Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis.

AIM: To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD: Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS: Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION: Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.

Emotional availability in the mother-child relationship for families of young children with autism spectrum disorder in Australia: A cross-sectional survey.

BACKGROUND: In families of children with autism spectrum disorder (ASD) the mother-child relationship can be affected by many factors; however, the impacts of maternal broad autism phenotype (BAP) and attachment styles are unknown. This study investigated predictors of emotional availability in the mother-child relationship in families of children with ASD. METHODS: Mothers (N = 231) of children with ASD living in Australia completed questionnaires assessing emotional availability in the parent-child relationship (mutual attunement, child involvement, affect quality) and mothers' BAP, mental health, adult attachment style and parenting experiences. Hierarchical multiple regressions and a mediation analysis were conducted. RESULTS: Parent-reported positive parenting experiences was the greatest predictor of mutual attunement, child involvement and affect quality in the parent-child relationship. Maternal stress and anxiety predicted poorer mutual attunement, stress and depressive symptoms predicted less child involvement and anxiety predicted worse affect quality. Negative parenting experiences, maternal anxiety and stress mediated the relationship between BAP and mutual attunement. CONCLUSION: Interventions combining mental health and parenting support for mothers of children with ASD to bolster emotional availability within the mother-child relationship may be warranted.

Parent-Reported Barriers and Enablers to Establishing Sun Safety Practices with Young Children in Australia.

This study investigated parent-reported barriers and enablers to establishing sun safety practices with young children (0-4 years; N = 423) living in Australia. An online survey examined parent/child adherence to recommended sun safety practices and barriers and enablers to establishing sun safety practices. Adherence to different sun safety practices varied across age groups. Lack of child cooperation was the most commonly-endorsed barrier while child compliance was the most commonly-endorsed facilitator. Young children's lack of cooperation with sun safety practices represents a major obstacle for parents. In conclusion, the development and testing of family-based intervention approaches to reduce child resistance and promote cooperation is warranted.

Mental health, broad autism phenotype and psychological inflexibility in mothers of young children with autism spectrum disorder in Australia: A cross-sectional survey.

LAY ABSTRACT: Mothers of children with autism tend to have poorer mental health outcomes compared to most mothers. Lack of social support, parenting challenges and relationship difficulties are more common for mothers of children with autism and can all affect maternal mental health. Mothers of children with autism are also more likely to have some autistic features, called the broad autism phenotype, that can contribute to poorer mental health; however, how these factors relate to one another are unclear. This study found that mothers who were less flexible in their thinking and behaviour and had more difficult parenting experiences tended to have poorer mental health. Mothers with more autistic features were less flexible in their thinking and behaviour, which, in turn, was linked to greater symptoms of depression, anxiety and stress. Mothers with greater autistic features also reported more difficult parenting experiences, which was in turn linked with greater symptoms of anxiety and depression. This study suggests that supporting mothers of young children with autism to manage parenting challenges and become more flexible with their thinking and behaviour could help to improve their mental health.

ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy): a randomised controlled trial of an innovative intervention for infants at risk of autism spectrum disorder.

INTRODUCTION: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with impacts on behaviour, cognition, communication, social interaction and family mental health. This paper reports the protocol of a randomised controlled trial (RCT) of a very early intervention, ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy), for families of infants at risk of ASD. METHODS AND ANALYSIS: We aim to recruit 66 mothers of infants at risk of ASD (ie, infants with a sibling or parent diagnosed with ASD) to this RCT. Families will be randomly assigned to care-as-usual or ENACT. ENACT is a very early intervention, leveraging parent-child interactions to improve early social reciprocity, while supporting parental mental health and the parent-child relationship through Acceptance and Commitment Therapy. Intervention content is delivered online (approximately 8 hours) and supported by more than 7 consultations with a clinician. Parents will perform the social reciprocity intervention with their child (30 min per day). Assessments at four time points (baseline, 3 months, 6 months, and 12 months corrected age) will assess parent-infant interaction, parental mental health, infant development and early ASD markers. Analysis will be by intention to treat using general linear models for RCTs. ETHICS AND DISSEMINATION: This protocol has been approved by the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/50131) and the University of Queensland Human Research Ethics Committee (2019000558). If efficacy is demonstrated, the intervention has the potential for wide and accessible dissemination. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12618002046280).

The Possums Infant Sleep Program: parents' perspectives on a novel parent-infant sleep intervention in Australia.

AIM: To evaluate parental perspectives on the acceptability and usefulness of a 'cued-care' approach to infant sleep implemented in an Australian primary care setting. The Possums Infant Sleep Program aims to empower parents to better understand their infant's sleep and their responses to it, and optimize healthy function of the infant's biological sleep regulators to protect against excessive night-waking. METHODS: The evaluation was undertaken by an independent infant sleep researcher, with no previous involvement in the Possums program. Parents' experiences of the sleep intervention were captured using a mixed methods approach involving (a) group discussions of sleep issues between parents and clinic staff, (b) discussions with parents who volunteered to provide face-to-face feedback, and (c) an online survey designed in light of the information gained from a and b. A one-year audit of clinic registrations provided contextual data. RESULTS: Sixty-four clinic clients fully (45) or partially (19) provided answers to survey questions. Respondents were primarily mothers, mean age 34, with a postgraduate qualification and high family income. Their term infants were predominantly breastfed and attended the clinic for feeding and/or sleeping difficulties across the first year of life. Almost all embraced the Possums approach, describing it as challenging and life changing. Audit data confirmed the survey sample reflected the general clinic population. CONCLUSIONS: The Possums Infant Sleep Program was acceptable to parents, and highly valued. Recipients reported reduced stress, less concern about perceived sleep problems (frequent night-waking, short-day-time naps, delayed sleep onset), and better quality of life.