Child social-emotional and behavioral problems and competencies contribute to changes in developmental functioning during Early Intervention.

This study examined how social-emotional and behavioral (SEB) problems and competencies contribute to changes in developmental functioning among children enrolled in Part C Early Intervention (EI), a U.S. program supporting young children with developmental delays and disabilities. The sample included 1,055 children enrolled in EI from 2011-2019 (mean age at EI entry = 17 months; 64% male; 72% marginalized racial and ethnic backgrounds). Standardized developmental assessments, drawn from administrative records, characterized developmental functioning at EI entry and exit and parents reported SEB functioning. Hierarchical regression analyses revealed that SEB problems and competencies interacted in predicting change in developmental functioning from EI entry to exit. Monitoring, identifying, and addressing SEB problems and competencies may optimize developmental outcomes for young children with developmental delays and disabilities.

Gene x responsive parenting interactions in social development: Characterizing heterogeneity in autism spectrum disorder.

Emerging research suggests that caregiving environments and genetic variants independently contribute to social functioning in children with typical development or autism spectrum disorder (ASD). However, biologically plausible interactive models and complimentary assessment of mechanisms are needed to: (a) explain considerable social heterogeneity, (b) resolve inconsistencies in the literature, and (c) develop and select optimal treatments based on individual differences. This study examined the role of child genotypes and responsive parenting in the social development of 104 children with ASD (ages 4-7 years). We utilized a longitudinal, multi-informant design and structural equation models to evaluate: (a) the additive and interactive effects of biologically plausible candidate genes (5-HTTLPR, OXTR, DRD4) and responsive parenting in predicting prospective social development in ASD across three time points spanning 1.5 years, and (b) whether child emotion regulation mediated observed gene x environment interactions (GxEs). Responsive parenting positively predicted prospective change in child social skills; these associations were moderated by 5-HTTLPR and DRD4 in teacher-report models, and DRD4 in parent-report models. No GxE effects were found for OXTR. Emotion regulation did not significantly mediate the GxEs involving 5-HTTLPR and DRD4. Acknowledging the complexities of GxE research, implications for future research, and targeted intervention efforts are discussed.

Prevention Services for Externalizing and Anxiety Symptoms in Low-Income Children: the Role of Parent Preferences in Early Childhood.

Dissemination of prevention programs targeting young children is impeded by challenges with parent engagement. Matching program characteristics to parent preferences is associated with increased retention in clinical/intervention settings, but little is known about the types of prevention programs that interest parents. The objectives of this study were to better understand parents' preferences for services designed to prevent externalizing and anxiety disorders and to identify factors associated with preferences. Ethnically diverse, low-income caregivers (n = 485) of young children (11-60 months) completed surveys on child anxiety and externalizing symptoms, parental worry about their children, parent anxiety symptoms, and preferences for prevention group topics. Parents were more likely to prefer a group targeting externalizing behaviors compared to anxiety. Cluster analysis revealed four groups of children: low symptoms, moderate anxiety-low externalizing, moderate externalizing-low anxiety, and high anxiety and externalizing. Parents' preferences varied according to co-occurrence of child anxiety and externalizing symptoms; interest in a program targeting externalizing problems was associated with elevated externalizing problems (regardless of anxiety symptom level), parent anxiety symptoms, and parent worry about their child. Only parent anxiety symptoms predicted parents' interest in an anxiety-focused program, and preference for an anxiety-focused program was actually reduced if children had co-occurring anxiety and externalizing symptoms versus only anxiety symptoms. Results suggest that parents' interest in a program to prevent externalizing problems was well-aligned with the presenting problem, whereas preferences for anxiety programming suggest a more complex interplay among factors. Parent preferences for targeted programming are discussed within a broader framework of parent engagement.

Targeted prevention of childhood anxiety: engaging parents in an underserved community.

Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11-71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6% of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions.

Exposure to interpersonal violence and socioemotional adjustment in economically disadvantaged preschoolers.

Focusing specifically on the experiences of economically disadvantaged preschoolers, the relations between interpersonal violence exposure, behavior problems, and social skills were examined in both the home and school settings. In this racially and ethnically diverse sample of preschoolers from poor, urban households (N = 64; 3-6 years old; 56% female), many children (33%) had been exposed to at least 1 type of interpersonal violence, and even more (70%) had been exposed to any type of potentially traumatic event (PTE). Although exposure to interpersonal violence was not directly associated with parent- or teacher-reported behavior problems or social skills, a significant interaction effect was observed between exposure to interpersonal violence and teacher-reported internalizing problems in predicting teacher-reported social skills; specifically, for children with the highest levels of internalizing problems, a positive relation between interpersonal violence exposure and social skills was observed. This indirect effect was observed only in the school setting, whereas children in this high-risk sample appeared to demonstrate resilience in the home setting. Given these high rates of exposure, additional, clinically relevant research is needed to inform interventions for this vulnerable population.

Pathways to service receipt: modeling parent help-seeking for childhood mental health problems.

Understanding parent appraisals of child behavior problems and parental help-seeking can reduce unmet mental health needs. Research has examined individual contributors to help-seeking and service receipt, but use of structural equation modeling (SEM) is rare. SEM was used to examine parents' appraisal of child behavior, thoughts about seeking help, and receipt of professional services in a diverse, urban sample (N = 189) recruited from women infant and children offices. Parents of children 11-60 months completed questionnaires about child behavior and development, parent well-being, help-seeking experiences, and service receipt. Child internalizing, externalizing, and dysregulation problems, language delay, and parent worry about child behavior loaded onto parent appraisal of child behavior. Parent stress and depression were positively associated with parent appraisal (and help-seeking). Parent appraisal and help-seeking were similar across child sex and age. In a final model, parent appraisals were significantly associated with parent thoughts about seeking help, which was significantly associated with service receipt.

Relationships of paraeducators and teachers with their autistic students.

Paraeducators play an important role in the classroom experiences of many autistic students. Although previous research has indicated that autistic students typically have strained relationships with their teachers, little is known about their relationships with paraeducators. We examined relationship quality reported by teachers (N = 171) and paraeducators (N = 28) with their elementary-age autistic students (IQ ≥ 50, ages 4-8 years, Grades PreK-3). Paraeducators reported strained relationships with their autistic students relative to normative means. This was especially apparent when compared with teacher report as paraeducators reported significantly lower overall relationship quality with their autistic students marked by higher conflict and dependency, yet similar reports of closeness. Indirect effect analysis indicated that higher conflict between paraeducators and their autistic students was accounted for by their fewer years of classroom experience compared to teachers. These findings should encourage school psychologists to consider the systemic factors likely contributing to paraeducators' fewer years of experiences and, as members of special education teams, use a consultative framework to provide supports needed to foster positive relationships between paraeducators and their autistic students.

Longitudinal associations between internalizing behaviors and social skills for autistic students during the early school years.

Autistic students experience greater social difficulties and heightened internalizing behaviors (e.g., anxiety, depression, withdrawal) relative to their nonautistic peers, yet little is known about how these domains influence one another over time. This 1.5-year longitudinal study analyzed the associations between teacher-reported social skills and internalizing behaviors across three time points for 177 autistic students aged 4-7 years. Cross-lagged panel analyses indicated an association between earlier internalizing behaviors and later social skills for autistic students, whereby lower internalizing behaviors predicted greater growth in social skills from one school year to the next. These changes in social skills followed children across multiple teachers and classroom contexts. The opposite cross-lagged path was not supported as early social skills did not predict changes in internalizing behaviors over time. Internalizing behaviors showed similar associations with later social skills for autistic students regardless of cognitive ability, for those in general and special education classrooms, and for those whose teachers did and did not have autism-specific training. Findings suggest that promoting students' early emotional well-being and targeting internalizing behaviors may indirectly enable social development over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Emotion Regulation Checklist with Young Autistic Children: Data Set for Comparative Use in Intervention Studies.

PURPOSE: Comparative data of autism-sensitive standardized measures of emotion regulation and lability, describing percentage change over time for populations of young autistic children, are currently publicly unavailable. We propose publication of such data as a support for future therapeutic intervention studies. METHODS: We generate and present data of the Emotion Regulation Checklist (and subscales) for a comparative array of percentage change over time (10 months) for autistic children not receiving psychological or behavioral therapies (N = 98, ages 4-8). RESULTS: Comparative data summaries are presented here, and the full data set is presented as Online Resource 1. CONCLUSION: We propose that this autism-sensitive measure, now with autism-specific comparative data to provide a comparison group in studies of therapeutic intervention, is well placed to assess co-occurring affective, regulatory, and behavioral factors of personal development for autistic children.

Bilingual and Monolingual Autistic Toddlers: Language and Social Communication Skills.

Parents of children diagnosed with autism spectrum disorders (ASD) express concern about raising their children bilingually, and often hear advice from professionals against the use of bilingualism. The current study examined the relation between bilingualism and the language and social communication skills of toddlers diagnosed with ASD (N = 353) in the US, while controlling for socioeconomic risk factors. Structural equation modeling showed no differences in language skills between bilingual Spanish-English speaking children and monolingual English-speaking (p = .596) or monolingual Spanish-speaking (p = .963) children and showed a bilingual advantage on socialization skills when comparing bilingual and monolingual English-speaking children (p = .001). Parents of autistic children exposed to Spanish and English should be encouraged to raise their child bilingually if it best suits familial needs.

Psychometric properties of a parent- and teacher-report measure for autistic children: Parent-Teacher Relationship Quality Scale (PTRQS).

Parent-teacher relationship (PTR) quality is linked to child and family-school functioning and may be especially important in the school adjustment of autistic children. However, measurement of PTR quality has been limited by inconsistency in the use of measures, a paucity of two-informant measurement, and limited psychometric consideration. We examined the psychometric properties of the Parent-Teacher Relationship Quality Scale (PTRQS), a parent- and teacher-report measure of PTR quality derived from multiple sources. Specifically, we examined the factor structure, reliability, and convergent validity of the PTRQS among parents and teachers of 192 autistic children in preschool to 2nd grade. Results supported a three-factor model, including (1) parent-perceived relationship quality, (2) teacher-perceived comfort with parent(s), and (3) teacher perceptions of parent abilities. Scores exhibited high internal consistency. As evidence of convergent validity, all three factors of PTR quality, as well as the total PTRQS score, were strongly associated with parent interview-based PTR quality, parent perceptions of teacher effectiveness, and teacher-rated parental school involvement. The two teacher-rated PTR quality factors were also associated with student-teacher relationship quality. Results indicated that (a) the measure can validly capture PTR quality in the context of preschool and early elementary-age autistic children, (b) early PTR quality is linked to parental involvement, and (c) teacher-rated PTR factors are linked to autistic students' own relationships with their teachers. The results have implications for researchers and school psychologists measuring PTR quality in their practice.

"My Autism Is My Own": Autistic Identity and Intersectionality in the School Context.

Background: School is an important context for identity development across childhood and adolescence. These formative experiences impact adulthood. Minimal research has examined first-person autistic perspectives of how school experiences shape autistic identity as well as other intersecting identities. In this study, we examined the school messages that autistic individuals received and how individuals engaged with these external messages to formulate their identities. Methods: Ten U.S.-based autistic adolescents and adults ages 15-35 participated in qualitative interviews about their elementary through secondary school experiences, interactions with teachers and peers, and how these shaped their identities. Two interviewees also engaged in three follow-up interviews each for member checking and further data gathering. Using a critical constructivist approach informed by grounded theory, we coded interviews inductively. We ensured the trustworthiness of data through peer debriefing, reflexive journaling, memoing, and member checking. Results: In the school context, autistic students received stigmatizing messages from teachers and peers regarding their autism. These messages varied in relation to students' other identities, including race and gender. Participants felt that, following autism disclosure, teachers viewed them narrowly through an autism lens. Participants actively resisted these negative messages from teachers and peers by reclaiming their autistic identity. They reframed and redefined their autistic identity, embraced their autism-related strengths, and actively made choices about how, when, and to whom to disclose their autism. Decisions around autism disclosure intersected with decisions to emphasize other identities such as race or mental health, especially when these identities were more visible or more acceptable to others. Conclusions: The school context conveyed powerful, stigmatizing messages around autism. In response, autistic students actively reclaimed and shaped their identities to prioritize a positive, empowered sense of self. Findings show a need for educators to model positive perceptions of autism, build an inclusive school community, and advocate for autistic representation in schools to facilitate autism-affirming messages.

What was the purpose of this study?: This study examined how autistic adolescents' and adults' school experiences affected their identities including autism, race, gender, and sexuality. We explored how teachers' and peers' messages impacted autistic students' views of themselves and how participants' experiences with autism differed by race, gender, mental health, and other identities. What did the researchers do?: We interviewed 10 autistic adolescents and adults ages 15­35 in the United States and conducted 3 follow-up interviews with 2 participants. Participants had diverse identities across gender, race, and sexuality. Participants answered questions about their autistic identity, their school experiences, and interactions with teachers and peers. We read and analyzed interviews to look for common themes. What were the results of the study?: Participants reported receiving negative messages about autism from teachers and peers in school. Participants felt that teachers often treated them differently than other students, seeing only their autism and not seeing other aspects of their identity. Autistic students' gender and race seemed to also affect how their teachers and peers treated them. For example, autistic women and people of color often described negative experiences related to their teachers' biases about gender or race. At the same time, autistic participants resisted these negative ideas. They held positive views and saw autism as bringing strengths, such as helping them learn. Participants believed that autistic identity looks different for each person and they were careful in deciding when to tell someone that they were autistic. They emphasized their autistic identity less than other identities that were more visible (e.g., race) or more acceptable to others (e.g., mental health problems). What do these findings add to what was already known?: Participants were vocal in rejecting negative messages from teachers and peers. They formed their own positive opinions about autism. Most past research does not look at autistic people's other identities, such as race and gender, but we did: we found that autistic students with other stigmatized identities, such as girls and people of color, reported especially negative treatment in school. What are potential weaknesses in the study?: With a small sample, we could not find patterns by gender or race. We did not always ask every participant about how their other identities, such as sexuality, race, or gender, were related to their autistic identity. If we had done so, we may have heard more details from some participants. We also did not have any participants with high communication support needs, and so, we could not include their experiences. As the researchers are all nonautistic, we may have interpreted people's responses differently from autistic people's experiences. How will these findings help autistic adults now or in the future?: Teacher and peer messages can negatively affect how autistic youth view themselves and their autistic identity. Teachers should be trained to affirm and support autistic students. Findings also showed that autistic students and their peers learn negative ideas about autism early. To address these biases, we need to educate all students about autism.

General Education Teachers' Perceptions of Autism, Inclusive Practices, and Relationship Building Strategies.

To identify target areas for professional development, this mixed-methods study examined general education teachers' perceptions of autism and pedagogical practices in early elementary classrooms in the United States. In focus groups, teachers (N = 18) identified terms they associated with autism and strategies they used for inclusion and relationship building. Participants systematically free-listed and ranked their responses to three prompts. Using ranked responses, saliency scores were calculated to assess the perceived importance and frequency of responses. Teachers' most salient perceptions of autism (e.g., social difficulties, focused/fixed interests) revealed an awareness of core symptoms. Salient inclusion practices included assigning special classroom responsibilities and showcasing student talents; salient relationship-building strategies included embracing students' special interests and engaging in one-on-one time. Implications for teacher trainings are discussed.

Effectiveness of Screening in Early Intervention Settings to Improve Diagnosis of Autism and Reduce Health Disparities.

IMPORTANCE: The American Academy of Pediatrics recommends referring children at elevated risk of autism spectrum disorder (ASD) for Part C early intervention (EI) services, but notes that EI services often fail to provide ASD screening. OBJECTIVE: To evaluate the hypothesis that a multistage screening protocol for ASD implemented in 3 EI settings will increase autism detection, especially among Spanish-speaking families. DESIGN, SETTING, AND PARTICIPANTS: Difference-in-differences analyses with propensity score weighting of a quasi-experimental design using administrative data on 3 implementation EI agencies and 9 comparison EI agencies from 2012 to 2018 provided by the Massachusetts Department of Public Health. Eligible children were aged 14 to 36 months, enrolled in EI, had no prior ASD diagnosis or medical condition precluding participation, and had parents who spoke English or Spanish. The final analytic sample included 33 326 unique patients assessed across 150 200 person-quarters. EXPOSURES: Multistage ASD assessment protocol including ASD screening questionnaires, observational screener, and diagnostic evaluation. MAIN OUTCOMES AND MEASURES: Increased incidence of ASD diagnoses as documented in Department of Public Health records and reductions in language-associated health care disparities. RESULTS: Implementation of screening at 3 EI sites was associated with a significant increase in the rate of ASD diagnoses (incidence rate ratios [IRR], 1.6; 95% CI, 1.3-2.1; P < .001), representing an additional 8.1 diagnoses per 1000 children per quarter. Among Spanish-speaking families, screening was also associated with a significant increase in the rate of ASD diagnoses (IRR, 2.6; 95% CI, 1.6-4.3; P < .001), representing 15.4 additional diagnoses per 1000 children per quarter-a larger increase than for non-Spanish-speaking families (interaction IRR, 1.8; 95% CI, 1.0-3.1; P = .005). Exploratory analyses revealed that screening was associated with a larger increase in the rate of ASD diagnoses among boys (IRR, 1.8; 95% CI, 1.4-2.3; P < .001) than among girls (IRR, 1.1; 95% CI, 0.6-1.7; P = .84). CONCLUSIONS AND RELEVANCE: In this study, associations between increased rates of ASD diagnoses and reductions in disparities for Spanish-speaking households support the effectiveness of multistage screening in EI. This study provides a comprehensive evaluation of ASD screening in EI settings as well as a rigorous evaluation of ASD screening in any setting with a no-screening comparison condition. Given that the intervention included multiple components, mechanisms of action warrant further research, as do disparities by child sex.

Delays in autism diagnosis for U.S. Spanish-speaking families: The contribution of appointment availability.

Promoting equity in health services requires an understanding of the mechanisms that produce disparities. Utilizing a sequential, mixed-methods, explanatory study design, we analyzed child-, family-, and organizational-level factors and their association with wait times for an ASD diagnostic evaluation among 353 families scheduled for English and Spanish language appointments (27% Spanish language). A subset of parents and caregivers participated in English and Spanish language focus groups to provide their perspectives on the diagnostic process. Spanish language was associated with greater completion of, and time to evaluations than English language. The only variable found to mediate associations with time-to-evaluation was appointment availability - an organizational factor. Qualitative results elucidate potential explanations for greater Spanish language evaluation completion (e.g., fewer community-based diagnostic options). Results serve as a case study to support the utility and importance of analyzing the influence of organizational-level factors on delays and disparities for childhood health and mental health services. We discuss our findings in relation to strategies that can be widely applied to support equitable services access for childhood diagnostic and intervention services.

A Taxonomy of Reported Harms in Pediatric Autism Spectrum Disorder Screening: Provider and Parent Perspectives.

The U.S. Preventive Services Task Force (USPSTF) report on screening for Autism Spectrum Disorder (ASD) highlighted the need for research that examines the harms potentially associated with screening so as to assess the overall net benefit of universal screening. In response, this study engages qualitative, semi-structured interviews to generate a taxonomy outlining potential harms reported by parents and providers (pediatricians and Early Intervention providers) with experience in screening young children for ASD. Potential harms emerged including: physical, psychological, social, logistical/financial, opportunity cost, attrition, and exacerbation of non-targeted disparities. Respondents reported harms being experienced by the toddlers, parents, and providers. The harms reported highlight opportunities for providers to offer resources that mitigate the potential for these unintended consequences.

Parent-Teacher Disagreement on Ratings of Behavior Problems in Children with ASD: Associations with Parental School Involvement Over Time.

ASD symptomology and behavioral problems pose challenges for children with ASD in school. Disagreement between parents and teachers in ratings of children's behavior problems may provide clinically relevant information. We examined parent-teacher disagreement on ratings of behavior problems among children with ASD during the fall and spring of the school year. When child, teacher, and class characteristics were considered simultaneously, only ASD symptom severity predicted informant disagreement on internalizing and externalizing behavior problems. We also examined associations between informant disagreement and parent school involvement. Cross-lagged panel analyses revealed that higher informant disagreement on children's behavior problems in the fall predicted lower parent school involvement in the spring, suggesting that greater informant agreement may foster parental school involvement over time.

Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities.

Health disparities in ASD detection affect children's access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14-36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.

Understanding How Parents Make Meaning of Their Child's Behaviors During Screening for Autism Spectrum Disorders: A Longitudinal Qualitative Investigation.

A family's journey in understanding their child's behaviors in relation to Autism Spectrum Disorders (ASD) frequently begins with screening. This study aimed to characterize the interpretive processes that unfold for parents. We employed longitudinal interviews with 19 families engaged in a community-based multi-stage screening protocol. Parents participated in 1-6 interviews dependent upon children's length of engagement in the screening protocol; data were analyzed through modified grounded theory. Parents who moved towards understanding their child's behaviors as ASD expressed (1) sensitization to ASD symptoms, (2) differentiation from other developmental conditions, and (3) use of the ASD diagnosis to explain the etiology of concerning behaviors. Identifying interpretive processes involved during ASD screening provides new opportunities for shared decision-making.

Parent and Teacher Reports of Comorbid Anxiety and ADHD Symptoms in Children with ASD.

This study examined the prevalence of ADHD symptoms and anxiety as reported by parents and teachers for 180 preschool children (ages 4-5) and school-aged children (ages 6-7) with ASD using the Child Behavior Checklist-Parent and Teacher Report Forms (Achenbach and Rescorla, Manual for ASEBA school-age forms & profiles, Research Center for Children, Youth, and Families, University of Vermont, Burlington, VT, 2001). Parents reported elevated anxiety symptoms in 31% of preschool children and 50% of school-aged children, while teachers reported lower rates of 5 and 30%, respectively. Parents reported elevated ADHD symptoms in 22% of preschool children and 45% of school-aged children, while teachers reported elevations in 20 and 24%, respectively. There was low concordance between parents and teachers, with teachers reporting fewer problems overall. Specific behaviors endorsed by parents and teachers are also discussed.