Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact

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.

Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives

Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.

Reducing Depressive Symptoms Among Latina Mothers of Autistic Children: A Randomized Controlled Trial

This study examines the intervention effect of a culturally tailored parent education program in reducing depressive symptoms among Latina mothers of autistic children. In this two-site randomized waitlist-control study (n = 109 mother-child dyads), a peer-to-peer mentoring (promotora) model was used to deliver an intervention that was designed to increase mothers' self-efficacy and use of evidence-based strategies. We assessed mothers' depressive symptom (CES-D) scores at three time points and used linear mixed models to determine whether their scores significantly changed from baseline to postintervention (Time 2) and at 4 months postintervention (Time 3). Results show that mothers in the intervention group reported a significant decrease in mean depressive symptom scores at Time 2 and that the effect was maintained at Time 3 with intermediate to medium effect sizes. There were no differences in results across sites. Findings suggest that Parents Taking Action, a culturally tailored intervention led by peer mentors, showed a significant effect both immediately after the intervention and 4 months postintervention in reducing depressive symptoms among Latina mothers of autistic children.

Exploring Racial and Ethnic Differences in Parent-Reported Strengths in Children with Autism Spectrum Disorder

BACKGROUND

Several studies have demonstrated racial/ethnic differences in parental concerns in children with autism spectrum disorder (ASD). However, no studies have investigated racial/ethnic differences in parent-reported strengths. The purpose of this study was to explore racial/ethnic differences in parent-reported strengths in children with ASD.

DESIGN AND METHODS

This was a retrospective cross-sectional study investigating the relationship between parent-reported strengths and race/ethnicity at the time of an ASD diagnosis. Parent-reported strengths were qualitatively clustered into themes, and theme frequencies were quantitatively examined for relationships to race/ethnicity.

RESULTS

Parents of Caucasian children reported a mean of 5.00 (SD = 2.17) total strengths compared to 3.75 (SD = 2.32) among Hispanic/Latinx children, 3.36 (SD = 1.43) among Asian/PI children, and 3.91 (SD = 2.05) among children from other races/ethnicities. Bivariate linear regression analyses indicated that Asian/PI, Hispanic, and other child race/ethnicity, compared to Caucasian child race/ethnicity, were associated with significantly fewer parent-reported total strengths. Asian/PI and Hispanic child race/ethnicity were associated with significantly fewer personality strengths, while maternal education was associated with a greater number of personality strengths.

CONCLUSION

This study found racial and ethnic differences in parent-reported strengths in children with ASD. Further, higher levels of maternal education influenced total, personality, and behavioral strengths. Receipt of a greater number of child services was also associated with a greater number of behavioral strengths.

Formal support and service needs of family caregivers of adults with intellectual and/or developmental disabilities in India

BACKGROUND

Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed.

METHOD

A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews.

RESULTS

Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions.

CONCLUSIONS

Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.

Role of child demographic, executive functions, and behavioral challenges on feelings about parenting among parents of youth with Down syndrome

BACKGROUND

Living with a child with Down syndrome (DS) influences the entire family, including caregivers.

AIMS

This study examined positive and negative caregiver feelings about parenting youth with DS and to what extent children's demographic, cognitive, behavioral characteristics, and co-occurring medical conditions are associated with those parental feelings. Specifically, the mediatory role of child behavioral challenges on the relationship between child executive functioning (EF) and parent feelings about parenting a child with DS was examined in a mediation analysis model.

METHODS AND PROCEDURES

Parents of 113 youth with DS aged 6 to 17 year rated their positive and negative feelings about parenting, and their child's behavioral challenges and EF.

OUTCOMES AND RESULTS

Externalizing and Internalizing behavioral challenges and emotional and behavioral regulations of EF were significantly associated with positive and negative parent feelings. Child behavioral challenges fully mediated the relationship between child EF and caregiver feelings about parenting, after controlling for identified covariates of child demographics.

CONCLUSIONS AND IMPLICATIONS

Findings have implications for understanding the role of EF, through its impact on behavioral challenges, on the feelings of caregivers about parenting a child with DS. These findings play a role in understanding outcomes of interventions targeted at EF and behavioral challenges, in the context of other child variables.

Association of child neurodevelopmental or behavioural problems with maternal unemployment in a population-based birth cohort

PURPOSE

To estimate associations between suspected or diagnosed neurodevelopmental or behavioural problems in 7-year-old children and maternal unemployment at child age 7 and 10, in a Portuguese birth cohort.

METHODS

We evaluated 5754 mothers and their children of the population-based birth cohort Generation XXI in Porto, Portugal. Data on suspected and diagnosed child neurodevelopmental and behavioural problems (exposures)-learning, attention and language problems, externalising behaviours, developmental delay, autism spectrum disorders, and other neurodevelopmental problems-were retrieved at 7 years of age by interviewing caregivers. Maternal employment status (outcome) was collected at the 7- and 10-year follow-up waves. Robust Poisson regression models were used to estimate associations.

RESULTS

After adjustment for maternal and household characteristics, women were more likely to be unemployed at child age 10 if the child had, up to age 7, any of the following suspected problems: an autism spectrum disorder (PR = 1.73; 95% CI 1.07, 2.79), developmental delay (PR = 1.58; 95% CI 1.20, 2.06), externalising behaviours (PR = 1.29; 95% CI 1.11, 1.50) or learning problems (PR = 1.26; 95% CI 1.07, 1.48). When the exposure was restricted to clinically diagnosed disorders, the magnitude of associations remained similar but estimates were less precise. Associations with unemployment were stronger at child age 10 (prospective analyses), than at child age 7 (cross-sectional).

CONCLUSION

Having a child with learning, developmental or behavioural problems, or an autism spectrum disorder up to age 7 was associated with maternal unemployment three years later, even in a less affluent European economy where the dual-earner family structure is often necessary to make ends meet.

A secondary analysis examining the influence of emotional support on the mental health of caregivers of children with autism spectrum disorder

PURPOSE

The study purpose was to examine the effect of emotional support on the overall mental health and stress for caregivers of children with autism spectrum disorder (ASD).

METHODS

A cross-sectional retrospective study using secondary data from the 2016-2019 National Survey of Children's Health was conducted using single variable and multivariable linear regression analyses.

RESULTS

More informal emotional support sources were associated with better overall mental health (β = 0.124, SE = 0.015, p < .001) and reduced stress (β = -0.261, SE = 0.039, p < .001) for caregivers of children with ASD, controlling for covariates. The number of formal emotional support sources was not significantly associated with caregiver overall mental health or stress when controlling for covariates. Increased amounts of total emotional support sources were significantly associated with increased overall mental health (β = 0.042, SE = 0.010, p < .001) and reduced stress (β = -0.093, SE = 0.024, p < .001) for caregivers. Other factors significantly associated with caregiver outcomes included caregiver sex, caregiver marital status, caregiver education level, economic hardship, child sex, child race/ethnicity, ASD severity, and child receipt of ASD treatment.

CONCLUSION

More emotional support sources, in particular informal support sources, may be a protective factor for well-being for caregivers of children with ASD.

PRACTICE IMPLICATIONS

Health care providers should evaluate the impact of their formal support services on caregivers of children with ASD and advocate for increased informal and formal support resources for these caregivers.

Adaptation at the Family Level in Families of Individuals With Down Syndrome: A Scoping Review

Down syndrome (DS) is a chromosomal disorder associated with intellectual and physical disabilities and has historically been viewed by health care providers through a negative lens when considering the effect the condition has on the individual, family, and community. The purpose of this scoping review was to provide an overview of recent research concerning adaptation in families of individuals with DS with a focus on family adaptation rather than individual or dyadic adaptation. Three literature indexes were searched from 2017 to 2022, with 41 articles included. Foci of the studies included strength/resilience, stress/coping, and negative/challenge. Thirteen studies reported using a family framework. Multiple methodological approaches and family measures were used in the studies and are outlined. Findings from this review show there has been a shift in focus when researching families of individuals with DS from a negative and challenging experience to one of strength and resilience.

Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy

Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3-13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.

Relative Efficacy of Self-directed and Therapist-assisted Telehealth Models of a Parent-mediated Intervention for Autism: Examining Effects on Parent Intervention Fidelity, Well-being, and Program Engagement

PURPOSE

Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement.

METHOD

Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up.

RESULTS

There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement.

CONCLUSION

This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program.

Sibling Support and Perceived Daily Hassles in Latino and Non-Latino Families of Children with DD

Parents of children with developmental delay (DD) report significantly higher levels of parenting stress compared to parents of children with typical development. There is a heightened need for social support among families of children with DD. Siblings play an important role in these contexts as a supportive resource and primary stress buffer. Little to no research has examined how these stress and supportive processes may differ among Latino and non-Latino parents. The current study examined the relation between sibling support and parents' perceived daily hassles between Latino and non-Latino parents of children with DD (N = 146; 65% Latino; mean parent age = 37.39 years; mean child age = 49.63 months; SD = 7.9). Latinos reported significantly greater use of sibling support and lower perceived daily hassles compared to non-Latino counterparts. In the combined sample, greater sibling support was significantly correlated with lower daily hassles. When examined separately in Latino and non-Latino groups, this correlation only remained significant among Latinos. The interaction between ethnicity and sibling support on perceived daily hassles was approaching significance, such that Latinos who reported high levels of sibling support reported lower perceived daily hassles. Findings emphasize the universal importance of familial support systems for the well-being of parents of children with DD and point to the possible protective role of Latino cultural factors that influence the degree to which these supports are employed. Results may inform culturally sensitive adaptations to parenting interventions for Latino families that harness sibling support to target and buffer parenting stress.

Co-occurrence of Neurodevelopmental Disorders Predict Caretaker Mental Health in a Latinx Sample

Caretakers to children and adults with neurodevelopmental disorders (NDDs) experience more emotional distress compared to community control samples. Risk factors for poorer mental health among this population include symptom severity and an autism spectrum disorder diagnosis. This study aimed to ascertain a relationship between NDD severity and caretakers' mental health. It was hypothesized that co-occurrence of multiple diagnoses would predict higher anxiety and depressive symptomatology and suicidality. Data was collected from a sample of 93 Latinx caregivers to a child or adult with at least one NDD. Multiple NDDs predicted higher levels of anxiety and depression compared to the symptom severity endorsed by caregivers to those with a single NDD diagnosis, but did not predict increased suicidality endorsement. Because caregivers to those with multiple NDDs are at an elevated risk for depression and anxiety, clinicians should consider screening for internalizing disorders in caregivers when treating individual with an NDD.

Psychopathological symptoms in parents and siblings of people on the autism spectrum: A systematic review and meta-analysis

Parents and siblings of children on the autism spectrum experience significant distress, and for this reason, it is essential to understand the most prevalent psychopathological symptoms among this population. This work aims to establish the prevalence of psychopathological symptoms in parents and siblings of individuals on the autism spectrum, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) criteria. Searches were carried out using the PubMed/Medline, Embase, PsycINFO, SciELO, and Biblioteca Virtual em Saúde (BVS) databases. Twenty-three articles were included in this review. Depressive symptoms were the most frequently reported conditions, with a higher prevalence in mothers of children on the autism spectrum. In the meta-analysis, mothers of children on the autism spectrum scored higher by 0.42 standard deviations on the symptom scales (SMD 0.42; CI 0.25-0.59), with low statistical heterogeneity (I² 0%, p = 0.5) when compared with mothers of children with atypical development. The psychopathological symptoms of relatives should be investigated as part of the follow-up procedures for the child on the autism spectrum to facilitate their treatment.

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.

What factors are associated with posttraumatic growth among mothers of children with developmental disabilities in South Korea?

BACKGROUND

The identification of PTG and its correlates in the aftermath of a traumatic event would assist professionals in recognizing and amplifying individual's potential strengths. However, there are few studies on PTG and its correlates in mothers who have birthed or raised children with developmental disabilities in South Korea.

AIM

This study examined the predictive role of caregiving strain and social support on the subdimensions of PTG among South Korean mothers of children with developmental disabilities.

METHODS AND PROCEDURES

The participants were 344 mothers of children with intellectual disabilities or autism. PTG was divided into four sub-dimensions (change in self-perception, increase in interpersonal depth, finding new possibilities, and increase in spiritual interest), and the predictive roles of caregiving strain and social support on each sub-dimension were identified using hierarchical multiple regression.

OUTCOMES AND RESULTS

Subjective caregiving strain; family support services; and support from family, friends, or significant others were significantly related to the subdimensions of PTG. Interestingly, support from significant others was positively associated with PTG.

CONCLUSIONS AND IMPLICATIONS

Social support was more likely to influence all subdimensions of PTG, except for changes in self-perception while only subject caregiving strain was associated with PTG. Thus, policymakers and practitioners should prioritize expanding family support services and strengthening various informal supportive resources for mothers with higher PTG.

"We're in the same book, but we're in different parts of the book": Dominant and sub-group narratives of life following a Down syndrome determination

Parents of children with Down syndrome (DS) were interviewed about if their experiences raising their children matched their initial assumptions about parenting a child with DS. A dominant narrative was identified, wherein most parents described initially having negative assumptions, which did not come to fruition; parenting their child was not very different from parenting a typical child. There was also a sub-group of participants who disputed the dominant narrative; parenting their child was challenging and the dominant narrative marginalizes that experience. The findings indicate that although for many parents, having a child with DS is like "taking the scenic route" (i.e., it involves a few more hurdles, but often more rewards), this framing is not always applicable. Therefore, health care providers and support organizations should promote a narrative that encompasses the diversity of parenting a child with DS.

Mediating and moderating effects of cognitive flexibility in the relationship between social media addiction and phubbing

Presently, social media is widely used worldwide among different populations. Therefore, phubbing rapidly became a popular phenomenon in our daily life. However, little is known about the underlying mechanism and interaction between social media use and phubbing. Therefore, this research examines the mediating and moderating role of cognitive flexibility in the association between social media addiction and phubbing. Participants were 385 university students (280 females) studying at a state university in eastern Turkey and completed the self-reported measures of cognitive flexibility, social media addiction, and phubbing. The results showed that cognitive flexibility mediated and moderated the effect of social media addiction on phubbing. These findings may contribute to the discussion around the psychological consequences of using social media alongside increasing awareness about factors affecting and explaining the association between social media use and phubbing, which have important implications for research and practice.

A Retrospective Analysis of Therapists' Coaching Behavior When Directing Parents to Conduct Behavioral Assessments and Treatments Via Telehealth

Research on the delivery of behavioral assessment and treatment via telehealth has focused largely on child outcomes and parent procedural fidelity. By contrast, the behavior of the therapists coaching parents to conduct assessment and treatment has garnered little research consideration. In this study, we conducted a retrospective analysis of behavior therapists' coaching behaviors when directing parents to conduct functional analysis (FA) and functional communication training (FCT) with their young children with autism via telehealth. Coaching behaviors for five experienced behavior therapists across seven parent-child dyads were scored using a combination of standardized and novel behavior codes. Therapists displayed more social engagement behaviors than any other type of behavior throughout the study, and rates of antecedent and consequence behaviors shifted across the FA and FCT phases. Results are discussed in relation to therapists' goals during behavioral assessment and treatment and the implications for training behavioral therapists to coach parents via telehealth.

Teacher- and parent-reported trajectories of maladaptive behaviors among individuals with autism and non-spectrum delays

People with autism spectrum disorder (ASD) and non-spectrum developmental delays frequently exhibit maladaptive behaviors throughout the lifespan, which can have pervasive effects on quality of life. Maladaptive behaviors have been shown to change over time as a function of various individual-level factors (e.g., cognitive ability), yet research is primarily limited to parent-reported measures. To expand upon this work, the present study aimed to examine trajectories of teacher- and parent-reported maladaptive behaviors (i.e., hyperactivity, irritability, social withdrawal) and to test whether individual-level predictors (e.g., autism features, verbal intelligence quotient) and school-related predictors (e.g., teacher type, student-adult ratio, personal aide, school type) impact these trajectories among 165 individuals with ASD or non-spectrum delays from ages 9 to 18. Multilevel models revealed that, according to both teacher and parent report, participants showed the greatest improvement in hyperactivity, less but still notable improvement in irritability, and stable levels of social withdrawal over time. Higher verbal ability and fewer ASD features, in addition to mainstream school placement, emerged as important individual- and school-related differences associated with fewer maladaptive behaviors over time. The multi-informant perspective and longitudinal design provide novel insight into the manifestations of these maladaptive behaviors across different contexts and across time. Findings highlight the consistency of teacher- and parent-reported trajectories over time and further emphasize the importance of targeting maladaptive behaviors using a multisystem intervention approach in both school and home contexts.

Risk and protective factors associated with maternal mental health in mothers of children with autism spectrum disorder

BACKGROUND

Mothers of children with Autism Spectrum Disorder (ASD) experience lower maternal mental health outcomes than mothers of children from other populations, including children with intellectual and developmental disorders.

OBJECTIVES

This study explored risk factors associated with maternal mental health. Several factors including maternal resilience, social support, coping, optimism and family functioning acted as protective factors between child behavioural and emotional problems and maternal mental health.

METHODS

Mothers of 70 children completed a cross-sectional online survey. Twenty-two children were diagnosed with ASD, 16 children were diagnosed with Dyslexia (DYS) and 32 children had no special educational needs diagnosis (NO SEND).

RESULTS

Mothers of children with ASD demonstrated greater maternal mental health problems compared to mothers of children with DYS and NO SEND. Socioeconomic status (SES), child diagnosis, child gender, and child behavioural and emotional problems were significant risk factors associated with reduced maternal mental health. Maternal resilience, family functioning, and practical coping served as protective factors, moderating the relationship between child behavioural and emotional problems and maternal mental health. There is little evidence to suggest social support, optimism, and wishful thinking were protective factors in this relationship between child behavioural and emotional problems and maternal mental health.

IMPLICATIONS

There is a need to support mothers of children with ASD through interventions to promote and increase their mental health.

Development and validation of a system for the prediction of challenging behaviors of people with autism spectrum disorder based on a smart wearable shirt: A mixed-methods design

Background

Most people with autism spectrum disorder (ASD) present at least one form of challenging behavior (CB), causing reduced life quality, social interactions, and community-based service inclusion.

Objectives

The current study had two objectives: (1) to assess the differences in physiological reaction to stressful stimuli between adults with and without high-functioning ASD; (2) to develop a system able to predict the incoming occurrence of a challenging behaviors (CBs) in real time and inform the caregiver that a CB is about to occur; (3) to evaluate the acceptability and usefulness of the developed system for users with ASD and their caregivers.

Methods

Comparison between physiological parameters will be conducted by enrolling two groups of 20 participants with and without ASD monitored while watching a relaxing and disturbing video. To understand the variations of the parameters that occur before the CB takes place, 10 participants with ASD who have aggressive or disruptive CBs will be monitored for 7 days. Then, an ML algorithm capable of predicting immediate CB occurrence based on physiological parameter variations is about to be developed. After developing the application-based algorithm, an efficient proof of concept (POC) will be carried out on one participant with ASD and CB. A focus group, including health professionals, will test the POC to identify the strengths and weaknesses of the developed system.

Results

Higher stress level is anticipated in the group of people with ASD looking at the disturbing video than in the typically developed peers. From the obtained data, the developed algorithm is used to predict CBs that are about to occur in the upcoming 1 min. A high level of satisfaction with the proposed technology and useful consideration for further developments are expected to emerge from the focus group.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT05340608].

Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder

Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children's Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.

Familism and Parenting Stress in Latinx Caregivers of Young Children with Developmental Delays

Several studies have documented the difficult experience of raising a child with a developmental delay (DD; DeGrace et al., 2014) but the majority of research has focused on non-Latinx White families and their experiences in childrearing and interacting with service providers (Hayes & Watson, 2013; Blanche et al., 2015). Additionally, stigma associated with mental illness and DD disproportionally affects Latinx communities (Burke et al., 2019). Familism plays a unique role among families of Latinx backgrounds (Moore, 1970; Coohey, 2001) and may act as a buffer to caregiver mental health. The current study aims to (1) determine the association between affiliate stigma and parenting stress among Latinx parents of young children with DD and (2) test whether familism moderates the relationship between affiliate stigma and parenting stress. Results revealed that the relationship between affiliate stigma and parenting stress was strongest in caregivers who reported low levels of familism, suggesting that familism may act as a buffer. More research is needed to further unpack the protective factors of familism on caregiver mental health.

Revisiting an RCT study of a parent education program for Latinx parents in the United States: Are treatment effects maintained over time?

LAY ABSTRACT

Background: We conducted a follow-up investigation of a two-site randomized controlled trial in the United States. We examined whether the treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder were maintained over time.Methods: Using linear mixed models, we compared differences in parent and child outcomes across three timepoints: baseline, 4 months after baseline (Time 2), and 8 months after baseline (T3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder.Results: After intervention at both Time 2 and Time 3 in both sites, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. We also found that there were treatment differences across the two study sites in several outcomes.Implications: The intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.

Raising Children in Risk Neighborhoods from Chile: Examining the Relationship between Parenting Stress and Parental Adjustment

Introduction: Parenting stress and parental adjustment could implicate key differences in the relational dynamics that parents establish with their children, particularly when families come from vulnerable social contexts. Method: Participants were 142 fathers and mothers from a risk neighborhood of Chile. The variables examined were parenting stress (parental distress, parent–child dysfunctional interaction and difficult child) and parental adjustment (depression, anxiety, and stress). Parents also completed a sociodemographic characterization survey. The statistical analyses were a correlation analysis and multiple linear regression analyses. Results: Overall, not all components of parenting stress were related to parental adjustment. Only parental distress was found as a significant predictor of poor parental adjustment (greater depression, anxiety, and stress), but not parent–child dysfunctional interaction and having a difficult child. Conclusions: The present study findings highlight the influence of stress on parenting as a relevant dimension of research for the improvement of the intervention deployed by the state regarding the protection of vulnerable Chilean children, providing multiple clinical and psychosocial applications for research and intervention purposes.

Mindful Parenting, Caregiver Distress, and Conduct Problems in Children With Autism

Children with autism may display an externalizing problem behavior, which are associated with increased parenting stress and depression in caregivers. Mindful parenting is defined as having a non-judgmental moment-to-moment awareness during caregiver-child interactions. The extant literature is mixed, with some reporting that associations between child problem behavior and parenting stress and depression vary by level of mindful parenting, while others have not found these relations. We sought to extend these explorations. Participants who were caregivers of 75 children with autism spectrum disorder (ASD) ages 5-10, in the Pacific Northwestern region of the United States. Child conduct problems, parenting stress and caregiver depression, and mindful parenting were measured using caregiver-reported measures. Child conduct problems, parenting stress, and caregiver depression, and mindful parenting were all significantly correlated. The association between child conduct problems and parenting stress was significant for caregivers with high and low levels of mindful parenting. In contrast, the association between child conduct problems and caregiver depression was significant only for caregivers with low levels of mindful parenting. Our results suggest that mindful parenting may be a promising protective factor for the well-being of caregivers of children with autism. Implications are discussed.

The Impact of COVID-19 Restrictions on Psychological Distress in Family Caregivers of Children with Neurodevelopmental Disability in the UK

Caregivers of a child with a neurodevelopmental disability are more vulnerable to mental health difficulties. These difficulties are influenced by the child’s challenging behaviours, and the caregiver’s coping strategies; factors impacted by the COVID-19 pandemic. An online mixed methods survey was conducted on caregivers of children with neurodevelopmental disabilities (n = 43) and children who are typically developing (n = 67). The results showed that presence of challenging behaviours related to neurodevelopmental disability, and caregiver coping strategies predicted caregiver psychological distress during lockdown. Themes that emerged included ‘confusing messages and guidance’, ‘loss of freedom’ and ‘unsupported and forgotten’. The results demonstrate the pressing need for the implementation of appropriate support to protect the mental health of caregivers across the UK.

Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

Failure to replicate a robust Down syndrome advantage for maternal well-being

BACKGROUND

Family members caring for children with intellectual disability (ID) routinely report heightened levels of psychological distress. However, families of children with Down syndrome typically report better outcomes (known as the Down syndrome advantage). We examined whether the Down syndrome advantage would be present for maternal psychological distress, impact of caregiving, life satisfaction and perceived positive impact of the child with ID when controlling for external variables.

METHODS

Mothers of children with Down syndrome (n = 111) and mothers of children with ID of mixed aetiologies (n = 196) completed measures about their own mental health, perceived impact of caregiving, life satisfaction and perceived positive impact of their child on themselves and the family unit.

RESULTS

A series of group comparisons revealed small to moderate differences supporting the presence of a putative Down syndrome advantage in relation to personal maternal well-being outcomes. However, when child-related characteristics and external variables were controlled, the Down syndrome advantage was no longer present, with reduced, small effect sizes observed for all maternal outcomes.

CONCLUSIONS

Initial group differences in psychological distress and life satisfaction were largely associated with family poverty, indicating that the Down syndrome advantage may be less robust than previously thought. Future research should seek to move beyond examining the existence of the putative Down syndrome advantage and focus on how families of children with Down syndrome experience family life, including longitudinal research exploring responses to life cycle and transition challenges.

Measurement of Family Management in Families of Individuals With Down Syndrome: A Cross-Cultural Investigation

Down syndrome (DS) is the most common genetic cause of intellectual disability worldwide. The purpose of this analysis was to determine the internal consistency reliability of eight language versions of the Family Management Measure (FaMM) and compare family management of DS across cultures. A total of 2,740 parents of individuals with DS from 11 countries completed the FaMM. The analysis provided evidence of internal consistency reliability exceeding .70 for four of six FaMM scales for the entire sample. Across countries, there was a pattern of positive family management. Cross-cultural comparisons revealed parents from Brazil, Spain, and the United States had the most positive family management and respondents from Ireland, Italy, Japan, and Korea had the least positive. The rankings were mixed for the four remaining countries. These findings provide evidence of overall strong internal consistency reliability of the FaMM. More cross-cultural research is needed to understand how social determinants of health influence family management in families of individuals with DS.

Participation in sport and physical activity in adults with intellectual disabilities

BACKGROUND

People with intellectual disability face a number of barriers to participation in physical activity. This paper aimed to determine rates of sport and physical activity participation in an Australian sample of adults with intellectual disability, compared with rates of participation in the general Australian population. A secondary aim was to investigate factors that may contribute to participation of adults with intellectual disability.

METHOD

Participants were part of the Australian Child to Adult Development (ACAD) study, consisting of a community sample with intellectual disability (n = 305), groups of adults with autism (n = 94), Down syndrome (n = 64), fragile X syndrome (n = 52), Williams syndrome (n = 45), and Prader-Willi syndrome (n = 30). Participation in sport/physical activity was reported over the past 3 months. Rates of participation were reported for adults with intellectual disability and compared with rates in a general Australian population sample. The relationship between participation in physical activity and age, degree of intellectual disability, physical mobility, living situation, socio-economic disadvantage, and behaviour and emotional problems were also conducted.

RESULTS

Participants in the ACAD community sample with intellectual disability participated in sport/physical activity at lower rates than the general Australian population (42% compared with 71%). Having no physical mobility impairment was significantly associated with higher rates of participation. Those with Down syndrome participated in sport/physical activity at higher rates than the community sample with intellectual disability, while no difference in sport/physical activity participation was observed in the groups with autism or other syndromes.

CONCLUSION

Australian adults with intellectual disability participate in sport and physical activity at lower rates than the general population. Having a physical mobility impairment was associated with lower rates of participation. However, people living in supported accommodation were more likely to participate than those in other living situations. Having Down syndrome was associated with a higher participation rate than the community sample.

Benefits and cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities in low-and middle-income countries: A systematic review

BACKGROUND

Evidence and awareness of the importance of culturally adapting psychosocial interventions is growing. The aim of this paper is to systematically review studies on cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities, in low- and middle-income countries.

METHODS

Studies were identified through electronic databases and searching bibliographies. The quality and cultural adaptations of thirteen studies focusing on parental trainings were analysed using standardised tools and frameworks.

RESULTS

Findings suggest interventions reduce the risk of depression and stress and increase coping strategies and positive perceptions of family functioning. Parenting skills training may improve parent-child interactions and child development. However, these benefits should be interpreted cautiously due to methodological shortcomings. Most studies described efforts to make appropriate cultural adaptations to the interventions, but these adaptations were not comprehensive.

CONCLUSION

High-quality cultural adaptations are crucial to providing meaningful interventions in different parts of the world.

Mental health risks of parents of children with developmental disabilities: A nationally representative study in the United States

BACKGROUND

Caring for a child with a developmental disability may affect parents' mental health. There are few longitudinal or nationally representative studies, none on new mental health problems. Studies have few young children, and few adult children.

OBJECTIVE/HYPOTHESES

We hypothesized that parents of children with developmental disability would be more likely to develop mental health problems than other parents.

METHODS

We used the Panel Study of Income Dynamics (PSID, 1997-2017) and its Child Development Supplements, defining developmental disability by diagnoses such as autism spectrum disorder or intellectual disability, and requiring additional evidence of lasting impairment. We linked children's and parents' data spanning 20 years, including 44,264 mental health measurements for 4024 parents of 7030 children. Discrete-time hazard analysis controlled for child and parent characteristics.

RESULTS

About 9.4% of children had developmental disability. Parents of children with developmental disability were more likely to develop mental health problems than other parents. The odds of developing anxiety or depression were higher when an adult child with developmental disability lived independently, nearly 3 times higher for mothers (OR 2.89, CI 2.33-3.59) and more than twice as large for fathers (OR 2.35, CI 1.70-3.26). Compared to fathers whose children did not have developmental disability and challenging behaviors, the odds of psychological distress were over 7 times larger (odds ratio, OR 7.18, 95% confidence interval, CI, 5.37-9.61) for those whose children had developmental disability and challenging behaviors.

CONCLUSIONS

Parents of children with developmental disability may benefit from increased emotional support, respite, and interventions addressing challenging behaviors.

Main Needs and Challenges of Parents of Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) comprises a group of complex lifelong neurodevelopmental disorders, characterized with symptoms related to the difficulty of communication and interaction with other people, as well as restricted interests and repetitive behaviors. These symptoms affects the person's ability to function properly in school, work, and other areas of life. For better understanding the needs and challenges of families the survey developed by Autism Speaks in collaboration with the National Coordinators for Autism from nine Balkan countries was established. The aim of this research is to obtain an overview of some important data for children with some form of autistic disorder. The same questionnaire was used in two different periods of time (during 2015 and at the beginning of 2020) including samples of 60 and 140 parents respectively. The questionnaire comprises 57 questions in the following four domains: demographic characteristics, index child characteristics, service encounters and parent/caregiver perceptions. Results are compared and discussed. The survey results underscore that parents and families of children with ASD in our country carry a heavy burden. They face significant financial difficulties and need improved services from the health, educational and social sectors. It was concluded that there is a critical need to strengthen national capacity in caring for children, young people and adults with ASD and other neurodevelopmental disorders.

Psychological distress and positive gain in mothers of children with autism, with or without other children with neurodevelopmental disorders

Although a wealth of literature has focused on the parenting experiences of mothers of children with autism spectrum disorder (ASD), there is a lack of research about mothers who are parenting a child with ASD, and who have other children with neurodevelopmental disorders. In this matched-comparison study, 10 mothers of a child with ASD and other typically developing children (ASD-TD) were compared to 10 mothers of a child with ASD who also had other children with neurodevelopmental disorders (ASD-NDD). Mothers completed self-report measures of mental health and positive gain. Results indicated no significant between-group differences for mental health, although mothers in the ASD-NDD group reported increased positive gain compared to mothers in the ASD-TD group. Further research is needed to understand practical support needs and theory development.

Parental stress and symptoms of depression: a preliminary report

The aim of the study was to examine the relationship between parental stress and parental depression symptoms. A total of 67 mothers took part in this study, of whom 39 mothers of children with autism spectrum disorder (ASD) and 28 mothers of typically developing children. The self-reported measures of the Parental Stress Index III and the Questionnaire for Measuring Depression were used in this study. Mothers' stress domain, but not children' stress domain, was positively associated not only with mothers' total symptoms of depression but also with its dimensions such as cognitive deficits and a lack of energy, thinking about dead, pessimism, and a feeling of alienation, anxiety and guilt symptoms, psychosomatic symptoms and a loss of interest, and lower self-regulation abilities in a group of mothers of children with ASD. There were not nearly any significant associations between mothers' stress and mothers' depression symptoms in a sample of mothers of typically developing children. The results have practical implications for mental health support providers.

Empowerment in Polish fathers of children with autism and Down syndrome: the role of social support and coping with stress - a preliminary report

BACKGROUND

Although empowerment is an important factor in the adaptation of parents of children with intellectual and developmental disabilities, our understanding of empowerment in fathers or how it relates to coping with stress and subjective social support is limited. In Poland, families with children with intellectual and developmental disabilities experience many challenges because of insufficient support. Although parental contribution to developing different forms of services for people with disability is crucial, the potential of fathers is underestimated and poorly understood.

METHODS

The study enrolled 35 fathers of children with autism with intellectual disability, 37 fathers of children with Down syndrome and 40 fathers of typically developing children. They completed three questionnaires: Family Empowerment Scale, Ways of Coping Questionnaire and Social Support Questionnaire - Short Form.

RESULTS

Compared with other groups, family empowerment was lower in fathers of children with autism. No group differences were found for the service system and community dimensions of empowerment. In the fathers of children with autism, social support was not related to empowerment, but there was a negative correlation between emotional coping and service system. Satisfaction with social support in fathers of children with Down syndrome correlated positively with the community dimension of empowerment.

CONCLUSIONS

Results show that fathers of children with autism and intellectual disability require support in family empowerment and that the significance of emotion-focused and problem-focused coping and social support in the context of empowerment differs in fathers of children with autism and Down syndrome. These results should be considered preliminary because of the limited sample size.

Rewards and challenges of parenting a child with Down syndrome: a qualitative study of fathers' perceptions

Aim: Most studies on parenting children with Down syndrome and other intellectual disabilities have focused on stress and coping; however, research has shown many rewards in parenting such children. Additionally, most research has assessed mothers' rather than fathers' perspectives. To take steps toward filling these literature gaps, we asked fathers of children with Down syndrome about their parenting experiences.Methods: Participants were 175 fathers of children with Down syndrome. Open-ended questions asked fathers what they found most rewarding and challenging about parenting a child with Down syndrome. Researchers coded responses using inductive content analysis.Results: Key themes for rewards included: (1) Child's Positive Attributes and Behaviors; (2) Rewarding Father-Child Relationship; (3) Child Has Positively Changed Father; and (4) Father's Positive Relationship with Others. Key themes for challenges included: (1) Father's Thoughts, Emotions, and Behaviors; (2) Child's Challenging Behavior and Development; (3) System and Institutional Problems; and (4) Other People's Negative Attitudes/Behaviors.Conclusions: Rewards mainly concerned the father-child bond and the loving, happy child. Fathers rarely mentioned financial stressors or their children's negative behaviors. Instead, many fathers reported children's speech problems. Our findings may assist healthcare professionals in providing more beneficial resources and interventions (especially language-related ones) to families with a child with Down syndrome.Implications for rehabilitationConsistent with a positive psychology approach, fathers reported more rewards than challenges in raising a child with Down syndrome.There may be a need for greater involvement of fathers in language interventions for children with Down syndrome.Healthcare professionals can assist parents of children with Down syndrome in recognizing parenting rewards.

Families under pressure: stress and quality of life in parents of children with an intellectual disability

Objective

To evaluate stress and quality of life in parents of children with an intellectual disability (moderate–severe–profound), who attend a Child and Adolescent Mental Health Intellectual Disability Service (CAMHS ID), and to estimate the perceived levels of challenging behaviour and satisfaction with supports.

Methods

Data from children attending the service from 2014 to 2017, along with clinician and parent rating scales were collected.

Results

Most children had medical comorbidities, autism spectrum disorder (ASD), and challenging behaviours. Half had a diagnosis of a mental health disorder. Less than half received respite care. Challenging behaviours and ASD were found to be correlated with increased parental stress while perception of support was inversely correlated with stress. Intellectual disability, ASD, and parental stress were correlated with a decrease in perceived family quality of life.

Conclusions

This study concurs with previous studies, outlining that parents of children with intellectual disability, in particular, where there is a diagnosis of comorbid ASD and challenging behaviour, experience increased psychological distress and lower quality of life.

Health-related quality of life amongst primary caregivers of children with intellectual disability

BACKGROUND

Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health-related quality of life (HRQoL) across co-morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population.

METHODS

Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ-5D-5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties.

RESULTS

Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ-5D-5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ-5D-5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age-equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co-morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL.

CONCLUSIONS

This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost-effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers.

Parental perception of stress and emotional-behavioural difficulties of children with autism spectrum disorder and specific language impairment

Background and aims

The daily challenges of caring for a child with autism spectrum disorder affect many areas of everyday life and parental well-being, as well as parents' ability to manage the needs of the family and the child concerned. A better understanding of parents' perception of their child's characteristics can allow better support for them and individualize intervention protocols in a more accurate way. The main objective of this study is the evaluation of the perception of stress by parents of children with autism compared to parents of children with specific language impairment.

Methods

The parents of 87 children aged between 2 and 6 years were included in this study, 34 children with a specific language impairment diagnosis and 53 children with an autism spectrum disorder diagnosis (ASD) or at risk of developing it. They were asked to complete a self-report on perceived stress and rating scales on adaptive/problematic behaviours, executive functions and sensory profile of the child.

Results

The results reveal that parents of ASD children, compared to the control group, showed significantly higher levels of stress, mainly due to the difficulty of managing unexpected events, the feeling of loss of control over one's life and the fear of not being able to cope with the adversities they were experiences. The most critical area, both for ASD and control group, concern the executive function related to emotional reactions.

Conclusions

Thus, we argue that the difficulties in self-control, sensory modulation and emotional regulation, represent an element of stress for parents of children with developmental disorders.Implications: Regarding the difficulties of children with ASD, supporting the ways in which caregivers adapt to the signals of children is an important strategy, which has now become a key element of treatments for autism mediated by parents.

Predictors of Change in Play-Based Communication and Behavior Intervention for High-Risk ASD: The Role of Mother-Child Dyadic Synchrony

Background: Interindividual variability is important in the evolution of adaptative profiles of children with ASD having benefited from an early intervention make up for deficits in communication, language and social interactions. Therefore, this paper aimed to determine the nature of factors influencing the efficacy variability of a particular intervention technique i.e., "Play-based communication and behavior intervention" (PCBI). Methods: The participants comprised 70 13-30-month-old toddlers with ASD enrolled in PCBI for 12 weeks. The Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the efficacy of PCBI. Video recordings of 5 min of free-play before and after PCBI were used to examine behaviors of mothers and children and parent-child dyadic synchrony. Hierarchical multiple regression analyses and machine learning algorithms were performed to explore the effect of these potential predictors (mothers' factors, children's factors and videotaped mother-child interaction) of intervention efficacy. Results: The hierarchical regression analysis and the machine learning algorithms indicated that parenting stress, level of completion of training at home and mother-child dyadic synchrony were crucial factors in predicting and monitoring the efficacy of PCBI. Conclusions: In summary, the findings suggest that PCBI could be particularly beneficial to children with ASD who show a good performance in the mother-child dyadic synchrony evaluation. A better dyadic mother-child synchrony could enhance the PCBI efficacy through adapted emotional and behavioral responses of the mother and the child and has a beneficial influence on the child's psychological development.

A Randomized Waitlist-Control Group Study of a Culturally Tailored Parent Education Intervention for Latino Parents of Children with ASD

This two-site randomized waitlist-control study (n = 96 mother-child dyads) examined the efficacy of a psychoeducation program as compared to usual care to empower Latina mothers and improve their confidence in and use of evidence-based practices (EBPs) for their children with ASD. A secondary aim was to improve child outcomes. Compared to control group, we found significant positive changes in the treatment group in maternal confidence of and frequency in use of EBPs, child social communication and the number of EB services the child received. We found no significant differences for the treatment group in family empowerment or in child challenging behaviors. This RCT presents evidence of an efficacious intervention for Latino children with ASD and their mothers in California and Illinois.

Parenting stress in caregivers of young children with ASD concerns prior to a formal diagnosis

Robust findings demonstrate that parents of children with autism spectrum disorder (ASD) experience high levels of parenting stress that are associated with negative outcomes for families. Although the majority of research on parenting stress has focused on parents of children with an existing diagnosis, parents of young children with concerns about ASD-related behaviors also face many unique challenges before the time of diagnosis. However, no study to date has examined patterns of parenting stress among parents of children with ASD concerns prior to a formal ASD diagnosis. Therefore, the current study investigated longitudinal trajectories of parenting stress among parents of young children with ASD concerns compared to parents of children with non-ASD developmental concerns (e.g., language delay), and parents of children with no developmental concerns. Known predictors of parenting stress were also examined. Results from multilevel model analyses revealed that parents of children with ASD concerns experienced consistently higher levels of parenting stress across early child development compared to parents of children with non-ASD developmental concerns and those with no concerns. Additionally, parenting efficacy, psychological functioning, social satisfaction, and child social communication behaviors predicted levels of parenting stress for all parents. Autism Res 2020, 13: 82-92. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examined parenting stress across time among parents of young children with ASD concerns before receiving a diagnosis. Parents of children with ASD concerns reported consistently higher levels of parenting stress compared to parents of children with other developmental concerns and parents of children with no concerns. Also, ASD concerns predicted parenting stress in addition to other parent and child predictors of parenting stress. These findings highlight the need to better support families before an ASD diagnosis.

The effects of early autism intervention on parents and family adaptive functioning

This review describes the effects of intervention for young children with autism spectrum disorder (ASD) on parents. Like all children, children with ASD bring both negative and positive experiences for parents and families-from increased resource needs, to higher levels of parenting-related stress, to positive personal growth for family members. It is increasingly recognized that, although children with ASD are the primary targets of early ASD intervention, ASD intervention also impacts parents. From the time emerging developmental concerns begin to be identified, through the process of obtaining a diagnosis and initiating services, parents play a central role in addressing the needs of young children with ASD, including implementing and supporting early intervention. Parents experience the impact of intervention directly, through interaction with providers within the health care and educational systems. Parents also experience indirect impacts of ASD intervention due to accelerated developmental progress of children who are benefitting from services and when children make slower progress than expected or have challenging behaviors. Parental stress and psychological well-being are legitimate targets of intervention and compelling research objectives, needing no additional justification. However, parents are also the major contributors to family adaptive functioning-the activities families employ to support positive outcomes for children with ASD (e.g., family-orchestrated child experiences, parent-child interaction, child health and safety functions; Guralnick, 1997). A parent's ability to carry out adaptive functions is, in part, related to their levels of stress and psychological well-being. Thus, there is a transactional process in which parents are both impacted by and have an impact on ASD interventions for their child. Evaluating the effect of ASD intervention on parents is needed to develop new strategies for helping parents and children with ASD reach their full potential. This review will provide an overview of research on the impact of early ASD intervention on parents. Evidence regarding the impact of three types of intervention (i.e., early intensive behavioral intervention, parent-implemented intervention, and programs directly targeting parent stress) on parent well-being and family adaptive functioning will be reviewed. Potential moderators of the impact of ASD intervention on parents and family adaptive functioning will be discussed. We conclude that research on the impact of ASD intervention on parents of young children with ASD is a promising avenue for improving the lives of children with ASD and their families.

Personal Growth Experiences of Parents to Children with Autism Spectrum Disorder

Experiences of parenting a child with Autism Spectrum Disorder (ASD) have mostly been studied in relation to hardship. The current study explored personal growth experiences of Israeli parents to children with ASD, specifically in relation to Tedeschi and Calhoun's crisis-related growth model. Nineteen parents were interviewed, and qualitative categorical content analysis was performed. Four major growth themes emerged: Empowerment and personal strength, Existential perspective/spiritual-emotional experience, Interpersonal and Expertise, professional or political involvement. Themes were largely consistent with the crisis-related growth model, with some being unique to the current subject of inquiry. Findings indicated growth might occur differently in different cultures. Clinically, with some parents, the focus regarding the parenting of their child with ASD should be shifted from adjustment to growth.

Child-rearing routines among Mexican-heritage children with autism spectrum disorder

This study examined the daily routines and activities of Mexican-heritage mothers and their children with autism spectrum disorder. Experienced sampling methods were used to capture families' current daily routines and activities, how parents valued those activities, and whether the activity was part of the child's autism spectrum disorder intervention. A total of 32 mothers were texted five times per day over five consecutive days for a total of 721 observations. Mothers frequently engaged in Self-Care (e.g. showering), General Caregiving (e.g. cooking), and House Chores (e.g. laundry). Children engaged in activities in which interventions could easily be integrated (e.g. Academics, Self-Care, and Playing with Others). Families spent less than one-third (26.1%) of their activities participating in interventions. Mothers and children jointly spent time in General Caregiving, Playing with Others, and Using Electronics. Practitioners should focus on integrating evidence-based interventions into daily joint routine activities.