Childhood intellectual disability and parents' mental health: integrating social, psychological and genetic influences

Examining the role of common variants in rare neurodevelopmental conditions

Although rare neurodevelopmental conditions have a large Mendelian component1, common genetic variants also contribute to risk2,3. However, little is known about how this polygenic risk is distributed among patients with these conditions and their parents nor its interplay with rare variants. It is also unclear whether polygenic background affects risk directly through alleles transmitted from parents to children, or whether indirect genetic effects mediated through the family environment4 also play a role. Here we addressed these questions using genetic data from 11,573 patients with rare neurodevelopmental conditions, 9,128 of their parents and 26,869 controls. Common variants explained around 10% of variance in risk. Patients with a monogenic diagnosis had significantly less polygenic risk than those without, supporting a liability threshold model5. A polygenic score for neurodevelopmental conditions showed only a direct genetic effect. By contrast, polygenic scores for educational attainment and cognitive performance showed no direct genetic effect, but the non-transmitted alleles in the parents were correlated with the child's risk, potentially due to indirect genetic effects and/or parental assortment for these traits4. Indeed, as expected under parental assortment, we show that common variant predisposition for neurodevelopmental conditions is correlated with the rare variant component of risk. These findings indicate that future studies should investigate the possible role and nature of indirect genetic effects on rare neurodevelopmental conditions, and consider the contribution of common and rare variants simultaneously when studying cognition-related phenotypes.

Psychological interventions for parents of children with intellectual disabilities to enhance child behavioral outcomes or parental well-being: A systematic review, content analysis and effects

The aim of this review was to identify the type, content, and effectiveness of psychological parenting interventions for parents of children with intellectual disabilities to enhance child behavior and/or parental well-being. A systematic search yielded 21 studies involving 1825 participants. Studies were evaluated according to intervention content, pre- and post-treatment and follow-up effect sizes, and risk of bias. We categorized the interventions into those targeting 'Child or interaction' (child behavior, interaction and learning, understanding disability), and those targeting 'Parent' (parental well-being) or both themes. All these interventions had positive effects on parental well-being or child behavior. Parental outcomes were improved by interventions targeting 'Parental well-being', as well as 'Child or interaction'. Child behavior showed improvements in programs focusing on 'Child or interaction', and in a mindfulness-based parental well-being program. During follow-up, most effects were sustained or further increased, but some studies showed no improvements over the control group.

Evaluating Saudi Parental Interagency on Collaborative Initiatives for Successful Post-Secondary Transition of Students with Intellectual Disabilities

Effective collaboration between schools and community agencies is paramount for the successful transition of students with disabilities to post-secondary educational settings. This study, conducted in Riyadh, Saudi Arabia, focuses on assessing the level of collaboration from the perspective of parents of students with intellectual disabilities. Using descriptive analysis, data was gathered from 191 parents, and the results indicate a perceived low level of collaboration between schools and various agencies in planning and supporting the transition to post-secondary environments. The study results evaluate collaboration in three dimensions: (a) universities rank lowest with x ¯ =1.61 and SD=1.102). (b) vocational training centers ranking highest (1st rank) with an x ¯ = 1.97 and SD = 1.079), and (c) other relevant service centers 2nd rank with x ¯ =1.69 and SD= 1.177. The findings emphasize the necessity for legislative measures directing agencies to engage in collaborative agreements with secondary schools. This proactive approach aims to enhance opportunities for students with intellectual disabilities during their transition to post-secondary education and training. The study concludes with implications for future research and recommendations for fostering improved collaboration and support mechanisms.

The effect of Transition to Adulthood Training Program for mothers of young adults with intellectual disability on family quality of life and perceived stress level: A pilot randomized controlled study

Families cannot easily identify and cope with the changing health problems and needs of children transitioning into adulthood. This pilot randomized controlled study aims to improve the family's quality of life and reduce mothers' perceived stress levels by implementing an educational program (Transition to Adulthood Training Program - TATP). A total of 33 mothers of children with intellectual disabilities were randomly assigned to the groups. Data were collected using the Personal Information Form, Beach Center Family Quality of Life (BCFQOL), and Perceived Stress Scale. The intervention group showed a significant increase in the BCFQOL mean score rather than the control group (p<.001). There was a significant decrease in the perceived stress scores of the mothers in the intervention group after the TATP training sessions (p<0.05). The TATP intervention not only increased the quality of family life for these mothers but also led to a reduction in their perceived stress levels.

Effect of resilience training on stress, hope and psychological toughness of mothers living with mentally and physically disabled children

INTRODUCTION

Welfare and rehabilitation centers prioritize the welfare of children over the mental and physical well-being of mothers. The present study aimed to determine the impact of resilience training on stress, hope, and psychological toughness of mothers living with mentally and physically disabled children.

MATERIALS AND METHODS

This intervention study was conducted in the Hamadan (Iran) Welfare and Rehabilitation Center in 2023. To this end, 70 parents of children with mental and physical disabilities were randomly selected and then randomly assigned to two control and intervention groups. In the intervention group, 9 resilience training sessions were conducted, each lasting 60 min. These meetings were held weekly at the welfare and rehabilitation center. The resilience training included three components: (1) exploring the concept of resilience within families and the attributes of individuals with high resilience, (2) examining internal and external factors that influence resilience, and (3) studying the strategies for enhancing family resilience. No intervention was performed in the control group. Data collection was done using parental stress, hope, and psychological toughness questionnaire. The mothers of both groups completed the above questionnaires both before and one month after the intervention. Data analysis was performed using chi-square (χ2), Kruskal-Wallis, and t-test with SPSS software (version 23) at a significance level of 0.05.

RESULTS

Before the intervention, there was no statistically significant difference in parental stress between the two groups (p = 0.370). However, after the intervention, the difference between the two groups became statistically significant (p = 0.001). Similarly, there was no significant difference in parents' hope before the intervention (p = 0.452), but a significant difference was observed after the intervention (p = 0.001). Besides, parental psychological toughness was not significant before the intervention (p = 0.179) but became significant after the intervention (p = 0.000).

CONCLUSION

Based on the results, resilience training reduced parental stress and increased hope and resilience in mothers of the test group. Therefore, resilience training is recommended to lower parental stress and increase the hope and psychological toughness of mothers of mentally and physically disabled children.

"All I know is that a disabled person is someone who is crippled": Using narratives of parents to unmask the misconceptions of Mild intellectual disabilities concept as a learning support hindrance

Background: Learning-support provision by parents is key to children's scholastic success. However, when children are diagnosed with mild intellectual disabilities and in need of additional support, learning support provision is hindered. Aim: The study sought to investigate parents' experiences when providing learning support to children diagnosed with Mild intellectual disabilities. Setting: Using a phenomenological design and an interpretive paradigm, anchored in a qualitative research approach, data were gathered from parents whose children were diagnosed with Mild intellectual disabilities across three inclusive schools from disadvantaged backgrounds in the Gauteng province, in South Africa. Methods: Twenty-three (23) parents were purposefully selected to participate in the study by sharing their lived experiences. Data was collected using semi-structured interviews and thematic content data analysis methods. Bronfenbrenner's bio-ecological systems theory underpinned the study. Results: The findings revealed that the parents' misconception of the mild intellectual disability concept is one of the learning support hindrances. Conclusion: Parental empowerment through psycho-education was highlighted as a need for policy and practice adaptation.

Mental Health Problems Among Adolescents With Mild Intellectual Disability and Relation to Sleep Quality and Perceived Social Support: A Comparative Study

The current cross-sectional study sought to determine the mental health problems of adolescents with mild intellectual disability (ID) and influencing factors. This study, which used a comparison group, was performed with 188 adolescents (91 with mild ID and 97 without ID) between January 2019 and June 2019 in Turkey. Data were collected using a Personal Information Form, the Strengths and Difficulties Questionnaire, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. Adolescents with mild ID were at higher risk for mental health problems compared to those without ID. According to linear regression analysis, sex, age, birth order, maternal age, parents' educational level, sleep quality, and perceived social support were statistically significant predictive factors of mental health problems in adolescents with mild ID. Results of this study indicate that adolescents with mild ID are at greater risk for mental health problems and that effective prevention/intervention strategies are needed. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 39-50.].

Rare neurodevelopmental conditions and parents' mental health - how and when does genetic diagnosis matter?

BACKGROUND

Parents of individuals with rare neurodevelopmental conditions and intellectual disabilities (ID) are vulnerable to mental health difficulties, which vary between parents and within parents over time. The underlying cause of a child's condition can influence parents' mental health, via uncertain pathways and within unknown time-windows.

RESULTS

We analysed baseline data from the IMAGINE-ID cohort, comprising 2655 parents of children and young people with ID of known genetic origin. First, we conducted a factor analysis of the SDQ Impact scale to isolate specific pathways from genetic aetiology to parents' mental health. This suggested a two-factor structure for the SDQ Impact scale, with a "home & distress" dimension and a "participation" dimension. Second, we tested via structural equation modelling (SEM) whether genetic diagnosis affects Impact and mental health directly, or indirectly via children's characteristics. This analysis identified an indirect pathway linking genetic aetiology to parents' mental health, serially through child characteristics (physical disabilities, emotional and behavioural difficulties) and Impact: home & distress. Third, we conducted moderation analysis to explore the influence of time elapsed since genetic diagnosis. This showed that the serial mediation model was moderated by time since diagnosis, with strongest mediating effects among recently diagnosed cases.

CONCLUSIONS

There are multiple steps on the pathway from ID-associated genetic diagnoses to parents' mental health. Pathway links are strongest within 5 years of receiving a genetic diagnosis, highlighting opportunities for better post-diagnostic support. Recognition and enhanced support for children's physical and behavioural needs might reduce impact on family life, ameliorating parents' vulnerabilities to mental health difficulties.

Whole exome sequencing and transcriptome analysis in two unrelated patients with novel SET mutations

The human SET nuclear proto-oncogene (SET) gene is a protein-coding gene that encodes proteins that affects chromatin remodeling and gene transcription. Mutations in the SET gene have been reported to cause intellectual disability (ID) and epilepsy. In this study, we collected and analyzed clinical, genetic, and transcript features of two unrelated Chinese patients with ID. Both patients were characterized by moderate intellectual disability. Whole-exome sequencing identified two novel heterozygous mutations in the SET gene: NM_001122821.1:c.532-3 T > A and NM_001122821.1:c.3 G > C (p.0?). Additionally, RNA sequencing revealed widespread dysregulation of genes involved in NF-kB signaling and neuronal system in these two patients. To our knowledge, this is the first report of SET mutations causing ID in the Chinese population, broadening the genetic and ethnic spectrum of SET-related disorders and highlighting the importance of screening for SET gene variants.

General practice experiences for parents of children with intellectual disability: a systematic review

BACKGROUND

Parents of children diagnosed with intellectual disability are at increased risk of mental and physical health difficulties compared with other parents. They are likely to regularly seek medical treatment for their health concerns from general practice as well as on behalf of their child with intellectual disability, yet there is limited evaluation of the role general practice plays for this patient group.

AIM

To explore parents' experiences of general practice support when caring for a child with intellectual disability.

DESIGN & SETTING

Systematic review of studies reporting experiences of general practice as described by parents who care for children with intellectual disability.

METHOD

Databases were searched using a pre-defined search strategy. Studies were included based on detailed inclusion criteria, title, abstract, and full-text screening. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted.

RESULTS

A total of nine studies were identified. There was a clear absence of data on parents' own health experience and consultation in general practice. Findings related to navigating general practice on behalf of their child's health including accessibility of general practice and positive and negative experiences of GPs.

CONCLUSION

Findings from this review highlight priority areas for research, including further exploration of parents' perspectives on seeking support specifically for their own health concerns, while caring for a child with intellectual disability, to bring more awareness and understanding of the role general practice plays in supporting the health of this carer group. This review also considers implications for clinical services, including tailoring appointments for this patient group as a priority for continuity of care, which may result in improved experiences of general practice and encourage better communication.

Psychopathology in mothers of children with pathogenic Copy Number Variants

BACKGROUND

Caring for children with pathogenic neurodevelopmental Copy Number Variants (CNVs) (ie, deletions and duplications of genetic material) can place a considerable burden on parents and their quality of life. Our study is the first to examine the frequency of psychiatric diagnoses in mothers of children with CNVs compared with the frequency of psychiatric problems in age-matched mothers from a large community study.

METHODS

Case-control study. 268 mothers of children with a CNV diagnosed in a medical genetics clinic and 2680 age-matched mothers taking part in the Avon Longitudinal Study of Parents and Children study.

RESULTS

Mothers of children with CNVs reported higher frequency of depression, anorexia, bulimia, alcohol abuse and drug addiction problems compared with the age-matched mothers from the community sample. Focusing on psychiatric problems arising immediately after the birth of the index child, we found that the levels of depression symptoms were similar between the two groups (48% in mothers of children with CNVs vs 44% in mothers of the community sample, p=0.43), but mothers of children with CNVs had higher frequency of anxiety symptoms (55%) compared with mothers from the community sample (30%, p=0.03).

CONCLUSION

Our study highlights the need for healthcare providers to devise treatment plans that not only focus on meeting the child's needs but also assess and, if needed, address the mental health needs of the parent.

Childhood Sexual Abuse, Intellectual Disability, and Subsequent Physical and Mental Health Disorders: A Matched Cohort Study

This study assesses whether children with intellectual disability (ID) are more at risk of sexual abuse and whether they have similar consultation rates for physical and mental health disorders than children without ID. The matched-cohort design study uses administrative databases of children who had a sexual abuse report corroborated by a child protection agency and a matched group from the general population. Children with ID were 3.5 times more likely to have a corroborated sexual abuse report when compared to their peers without ID and a higher post-abuse number of medical consultations for physical and mental health disorders. Children with ID are more at risk of sexual abuse and physical and mental health disorders and may also be more vulnerable to the effects of abuse.

Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin

Background

Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD + IDD, in terms of both children's mental health and parental psychological distress.

Methods

Participants with a copy number variant or single nucleotide variant (5-19 years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co-occurring ASD, and co-occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio-economic deprivation.

Results

Of the 1904 participants with IDD, 701 (36.8%) had co-occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR = 1.84, 95% confidence interval [CI] 1.46-2.32, p < 0.0001; emotional disorders: OR = 1.85, 95%CI 1.36-2.5, p < 0.0001; disruptive behaviour disorders: OR = 1.79, 95%CI 1.36-2.37, p < 0.0001). The severity of associated symptoms was also greater in those with ASD (hyperactivity: B = 0.25, 95%CI 0.07-0.34, p = 0.006; emotional difficulties: B = 0.91, 95%CI 0.67 to 1.14, p < 0.0001; conduct problems: B = 0.25, 95%CI 0.05 to 0.46, p = 0.013). Parents of children with IDD and ASD also reported greater psychological distress than those with IDD alone (β = 0.1, 95% CI 0.85 to 2.21, p < 0.0001). Specifically, in those with ASD, symptoms of hyperactivity (β = 0.13, 95% CI 0.29-0.63, p < 0.0001), emotional difficulties (β = 0.15, 95% CI 0.26-0.51, p < 0.0001) and conduct difficulties (β = 0.07, 95% CI 0.07-0.37, p < 0.004) all significantly contributed to parental psychological distress.

Conclusions

Among children with IDD of genetic aetiology, one third have co-occurring ASD. Not only do those with co-occurring ASD present with a wider range of associated mental health disorders and more severe mental health difficulties than those with IDD alone, but their parents also experience more psychological distress. Our findings suggest that the additional mental health and behavioural symptoms in those with ASD contributed to the degree of parental psychological distress.

The mental health of women and climate change: Direct neuropsychiatric impacts and associated psychological concerns

Climate change brings exposures to heat, air pollution, poorer quality food, and infectious disease that have significant direct effects on women and their mental health. These environmental impacts are multifaceted in their consequences and raise risks of depression, suicide, violent victimization, post-traumatic stress disorder, and various other neuropsychiatric symptoms. Women also suffer increased climate psychological risks from higher rates of stillbirth, preterm birth, and developmental problems in their children. Here we review what is known about the overlap of women's individual mental health and climate change, and highlight areas where more research is needed.

Sleep disturbance as a transdiagnostic marker of psychiatric risk in children with neurodevelopmental risk genetic conditions

Children with rare neurodevelopmental genetic conditions (ND-GCs) are at high risk for a range of neuropsychiatric conditions. Sleep symptomatology may represent a transdiagnostic risk indicator within this patient group. Here we present data from 629 children with ND-GCs, recruited via the United Kingdom's National Health Service medical genetic clinics. Sibling controls (183) were also invited to take part. Detailed assessments were conducted to characterise the sleep phenotype of children with ND-GCs in comparison to controls. Latent class analysis was conducted to derive subgroups of children with an ND-GC based on sleep symptomatology. Assessment of cognition and psychopathology allowed investigation of whether the sleep phenotypic subgroup was associated with neuropsychiatric outcomes. We found that children with an ND-GC, when compared to control siblings, were at elevated risk of insomnia (ND-GC = 41% vs Controls = 17%, p < 0.001) and of experiencing at least one sleep symptom (ND-GC = 66% vs Controls = 39%, p < 0.001). On average, insomnia was found to have an early onset (2.8 years) in children with an ND-GC and to impact across multiple contexts. Children in subgroups linked to high sleep symptomatology were also at high risk of psychiatric outcomes (OR ranging from 2.0 to 21.5 depending on psychiatric condition). Our findings demonstrate that children with high genetic vulnerability for neurodevelopmental outcomes exhibit high rates of insomnia and sleep symptomatology. Sleep disruption has wide-ranging impacts on psychosocial function, and indexes those children at greater neuropsychiatric risk. Insomnia was found to onset in early childhood, highlighting the potential for early intervention strategies for psychiatric risk informed by sleep profile.

Relationship between parental perceptions, family income and support received with family quality of life in families with a child with an intellectual disability

Research has shown that families raising a child with intellectual disability (ID) face many challenges and need to implement adaptation strategies. Some authors suggest that positive parental perceptions and perceived control could reduce emotional impact and promote family wellbeing. Nevertheless, there are few studies about the relationship between parental perceptions and family quality of life (FQoL) in those families. In this study, we used data from a sample of 251 Spanish parents whose children have ID. Positive perceptions scale and control perceptions scale, Spanish FQoL scale under 18 years-old and a sociodemographic questionnaire were administered to those families. The results of bivariate analysis showed that some dimensions of positive perceptions were related to different areas of FQoL, for example, social inclusion and family accommodation. FQoL was associated with family income and support received. To predict the FQoL level, a multivariate linear regression analysis was conducted. Results indicated that FQoL scores can be predicted by a linear combination of positive perceptions and family income. Practical implications for promoting FQoL in these families are discussed.

Within-family relations of mental health problems across childhood and adolescence

BACKGROUND

While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics.

METHODS

We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children's internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N = 10,746, ~50% female).

RESULTS

Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys' later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence.

CONCLUSIONS

Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system.

Neuropsychiatric risk in children with intellectual disability of genetic origin: IMAGINE, a UK national cohort study

BACKGROUND

Children with intellectual disability frequently have multiple co-morbid neuropsychiatric conditions and poor physical health. Genomic testing is increasingly recommended as a first-line investigation for these children. We aim to determine the effect of genomics, inheritance, and socioeconomic deprivation on neuropsychiatric risk in children with intellectual disability of genetic origin as compared with the general population.

METHODS

IMAGINE is a prospective cohort study using online mental health and medical assessments in a cohort of 3407 UK participants with intellectual disability and pathogenic genomic variants as identified by the UK's National Health Service (NHS). Our study is on a subset of these participants, including all children aged 4-19 years. We collected diagnostic genomic reports from NHS records and asked primary caregivers to provide an assessment of their child using the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), the Adaptive Behaviour Assessment System 3 (ABAS-3), and a medical history questionnaire. Each child was assigned a rank based on their postcode using the index of multiple deprivation (IMD). We compared the IMAGINE cohort with the 2017 National Survey of Children's Mental Health in England. The main outcomes of interest were mental health and neurodevelopment according to the DAWBA and SDQ.

FINDINGS

We recruited 2770 children from the IMAGINE study between Oct 1, 2014 and June 30, 2019, of whom 2397 (86·5%) had a basic assessment of their mental health completed by their families and 1277 (46·1%) completed a medical history questionnaire. The mean age of participants was 9·2 years (SD 3·9); 1339 (55·9%) were boys and 1058 (44·1%) were girls. 355 (27·8%) of 1277 reported a seizure disorder and 814 (63·7%) reported movement or co-ordination problems. 1771 (73·9%) of 2397 participants had a pathogenic copy number variant (CNV) and 626 (26·1%) had a pathogenic single nucleotide variant (SNV). Participants were representative of the socioeconomic spectrum of the UK general population. The relative risk (RR) of co-occurring neuropsychiatric diagnoses, compared with the English national population, was high: autism spectrum disorder RR 29·2 (95% CI 23·9-36·5), ADHD RR 13·5 (95% CI 11·1-16·3). In children with a CNV, those with a familial variant tended to live in more socioeconomically deprived areas than those with a de novo variant. Both inheritance and socioeconomic deprivation contributed to neuropsychiatric risk in those with a CNV.

INTERPRETATION

Children with genomic variants and intellectual disability are at an increased risk of neuropsychiatric difficulties. CNV variant inheritance and socioeconomic deprivation also contribute to the risk. Early genomic investigations of children with intellectual disability could facilitate the identification of the most vulnerable children. Additionally, harnessing parental expertise using online DAWBA assessments could rapidly identify children with exceptional needs to child mental health services.

FUNDING

UK Medical Research Council and Medical Research Foundation.

Social and emotional characteristics of girls and young women with DDX3X-associated intellectual disability: a descriptive and comparative study

DDX3X variants are a common cause of intellectual disability (ID) in females, and have been associated with autism spectrum disorder and emotional-behavioural difficulties. In this study, we compared phenotypic data for 23 females with DDX3X variants, to 23 females with ID and other genetic diagnoses. We found a wide range of adaptive, social and emotional function within the DDX3X group. Autism characteristics did not differ between DDX3X and comparison groups, while levels of anxiety and self-injurious behaviour (SIB) were significantly higher in the DDX3X group. Within the DDX3X group, adaptive function, autism characteristics, anxiety and SIB scores were positively correlated, with evidence for group-specific associations with SIB. Future work is warranted to explore the multilevel mechanisms contributing to social and emotional development in individuals with DDX3X variants.

Feasibility of low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions: a case series

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings.

Key learning aims

(1)

Clinical evaluation of patients with a neuropsychiatric risk copy number variant

Several copy number variants (CNVs) have been identified to confer high risk for a range of neuropsychiatric conditions. Because of advances in genetic testing within clinical settings, patients are increasingly receiving diagnoses of copy number variant genomic disorders. However, clinical guidelines surrounding assessment and management are limited. This review synthesises recent research and makes preliminary recommendations regarding the clinical evaluation of patients with neuropsychiatric risk CNVs. We recommend multi-system assessment beyond the initial referral reason, recognition of the potential need for co-ordinated multidisciplinary care, and that interventions take account of relevant multimorbidity. The frequently complex needs of patients with CNVs across the life-course pose challenges for many health care systems and may be best provided for by the establishment of specialist clinics.

Fathers of children with a disability: health, work, and family life issues

PURPOSE

Fathers in families raising children with disabilities are under-researched. Fathers' perspectives can be better accommodated in childhood disability services that operate on a family-centred paradigm if their perspectives are understood. This study aimed to investigate the perspectives of fathers on caring and family life, work, and health.

METHODS

A mixed-methods design with an online questionnaire included open-ended questions and three instruments: Depression Anxiety Stress Scales (DASS); Health Promoting Activities Scale (HPAS-M); Fathers of Children with Developmental Challenges (FCDC) Scale.

RESULTS

Fathers (n = 33) reported high depressive (58%), anxiety (37%), and stress symptoms (61%). Fathers reported low participation in health-promoting activity with less than weekly: planning health activities (58%); solo physical activity (26%); social activity (3%); time relaxing (16%). Sixty-four percent worked full-time, although work was reported to be challenged by family responsibilities. Fathers described directly caring for their children although service interactions were low and delegated to mothers.

CONCLUSIONS

Fathers in this study reported stress, mental health issues, and low participation in healthy activity. Fathers experienced challenges related to career progression and job choices due to family responsibilities. Providing individualised and responsive support to fathers of a child with a disability would better support the family unit.IMPLICATIONS FOR REHABILITATIONFathers of children with a disability in this study experienced high mental health symptoms.Fathers were involved with their child's care at home but had low service interactions suggesting that service providers need to discover new ways to better engage fathers.Fathers experienced challenges to participation in paid work secondary to care responsibilities for their child with a disability and resulting needs of their family.Services that better support fathers are important to promote better health and wellbeing and support families.

Exploring how mothers of a child with a genetic disorder experience their couple relationship in a low socio-economic setting

Having a child with a genetic disorder directly impacts a couple's relationship due to increased care demands. Most research on couple relationships in the context of having a child with a disability has been done in well-resourced, developed countries. In South Africa, the black South African population has been historically disadvantaged resulting in high rates of unemployment and poverty, and disruption of the family system. The purpose of this study was to explore the impact of having a child with a genetic disorder on the couple relationship in a low socio-economic setting. Thirteen black South African mothers of a child with a confirmed or suspected genetic disorder participated in the study. All participants were recruited while waiting to be seen for a follow-up appointment by a medical geneticist at a Genetic Clinic in Johannesburg, South Africa between 2016 and 2019. Data were collected through semi-structured interviews lasting between 25 and 60 min and analyzed using thematic content analysis. Findings showed that mothers of a child with a genetic disorder in this low socio-economic setting frequently felt unsupported and carried the responsibility of childcare alone. The majority of participants wanted more tangible and emotional support from their partners and without this support they felt isolated and alone. The participants used many different coping strategies to deal with the distress of having a child with a genetic disorder but most frequently they described using 'acceptance'. Participants' partners were more often reported to use escape-avoidance strategies such as abandonment, denying paternity, withdrawal, and partner-blame. We suggest that mothers of a child with a genetic disorder should consult with a genetic counselor in addition to a medical geneticist to enable the provision of emotional support.

Gene functional networks and autism spectrum characteristics in young people with intellectual disability: a dimensional phenotyping study

BACKGROUND

The relationships between specific genetic aetiology and phenotype in neurodevelopmental disorders are complex and hotly contested. Genes associated with intellectual disability (ID) can be grouped into networks according to gene function. This study explored whether individuals with ID show differences in autism spectrum characteristics (ASC), depending on the functional network membership of their rare, pathogenic de novo genetic variants.

METHODS

Children and young people with ID of known genetic origin were allocated to two broad functional network groups: synaptic physiology (n = 29) or chromatin regulation (n = 23). We applied principle components analysis to the Social Responsiveness Scale to map the structure of ASC in this population and identified three components-Inflexibility, Social Understanding and Social Motivation. We then used Akaike information criterion to test the best fitting models for predicting ASC components, including demographic factors (age, gender), non-ASC behavioural factors (global adaptive function, anxiety, hyperactivity, inattention), and gene functional networks.

RESULTS

We found that, when other factors are accounted for, the chromatin regulation group showed higher levels of Inflexibility. We also observed contrasting predictors of ASC within each network group. Within the chromatin regulation group, Social Understanding was associated with inattention, and Social Motivation was predicted by hyperactivity. Within the synaptic group, Social Understanding was associated with hyperactivity, and Social Motivation was linked to anxiety.

LIMITATIONS

Functional network definitions were manually curated based on multiple sources of evidence, but a data-driven approach to classification may be more robust. Sample sizes for rare genetic diagnoses remain small, mitigated by our network-based approach to group comparisons. This is a cross-sectional study across a wide age range, and longitudinal data within focused age groups will be informative of developmental trajectories across network groups.

CONCLUSION

We report that gene functional networks can predict Inflexibility, but not other ASC dimensions. Contrasting behavioural associations within each group suggest network-specific developmental pathways from genomic variation to autism. Simple classification of neurodevelopmental disorder genes as high risk or low risk for autism is unlikely to be valid or useful.

Evaluating heterogeneity in ASD symptomatology, cognitive ability, and adaptive functioning among 16p11.2 CNV carriers

Individuals with 16p11.2 copy number variant (CNV) show considerable phenotypic heterogeneity. Although autism spectrum disorder (ASD) is reported in approximately 20-23% of individuals with 16p11.2 CNVs, ASD-associated symptoms are observed in those without a clinical ASD diagnosis. Previous work has shown that genetic variation and prenatal and perinatal birth complications influence ASD risk and symptom severity. This study examined the impact of genetic and environmental risk factors on phenotypic heterogeneity among 16p11.2 CNV carriers. Participants included individuals with a 16p11.2 deletion (N = 96) or duplication (N = 77) with exome sequencing from the Simons VIP study. The presence of prenatal factors, perinatal events, additional genetic events, and gender was studied. Regression analyses examined the contribution of each risk factor on ASD symptomatology, cognitive functioning, and adaptive abilities. For deletion carriers, perinatal and additional genetic events were associated with increased ASD symptomatology and decrements in cognitive and adaptive functioning. For duplication carriers, secondary genetic events were associated with greater cognitive impairments. Being female sex was a protective factor for both deletion and duplication carriers. Our findings suggest that ASD-associated risk factors contribute to the variability in symptom presentation in individuals with 16p11.2 CNVs. LAY SUMMARY: There are a wide range of autism spectrum disorder (ASD) symptoms and abilities observed for individuals with genetic changes of the 16p11.2 region. Here, we found perinatal complications contributed to more severe ASD symptoms (deletion carriers) and additional genetic mutations contributed to decreased cognitive abilities (deletion and duplication carriers). A potential protective factor was also observed for females with 16p11.2 variations. Autism Res 2020, 13: 1300-1310. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.