Predictors and outcomes associated with therapeutic alliance in cognitive behaviour therapy for children with autism.

Therapeutic alliance is often an important aspect of psychotherapy, though it is rarely examined in clients with autism. This study aims to determine the child pre-treatment variables and treatment outcomes associated with early and late alliance in cognitive behaviour therapy targeting emotion regulation for children with autism. Data were collected from 48 children with autism who participated in a larger randomized-controlled trial. Pre-treatment child characteristics included child, parent, and clinician report of child emotional and behavioural functioning. Primary outcome measures included child and parent-reported emotion regulation. Therapeutic alliance (bond and task-collaboration) was measured using observational coding of early and late therapy sessions. Pre-treatment levels of child-reported emotion inhibition were associated with subsequent early and late bond. Pre-treatment levels of parent and child-reported emotion regulation were related to early and late task-collaboration. Late task-collaboration was also associated with pre-treatment levels of behavioural and emotional symptom severity. Task-collaboration in later sessions predicted improvements in parent-reported emotion regulation from pre- to post-therapy. Future research is needed to further examine the role of task-collaboration as a mechanism of treatment change in therapies for children with autism.

MYmind: a Concurrent Group-Based Mindfulness Intervention for Youth with Autism and Their Parents.

OBJECTIVES: The current study evaluated the use of MYmind, a concurrent mindfulness program in which youth with autism and their parents simultaneously receive group specific mindfulness training. Youth with autism can experience emotional and behavioral challenges, which are associated with parental stress. Mindfulness-based programs are emerging as a promising support for these challenges, for both children and parents. While two studies have documented the use of concurrent parent-child programs, neither involve control conditions. METHODS: Using a within-subject repeated measures design with a baseline component, 23 parent-child dyads were assessed on mindfulness, mental health, and youth emotion regulation and autism symptoms. Participants also rated their perceived improvement on a social validity questionnaire. RESULTS: There was improvement in youth autism symptoms, emotion regulation, and adaptive skills, and in parent reports of their own mindfulness following the program. There was also some indication of a waitlist effect for parent mental health, but not for other outcome variables. Participant feedback was mainly positive. CONCLUSIONS: MYmind has the potential to contribute to emotion regulation and adaptability in youth with autism, and mindfulness in parents, though more rigorous controlled trials are needed.

A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism.

BACKGROUND: Mental health problems are common among individuals with autism spectrum disorder (ASD), and difficulties with emotion regulation processes may underlie these issues. Cognitive behavior therapy (CBT) is considered an efficacious treatment for anxiety in children with ASD. Additional research is needed to examine the efficacy of a transdiagnostic treatment approach, whereby the same treatment can be applied to multiple emotional problems, beyond solely anxiety. The purpose of the present study was to examine the efficacy of a manualized and individually delivered 10-session, transdiagnostic CBT intervention, aimed at improving emotion regulation and mental health difficulties in children with ASD. METHODS: Sixty-eight children (M age = 9.75, SD = 1.27) and their parents participated in the study, randomly allocated to either a treatment immediate (n = 35) or waitlist control condition (n = 33) (ISRCTN #67079741). Parent-, child-, and clinician-reported measures of emotion regulation and mental health were administered at baseline, postintervention/postwaitlist, and at 10-week follow-up. RESULTS: Children in the treatment immediate condition demonstrated significant improvements on measures of emotion regulation (i.e., emotionality, emotion regulation abilities with social skills) and aspects of psychopathology (i.e., a composite measure of internalizing and externalizing symptoms, adaptive behaviors) compared to those in the waitlist control condition. Treatment gains were maintained at follow-up. CONCLUSIONS: This study is the first transdiagnostic CBT efficacy trial for children with ASD. Additional investigations are needed to further establish its relative efficacy compared to more traditional models of CBT for children with ASD and other neurodevelopmental conditions.

Developing a measure of distress-promoting parent behaviors during infant vaccination: Assessing reliability and validity.

BACKGROUND: Infants rely on their parents' sensitive and contingent soothing to support their regulation from pain-related distress. However, despite being of potentially equal or greater import, there has been little focus on how to measure distress-promoting parent behaviors. AIMS: The goal of this article was to develop and validate a measure of distress-promoting parent behaviors for acute painful procedures (e.g., vaccinations) that could be used by researchers and clinicians. METHODS: Following initial generation of measure items, focused group discussions were held with vaccinating clinicians to understand the measure's face, content, and ecological validity. Archival video footage (n = 537 videos of infant-caregiver dyads during vaccination) was then coded using the measure of distress-promoting behaviors for 3 minutes post vaccine injection. Validity and reliability were examined using correlational analyses. Construct validity was assessed by convergent relationships with infant pain-related distress and divergent relationships were assessed with parent sensitivity and soothing-promoting behaviors. RESULTS: The measure demonstrated both moderate to excellent interrater and test-retest reliability and convergent and divergent validity (absolute magnitude of r's = 0.30 to 0.46). CONCLUSIONS: By demonstrating strong reliability and validity, this measure represents a promising new way to understand how caregivers interact with infants during painful procedures. Through focusing on distress promotion and using a format that may be coded both from video or in vivo, it is a feasible way to operationalize the impact of the caregiver on the infant's pain experience in both research and clinical settings.

Contexte: Les nourrissons dépendent de l'apaisement que peuvent éventuellement leur procurer leurs parents avec sensibilité afin de les soutenir dans la régulation de leur détresse liée à la douleur. Toutefois, malgré le fait qu'ils soient d'importance égale ou supérieure, peu d'attention a été accordée à la façon de mesurer les comportements parentaux qui favorisent la détresse.But: Le but de cet article était de développer et de valider un outil de mesure de la détresse suscitée par les comportements parentaux dans le cadre de procédures entrainant une douleur aigue (ex.: la vaccination), qui pourrait être utilisée par les chercheurs et les cliniciens.Méthodes: Suite à une première production d'outils de mesure, des groupes de discussion ont été menés avec des cliniciens faisant de la vaccination afin de comprendre la validité apparente, la validité de contenu et la validité écologique de l'outil de mesure. Des séquences vidéo d'archives (n = 537 vidéos de dyades nourrisson-prestataire de soins) ont ensuite été codifiées afin de mesurer les comportements qui favorisent la détresse au cours des trois minutes suivant l'injection du vaccin. La validité et la fiabilité ont été étudiées à l'aide d'analyses corrélationnelles. La validité de construit a été évaluée par les relations convergentes avec la détresse liée à la douleur du nourrisson, tandis que les relations divergentes ont été évaluées avec la sensibilité parentale et les comportements d'apaisement.Résultats: L'outil de mesure a démontré un degré de fiabilité inter-évaluateurs et de fiabilité test-retest allant de modéré à excellent, ainsi qu'une validité convergente et divergente (valeur absolue de f 0,30 à 0,46).Conclusions: En démontrant une grande fiabiilité et une grande validité, cet outil de mesure représente une nouvelle façon prometteuse de comprendre comment les prestataires de soins interagissent avec les nourissons pendant les procédures douloureuses. En mettant l'accent sur ce qui favorise la détresse et en ayant recours à un format qui peut être codifié à partir d'une vidéo ou in vivo, il est possible d'opérationnaliser l'effet du prestataire de soins sur l'expérience de douleur de l'enfant, que ce soit dans le cadre d'une étude ou dans un cadre clinique.

Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review.

Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life. Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants. Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions. Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.

Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children.

OBJECTIVE: To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. METHODS: A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. RESULTS: 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. CONCLUSIONS: Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.