Determinants of Stress in Parents of Children with Autism Spectrum Disorders

Parents of children with autism spectrum disorder are known to experience more stress than parents of children with any other conditions. The current study describes the parental stress of 118 fathers and 118 mothers at the onset of their children’s Early Intensive Behavioral Intervention program. The objectives of the study were to compare and analyze each parent’s stress and to identify factors that might predict their stress. Results indicated that fathers reported higher levels of stress than mothers. Correlations indicated that the stress levels of both parents were associated with their child’s age, intellectual quotient, severity of autistic symptoms, and adaptive behaviors. Paternal stress, but not maternal stress, was predicted by severity of autistic symptoms and child’s gender. Results are discussed in terms of their implications for services and early interventions.     

Factors impacting on the outcomes of Greek intervention programmes for children with autistic spectrum disorders

This study explored the best predictors of the progress of children with autistic spectrum disorders (ASD), on some developmental domains (autistic severity, language, communication and socialisation), which are related to the core features of ASD. Eighty-six children (2.5–14 years old) with ASD, from 10 schools in Greece, were included in the study, and their developmental progress was assessed over a period of 9 months. The data indicated that, apart from the factors related to the child (e.g., non-verbal IQ, language, adaptive behaviour, autistic severity, behavioural problems at baseline, as well as the age that the child started treatment), which were correlated to the child's developmental progress, there are also factors in the child's environment that influence his or her developmental progress; the most important being the levels of parental stress, and the parents’ abilities to discipline their child. These findings suggested that there are some factors (age that a child starts treatment, parental stress and parents’ abilities to discipline their child) that the intervention programmes, the teachers and the parents could take into account, in order to enhance the children's gains.     

Preventive Intervention for Anxious Preschoolers and Their Parents: Strengthening Early Emotional Development

The high prevalence and early onset of anxiety disorders have inspired innovative prevention efforts targeting young at-risk children. With parent–child prevention models showing success for older children and adolescents, the goal of this study was to evaluate a parent–child indicated preventive intervention for preschoolers with mild to moderate anxiety symptoms. Sixteen children (ages 3–5) and at least one of their parents participated in Strengthening Early Emotional Development (SEED), a new 10-week intervention with concurrent groups for parents and children. Outcome measures included clinician-rated and parent-rated assessments of anxiety symptoms, as well as measures of emotion knowledge, parent anxiety, and parental attitudes about children’s anxiety. Participation in SEED was associated with reduced child anxiety symptoms and improved emotion understanding skills. Parents reported decreases in their own anxiety, along with attitudes reflecting enhanced confidence in their children’s ability to cope with anxiety. Reductions in child and parent anxiety were maintained at 3-month follow-up. Findings suggest that a parent–child cognitive-behavioral preventive intervention may hold promise for young children with mild to moderate anxiety. Improvements in parent anxiety and parental attitudes may support the utility of intervening with parents. Fostering increased willingness to encourage their children to engage in new and anxiety-provoking situations may help promote continued mastery of new skills and successful coping with anxiety.     

Parental Involvement in Cognitive-Behavioral Intervention for Anxious Children: Parents’ In-Session and Out-Session Activities and Their Relationship with Treatment Outcome

The present study explored the role of parents’ in-session and out-session involvement in CBT for anxious children. Fifty 8- to 12-year-old children with a principal DSM-IV anxiety disorder participated in a group CBT program. Parental involvement in the therapy was assessed by the clinician and the children and parents completed a standardized anxiety scale as the main therapy outcome measure, at pre- and post-intervention. In addition, the parents completed questionnaires to evaluate a number of possible correlates of parental involvement, namely, child’s anxiety symptoms intensity and interference, parental beliefs about anxiety, expectancies regarding the efficacy of the intervention, and parental anxiety. The results indicated that the parents were moderately involved in the therapy and that socio-economic status and parental beliefs about anxiety were significant correlates of parental involvement. Finally, partial support was found for the idea that parents’ involvement in the therapy might have a positive impact on therapy outcome.     

A Parental Report of Children’s Anxiety Symptoms in Japan

Using parental reports, the current study investigated anxiety symptoms among Japanese children as part of the process of developing the Japanese version of the Spence Children’s Anxiety Scale for Parents (SCAS-P). The participants were 677 parents and children aged 9–12 years. Confirmatory factor analysis on 568 parents and children supported that the SCAS-P had a 6-factor structure. The scale showed satisfactory internal consistency and good convergent validity. A MANOVA indicated no significant gender or age differences except for the obsessive–compulsive disorder subscale. Among Japanese children, the most prevalent symptoms within the parental report were items related to fear of the dark and of insects/spiders. Finally, we observed very low correlations between parental and child reports of anxiety symptoms; the relationships between child and parental reports were rather poor among Japanese children. We briefly discuss the utility of the SCAS-P as a screening instrument assessing parental reports of anxiety symptoms.     

Parenting Strategies to Deal with Children’s Anxiety: Do Parents Do What They Say They Do?

Parents’ perceptions about their strategies to deal with children’s anxiety have been minimally explored. Based on a mixed-method approach, the current study compared the strategies that parents said they use more frequently to deal with their child’s anxious behaviors and the strategies they actually used during two mildly anxiogenic interactions with their child. Forty-two parents of children with anxiety disorders, aged 9–12 years, participated in the study. Semi-structured interviews were administered to identify parental perceptions about their strategies to deal with their children’s anxiety. Subsequently dyadic interactions were observed and coded by two independent coders. We found discrepancies relating to four strategies. Significantly more parents used strategies based on overinvolvement and anxious behavior during the interactions than had been reported by them in the interviews. In contrast, reassurance and reinforcement of avoidance/dependence were used in interactions by fewer parents than would be expected, according to the interviews. Relevant implications for assessment and intervention with families of anxious children are suggested.     

Assessment of parental perception of relevant symptoms in children with developmental disorders

We assessed parental perception of relevant symptoms in children with developmental disorders (concern, anxiety and worries regarding to the development of their child) and examined the circumstances leading to consultations with physicians. We analyzed answers from 53 parents who were grouped according to the diagnoses of their children. Developmental disorders were perceived by the parents and the parents immediately consulted physicians at the time of their child's birth in the case of children with Down syndrome, when their child was around 1-1.5 years old in children with pervasive developmental disorders, and when their child was around 3 years old in children with mental retardation. Both worries and the use of consultations by the parents of 1.5-year olds were similar to those of the parents of 2-year olds. Specialists need to recognize that parental perception of developmental disorders and the use of consultations differs according to the diagnosis. To provide continuous support to the families of children with developmental disorders, public medical examination of infants and collaborations between medical, educational and other social organizations must be organized to meet the needs.     

Parental Attitudes,Beliefs, and Understanding of Anxiety (PABUA): Development and psychometric properties of a measure

The Parental Attitudes, Beliefs, and Understanding of Anxiety (PABUA) was developed to assess parental beliefs about their child’s anxiety, parents’ perceived ability to cope with their child’s anxiety and to help their child manage anxious symptoms, and to evaluate parents’ understanding of various parenting strategies in response to their child’s anxiety. The study evaluated the PABUA in mother-child dyads (N = 192) seeking treatment for youth anxiety. Exploratory factor analysis yielded a three-factor solution and identified PABUA scales of Overprotection, Distress, and Approach (with Cronbach’s alpha ranging from .67 to .83). Convergent and divergent validity of PABUA scales was supported by the pattern of associations with measures of experiential avoidance, beliefs related to children’s anxiety, empathy, trait anxiety, and depressive symptoms; parent-reported family functioning; parent- and youth-reported anxiety severity; and parent-reported functional impairment (n = 83). Results provide preliminary support for the PABUA as a measure of parental attitudes and beliefs about anxiety, and future studies that investigate this measure with large and diverse samples are encouraged.     

Comorbid anxiety and depression in school-aged children with attention deficit hyperactivity disorder (ADHD) and selfreported symptoms of ADHD,anxiety, and depression among parents of school-aged children with and without ADHD

Background

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children that can extend into adulthood and that is often associated with a variety of comorbid psychiatric disorders.

Aim

Assess the comorbidity of ADHD with anxiety disorders and depressive disorders in school-aged children, and the relationship of the severity of ADHD, anxiety, and depressive symptoms in children who have ADHD with the severity of the corresponding symptoms in their parents.

Methods

A two-stage screening process identified children 7-10 years of age with and without ADHD treated at the Xin Hua Hospital in Shanghai. ADHD and other DSM-IV diagnoses were determined by a senior clinician using the Schedule for Affective Disorder and Schizophrenia for School-Aged Children (K-SADS-PL). One parent for each enrolled child completed three self-report scales: the ADHD Adult Self Report Scale (ASRS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In total 135 children with ADHD and 65 control group children without ADHD were enrolled; parents for 94 of the children with ADHD and 63 of the children without ADHD completed the parental assessment scales.

Results

Among the 135 children with ADHD, 27% had a comorbid anxiety disorder, 18% had a comorbid depressive disorder, and another 15% had both comorbid anxiety and depressive disorders. Parents of children with ADHD self-reported more severe ADHD inattention symptoms than parents of children without ADHD and were more likely to meet criteria for adult ADHD. Mothers (but not fathers) of children with ADHD had significantly more severe trait anxiety and depressive symptoms than mothers of children without ADHD. Among children with ADHD, the severity of ADHD symptoms was not significantly correlated with the severity of ADHD symptoms in parents, but depressive symptoms and anxiety symptoms in the children were significantly correlated with the corresponding symptoms in the parents.

Conclusion

School-aged children with ADHD commonly suffer from comorbid anxiety and depressive disorders, and the severity of these symptoms parallels the level of anxiety and depressive symptoms in their parents. Self-reported symptoms of ADHD are significantly more common in parents of children with ADHD than in parents of children without ADHD. Longitudinal studies are needed to disentangle the genetic, biological, and social factors responsible for these complex inter-relationships.     

Parental anxiety in childhood epilepsy: A systematic review

The aim was to systematically review studies that have focused on symptoms of anxiety reported by parents of children (0–18 years) with epilepsy. PubMed was used to identify relevant studies. Selected studies were reviewed with respect to prevalence of above threshold scores and comparisons with controls on standardized measures of anxiety. Studies are also reported with respect to factors associated with parental anxiety, impact on child outcomes, and comparisons with studies that have included equivalent measures of symptoms of depression. Fifteen studies that met inclusion criteria were identified. None of the studies were population based. The percentage of parents scoring above cutoffs on standardized measures of anxiety was 9–58%. In comparison with parents of healthy controls, parents of children with epilepsy had higher mean scores in two of three studies where this was measured. Possible correlates of parental anxiety in childhood epilepsy that were considered varied widely across studies. Factors such as seizure frequency and use of antiepileptic drugs (AEDs) have been associated with parental anxiety in some but not all studies. With respect to child outcome, increased parental anxiety has been associated with lower quality of life and lower scores on adaptive behavior domains. Symptoms of anxiety are common among parents of children with epilepsy. There is a need for more systematic, representative studies to identify the prevalence of clinically significant anxiety and track the course of symptoms. Such studies will help to identify more clearly factors associated with parental anxiety and impact of symptoms on child and parent outcomes. Intervention studies are needed to evaluate approaches that target a reduction in symptoms and the potential impact on parental and child functioning. Furthermore, there is a need to evaluate the impact of antiepileptic therapies and interventions that focus on child neurobehavioral comorbidities on parental anxiety     

Parental Reaction to Early Diagnosis of Their Children’s Autism Spectrum Disorder: An Exploratory Study

This study explores parental reactions subsequent to receiving their child’s autism spectrum disorder (ASD)-diagnosis. Seventy seven parents of recently diagnosed children participated in the Reaction to Diagnosis Interview. Within this group, associations between parental reaction to diagnosis, parental and child characteristics and prediagnostic circumstances were analysed. In a sub-sample, the stability of reaction to diagnosis was examined. The majority of parents were classified as ‘resolved’ regarding their child’s diagnosis. Conversely, parents of children with more severe ASD symptoms or non-Dutch parents were more likely to be classified as ‘unresolved’. Sub-sample analysis revealed stability of reaction to ASD-diagnosis. The majority of parents adapted well to the circumstances and the care for their child. Autism severity and parental nationality were significant factors affecting parental reactions. Thus, early identification of parental reaction to children’s ASD-diagnosis may aid in providing more tailored parental support programs.     

Stress and Personal Resource as Predictors of the Adjustment of Parents to Autistic Children: A Multivariate Model

The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child’s autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires measuring parental stress, personal resources (sense of coherence, locus of control, social support) adjustment (mental health and marriage quality) and the child’s autism symptoms. Path analysis showed that sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child. Directions for further research are suggested.     

Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study

ObjectiveThe efficacy and partial effectiveness of child-focused versus family-focused cognitive-behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and child's age.MethodClinically referred children with anxiety disorders (N = 128) and their parents were randomly assigned to child or family CBT and evaluated at pretreatment, posttreatment, and 3-month follow-up. Twenty-five families were measured before and after a 2- to 3-month waitlist period.ResultsNone of the waitlisted children recovered from their anxiety disorders. In contrast, 41% of the treated children no longer met criteria for any anxiety disorder after CBT, and 52% demonstrated continued improvement at the 3-month follow-up. Significantly more children were free of anxiety disorders (53%) in the child CBT condition compared with family CBT condition (28%) at posttreatment, whereas at 3-month follow-up, the superior effect of child CBT was no longer significant. Similar results were obtained from the questionnaire measures. Both child and family CBT were less effective if parents had an anxiety disorder themselves. On some of the measures, child CBT was superior if parents had anxiety disorders themselves, whereas family CBT was superior if parents had no anxiety disorders. Finally, younger children had better outcomes than older children, regardless of the treatment condition.ConclusionsOverall, child CBT seems slightly more beneficial than family CBT. Because this study was conducted in a clinical setting with clinically referred children, results indicate partial effectiveness for child CBT.     

Broader Autism Phenotype in Parents of Autistic Children: Reality or Myth?

The finding that relatives of individuals with autism show mild autistic traits is referred to as the broader autism phenotype (BAP). In the current study, 25 parents with a child with high-functioning autism and 25 parents with typically developed children were compared on: (1) the Block Design Test, (2) the Autism-Spectrum Quotient (AQ), and (3) a reaction time task to examine reflexive covert visual orienting to social (eyes) and non-social (arrows) cues. The parent groups were scored similar on the Block Design Test and the AQ. However, fathers with an autistic child demonstrated a different reaction time pattern and responded slower on the social cues than control fathers. These results partly support and further elaborate on the BAP in parents with an autistic child.     

The Relation of Parental Emotion Dysregulation to Children’s Psychopathology Symptoms: The Moderating Role of Child Emotion Dysregulation

This study investigated the roles of parents’ and children’s emotion dysregulation in children’s display of internalizing and externalizing symptoms by incorporating person- and variable-centered approaches. Sixty-four children (ages 8–11) participated in this study with their mothers. Study variables were collected via multiple methods, including behavioral observation and questionnaire assessment from both parents’ and children’s perspectives. Using model-based cluster analysis, children’s profiles with regulating emotions were created by incorporating multiple measurements. Two profiles were identified and applied in a moderation model testing whether the combination of parents’ and children’s regulatory style influence child outcomes. Results showed that children’s emotion dysregulation profiles moderated the relationship between parental emotion dysregulation and child internalizing symptoms, with children who adopted more internalizing regulatory styles display more internalizing symptoms in the context of high parental emotion dysregulation. Implications for the measurement of emotion regulation in the family context, and future directions for intervention, are discussed.     

Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement.

OBJECTIVES: This study examined (1) the effect of a cognitive-behavioral group intervention on anxiety, depression, and coping strategies in school-age children (aged 7-12 years) with Axis I anxiety disorders; and (2) the effect of parental involvement on treatment outcomes. METHOD: Parents and children (N = 62) were randomly assigned to one of three 12-week treatment conditions: parent and child intervention, child-only intervention, and parent-only intervention. Child anxiety, depression, and coping strategies were assessed before and after treatment. RESULTS: All treatment groups reported fewer symptoms of anxiety and depression posttreatment and changes in their use of coping strategies. Children in the parent and child intervention used more active coping strategies posttreatment compared with children in the other 2 treatment conditions. Parents in this treatment condition reported a significantly greater improvement in their children's emotional well-being than parents in the other treatment conditions. CONCLUSIONS: Cognitive-behavioral group interventions reduced symptoms of anxiety and depression in school-age children with anxiety disorders. Concurrent parental involvement enhanced the effect on coping strategies. Further investigation is needed to corroborate the effectiveness of such short-term interventions and the maintenance of treatment effects.     

Plasma Oxytocin in Children with Autism and Its Correlations with Behavioral Parameters in Children and Parents

Objective

Oxytocin (OT) has been implicated to play an important role in autism spectrum disorders (ASD) etiology. We aimed to find out the differences in plasma OT levels between children with autism and healthy children, the associations of OT levels with particular autism symptoms and the associations of particular parental autistic traits with their ASD children OT levels.

Methods

We included 19 boys with autism and 44 healthy age-matched boys. OT levels were analyzed by ELISA method. Children with autism were scored by Childhood Autism Rating Scale and Autism Diagnostic Interview (ADI), adjusted research version. Autism Spectrum Quotient (AQ), Systemizing Quotient (SQ) and Empathizing Quotient were completed by parents of children with autism.

Results

Children with autism had significantly lower plasma OT levels than controls. OT levels positively correlated with ADI Reciprocal Interaction and Communication scores. AQ and SQ of fathers positively correlated with children plasma OT level.

Conclusion

Our results support the hypothesis of OT deficiency in autism. The "paradoxical" associations of OT levels and social skills in children with autism indicate disturbances at various levels of OT system. We first reported associations of OT levels in children with autism and behavioral measures in fathers indicating that OT abnormalities stay between parental autistic traits and autism symptoms in their children.     

Prospective Relations Between Parental Depression, Negative Expressiveness, Emotional Insecurity, and Children’s Internalizing Symptoms

Building on the conceptual framework of emotional security theory (Davies and Cummings in Psychol Bull 116:387–411, 1994), this study longitudinally examined multiple factors linking parental depressive symptoms and child internalizing symptoms. Participants were 235 children (106 boys, 129 girls) and their cohabiting parents. Assessments included mothers’ and fathers’ depressive symptoms when children were in kindergarten, parents’ negative expressiveness when children were in first grade, children’s emotional insecurity 1 year later, and children’s internalizing symptoms in kindergarten and second grade. Findings revealed both mothers’ and fathers’ depressive symptoms were related to changes in children’s internalizing symptoms as a function of parents’ negative emotional expressiveness and children’s emotional insecurity. In addition to these similar pathways, distinctive pathways as a function of parental gender were identified. Contributions are considered for understanding relations between parental depressive symptoms and children’s development.     

Parents’ State and Trait Anxiety: Relationships with Anxiety Severity and Treatment Response in Adolescents with Autism Spectrum Disorders

Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxiety disorders. This study investigated the relationship between parents’ state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well as the relationship of parents’ anxiety symptoms and adolescent treatment response in the context of a randomized controlled trial. Parental state anxiety correlated with severity of adolescent anxiety, and trait anxiety in parents correlated with parent-reported adolescent internalizing and externalizing symptoms. Also, parents of adolescent treatment responders experienced a decrease in their own trait anxiety. Findings highlight the importance of considering parental anxiety when targeting anxiety among youth with ASD.     

No association between early gastrointestinal problems and autistic-like traits in the general population

Aim The aim of this study was to determine whether gastrointestinal problems in early childhood relate to autistic‐like traits in a general population sample. Method The parents of 804 children (442 females; 362 males) reported at 1‐, 2‐, 3‐, and 5‐year follow‐ups whether their child had been taken to a hospital, general practitioner, or health clinic for any of five gastrointestinal symptoms: (1) constipation; (2) diarrhoea; (3) abdominal bloating, discomfort, or irritability; (4) gastro‐oesophageal reflux or vomiting; and (5) feeding issues or food selectivity. Parents also reported whether their child had received the measles, mumps, and rubella vaccination. Autistic‐like traits were measured when the children had reached early adulthood (mean age 19y 7mo; SD 0.63y) using a self‐report questionnaire, the Autism Spectrum Quotient (AQ). Results There was no statistically significant difference in AQ scores between those who had (n=133) and those who had not (n=671) experienced early gastrointestinal symptoms. χ² analyses revealed that the children with early gastrointestinal problems were no more likely to be represented in the upper quintile of scores on any of the AQ scales. The measles, mumps, and rubella vaccination was unrelated to gastrointestinal symptoms or AQ scores. Interpretation Parent‐reported gastrointestinal problems in early childhood are unrelated to self‐reported autistic‐like traits in the general population.