjects. In all three groups there are specific deficiencies compared to the control group in the cognitive profile, behavioral and emotional problems, and parental stress. Conclusions: Our comparative analysis highlighted similarities and differences in three groups of children with different neurodevelopmental disorders, helping to better define cognitive, behavioral, and emotional characteristics of these children and parental stress of their parents.

Posttraumatic Growth Among Parents of Children with Autism Spectrum Disorder in China and Its Relationship to Family Function and Mental Resilience: A Cross-Sectional Study

OBJECTIVE

This study was conducted to examine the posttraumatic growth (PTG) of parents of children with autism spectrum disorder (ASD) and the association among family function, mental resilience and PTG.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted with 205 parents of children with ASD in the clinical department of a university-affiliated hospital in Guangzhou from January to October 2019. The Posttraumatic Growth Inventory, Family Assessment Device, and Connor-Davidson Resilience Scale were employed for data collection.

RESULTS

The mean PTG score of parents was 59.56±18.46; and 24.63%, 43.84%, and 32.51% of parents exhibited a high level, moderate level and low level, respectively, of PTG. The problem-solving dimension of family function (p = 0.005) and the strength dimension of mental resilience (p ≤0.001) were positively related to PTG.

CONCLUSIONS

Parents of children with ASD experienced moderate PTG overall. The problem-solving dimension of family function and the strength dimension of mental resilience were significant predictors of PTG.

PRACTICAL IMPLICATIONS

Interventions to improve family function and the mental resilience of parents with ASD children could contribute to improving the PTG of parents.

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.

The Impact of COVID-19 on the Adaptive Functioning, Behavioral Problems, and Repetitive Behaviors of Italian Children with Autism Spectrum Disorder: An Observational Study

Children with autism spectrum disorder (ASD) and their families have represented a fragile population on which the extreme circumstances of the COVID-19 outbreak may have doubly impaired. Interruption of therapeutical interventions delivered in-person and routine disruption constituted some of the main challenges they had to face. This study investigated the impact of the COVID-19 lockdown on adaptive functioning, behavioral problems, and repetitive behaviors of children with ASD. In a sample of 85 Italian ASD children (mean age 7 years old; 68 males, 17 females), through a comparison with a baseline evaluation performed during the months preceding COVID-19, we evaluated whether after the compulsory home confinement any improvement or worsening was reported by parents of ASD individuals using standardized instruments (Adaptive Behavior Assessment System (Second Edition), Achenbach Child Behavior Checklist, Repetitive Behavior Scale-Revised). No significant worsening in the adaptive functioning, problematic, and repetitive behaviors emerged after the compulsory home confinement. Within the schooler children, clinical stability was found in reference to both adaptive skills and behavioral aspects, whereas within preschoolers, a significant improvement in adaptive skills emerged and was related to the subsistence of web-delivered intervention, parental work continuance, and online support during the lockdown.

Parenting Stress and its Associated Components Prior to an Autism Spectrum Disorder (ASD) Diagnostic Evaluation

Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis.