Examining bidirectional relationships between parenting and child maladjustment in youth with autism spectrum disorder: A 9-year longitudinal study

A longitudinal path model examining the transactional nature of parenting and child externalizing behaviors in a large, sociodemographically diverse sample

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

Parenting Practices and Externalizing Behaviors in Autistic Children: A Systematic Literature Review

There is limited recent research on the association between parenting practices and externalizing behaviors in autistic children. To address this gap, the current systematic review examined the associations between parenting practices and externalizing behaviors in autistic children, along with the mediating and moderating effects of parent and child variables (PROSPERO registration number CRD42022268667). Study inclusion criteria were (1) Peer-reviewed journals, (2) Participants included parents of autistic children and their children, (3) Quantitative measures of both parenting practices or behaviors/style and child externalizing behaviors, (4) Cross-sectional or longitudinal studies only, and (5) Studies published in English. Study exclusion criteria were: (1) Qualitative studies, (2) Published in a language other than English, (3) Participants included non-human participants, (4) Participants that did not include parents and their autistic children as participants or did not report this group separately, (5) Systematic review and meta-analyses, and (6) No quantitative measures of parenting practices and/or child externalizing behaviors. Quality appraisal and risk of bias were conducted using the McMaster Tool and results were synthesized in Covidence and Excel. Thirty studies were included in the review. Results demonstrated that mindful parenting was associated with fewer or lower levels of externalizing behaviors; positive parenting practices had non-significant associations with externalizing behaviors; specific parenting practices had differing associations with externalizing behaviors; and negative parenting practices were associated with higher levels of externalizing behaviors. We are unable to draw causal relationships due to focus on cross-sectional and longitudinal articles only. The potential for future research to target specific parent practices to support children's externalizing behaviors is discussed.

The Diagnostic Period for Autism: Risk and Protective Factors for Family Quality of Life in Early Childhood

During the diagnostic evaluation period for autism or intellectual disability (ID), families of young children are at risk for poor adjustment. The present study aimed to document family quality of life (FQOL), along with associated risk and protective factors, during this critical step of families' services trajectory. FQOL was measured in a large sample of families of children recently diagnosed with a neurodevelopmental disorder and examined in relation to the type of services received, children's clinical profile, and family variables. FQOL was related to types of services, children's challenging behavior, parenting stress, and several aspects of family composition and status. These findings highlight a need for mental health support for parents, coaching interventions for challenging behaviors, and family-centered supports.

Longitudinal studies of challenging behaviours in autistic children and adults: A systematic review and meta-analysis

Autistic children and adults are at increased risk of showing behaviours that may be described as challenging, however, little is known about whether or how these behaviours may change over time. Given the profound impact that challenging behaviour can have on both the autistic individual and their support network, it is critical that the trajectory of challenging behaviours be better understood. This systematic review and meta-analysis identified and synthesised observational longitudinal studies of challenging behaviour in autistic individuals. Fifty-six studies were included in the systematic review, and the effect sizes of 37 independent samples arising from 34 of these reports were examined through meta-analysis. Crucially, across the 37 samples, scores on the measures of challenging behaviour reduced by a small, yet significant, extent over time. Although age of the sample at baseline assessment did not moderate the effect, the time between the baseline assessment and final follow-up and age at final follow-up both moderated the magnitude of the effect, with challenging behaviour scores reducing to a larger extent in (a) studies with longer intervals between baseline and final follow-up and (b) studies with older samples at follow-up. The results from the current systematic review and meta-analysis have both theoretical and practical implications for understanding challenging behaviour over time in autistic individuals. Avenues for future research are also highlighted that may allow better understanding, and therefore support of, challenging behaviour in autistic individuals.

Factors influencing the mental health of autistic children and teenagers: Parents' observations and experiences

LAY ABSTRACT

Autistic people are more likely to experience mental health difficulties compared to neurotypical people. It is very important that we understand what increases the risk for mental health difficulties, and what helps to protect against them. So far, research on this for children and young people has only investigated a small number of factors and these have been chosen by researchers and clinicians. This study took a different approach in which parents' expertise in their children was recognised. Parents were asked to tell the story of their autistic teenagers' mental health from diagnosis in early childhood through to the present, and to explain the 'theories' they developed about what affected their child's mental health - positively and negatively - and how. Parents believed a wide range of factors played a role. These include: (1) aspects of their child (e.g. their autistic traits, intelligence); (2) aspects of their surroundings (e.g. the efforts parents make to prevent and respond to their child's difficulties, features of the school they attend, availability of social activities); (3) changes their child experienced growing up (e.g. puberty, awareness of being autistic); and (4) life events involving loss and separation. Many of the factors parents identified as important have received little or no research attention to date. The findings suggest issues that should be considered in future research and reveal ways that support for parents and autistic children and teenagers can be improved.

Characterizing Parent–Child Interactions in Families of Autistic Children in Late Childhood

Parent–child interactions are influential to a wide range of positive developmental processes in neurotypical children, yet contributions to our understanding of these interactions using observational methods in families of children on the autism spectrum are lacking. The aim of the current study is to investigate how autism symptoms might impact these interactions. We use a family discussion task to: (1) compare families of autistic children aged 8–12 years (n = 21) to families of typically developing children (n = 21, matched on age and cognitive abilities) on the observed levels of supportive and directive behaviors in the parent–child relationship, and (2) examine the associations between parent–child interaction characteristics and child functioning. Results showed no differences in the observed levels of supportive behavior exhibited by parents, but significantly less supportive behavior in autistic children compared to neurotypical children. In addition, parents of autistic children had higher levels of observed directive behavior compared to parents of neurotypical children. Levels of supportive behavior in parents and autistic children were negatively associated with child ADHD symptoms. Findings reinforce literature on younger children describing positive parenting characteristics and further rebuke historical accounts of negative parenting qualities of parents of autistic children.

An Evaluation of the Quality of Parent-Child Interactions in Vulnerable Families That Are Followed by Child Protective Services: A Latent Profile Analysis

In the current study, an observational procedure, recorded in video, was used to evaluate the quality of parent-child interactions in a sample of vulnerable Portuguese families (n = 47) with school-aged children followed by Child Protective Services (CPS). The study sought to explore if the families presented different profiles of parent-child interaction quality, and to characterize such profiles in terms of discrete behaviors observed, parenting outcome variables, and families’ sociodemographic and CPS referral characteristics. The parent-child dyads took part in a 15 minutes structured task and parents completed self-report measures (affection, parenting behaviors, and stress). Discrete behaviors of parents and children during interactions were coded with a micro-analytic coding procedure. The global dimensions of the parents’ interactions were coded with a global rating system. A latent profile analysis, estimated with global dimensions, identified two subgroups, one subgroup in which parents displayed higher quality interactions (n = 12), and another subgroup in which parents displayed lower quality interactions (n = 35). Further analyses comparing the subgroups determined that the higher quality subgroup presented more positive behaviors, and the lower quality subgroup presented more negative behaviors during the interactions. No further differences or associations were found regarding the parenting outcome variables, and the families’ sociodemographic and CPS referral characteristics. The findings are in line with prior studies, suggesting that vulnerable families may frequently present depleted parent-child interactions. However, given the small sample size, future studies should replicate the described procedures and analyses in larger sample sizes.

Symptom Severity, Internalized and Externalized Behavioral and Emotional Problems: Links with Parenting Stress in Mothers of Children Recently Diagnosed with Autism

The present study examined which aspects of the child's behavior and clinical profile accounted for three dimensions of parenting stress: related to parenting roles, to interactions with the child, and to the child. Measures of adaptive behavior, intellectual functioning, autism symptom severity, and challenging behavior and emotional difficulties were examined as predictors of parenting stress in 157 mothers of children recently diagnosed with autism. Children's emotional problems and aggressive behavior were most predictive of parenting distress, whereas autism symptoms along with emotional problems and aggressive behavior, respectively, were linked to stress pertaining to interactions and to the child. These findings underscore the need for comprehensive and complementary interventions that focus on children's behavior and symptoms but also on parent adjustment.

Expressed Emotion in Families of Children With and Without Autism Spectrum Disorder, Cerebral Palsy and Down Syndrome: Relations with Parenting Stress and Parenting Behaviors

This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.

Unraveling Prospective Reciprocal Effects between Parental Invalidation and Pre-Adolescents' Borderline Traits: Between- and Within-Family Associations and Differences with Common Psychopathology-Parenting Transactions

The etiology of borderline personality pathology has consistently been framed as an interactional process between child vulnerability (i.e. emotional sensitivity and reactivity; Linehan, 1993) and invalidating parenting strategies, which evolves into increased emotion dysregulation and disinhibited behavior of the child and in turn activates more parental invalidation. Despite the strong theoretical base in support of these high-risk parent-child transactions, invalidating parenting behaviors have mostly been explored as a cause of child dysregulation and disinhibition, rather than as a result of child-driven effects. Also, most transactional research in this regard focused at differences between families, thereby not addressing potential changes within families across time. The current study therefore examines bidirectional between- and within-family effects of childhood borderline-related traits and maternal invalidation in the sensitive developmental phase of pre-adolescence (n = 574; 54.4% girls) along three assessment points. Cross-Lagged Panel Models and Random-Intercept Cross-Lagged Panel Models indicated detrimental parenting effects of invalidation on subsequent development in borderline-related traits of the child both between and within families, and additional child-driven effects for subsequent invalidating parenting strategies within families. Beyond these transactions between borderline-related traits and parenting, the current study also indicates significant differences in the direction of effects when exploring transactions between more common dimensions of child internalizing/externalizing symptomatology and parental invalidation, suggesting a more substantial parenting etiology in the developmental process of borderline traits throughout pre-adolescence. Future longitudinal research may explore to what extent the transactional nature of borderline personality traits during important developmental stages indeed holds unique aspects compared to more common manifestations of symptomatology at young age.

Negative Controlling Parenting and Child Personality as Modifiers of Psychosocial Development in Youth with Autism Spectrum Disorder: A 9-Year Longitudinal Study at the Level of Within-Person Change

This nine-year longitudinal study addresses the joint contribution of parent-rated negative controlling parenting and child personality on psychosocial outcomes in 141 families of children with autism spectrum disorder (83% boys, mean age Time 1 = 10.1). Latent change modeling revealed substantial variation in within-person change in parenting and psychosocial outcomes across a six- and three-year-interval. Over time, negative controlling parenting and child personality were consistently related to externalizing problems, whereas child personality was differentially related to internalizing problems and psychosocial strengths. Three personality-by-parenting interactions were significant, suggesting that children with less mature personality traits show more externalizing behaviors in the presence of controlling parenting. This study identified both parenting and child personality as important modifiers of developmental outcomes in youth with autism.

A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research

This paper reviews and synthesizes key areas of research related to the etiology, development, and maintenance of internalizing symptoms in children, adolescents, and adults with autism spectrum disorder (ASD). In developing an integrated conceptual model, we draw from current conceptual models of internalizing symptoms in ASD and extend the model to include factors related to internalizing within other populations (e.g., children that have experienced early life stress, children with other neurodevelopmental conditions, typically developing children) that have not been systematically examined in ASD. Our review highlights the need for more research to understand the developmental course of internalizing symptoms, potential moderators, and the interplay between early risk and protective factors. Longitudinal studies incorporating multiple methods and both environmental and biological factors will be important in order to elucidate these mechanisms.

Parenting Strategies Used by Parents of Children with ASD: Differential Links with Child Problem Behaviour

Here, we explored the structure of the 'Parenting Strategies Questionnaire', a new scale designed to measure parenting strategies for problem behaviour in ASD. We then examined links between child behaviour and parenting in a sample of 222 predominantly-UK parents of ASD children exhibiting behaviour found difficult or challenging. Analysis revealed three parenting subscales: Accommodation, Reinforcement Approaches and Reducing Uncertainty. Both Accommodation and Reducing Uncertainty were linked to child problem behaviour. Child factors explained up to 29% of the variance in Accommodation, with Socially Inflexible Non-compliance the strongest predictor, and up to 24% of the variance in Reducing Uncertainty, with Intolerance of Uncertainty the strongest predictor. Child factors were not related to Reinforcement Approaches. Longitudinal studies investigating these relationships are needed.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

Parenting adolescents with ASD: A multimethod study

A number of studies have concluded that parents of children with ASD experience high levels of parenting stress. However, little is known about their parenting behaviors. Especially few studies investigated parenting in adolescence, although this period is associated with additional challenges for both adolescents and their parents. In the present study, a multi-method approach was used, combining data from a self-report questionnaire and observation of mother-child interactions during different semi-structured (e.g., inventing and building a vehicle of the future with construction toys) and structured tasks (e.g., solving marble maze). Linear mixed models (LMM) were used to compare the means of parenting behaviors among mothers of adolescents with (n = 44) and without ASD (n = 38), aged 12 to 16 years old. During the observations, mothers of adolescents with ASD showed more sensitivity and creativity, compared to the general population control group. In addition, mothers in the ASD group reported on the self-report questionnaire to adapt the environment more, for example, by establishing routines. Furthermore, this study investigated the role of maternal characteristics, that is, ASD characteristics and parenting stress. Parenting stress was associated with less self-reported positive parenting. Higher levels of ASD characteristics of the mother were related to more negativity and less sensitivity during the observation, and more self-reported harsh punishment and adapting the environment. This study additionally examined whether the impact of these maternal characteristics was the same across the two groups. Whereas group by parenting stress interaction effects were not significant for any of the observed and self-reported parenting behaviors, significant group by ASD characteristics interaction effects were noticed for self-reported harsh punishment and adapting the environment. Autism Res 2018, 11: 1000-1010. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

A number of studies have concluded that parents of children with ASD experience high levels of parenting stress. However, little is known about their parenting behaviors. Especially parenting in adolescence remains under investigated, although this period is associated with additional challenges for both adolescents and their parents. In this study, 44 adolescents with ASD and a control group of 38 adolescents without ASD, aged 12-16 years old, participated together with their mother. We compared parenting behaviors between the two groups, based on observations of mother-child interactions and a questionnaire that was filled out by the mother. During the observation, mothers of adolescents with ASD showed more sensitivity and creativity, compared to the control group. In addition, the questionnaire responses indicated that mothers in the ASD group adapted the environment more by for example, establishing routines. Furthermore, this study investigated the role of parenting stress and ASD characteristics of the mother on parenting behavior. Parenting stress was associated with less self-reported positive parenting. Higher levels of ASD characteristics of the mother were related to more negativity and less sensitivity during the observation in both groups, and more self-reported harsh punishment and adapting the environment in the control group only.

Relations between problem behaviors, perceived symptom severity and parenting in adolescents and emerging adults with ASD: The mediating role of parental psychological need frustration

Research in parents of youngsters with Autism Spectrum Disorder (ASD) increasingly documents associations between children's problem behaviors and symptom severity and more dysfunctional and less adaptive parenting behaviors. However, the mechanisms underlying these associations have not been examined thoroughly. This study examines the mediating role of parental need frustration in the relation between child maladjustment (i.e., problem behavior and autism severity) and parenting behavior (i.e., controlling and autonomy-supportive parenting). The sample included 95 parents of adolescents/emerging adults with ASD (M_age=18.8years, SD=2.3). Parents completed questionnaires assessing their parenting strategies and psychological need frustration as well as the internalizing and externalizing problem behaviors and autism severity of their child. Results indicate that the association between externalizing problems and controlling parenting was partially mediated by need frustration. This suggests that externalizing problems go together with lower feelings of parent-child closeness, lower parental competence, and a decreased sense of volitional functioning, feelings that, in turn, relate to more controlling strategies. Symptom severity has a direct negative association with autonomy support, suggesting that parents lower their autonomy support when their child has high levels of autism symptoms, without experiencing these symptoms as a threat to their own psychological needs.