The Impact of Child Symptom Severity on Depressed Mood Among Parents of Children with ASD: The Mediating Role of Stress Proliferation

Stress proliferation (the tendency of stressors to engender additional stressors in other life domains) is explored in a sample of 68 parents of children identified with ASD. Regression analyses showed that parent depression was predicted by both child symptom severity and by stress proliferation and that stress proliferation partially mediated the effect of child symptom severity on parent depression. In addition, informal social support was found to reduce levels of parent stress proliferation and parent depression; however, contrary to the stress buffering hypothesis, the ameliorative effect of support on stress proliferation was shown to be greatest when reported child symptomatology was less (rather than more) severe. Study implications for future research and practice are discussed.     

Assessing Need for Social Support in Parents of Children with Autism and Down Syndrome

Parents of children with autism frequently turn to the service delivery system to access supports designed to help adapt to the challenges of having a child with a life-long impairment. Although studies have suggested various supports and coping strategies that are effective for adapting, few studies have examined parents’ own perceptions of needs, and whether parents felt their needs were being met. In the present study the Family Needs Questionnaire (FNQ; Waaland et al., 1993) was modified to address needs for children with developmental disorders. A sample of fifty-six parents of children with autism and a comparison group of thirty-two parents of children with Down syndrome completed the FNQ. The groups did not differ significantly on the number of important needs reported nor the number of important needs being met. However, the two groups differed in the types of supports they most frequently endorsed as Important or Unmet.     

Friendship interventions and measurements in children with ASD: A systematic review

BackgroundFriendships are vital to children's social well-being and overall development, and they can also serve as a protector factor from peer victimization and bullying. For children with ASD, friendship development can be an area of challenge. Friendship interventions may help children and adolescents with ASD in developing the skills for making and keeping friends.MethodThis systematic review examined friendship interventions for children and adolescents with autism spectrum disorder (ASD). It also explored measures of friendship skills in children with ASD. Twenty-seven studies met the inclusion criteria: (a) experimental intervention studies focused on improving friendships of individuals with ASD, (b) the measurement of friendship outcomes, and (c) strong or acceptable methodological ratings.ResultsFifteen unique interventions were tested across the 27 studies. Thirteen interventions included strategies specifically focused on improving (making and maintaining) friendships in the participants with ASD. Friendship interventions were primarily focused on behaviorally based social skills building and varied in implementation settings. Friendship measures included the use of parent reports, child and adolescent surveys and questionnaires, peer nominations, and sociometric ratings.ConclusionThe results highlighted the benefit of including targeted friendship-building strategies in social and friendship interventions and the value of multiple perspectives when measuring friendship. The findings of the study can influence how families and practitioners collaborate to support children and adolescents with ASD in the development and maintenance of their friendships.     

A comparison of tantrum behavior profiles in children with ASD,ADHD and comorbid ASD and ADHD

The present study was conducted to compare rates of tantrum behaviors in children with autism spectrum disorders (ASD) (n = 255), attention-deficit/hyperactivity disorder (ADHD) (n = 40) and children with comorbid ASD and ADHD (n = 47). Parents/guardians of children aged 3–16 years were surveyed about their children's behaviors using the Autism Spectrum Disorders-Comorbidity for Children (ASD-C-C). Children with ADHD alone differed from children with ASD alone and children with comorbid ASD and ADHD on rates of tantrum behaviors. Examination of individual tantrum behavior items indicated that children with comorbid ASD and ADHD have a more similar symptom presentation to children with ASD than children with ADHD. This study adds to the literature on the presentation of common co-occurring behaviors of ASD when there is comorbid ADHD. The implications of these findings may aid in the assessment and treatment of tantrum behaviors in children with comorbid ASD and ADHD.     

Rates of comorbid symptoms in children with ASD,ADHD, and comorbid ASD and ADHD

The current diagnostic criteria do not allow co-diagnosis of autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). As a result, there has been little research on how these two disorders co-occur in the ASD population. The current study aimed to extend the literature in this area by examining comorbid rates in three different diagnostic groups (ASD, ADHD, and comorbid ASD + ADHD) using the Autism Spectrum Disorders-Comorbidity for Children (ASD-CC). Children with comorbid ASD and ADHD evinced higher rates of comorbid symptoms than children with ASD or ADHD alone. Additionally, children with comorbid ASD and ADHD endorsed more severe comorbid symptoms. Implications regarding these findings are discussed.     

The relationship between sleep and behavior in autism spectrum disorder (ASD): a review

Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.     

A lack of self-consciousness in Asperger's disorder but not in PDDNOS: Implication for the clinical importance of ASD subtypes

Self-consciousness plays an important role in a person's social life. Assuming that self-consciousness is a key to understanding social impairments in high-functioning autism spectrum disorder (ASD), we examined self-consciousness in individuals with Asperger's disorder, pervasive developmental disorder not otherwise specified (PDDNOS) and their controls using an episodic memory task. The PDDNOS group consisted of individuals in a milder subgroup of PDDNOS, with less autistic features than Asperger's disorder. In the learning phase, one of three types of questions (phonological, semantic, self-referential) was asked about each following target word. The target words were all personality trait adjectives. Next, a recognition test was conducted. The PDDNOS group, like the control, showed the most superior performance in self-referential processing (i.e. the self-reference effect) while the Asperger's group did not; however, both the ASD groups revealed an atypical pattern of relationship between memory performance and IQ. Individuals with PDDNOS, unlike those with Asperger's disorder, may be self-conscious to the same degree as typically developing individuals, but the cognitive process leading them to self-consciousness seems atypical, causing social impairments similar to those seen in individuals with Asperger's disorder who lack self-consciousness.     

Pathways to meaning: Written and spoken word priming in children with ASD versus typically developing peers

Visual supports are widely utilized with children on the autism spectrum, however, the effect of visual versus auditory modality on language comprehension has not been directly investigated. To address this issue, we utilized a semantic priming paradigm in two experiments with 18 children with ASD and no language impairment and 14 children with typical development. In the first, cross-modal experiment with a spoken word prime, no priming effect was identified. In the second, uni-modal written word prime experiment, a three-way interaction was identified. Subsequent analysis revealed that priming occurred only in the younger participants with ASD. These results are discussed in terms of the cross- and uni-modal demands of the two experiments and in light of lexical processing of spoken and written words within a developmental framework.     

Abnormal Activation of the Social Brain Network in Children with Autism Spectrum Disorder: An fMRI Study

Objective

The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC).

Methods

Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC.

Results

When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation.

Conclusion

These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.     

Do You Really Lose When You Snooze? Sleep Correlates of Externalizing and Attention Problems Among Pediatric Patients with ADHD,ASD, and Comorbid Diagnosis

ABSTRACT

Introduction

The primary aim of this retrospective study was to assess differential associations between sleep disturbances with externalizing/internalizing problems, ADHD profiles (inattention, hyperactivity/impulsivity), and social impairment among children with ADHD, autism spectrum disorder (ASD), and comorbid diagnoses (ASD+ADHD).     

Effect of Social Familiarity on Salivary Cortisol and Self-Reports of Social Anxiety and Stress in Children with High Functioning Autism Spectrum Disorders

This study examined the effect of social familiarity on salivary cortisol and social anxiety/stress for a sample of children with high-functioning autism spectrum disorders. The relationship between self-reported social anxiety/stress and salivary cortisol was also examined. Participants interacted with a familiar peer on one occasion and an unfamiliar peer on another occasion. Data were collected using salivary cortisol and a scale measuring subjective stress. Results indicated a significant condition by order interaction for salivary cortisol levels, while self-rated stress did not differ significantly across situations. A mild-moderate correlation was found between self-reported distress and salivary cortisol within each condition. Examination of self-rated distress vs. cortisol scatter plots suggested a more complex relationship than the correlation coefficient could adequately convey.     

A systematic review of weighted vests with individuals with autism spectrum disorder

The purpose of the study was to evaluate the current literature on the use of weighted vests (WV) with individuals with autism spectrum disorder (ASD). A literature review using the standards recommended by the What Works Clearinghouse was conducted. The studies included in the review met the following criteria: (a) use of a single case research design; (b) inclusion of at least one individual with ASD; (c) examination of the effects of WV on a particular dependent variable; and (d) publication in English in a peer-refereed journal in the past 25 years. The results of the review show that the use of WV with individuals with ASD is not an evidence-based practice.     

Longitudinal effects of educational involvement on parent and family functioning among mothers of children with ASD

Utilizing a cohort sequential design and multilevel modeling on a sample of 113 mothers, the effects of three forms of maternal educational involvement (school-based involvement, home-based involvement, and home-school communication) on maternal and family functioning (maternal psychological distress, parenting efficacy, and family cohesion) were assessed over a seven year period when children with ASD in the study were 7–14 years of age. Findings indicated that maternal home-based educational involvement was linked to decreased psychological distress as well as to increased parenting efficacy and family cohesion, while home-school communication was linked to decreased distress and increased parenting efficacy (school-based involvement was related to decreased maternal distress only). In addition, in two instances, home-based involvement was found to moderate the effects of child and maternal risk factors (child problem behavior and stress proliferation) on maternal and family outcomes. Study findings are discussed in light of prior research and study limitations and implications are highlighted.     

Emotional stress,cortisol response,and cortisol rhythm in autism spectrum disorders: A systematic review

BackgroundThis systematic review evaluated whether there is evidence for (i) increased emotional stress levels, and (ii) a different biological stress response or rhythm [i.e., cortisol stress response, diurnal rhythm, or cortisol awakening response (CAR)] in individuals with autism spectrum disorder (ASD) relative to controls. Thirdly, the evidence for an association between emotional and biological stress in ASD was reviewed.MethodMEDLINE, Cochrane Library, and SAGE journals were searched until December 2020. In this review, there were no limitations regarding age, sex, or intelligence quotient. Studies were only reviewed if results were compared with controls without a developmental disorder. Only salivary cortisol was considered as biological stress measure.ResultsThirty-one studies were reviewed. Significantly higher self- and parent-reported emotional stress levels were found in individuals with ASD compared to controls. Regarding biological stress, the few studies in adults reported comparable cortisol stress responses and rhythms between both groups. In children/adolescents with ASD relative to controls, an increased, blunted, or similar cortisol stress response was reported, whereas the CAR did not differ in most studies, and diurnal rhythm was described as blunted or similar. Most studies found no significant association between parent-reported emotional stress and biological stress in ASD.ConclusionsCurrent findings suggest that heightened emotional stress is a clinically significant factor in ASD. To unravel the cortisol response and rhythm, research in specific subgroups within the ASD spectrum is warranted, aiming at a higher frequency of cortisol measurements, preferably combined with momentary emotional stress measurements.     

Investigating attention in young adults with autism spectrum disorder (ASD) using change blindness and eye tracking

BackgroundSocial interaction at its core entails allocating attention to relevant stimuli. As such, the perception of change requires attention, but studies have suggested that the social impairment in people with autism spectrum disorder (ASD) occurs at the attentual level of "on-line" social cognition.MethodForty-four young adults—22 with autism spectrum disorder (ASD) and 22 with typical development (TD)—participated in two experiments. The first used a change blindness (CB) paradigm where attention was investigated through the detection of changed items with central and marginal levels of interest when viewing images of everyday scenarios. Eye-tracking was used to compare response times, first fixations and total fixation time on changes. The second used social films with eye tracking of gaze fixations.ResultsParticipants with ASD were slower in response time and first fixation than were participants with TD. Participants with TD showed longer fixation on items with marginal (compared to central) levels of interest. The social-film experiment showed that participants with ASD were slower to orient their gazes towards the characters’ faces and looked at speaking characters for less time than did the group with TD. This result correlates with less use of mental verbs in their narratives and less time spent looking at marginal items in the CB experiment.ConclusionsResults suggest reduced processing speed in young adults with ASD, which is associated with enhanced processing of local details. Clinically, these results imply that teaching strategies (e.g., cognitive cues) to process social context efficiently could benefit individuals with ASD.     

Constipation prevalence and perceptions: Comparison of children and adolescents with ASD and other developmental-behavioral disorders

BackgroundFew studies have compared youth constipation in autism spectrum disorder (ASD) to constipation in other developmental-behavioral (DB) disorders.MethodsChildren and caregivers presenting to a DB pediatrics and psychology clinic completed written questionnaires on constipation. Comparison groups were ASD vs without ASD and caregiver vs child responses. Binary logistic regression were conducted to compare categorical variables.ResultsCaregivers of 169 toilet trained children and 26 non-toilet trained children completed the survey; 30 % of the toilet trained and 62 % of the non-toilet trained children had ASD. 88 toilet trained children completed the survey. Based on caregiver response, toilet trained youth with ASD were more likely to have been constipated in the past and to currently or previously taken medication to manage constipation. In both the total toilet trained and non-toilet trained sample, more caregivers endorsed their child meeting Rome IV criteria for functional constipation than endorsed current constipation. 37 % of parent/child pairs disagreed on whether the child met the Rome IV criteria. Caregivers of toilet trained youth with ASD were more likely to endorse specific barriers and impairment due to managing constipation in comparison to caregivers of youth without ASD.ConclusionsChildren with ASD may be at a higher lifetime risk of constipation and of needing medication compared to children with other DB disorders. Providers should use thorough questions to identify constipation and gather information from both caregiver and child when possible. Clinicians should consider targeting behavioral treatment recommendations to perceived caregiver concerns.     

A comparison of children and adolescents with ASD,atypical development,and typical development on the Behavioral Assessment System for Children,Second Edition (BASC-2)

The present study examined the use of the Behavioral Assessment System for Children, Second Edition (BASC-2) in discerning 151 children and adolescents 12–16 years of age with autism spectrum disorder (ASD) from atypically and typically developing children and adolescents. Scores on the BASC-2 composites (i.e., externalizing behaviors, internalizing behaviors, behavior symptom index [BSI], adaptive behaviors) and subscales (i.e., hyperactivity, aggression, conduct problems, anxiety, depression, somatization, atypicality, withdrawal, attention, adaptability, social skills, leadership, activities of daily living, functional communication) were compared between children and adolescents with ASD, atypical development, and typical development. With the exception of aggression, somatization, and internalizing behaviors, participants with ASD were significantly more impaired than typically developing participants in all other composites and subscales. In comparison to atypically developing participants, the scores of participants with ASD evinced more impairment for BSI and its subscales, with the exception of attention, and the adaptive behavior composite and its subscales, with the exception of adaptability. Scores on the externalizing behaviors and internalizing behaviors composites and their subscales, with the exception of anxiety, were not significantly different. Research and clinical implications are discussed.     

An Examination of Specific Child Behavior Problems as Predictors of Parenting Stress Among Families of Children With Pervasive Developmental Disorders

Introduction: Studies have shown that parents of children with pervasive developmental disorders (PDD) exhibit higher levels of stress than parents of typically developing children or children with other types of developmental delays (DD). This relationship appears to be mediated by elevated levels of behavior problems observed in children with PDD. However, little is known about what specific child behavior problems are most common in this population or how these behavior problems relate to parental stress. We examined the relationship between parenting stress and child behavior problems in parents of young children with PDD. Method: The current study utilized data from the Mindful Awareness for Parenting Stress (MAPS) project and included 72 parents of children with PDD. The mean age of the parents in the current study was 34.81 years (SD = 7.67) and the mean age of the children was 3.86 years (SD = 0.98). Results: The most commonly endorsed classes of child behavior problems included attention problems, language problems, and externalizing behavior problems. Three specific behavior problems, “Doesn’t answer when people talk to him/her,” “Speech problem,” and “Temper tantrums or hot temper,” were significantly related to parental stress levels at intake. Furthermore, these three behavior problems uniquely predicted parenting stress. Conclusions: Identifying the behavior problems that are most difficult for parents to handle may allow clinicians to tailor interventions to the specific needs of families. The current study indicated that social difficulties, speech problems, and tantrums have the greatest negative impact on parental stress, highlighting these problems as ideal targets for interventions.     

Individual and Marital Adaptation in Men with Autism Spectrum Disorder and their Spouses: The Role of Social Support and Coping Strategies

The aim of the present study was to examine the predictive value of social support and coping for individual and marital adaptation in adult men with autism spectrum disorder (ASD) and their spouses, based on the double ABCX model of adaptation. Twenty-one couples participated in the study and completed measures of stressor severity, social support, coping, individual and marital adaptation. Bivariate analyses showed that each of the model components was related to adaptation in men and women. Hierarchical regression analyses revealed that, after controlling for relevant demographics and stressor severity, informal support was a strong, and unique predictor of adaptation in both spouses (explained variance: 27–89%). Coping did not add to the prediction of adaptation. Clinical implications and limitations are discussed.     

The quality of life of parents of children with autism spectrum disorder: A systematic review

BackgroundPrevious research has raised concerns about the quality of life (QoL) of parents of children with autism spectrum disorder (ASD). A better understanding of parental QoL can inform clinicians and policymakers and lead to improved outcomes for both parents and children.AimsThis review aimed to systematically examine studies measuring the QoL among parents of children with ASD (<18 years) and to investigate its parental, child-related and contextual associated factors.MethodologyAn electronic database search was conducted using Medline, Psycinfo, Embase, CINAHL, Biosis, ASSIA, Social Services Abstracts, Sociological Abstracts and Open grey.ResultsThis review indicated poorer QoL among parents of children with ASD compared to parents of typically developing children or to population norms. Variables associated with lower parental QoL within this group included child behavioural difficulties, unemployment, being a mother and lack of social support.ConclusionThis review verified previous reports on lower QoL among parents of children with ASD and highlighted potential areas of support. Implications for future research, policy and practice are discussed.