Parental Depression and Child Behavior Problems: A Pilot Study Examining Pathways of Influence

Parents of children with autism spectrum disorders (ASD) have higher rates of depressive symptoms than parents of typically developing children and parents of children with other developmental disorders. Parental depressive symptoms are strongly associated with problem behaviors in children; however, the mechanisms through which parental depression influences child behavior in families of children with ASD are unclear. The purpose of this study was to examine the relationship between parental depression and child behavior problems among families of children with ASD, more specifically to investigate the mediating variables that may explain the processes through which parental depression and child behavior problems are associated. The sample consisted of 33 parents of children with ASD (ages 2 to 5 years old). Findings suggested that authoritative parenting style significantly mediated the relationship between parental depression and behavior problems. This study highlights the importance of considering parental mental health and its impact on parenting behavior in interventions targeting child behavior problems.     

Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders

This study examined sleep problems and their correlates and comorbid psychopathology in children with autism spectrum disorders (ASDs). Participants consisted of 166 ASD children and 111 unaffected siblings aged 4–15 years. Parents completed a self-administered child sleep questionnaire. Of the children with ASDs, 47.0% (78/166) had at least one sleep problem. Children with ASDs were more likely to have bedtime resistance (OR 2.72, 95% CI 1.02–7.21), insomnia (OR 4.07, 95% CI 1.60–10.35), and daytime sleepiness (OR 7.62, 95% CI 1.17–49.38) compared to their unaffected siblings. Among children with ASDs, multivariate logistic regression analyses indicated that communication abnormalities and repetitive stereotyped behaviors were associated with increased risk of sleep problems. ASD children with sleep problems were more likely to have withdrawal problems, somatizing problems, aggressive behaviors, internalizing problems, externalizing problems, and total behavioral problems compared to those without sleep problems. Sleep problems are prevalent in children with ASDs and are associated with both internalizing and externalizing problems. Clinicians should pay close attention to sleep problems when assessing and treating autistic behaviors.     

Cross syndrome comparison of sleep problems in children with Down syndrome and Williams syndrome

Based on previous findings of frequent sleep problems in children with Down syndrome (DS) and Williams syndrome (WS), the present study aimed to expand our knowledge by using parent report and actigraphy to define sleep problems more precisely in these groups. Twenty-two school-aged children with DS, 24 with WS and 52 typically developing (TD) children took part in the study. Each child wore an actiwatch for a minimum of four nights and parents completed the Children's Sleep Habits Questionnaire (CSHQ). Sleep problems were common in both developmental disorders. Children with DS had the greatest sleep disruption, with frequent and longer night wakings as well as restlessness. Parents reported symptoms of sleep-disordered breathing and a range of other problems including grinding teeth, bedtime resistance and sleep anxiety. Children with WS had problems initiating sleep and parents also reported bed-wetting and body pain. Despite these problems, the mean actual sleep time, as measured by actigraphy, did not differ between the three groups. CSHQ reports were in agreement with actigraphy for children's sleep duration, but this was not the case for sleep latency, restlessness and the night wakings variables. Sleep problems in DS and WS are common and appear to be syndrome-specific. Due to the inaccuracy of parent report, it is recommended that children at risk undergo objective measures of sleep assessment.     

Vicarious futurity,hope, and well-being in parents of children with autism spectrum disorder

Hope is shown to provide resiliency for parents of children with autism spectrum disorders (ASDs) against the negative effects related to extreme parenting stressors. The broad positivity of hope may overlook opposing parental feelings about their child that may be important for well-being. Vicarious futurity (VF) is the hope and despair a parent feels for the future of their child, which reflects both positive and negative components of parental attitudes directed toward their child. In this study we examined how vicarious futurity related to hope, and how each predicted well-being in 71 parents (53 mothers) of children with ASD. Results indicated that regardless of child symptom severity, vicarious futurity strongly predicted stress experienced by parents, hope predicted depressive symptoms, and both predicted life satisfaction. Vicarious futurity and hope were found to be weakly correlated, indicating that both constructs are largely independent when influencing the well-being of parents raising a child with ASD. General hopefulness is important for parental well-being, but in the unique context of parents raising children with ASD, child focused constructs that measure both positive and negative components, such as vicarious futurity, may be more informative and useful when understanding how parental feelings about their child influence their own well-being.     

Sleep-disordered breathing and behavior in three risk groups: preliminary findings from parental reports

Sleep-related breathing disorders may cause excessive daytime sleepiness, cognitive impairment, and behavior problems in children and adolescents. Adenotonsillar enlargement (AT) is known to be a significant risk factor for these disorders, which have also been reported in several patients with Down syndrome (DS). Children with attention deficit disorder/hyperactivity (ADD) show behavior problems that may be related to disturbed nocturnal sleep in some. To evaluate the relationships among these disorders and symptoms, parents of 29 school-aged children with AT, 70 with DS and 48 of their siblings (DS-SIB), and 21 with ADD completed a 20-item screening questionnaire covering nocturnal sleep symptoms and daytime behavior problems. Nocturnal symptoms of sleep-related breathing disorders — snoring, breathing pauses during sleep — were reported more commonly by parents of AT and DS children. However, parents of two of the ADD children reported significant signs of sleep-related breathing disorders. Daytime behavior problems were more common in ADD and AT than in the DS group. Bedwetting reports did not distinguish groups. Direct comparisons of DS and DS-SIB groups showed that more DS were mouth breathers, snored, stopped breathing at night, and were sleepy in the daytime. These findings underscore the importance of obtaining a history of nocturnal sleep from parents of children with AT and DS, as well as those with disrupted daytime behavior.     

Associations between child behavior problems,family management,and depressive symptoms for mothers of children with autism spectrum disorder

PurposeThe purpose of the current study was to examine the relationships between child behavior problems and mothers’ depressive symptoms and to determine whether family management mediates this relationship.MethodsWe conducted a cross-sectional survey of parents in a southeastern state. Mothers of children with ASD (n = 234) completed self-reported measures of child behavior problems, depressive symptoms, and family management using ad-hoc questions, CES-D-Boston short form, and family management measure (FaMM), respectively. We used a parallel multiple mediator model to address the study hypotheses.ResultsChildren’s behavior problems were significantly associated with mothers’ depressive symptoms and with all five subscales of the FaMM. However, only the Family Life Difficulty subscale was a significant predictor of parent depressive symptoms, suggesting that Family Life Difficulty was the only mediator of the association between child behavior problems and mothers’ depressive symptoms. After accounting for the mediators, the direct effect of child behavior problems on parent depressive symptoms was non-significant.ConclusionAs the severity of child behavior problems increased, mothers of children with ASD perceived a greater impact of ASD on their family life, which in turn increased the levels of the mothers’ depressive symptoms. Family Life Difficulty assesses parent perceptions of the extent to which their child with ASD influences family relationships and routines, suggesting a need for family-centered services that assist the family in maintaining or adapting to their routines.     

Heavy Metal in Children’s Tooth Enamel: Related to Autism and Disruptive Behaviors?

To examine possible links between neurotoxicant exposure and neuropsychological disorders and child behavior, relative concentrations of lead, mercury, and manganese were examined in prenatal and postnatal enamel regions of deciduous teeth from children with Autism Spectrum Disorders (ASDs), high levels of disruptive behavior (HDB), and typically developing (TD) children. Using laser ablation inductively coupled plasma mass spectrometry, we found no significant differences in levels of these neurotoxicants for children with ASDs compared with TD children, but there was marginal significance indicating that children with ASDs have lower manganese levels. No significant differences emerged between children with HDB and TD children. The current findings challenge the notion that perinatal heavy metal exposure is a major contributor to the development of ASDs and HDB.     

Informing children about their sibling's diagnosis of autism spectrum disorder: An initial investigation into current practices

The manner in which typically developing (TD) children were informed about their sibling's diagnosis of autism spectrum disorders (ASDs) was examined in Japan. Seventy-seven parents, each with a child with ASD and a TD child, participated in a questionnaire survey. From the data obtained, it was revealed that parents informed 66.7% (72/108) TD children about their sibling's diagnosis, and usually informed them when they were around 9 years of age. Birth order, age spacing and type of ASD affected the parents’ decision about whether or not to inform them, and type of ASD, sex, age spacing and total number of children affected the timing of when parents informed them. TD children whose sibling had high-functioning ASD were informed less often and later. The most common question asked by TD children concerned communication problems, and parents often informed them of symptoms and difficulties of ASD as well as the diagnosis. Before receiving an explanation, 77.9% (53/68) of TD children had guessed the diagnosis or noticed something different about their sibling with ASD and 77.3% (51/66) of them reacted moderately to the parent's explanation. The influence of the parent's explanation on TD children's understanding of ASD warrants further research.     

Mood symptoms in children and adolescents with autism spectrum disorders

Asperger Syndrome (AS) and High Functioning Autism (HFA) are psychiatric conditions belonging to the Autistic Spectrum Disorders (ASDs), characterized by social dysfunction and focused interest, in the absence of mental retardation. Previous reports suggest that AS/HFA may be associated with important psychiatric comorbidities. Among the psychiatric internalizing disorders, depression and anxiety are probably the most common disorders. The aim of this study is to evaluate the prevalence of mood disorders and identifying peculiar clinical features in subjects suffering from AS and HFA. 30 male patients with AS/HFA, 30 male patients affected by Major Depression (MD) and 35 male Typically Developing (TD) comparison were assessed with the CDI and the CDRS-R. Participants’ parents were invited to complete the CBCL and the P-YMRS. Moreover, the CGAS was rated by the clinicians. The evaluation of depressive symptoms showed that AS/HFA group reported higher depressive symptoms, as showed by CDI total, CBCL internalizing and CDRS-R total, compared to the TD group. No significant difference of depressive symptoms was found between the AS/HFA and the MD group, with the exception of CDRS-R total score. Moreover, linear regression analysis in the AS/HFA group between CGAS and depressive symptoms revealed that a higher level of depressive symptoms increased the risk of poorer global functioning. These results suggest that the depressive symptoms in AS/HFA patients may be associated with poorer global functioning, with a consequent impairment in their psychological profile and social adjustment, and should alert clinicians to the importance of assessing mood disorders in order to choose the appropriate treatment.     

Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders

Background:Parents of children with autism spectrum disorders (ASDs) are at risk for higher stress levels than parents of children with other developmental disabilities and typical development. Recent advances in early diagnosis have resulted in younger children being diagnosed with ASDs but factors associated with parent stress in this age group are not well understood. Aims: The present study examined parenting-related stress and psychological distress in mothers of toddlers with ASD, developmental delay without ASD (DD), and typical development. The impact of child problem behavior and daily living skills on parenting-stress and psychological distress were further investigated. Methods: Participants were part of a larger research study on early ASD intervention. Results: Parent self-report of parenting-related stress and psychological distress was utilized. Parents of toddlers with ASD demonstrated increased parenting-related stress compared with parents of toddlers with DD and typical development. However, psychological distress did not differ significantly between the groups. Child behavior problems, but not daily living skills emerged as a significant predictor of parenting-related stress and psychological distress. This was true for both mothers of children with ASD and DD. Conclusions: These finding suggest that parents’ abilities to manage and reduce behavior problems is a critical target for interventions for young children with ASD and DD in order to improve child functioning and decrease parenting-related stress.     

Sleep disturbance in children with epilepsy

This study employed a validated pediatric sleep questionnaire to evaluate for sleep-disordered symptoms in children with epilepsy (n=14). Results were compared with those for age-matched children (n=14) with known obstructive sleep apnea. Subjects were enrolled from an outpatient epilepsy clinic and a pediatric sleep disorders clinic. We hypothesized that children with epilepsy would (1) report symptoms of sleep disturbance similar to those of children with documented obstructive sleep apnea, and (2) display behavioral disturbances on parent and child behavioral symptom measures. Results indicate that more than 50% of children with epilepsy had behavioral problems (n=14). No differences in snoring, excessive daytime sleepiness, and restless sleep were seen between the two subject groups. Results suggest that neurobehavioral problems in children with epilepsy may in part be attributed to an underlying sleep disturbance.     

Sleep patterns in children with and without autism spectrum disorders: Developmental comparisons

The present study examined age-related changes in the sleep of children with autism spectrum disorders (ASD) compared to age-related changes in the sleep of typically developing (TD) children. Participants were 108 mothers of children with ASD and 108 mothers of TD children. Participants completed a questionnaire on children's overall sleep quality that also tapped specific sleep-domains (i.e., bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, disordered breathing, daytime sleepiness). Results confirm significantly poorer sleep quantity and quality in children with ASD, particularly children age 6–9 years. Unlike TD children, the sleep problems of children with ASD were unlikely to diminish with age. Our findings suggest that it is important to exam specific domains of sleep as well as overall sleep patterns. Finding of significant age-related interactions suggests that the practice of combining children from wide age-ranges into a single category obfuscates potentially important developmental differences.     

Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents

Purpose: Disrupted sleep patterns in children with epilepsy and their parents are commonly described clinically. A number of studies have shown increased frequency of sleep disorders among pediatric epilepsy patients; however, few have characterized the association between epilepsy and parental sleep quality and household sleeping arrangements. The purpose of this study was to explore the effect of pediatric epilepsy on child sleep, parental sleep and fatigue, and parent‐child sleeping arrangements, including room sharing and cosleeping. Methods: Parents of children 2 to 10 years of age with and without epilepsy completed written questionnaires assessing seizure history, child and parent sleep, and household sleeping arrangements. Children’s Sleep Habits Questionnaire (CSHQ) scores were used to evaluate sleep disturbances for the child. The Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) were used to evaluate parental sleep and fatigue, respectively. The Early Childhood Epilepsy Severity Scale (E‐Chess) was used to assess epilepsy severity. Key Findings: One hundred five households with a child with epilepsy and 79 controls participated in this study. Households with a child with epilepsy reported increased rates of both parent–child room sharing (p < 0.001) and cosleeping (p = 0.005) compared to controls. Children with epilepsy were found to have greater sleep disturbance by total CSHQ score (p < 0.001) and the following subscores: parasomnias (p < 0.001), night wakings (p < 0.001), sleep duration (p < 0.001), daytime sleepiness (<0.001), sleep onset delay (p = 0.009), and bedtime resistance (p = 0.023). Parents of children with epilepsy had increased sleep dysfunction (p = 0.005) and were more fatigued (p < 0.001). Severity of epilepsy correlated positively with degree of child sleep dysfunction (0.192, p = 0.049), parental sleep dysfunction (0.273, p = 0.005), and parental fatigue (0.324, p = 0.001). Antiepileptic drug polytherapy was predictive of greater childhood sleep disturbances. Nocturnal seizures were associated with parental sleep problems, whereas room sharing and cosleeping behavior were associated with child sleep problems. Within the epilepsy cohort, 69% of parents felt concerned about night seizures and 44% reported feeling rested rarely or never. Finally, 62% of parents described decreased sleep quality and/or quantity with cosleeping. Significance: Pediatric epilepsy can significantly affect sleep patterns for both the affected child and his or her parents. Parents frequently room share or cosleep with their child, adaptations which may have detrimental effects for many households. Clinicians must not only be attentive to the sleep issues occurring in pediatric patients with epilepsy, but also for the household as a whole. These data provide evidence of a profound clinical need for improved epilepsy therapeutics and the development of nocturnal seizure monitoring technologies.     

Caring for a Child with Autism Spectrum Disorder and Parents’ Quality of Life: Application of the CarerQol

This study describes the impact of caregiving on parents of children with autism spectrum disorders (ASDs). Secondly, we investigate construct validation of the care-related quality of life instrument (CarerQol) measuring impact of caregiving. Primary caregivers of children with ASDs were included. Many parents experienced considerable problems combining daily activities with care, had financial problems or suffered from depressive mood. Validity tests showed that a higher impact of caring on the CarerQol was positively associated with higher subjective burden and lower family quality of life. Most of the associations between CarerQol scores and background characteristics confirmed previous research. The CarerQol validly measures the impact of caregiving for children with ASDs on caregivers in our sample. The CarerQol may therefore be useful for including parent outcomes in research on ASDs.     

The role of insomnia,pre-sleep arousal and psychopathology symptoms in daytime impairment in adolescents with high-functioning autism spectrum disorder

ObjectivesSleep disturbance and psychopathology are common during adolescence and are highly prevalent in individuals diagnosed with autism spectrum disorder (ASD). The aim of this study was to investigate relationships between sleep disturbance, psychopathology symptoms, and daytime functioning in adolescents with high-functioning autism spectrum disorder (HFASD) compared to typically developing (TD) adolescents.MethodsTwenty-seven adolescents with HFASD and 27 age- and sex-matched TD adolescents completed questionnaires related to sleep, psychopathology and daytime functioning. Participants also completed a 7-day sleep/wake diary. A subsample of HFASD adolescents (55%) and all the TD adolescents wore an actigraphy monitor concurrently with the sleep diary.ResultsAdolescents with HFASD had significantly higher scores for depressed mood, anxiety and pre-sleep arousal compared with TD adolescents and poorer daytime functioning. There were more significant correlations between sleep variables and psychopathology variables, and sleep variables and daytime functioning, in the HFASD group than in the TD group. Standard regression found that sleep variables significantly accounted for 57% of the variance in daytime functioning symptoms of insufficient sleep in the HFASD group, while psychopathology variables accounted for 63% of the variance in daytime functioning.ConclusionsBoth sleep disturbance and psychopathology are more prevalent in adolescents with HFASD and are major contributors to poor daytime functioning in these individuals.     

Sluggish cognitive tempo in children referred to a pediatric Sleep Disorders Center: Examining possible overlap with sleep problems and associations with impairment

Research supports the distinctness of sluggish cognitive tempo (SCT) (e.g., mental confusion and slowed behavior/thinking) from other psychopathologies. However, the relation between SCT and sleep functioning has not been adequately studied. We examined the association between SCT and sleep functioning in 325 children (62% male) ages 6–10 years referred to a pulmonary-based, accredited Sleep Disorders Center. Correlations between caregiver ratings of SCT, other psychopathologies (i.e., inattention/hyperactivity, oppositionality, depression, anxiety), sleep functioning (both behavioral and organic symptoms), as well as sleep disorder diagnoses, were examined. Unique effects of SCT and other psychopathologies on sleep problem severity controlling for child demographics were assessed using regressions. Regression analyses were also conducted to examine the unique effects of SCT on impairment (i.e., academic difficulties, parenting stress, and other psychopathologies) controlling for child demographics, sleep problem severity, and other psychopathology symptoms. SCT was weakly to moderately correlated with most measures of sleep (rs = .07–.39) and moderately to strongly correlated with measures of daytime sleepiness (rs = .33 and .53). In the regression analyses, SCT was uniquely associated with greater sleep functioning severity and impairment in academic functioning. SCT was also uniquely associated with higher levels of depression and inattention/hyperactivity, but not anxiety, and negatively associated with oppositionality. Finally, SCT symptoms were uniquely associated with greater parent-child dysfunctional interaction. Findings demonstrate that SCT is related to, but not redundant with, sleep problems and daytime sleepiness specifically. Further, SCT remained associated with several domains of functional impairment in sleep-disordered children after controlling for clinically-relevant variables, highlighting the potential value in assessing SCT symptoms in children with sleep problems.     

Predictors of outcome of a parenting group curriculum: a pilot study

One pressing issue facing parenting interventions for disruptive behaviors of young children is forecasting who will benefit from participation. The purpose of this study was to examine four personal and interpersonal predictors (i.e., parent depressive symptoms, parent education, coparent conflict, and marital status) of engagement (i.e., number of sessions attended) in and child outcome (i.e., problematic behavior) of a parenting group curriculum program targeting young children's disruptive behaviors. Participants were 39 parents (34 mothers and 5 fathers; M = 38.6 years) who expressed an interest in improving the behavior of their 3- to 6-year-old child (19 females and 20 males; M = 4.50 years). Findings indicated that one baseline personal variable, parent depressive symptoms, predicted change in child disruptive behavior at follow-up, and two baseline interpersonal variables, marital status and coparent conflict, predicted engagement in treatment (i.e., number of sessions attended). Implications and directions for future research are discussed.     

Attention deficit disorder in children at risk for anxiety and depression

The comorbidity between attention deficit disorder (ADD) and anxiety and/or depressive disorders was examined in the children of parents with panic disorder, major depressive disorder, or with no diagnosis. A child received a diagnosis by a self-report, parent report, and by consensus, using a best estimate procedure. The prevalence rates of ADD were significantly greater in offspring of parents with depressive and panic disorder by the parents' report and in children of depressed parents by consensus. A significant relationship between ADD and anxiety and/or depression was found for parent, child, and consensus diagnoses. Higher rates of ADD were reported by children (1% versus 13%), parents (8% versus 31%), and in the consensus diagnoses (13% versus 29%) when anxiety and/or depression was present. These results suggest that in children referred for evaluation of ADD, the possibility of a primary anxiety or depressive disorder should be considered.     

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.