Parenting Practices and Externalizing Behaviors in Autistic Children: A Systematic Literature Review.

There is limited recent research on the association between parenting practices and externalizing behaviors in autistic children. To address this gap, the current systematic review examined the associations between parenting practices and externalizing behaviors in autistic children, along with the mediating and moderating effects of parent and child variables (PROSPERO registration number CRD42022268667). Study inclusion criteria were (1) Peer-reviewed journals, (2) Participants included parents of autistic children and their children, (3) Quantitative measures of both parenting practices or behaviors/style and child externalizing behaviors, (4) Cross-sectional or longitudinal studies only, and (5) Studies published in English. Study exclusion criteria were: (1) Qualitative studies, (2) Published in a language other than English, (3) Participants included non-human participants, (4) Participants that did not include parents and their autistic children as participants or did not report this group separately, (5) Systematic review and meta-analyses, and (6) No quantitative measures of parenting practices and/or child externalizing behaviors. Quality appraisal and risk of bias were conducted using the McMaster Tool and results were synthesized in Covidence and Excel. Thirty studies were included in the review. Results demonstrated that mindful parenting was associated with fewer or lower levels of externalizing behaviors; positive parenting practices had non-significant associations with externalizing behaviors; specific parenting practices had differing associations with externalizing behaviors; and negative parenting practices were associated with higher levels of externalizing behaviors. We are unable to draw causal relationships due to focus on cross-sectional and longitudinal articles only. The potential for future research to target specific parent practices to support children's externalizing behaviors is discussed.

The protective value of trait mindfulness for mothers' anxiety during the perinatal period.

OBJECTIVES: Anxiety is highly prevalent in the perinatal period and can have negative consequences for the mother and the child. Extensive research has been done on risk factors for anxiety during the perinatal period, but less is known about protective factors. The current study aims to determine the relative contribution of trait mindfulness as a protective factor for anxiety. METHODS: A longitudinal study design was used, with four measurement points: 12, 22, and 32 weeks of pregnancy (T0, T1, and T2, respectively), and 6 weeks postpartum (T3). General anxiety was measured at T1, T2, and T3, pregnancy-specific distress was measured at T1 and T2, mindfulness facets (acting with awareness, non-reacting, and non-judging) and partner involvement were measured at T1, and other known risk factors for anxiety were measured at T0. Multilevel regression models were used for statistical analyses. RESULTS: Mindfulness facets measured at T1 were negatively associated with anxiety at T1, T2, and T3, and pregnancy-specific distress at T1 and T2. Of the mindfulness facets, non-judging was shown to have the largest protective effect against anxiety and pregnancy-specific distress. Also compared to partner-involvement and known risk factors, non-judging showed the largest effect on anxiety and pregnancy-specific distress. CONCLUSIONS: For pregnant women who are at risk for developing or experiencing high levels of anxiety, it may be beneficial to participate in a mindfulness training with special attention for the attitudinal aspects of mindfulness.

Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: protocol for a multi-arm parallel group randomised clinical trial.

INTRODUCTION: Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. METHODS AND ANALYSIS: The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. ETHICS AND DISSEMINATION: The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).

A brief online mindful parenting program: Feasibility and initial effects pilot in a community sample.

Mindful parenting programs are effective in reducing parenting stress. More efficient offerings may increase accessibility. The current single case study aimed to determine the feasibility, acceptability and initial effects of a brief, online mindful parenting program. Six parents, recruited from the community, completed a 4-week online mindful parenting program (Two Hearts). Feasibility and acceptability were assessed by participant program evaluation, retention, engagement with program materials (i.e., videos), and home practice. Parents completed primary outcome measurements of parenting stress, and general distress, at pre- and post-intervention, and 4-week follow-up. Individual level reliable change index and clinically significant change were calculated for outcome measures. All parents were retained through the study; all participants reported obtaining something of lasting value from the training. Program adherence varied over time. At post-intervention, four parents reported 40-50 minutes practice per week; two parents reported 10-15 minutes practice per week. At follow-up, 50% of parents reported 30-50 minutes practice per week. Three parents showed a reliable reduction in parenting stress; two of these parents demonstrated clinically significant change. Improvements in parent general distress were indicated in half the sample. Two parents experienced a clinically significant increase in parenting stress and/or general distress. In conclusion, the Two Hearts program demonstrated good acceptability, and may be a feasible and effective program for some parents. Program adherence and dosage require further investigation. The role of acute stressors (e.g., COVID-19) must be also considered.

A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021.

LAY ABSTRACT: We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.

Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders.

Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.

Obsessional intrusive thoughts in children: An interview based study.

OBJECTIVES: We aimed to investigate the experience of obsessional intrusive thoughts (OITs) in a sample of children aged 8 to 10 years old and to test the main tenets of the cognitive model of OCD. Specifically, we assessed: (1) the prevalence of OITs experienced by young children; (2) their frequency and content; (3) the emotions they evoke; (4) the reasons why they are upsetting; (5) how they are appraised (6) and what control strategies they use. METHODS: Forty-nine children (28 girls, 21 boys; mean age 9.1 years) from the community completed two self-report questionnaires assessing anxiety and obsessive-compulsive symptoms. Children were interviewed using the Children's Anxious Thoughts Interview, which assessed their experiences of OITs. RESULTS: From the 49 participants, 71.43% reported having experienced at least one OIT. The most frequent contents related to harm and doubt. Of the total sample, 28.6% reported having experienced one OIT recently with at least moderate frequency; these participants reported higher anxiety and obsessive-compulsive interference, described feeling nervous and anxious when experiencing their OIT, and rated their OIT as highly important and distracting. The most frequently reported control strategies were cognitive - suppression, distraction and thought replacement. CONCLUSIONS: Almost two thirds of community children reported experiencing OITs. The findings from this study provide preliminary support for the application of the cognitive model of OCD in children. Subtle differences from previous research with adults are discussed.

Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism.

Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child's life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and severity and impact of their child's anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.

Facets of Mindfulness Mediate the Relationship Between Attachment Orientation and Emotion Regulation in University Students.

Whilst both mindfulness and adult attachment have been linked to wellbeing, little is known about how these constructs relate to emotion regulation that can underpin wellbeing. The present study examined the association between adult attachment orientation and emotion regulation (strategies and difficulties) and the mediating role of facets of dispositional mindfulness. A sample of 301 university students (Mage = 23.08, SD = 8.08; 74.75% female) completed measures of adult attachment, emotion regulation, difficulties in emotion regulation, and dispositional mindfulness. Parallel multiple mediation analyses indicated that the act with awareness and non-judging facets of mindfulness repeatedly emerged as significant mediators in the positive associations between the dimensions of attachment insecurity (anxiety, avoidance, and disorganized) and maladaptive emotion regulation strategies and difficulties in emotion regulation. Those individuals exhibiting greater attachment insecurity employ maladaptive emotion regulation strategies and display difficulties in emotion regulation via mindfulness deficits. The present findings extend our current understanding of the role of dispositional mindfulness in the associations between adult attachment orientation and varying aspects of the emotion regulation process.

Mindful parenting intervention for parents of children with skin conditions: a single group experimental cases series.

BACKGROUND: Parents of children with eczema or psoriasis experience high levels of parenting stress, which can negatively impact their child's mental and physical health. AIMS: We aimed to investigate the effectiveness, feasibility and acceptability of a mindful parenting intervention for parents of children with eczema or psoriasis. METHOD: Seven parents of children (4-12 years old) with eczema or psoriasis took part in an 8-week mindful parenting group intervention. A single-case experimental design was adopted, whereby parents completed daily idiographic measures of parenting stress related to their child's skin condition. Parents also completed standardised questionnaires measuring their parenting stress, depression, anxiety and quality of life, and children completed a quality of life measure, at four time points: baseline, pre-intervention, post-intervention and 6-week follow-up. Parents provided qualitative feedback after the intervention. RESULTS: All parents completed the intervention and showed improvements in idiographic measures of parenting stress from baseline to follow-up. Improvements in parenting stress were larger at follow-up than post-intervention, suggesting the benefits of intervention continue beyond the intervention. Six of seven parent-child dyads showed improvement in at least one of the wellbeing measures, from pre-intervention to post-intervention or follow-up. Feasibility was demonstrated through good participant retention, adherence to home practice, and treatment fidelity. Acceptability was demonstrated through positive parent evaluations of the intervention. CONCLUSIONS: Mindful parenting can be an effective, feasible and acceptable intervention for parents of children with eczema or psoriasis. Future studies should attempt to replicate the findings through randomised controlled trials.

Are failures to suppress obsessive-intrusive thoughts associated with working memory?

BACKGROUND AND OBJECTIVES: Obsessive compulsive disorder (OCD) is characterised by repeated attempts to suppress obsessive-intrusive thoughts (OITs). Nonclinical individuals also regularly engage in thought suppression. Attempts to suppress OITs are often unsuccessful and there is wide variation in suppression abilities across nonclinical and clinical samples. Understanding the mechanisms that explain variations in suppression abilities could enhance our understanding of OCD. This study aimed to investigate one potential mechanism - working memory - using a comprehensive thought suppression task. METHODS: Eighty-three nonclinical participants completed a computerized thought dismissibility task (in which they replaced an obsessive-intrusive thought with a neutral thought), and a computerized working memory task. Participants also completed measures of OCD and negative mood. RESULTS: None of the suppression variables (OIT frequency, mean OIT duration, mean latency to return, total OIT duration) were correlated with working memory capacity. Obsessive-compulsive symptoms were correlated with total OIT duration, but the relationship was not significant after controlling for negative mood. LIMITATIONS: The thought dismissibility task does not account for differences in motivation to suppress OITs. The sample was non-clinical and mostly female. CONCLUSION: An individual's ability to suppress OITs is not associated with their working memory capacity, suggesting poor working memory does not explain persistent OITs in individuals with OCD.

The Impact of Anxiety in Children on the Autism Spectrum.

The recognition of anxiety as one of the most commonly co-occurring diagnoses for individuals on the autism spectrum has led to increased research on symptomatology and treatment, but there is limited research documenting the impact of this anxiety. To address this, this study reports on the Child Anxiety Life Interference Scale (CALIS, parent version) in a community sample of 121 parents of children on the autism spectrum. Scores indicate that the anxiety is impacting upon the child's engagement in activities both in and outside of home as well as impacting upon parent life. Explanatory variables differed for CALIS subscales. As the child's difficulties with uncertainty and parent level of anxiety were the variables that explained the most variance, these may be important foci for effective interventions.

Family accommodation of anxiety in a community sample of children on the autism spectrum.

Anxiety is recognised as one of the most common co-occurring conditions for individuals with a diagnosis on the autism spectrum, with approximately 40 % of children on the spectrum receiving a clinical diagnosis of an anxiety disorder. To date, research has tended to focus upon understanding presentation and evaluating treatment, with little focus on assessing systemic factors, such as the way that family members accommodate the anxiety. This study aimed to investigate the relationship between parent and child anxiety levels and child autism characteristics on the four domains of family accommodation; Participation, Modification, Distress, and Consequence. A community sample (n = 132) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and anxiety symptomatology as well as their own levels of anxiety and family accommodation behaviours. Regression models identified specific aspects of child anxiety as well as parent anxiety as predictive of family accommodation, with the child's difficulties with uncertainty being a consistent predictor of all four domains. Clinical and research implications of this study, including the importance of understanding similarities or differences in the nature and consequence of family accommodation in children on the autism spectrum, are discussed.

Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial.

Objective: This study tested the feasibility of a self-help intervention based on Compassion-Focused Theory (CFT), and estimated treatment effects in a population of adults with skin conditions and associated psychological distress.Design: A randomized-controlled design was used, with 176 participants being allocated to either CFT-based self-help or a waitlist control group, who received usual medical care. The two-week intervention was provided by email.Main Outcome Measures: Treatment adherence and attrition rates were calculated, and effectiveness was estimated using measures of perceived stress, anxiety, depression, dermatology-specific quality of life and self-compassion.Results: Eighty-seven participants completed the post-intervention questionnaires (51%), and practiced on a median of 9/14 days. Study completers demonstrated significant, moderate improvements on measures of stress, anxiety, depression, self-compassion and dermatology-specific quality of life, relative to controls. In intention-to-treat (ITT) analyses, these findings remained significant, however effect sizes reduced from moderate to small.Conclusions: The findings indicate that CFT self-help shows promise in the treatment of psychological distress associated with skin conditions, however further testing of the intervention is not feasible without significant methodological changes, including the method of treatment delivery. Future studies should also include a follow-up period, as the duration of treatment effects could not be shown.

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety.

Parenting behavior and practices contribute to the intergenerational relationship between parent and child anxiety, with parental control being a consistent predictor of child anxiety. Parental experiential avoidance refers to how a parent copes with their internal world in the context of parenting. Little is known about how this relatively new parenting concept relates to child anxiety. The current study tested the indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance; the indirect effect of parent anxiety on parental control through parental experiential avoidance; and the moderating effect of parental experiential avoidance on the relationship between parental control and child anxiety. Using a cross-sectional design, parents (N = 85) from a community sample of 8-12-year-old children self-reported on a survey measuring parent anxiety, child anxiety, parental control, and parental experiential avoidance. A hierarchical regression indicated that parental experiential avoidance significantly predicted child anxiety and accounted for further variance in child anxiety, over, and above parental control. There was an indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance. Parental experiential avoidance moderated the relationship between parental control and child anxiety, such that the relationship was only significant at high levels of parental experiential avoidance. The current study provides support for the role of parental experiential avoidance in an intergenerational understanding of anxiety. Future research should replicate the study with a clinical sample. Theoretical and practice implications are considered.

The mindful family: a systemic approach to mindfulness, relational functioning, and somatic and mental health.

The stress in family members of individuals with chronic mental or somatic health conditions may be great, and interferes with healthy adaptation of individuals and their families. Interventions that address these systemic factors may be beneficial. Mindfulness-based interventions (MBIs) are effective in helping individuals living with chronic health conditions. However, most MBIs are directed towards individuals with the condition. We present research showing that individual mindfulness improves relational functioning,mindful parenting improves child outcomes, and mindful partners positively affect their partner's health and wellbeing. Regulating stress in relations appears an important underlying mechanism. We conclude that MBIs that target the system and not just the individual with a health condition, and target family relations, deserve a place in health care.

Experimental effects of mindfulness inductions on self-regulation: Systematic review and meta-analysis.

Self-regulation is the control of aspects of the self to allow pursuit of long-term goals, and it is proposed as a central pathway through which mindfulness may exert benefits on well-being. However, the effects of a single mindfulness induction on self-regulation are not clear, as there has been no comprehensive review of this evidence. The current review synthesized existing findings relating to the effect of a mindfulness induction delivered in a laboratory setting on measures of self-regulation. Twenty-seven studies were included and grouped according to 3 outcomes: regulation of experimentally induced negative affect (k = 15; meta-analysis), emotion-regulation strategies (k = 7) and executive functions (k = 9; narrative synthesis). A mindfulness induction was superior to comparison groups in enhancing the regulation of negative affect (d = -.28). Executive-function performance was enhanced only when the experimental design included an affect induction or when the outcome was sustained attention. The effect on emotion-regulation strategies was inconclusive, but with emerging evidence for an effect on rumination. Overall, the findings indicate that, in the form of an induction, mindfulness may have the most immediate effect on attention mechanisms rather than exerting cognitive changes in other domains, as are often reported outcomes of longer mindfulness training. Through effecting change in attention, emotion regulation of negative affect can be enhanced, and subsequently, executive-function performance more quickly restored. The interpretations of the findings are caveated with consideration of the low quality of many of the included study designs determined by the quality appraisal tool. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Self-compassion Improves Parental Well-being in Response to Challenging Parenting Events.

Shame and guilt are common during the course of parenting and can reflect feelings of "bad self "and "bad behaviour" in relation to parenting events. Self-compassion is known to be beneficial for well-being by reducing negative emotions, yet there is little research examining whether self-compassion might reduce parental guilt and shame. The current study examined the effects of dispositional and induced self-compassion on guilt and shame in a sample of 167 parents (Mage = 37.23, SD = 6.73, 83.1% female) of children ≤12 years recruited online. After completing baseline measures, parents were randomly assigned to recall a guilt versus shame provoking parenting event, and randomly allocated to either a self-compassion prompt versus a control condition. Analyses confirmed that those who received the self-compassion prompt reported higher levels of self-compassion, and reduced feelings of guilt and shame compared to the control group. Effects did not differ as a function of the guilt versus shame instructions. Multivariate analyses revealed that, when controlling for dispositional self-compassion, and baseline guilt and shame, differences between conditions were maintained for post-manipulation guilt and shame. Findings extend our understanding of the role of self-compassion for improving well-being when dealing with the challenges of parenting.

A systematic review of the role of parents in the development of anxious cognitions in children.

Anxious cognitions and parental behavior are important in the development of child anxiety. The current review aims to appraise the literature on the relationship between parental factors and chid anxious cognitions. Online database searches of PsycInfo, Scopus, ProQuest Dissertations and Web of Science were systematically searched using key terms related to 'parent', 'child', 'anxiety' and 'cognitions'. Included studies (N = 13) were quality assessed and study findings were appraised in line with cognitive behavioral frameworks of the parental pathways to the development of anxious cognitions in children. Reviewed studies confirmed that parental factors have a role in the development of their children's anxious cognitions by modelling fearful responses, reducing their child's autonomy, and indirectly via their own expectations about their child. Limitations of the literature are considered, including issues of measurement. Future research should consider multi-modal assessment of parental factors and examine parental behavior and child anxious cognitions in the context of real-life threatening events.

A systematic review of self-report measures of paranoia.

Paranoia can be conceptualized as consisting of a hierarchy of cognitions, ranging from commonly experienced thoughts about less severe perceived threats, up to less common, persecutory thoughts about extreme threats, which are associated with distressing psychosis. This review systematically appraises self-report paranoia questionnaires validated for use among the general population; the type of paranoia assessed, measurement or psychometric properties, and subsequent validation with clinical samples are all considered. A systematic literature search was performed using PubMed, Web of Science, and PsycINFO databases. Study methodologies and measurement properties were evaluated according to COnsenus-based Standards for the selection of health-based Measurement Instruments (Mokkink et al., 2012). Twenty-six studies, describing the validation of nine paranoia-related questionnaires, were identified. Questionnaires were reviewed in relation to the hierarchy of paranoia; with 2 questionnaires assessing "low-level" paranoia, 4 assessing persecutory thoughts, and the remainder assessing paranoia across this continua. Questionnaires assessing the full hierarchy of paranoid thoughts, alongside associated dimensions such as preoccupation, conviction, and distress, offer the most comprehensive assessment of paranoia in both nonclinical and clinical populations. Of the measures which do this, the Green et al. (2008) Paranoid Thoughts Scale had the strongest evidence for its measurement properties and is, therefore, recommended as the most reliable and valid self-report assessment of paranoia currently available. However, this review illustrated that generally paranoia questionnaires lack high quality evidence for their measurement properties. Implications of these findings for clinical practice and research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).