The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-developing Sibling Internalizing Behavior in Families with a Child with ASD.

Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.

Discrepancy in perceived social support among typically developing siblings of youth with autism spectrum disorder.

Social support can buffer against stressors often associated with having family members with autism spectrum disorder. This study included 112 parents and typically developing siblings of children with autism spectrum disorder. Relations between self-reported typically developing sibling emotional and behavioral problems and discrepancy between social support frequency and importance were examined via polynomial regression with response surface analysis. Typically developing siblings who described social support as frequent and important reported relatively few problems. Typically developing siblings who reported social support as highly important but infrequent exhibited the highest emotional and behavioral difficulties. Thus, typically developing siblings with little support who view support as highly important may be particularly responsive to social support improvement efforts.

Protective Factors Against Distress for Caregivers of a Child with Autism Spectrum Disorder.

Caregivers of a child with autism spectrum disorder (ASD) often experience elevated distress. The current study examined potential protective factors against caregiver distress when child externalizing and internalizing behaviors are present: family resources, perceived social support, parenting efficacy, knowledge of ASD, and the agreement between actual and perceived knowledge of ASD. Caregivers of a child with ASD completed an online questionnaire. Results demonstrated main effects for externalizing behavior, family resources, and perceived social support. Significant interactions were found among parenting efficacy and internalizing behavior, and the agreement between actual and perceived knowledge with both externalizing and internalizing behaviors. Results indicate important factors that should be emphasized when working with families of a child with ASD.

Multi-informant assessment of siblings of youth with autism spectrum disorder: Parent-child discrepancies in at-risk classification.

BACKGROUND: The behavioral and emotional functioning of typically-developing (TD) siblings of youth with autism spectrum disorder (ASD) has been frequently assessed in the literature; however, these assessments typically include only one informant, rarely considering differences between parent and self-reports of sibling adjustment. AIMS: This study examined parent-youth reported informant discrepancies in behavioral and emotional functioning, including whether parent and youth reports yielded the same conclusions regarding TD sibling risk status. METHODS, PROCEDURES, AND RESULTS: Among 113 parents and TD siblings of youth with ASD, TD siblings self-reported more overall, conduct, hyperactivity, and peer problems (compared to parent reports). Although few siblings were considered at-risk, those who were identified were not usually identified as at-risk on both informants' reports. Moreover, ASD symptoms, broader autism phenotype symptoms, parent mental health concerns, and social support from parents were all related to differences in at-risk classification between parent- and sibling self-report. CONCLUSIONS AND IMPLICATIONS: This paper highlights the necessity of multi-informant reporting when considering TD sibling psychological functioning. WHAT THIS PAPER ADDS: This study helps to address gaps in the literature on assessment of emotional and behavioral functioning of TD siblings of youth with ASD. The results highlight the importance of utilizing both parent- and self-report when identifying TD siblings at-risk for maladjustment. Although few siblings were considered at-risk, those who were identified were not usually identified as such on both informants' reports, and a variety of sibling- and parent-factors were associated with differences in at-risk classification. Thus, inclusion and examination of both parent- and self-report of TD sibling psychological functioning is vital for accurately identifying numbers of TD siblings at-risk of maladjustment.

Sibling relationship quality and psychosocial outcomes among adult siblings of individuals with autism spectrum disorder and individuals with intellectual disability without autism.

Research on adult typically-developing (TD) siblings of individuals with developmental disabilities remains limited, and outcomes for TD siblings appear to vary widely. For the current study, 82 adult TD siblings of individuals with autism spectrum disorder (ASD) or intellectual disability (ID) completed questionnaires about themselves and their affected sibling. Results of this study suggest that the attitudes possessed by adult TD siblings are important to consider when understanding adult TD sibling outcomes. Specifically, data indicate that higher levels of positive sibling relationship attitudes are related to TD siblings providing more aid/support to their sibling with a disability, along with having higher levels of general life satisfaction, and negatively related to levels of stress and depressive symptoms among TD siblings. Consistent with previous child research, siblings of individuals with ASD reported fewer positive sibling relationship attitudes compared to siblings of individuals with ID. Finally, group membership related to aid provided, depressive symptoms, and stress of TD siblings indirectly through sibling relationship attitudes. Overall, results indicate that sibling relationship attitudes may be particularly important to consider when conceptualizing sibling relationships when one sibling has an intellectual or developmental disability.

School-based Screening to Identify Children At Risk for Attention-Deficit/Hyperactivity Disorder: Barriers and Implications.

This report describes a school-based screening project to improve early identification of children at risk for attention-deficit/hyperactivity disorder (ADHD) and communicate these concerns to parents, recommending that they contact their child's primary care provider (PCP). Of 17,440 eligible children in first through fifth grades in five school districts, 47.0% of parents provided required written consent, and teachers completed 70.4% of the online screeners (using the Vanderbilt AD/HD Diagnostic Teacher Rating Scale). Of 5,772 screeners completed, 18.1% of children (n = 1,044) were identified as at risk. Parents of at-risk children were contacted to explain risk status and recommended to visit their child's PCP for further evaluation. It was not possible to contact 39.1% of parents of at-risk children. Of the 636 parents of at-risk children who could be contacted, 53.1% (n = 338) verbally accepted the recommendation to follow-up with their PCP, which was not related to ADHD symptom severity. Parents of children with IEPs or related services were more likely to accept the recommendation to visit the PCP. Our exploration of the potential for school-based screening for ADHD identified a number of barriers to successful execution, but the data also indicated that this is an important problem to address.

The relationship between intentional self-injurious behavior and the loudness dependence of auditory evoked potential in research volunteers.

OBJECTIVE: Serotonergic (5-HT) functioning has been shown to be inversely associated with intentional self-injurious behaviors. The purpose of this study was to examine the association between three related self-report measures of intentional self-injurious behaviors (suicidal thoughts/behavior, history of nonsuicidal self-injury, history of severe self-harm when angry) and a putative electrophysiological index of 5-HT activity, the loudness dependence of auditory evoked potential (LDAEP). METHOD: Auditory evoked potentials were recorded from 41 men (mean age = 20.69, standard deviation [SD] = 2.98) during the administration of various tone loudness stimuli, followed by completion of the self-report measures. RESULTS: The component slope was associated with all measures of self-injurious behavior in the expected direction. CONCLUSION: The LDAEP has the potential to be used as a noninvasive index of intentional self-harm disposition. Additional studies are needed using other populations, including women and treatment-seeking individuals, to determine if the LDAEP more broadly discriminates risk of self-injuring.

Parents' goals for ADHD care in a clinical pediatric sample.

OBJECTIVE: This report describes goals parents have for their children with attention deficit/hyperactivity disorder (ADHD) when coming for a pediatric visit. METHOD: Data were collected from 441 parents of children presenting to either a primary care pediatric practice or a developmental behavioral pediatric practice. Parents were asked to report their top 1 or 2 goals for improvement for their children, and responses were coded into 17 categories. These categories were further grouped into 7 goal composites and examined in relation to demographic characteristics of the families, office type, and symptomology. RESULTS: Goals related to reducing symptoms of inattention were most common, but goals were heterogeneous in nature. Goals were meaningfully, but modestly, related to symptomology. In several instances, symptoms of comorbid conditions interacted with symptoms of ADHD in relation to specific goals being reported. CONCLUSIONS: Parents' goals extended beyond ADHD symptoms. Pediatricians need an array of resources to address parents' goals.

A longitudinal examination of the relation between parental expressed emotion and externalizing behaviors in children and adolescents with autism spectrum disorder.

The current study explored the longitudinal relation between parental expressed emotion, a well-established predictor of symptom relapse in various other disorders (e.g., schizophrenia) with externalizing behaviors in 84 children, ages 8-18 (at Time 2), with autism spectrum disorder (ASD). It was found that parental expressed emotion, specifically criticism/hostility at Time 1, significantly related to a change in externalizing behaviors from Time 1 to Time 2, even after controlling for Time 1 family income, ASD symptom severity, parental distress, and parenting practices. That is, higher levels of parental criticism/hostility at Time 1 predicted higher levels of child externalizing behaviors at Time 2. However, the reverse was not found. This finding of a unidirectional relation has important clinical implications.

Birth order rank as a moderator of the relation between behavior problems among children with an autism spectrum disorder and their siblings.

Variability within the literature investigating typically-developing siblings of children with an autism spectrum disorder suggests that the quality of sibling outcomes may depend on specific factors. For this study, 42 parents of a child with an autism spectrum disorder and a typically- developing sibling provided data via online questionnaires. Birth order rank of the child with an autism spectrum disorder significantly moderated the relation between externalizing behaviors in children with an autism spectrum disorder and externalizing behaviors in their typically-developing siblings. Children with an autism spectrum disorder and higher levels of behavior problems had typically-developing siblings with higher levels of behavior problems only when the child with an autism spectrum disorder was older. These results provide a hint of clarification about the complex nature of sibling relations, but a great deal more research is needed to further examine outcomes of typically-developing siblings of children with an autism spectrum disorder.

The latent structure of oppositional defiant disorder in children and adults.

An understanding of the latent structure of oppositional defiant disorder (ODD) is essential for better developing causal models, improving diagnostic and assessment procedures, and enhancing treatments for the disorder. Although much research has focused on ODD-including recent studies informing the diagnostic criteria for DSM-5-research examining the latent structure of ODD is sparse, and no known study has specifically undertaken a taxometric analysis to address the issue of whether ODD is a categorical or dimensional construct. To address this gap, the authors conducted two separate studies using a set of taxometric analyses with data from the NICHD Study of Early Child Care and Youth Development (child study; n = 969) and with data from a large mixed sample of adults, which included participants reporting psychiatric difficulties as well as healthy controls (adult study; n = 600). The results of a variety of non-redundant analyses across both studies revealed a dimensional latent structure for ODD symptoms among both children and adults. These findings are consistent with previous studies that have examined latent structure of related constructs (e.g., aggression, antisocial behavior) as well as studies that have examined the dimensional versus categorical structure of ODD using methods other than taxometric analysis.

Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis.

An understanding of the latent structure of attention-deficit/hyperactivity disorder (ADHD) is essential for developing causal models of this disorder. Although some researchers have presumed that ADHD is dimensional and others have assumed that it is taxonic, there has been relatively little research directly examining the latent structure of ADHD. The authors conducted a set of taxometric analyses using data from the NICHD Study of Early Child Care and Youth Development (ns between 667 and 1,078). The results revealed a dimensional latent structure across a variety of different analyses and sets of indicators for inattention, hyperactivity/impulsivity, and ADHD. Furthermore, analyses of correlations with associated features indicated that dimensional models demonstrated stronger validity coefficients with these criterion measures than dichotomous models. These findings jibe with recent research on the genetic basis of ADHD and with contemporary models of ADHD.

The utility of home problem pervasiveness and severity in classifying children identified with attention-deficit/hyperactivity disorder.

Given the propensity for clinical assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) to focus on core behavioral symptoms, the current study examined how well other predictors classified children who were diagnosed with ADHD by licensed practitioners. Participants were 91 children (39 ADHD-identified, 52 without ADHD), aged 8 to 13 years. In addition to significantly more ADHD symptoms, the ADHD-identified group exhibited significantly more externalizing problems and internalizing symptoms, less adaptive functioning, and greater problem pervasiveness and severity. Binary logistic regression analyses indicated that problem pervasiveness and severity significantly predicted diagnostic group membership when controlling for other predictors, and pervasiveness added unique variance beyond measures of core ADHD symptoms. Diagnostic utility analyses showed measurement of problem pervasiveness and severity to be a useful tool in the identification of ADHD. Findings provide support for the practical use of a parent-report measure of impairment in the home as part of evidence-based assessment of ADHD.

The importance of narcissism in predicting proactive and reactive aggression in moderately to highly aggressive children.

The present study examined the importance of psychopathy-linked narcissism in predicting proactive and reactive aggression and conduct problems in a group of 160 moderately to highly aggressive children (mean age of 10 years, 9 months). Children's self-report of self-esteem and parent and teacher report of dimensions of psychopathy [narcissism, callous-unemotional (CU) traits, and impulsivity], proactive and reactive aggression, and conduct problems were collected. Composites of parent and teacher ratings of children's behavior were used. Consistent with the study's hypotheses, narcissism predicted unique variance in both proactive and reactive aggression, even when controlling for other dimensions of psychopathy, demographic variables associated with narcissism, and the alternative subtype of aggression. As hypothesized, impulsivity was significantly associated with only reactive aggression. CU traits were not related to proactive or reactive aggression once the control variables were entered. All dimensions of psychopathy predicted unique variance in conduct problems. Consistent with prediction, narcissism was not significantly related to general self-esteem, providing support that narcissism and self-esteem are different constructs. Furthermore, narcissism and self-esteem related differentially to proactive aggression, reactive aggression, and conduct problems. Furthermore, narcissism but not self-esteem accounted for unique variance in aggression and conduct problems. The importance of narcissism in the prediction of aggressive behaviors and clinical implications are discussed.

The influence of maternal stress and distress on disruptive behavior problems in boys.

OBJECTIVE: The current study examined how self-reported maternal stress and distress are associated with child disruptive behaviors. METHOD: Mother and teacher ratings of child disruptive behavior problems (attention problems, aggression, and delinquency) were collected for 215 male participants, ranging in age from 9 to 12 years. Participating mothers also provided self-report data on socioeconomic status (SES), parenting stress, and distress (depression and anxiety/somatization). RESULTS: Low SES was significantly associated with both mother- and teacher-reported child disruptive behavior problems. Regression analyses indicated a relation between parenting stress and mother-reported child disruptive behavior problems, even when controlling for SES. Results also indicated a significant relation between maternal distress and mother-reported child disruptive behavior problems (particularly attention problems), even when controlling for SES and parenting stress. Maternal stress and distress were not significantly related to teacher-reported child disruptive behavior problems. CONCLUSIONS: Although the lack of an association between teacher-reported behavior problems and maternal stress and distress could be interpreted as a rater bias by these mothers, it may be that the mothers' symptoms are associated with a stressful home environment, thus exacerbating child disruptive behavior problems and eventually leading to a reciprocal relation between symptomatology in mothers and children.

Aggressive and nonaggressive boys' physiological and cognitive processes in response to peer provocations.

This study examined physiological and social-cognitive correlates of aggression in an in vivo laboratory provocation situation. Fifty-one male participants (ages 9 to 13) were selected based on teacher aggression screenings, ranging from normative to high levels. A provocation was induced by the experimenter communicating a threat from an unseen "peer" in the laboratory. Bivariate linear regression analyses showed that aggression significantly predicted heart rate at both pre- and postinduction, and aggression significantly predicted attributions of intent following the provocation. Results indicated that aggression was a significant predictor of changes in hostile attribution and heart rate following the threat induction. A positive correlation also was found between heart rate change and attribution change. The findings suggest that both physiological and social-cognitive processes should be addressed in clinical interventions with aggressive children.

Examining the effectiveness of an outpatient clinic-based social skills group for high-functioning children with autism.

Although social skills group interventions for children with autism are common in outpatient clinic settings, little research has been conducted to determine the efficacy of such treatments. This study examined the effectiveness of an outpatient clinic-based social skills group intervention with four high-functioning elementary-aged children with autism. The group was designed to teach specific social skills, including greeting, conversation, and play skills in a brief therapy format (eight sessions total). At the end of each skills-training session, children with autism were observed in play sessions with typical peers. Typical peers received peer education about ways to interact with children with autism. Results indicate that a social skills group implemented in an outpatient clinic setting was effective in improving greeting and play skills, with less clear improvements noted in conversation skills. In addition, children with autism reported increased feelings of social support from classmates at school following participation in the group. However, parent report data of greeting, conversation, and play skills outside of the clinic setting indicated significant improvements in only greeting skills. Thus, although the clinic-based intervention led to improvements in social skills, fewer changes were noted in the generalization to nonclinic settings.