Meaningful Social Inclusion and Mental Well-Being Among Autistic Adolescents and Emerging Adults: Protocol for a Community-Based Mixed Methods Study.

BACKGROUND: In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague's (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships. OBJECTIVE: The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults. METHODS: The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project. RESULTS: Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025. CONCLUSIONS: Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52658.

Supportive parent-adolescent relationships as a foundation for adolescent emotion regulation and adjustment.

Introduction: The purpose of this investigation was to examine the influence of supportive parent-adolescent relationships on adolescent adjustment (i.e., prosocial behavior, aggression, depressive symptoms) both directly and indirectly (via adolescent emotion regulation). Scholars have posited that adolescent emotion regulation (ER) may serve as an underlying mechanism in the link between parenting and adolescent adjustment. Supportive parent-adolescent relationships (i.e., openness, acceptance, emotional responsiveness) may be a key emotion socialization mechanism influencing adolescent ER. Methods: The sample included 206 adolescents (Age Range= 10-18years; 51% female; 70.4% ethnic minorities) and one primary caregiver (83.3% biological mothers, 38.7% single parents). Structural equation modeling (SEM) was implemented to investigate the direct and indirect (via adolescent ER) effects of supportive parent-adolescent relationships on adolescent adjustment. We also explored whether these indirect and direct effects varied by adolescent sex and age. Results: Results suggested direct and indirect (via adolescent ER) links between supportive parent-adolescent relationships and adolescent prosocial behavior, aggressive behavior, and depressive symptoms. Moreover, evidence indicated that many of these pathways were significant for boys but not girls. No evidence of youth age as a moderator was found. Discussion: These findings highlight the important role supportive parent-adolescent relationships play in adolescent emotional and behavioral adjustment. Parenting programs could focus on facilitating a mutually responsive parent-adolescent relationship with a specific focus on the dynamic nature of emotion socialization during adolescence.

Mental health-related hospitalizations among adolescents and emerging adults with autism in the United States: A retrospective, cross-sectional analysis of national hospital discharge data.

LAY ABSTRACT: Autistic young people are more likely to have mental health conditions, like depression and bipolar disorder, than people without autism. These mental health issues sometimes lead to hospitalizations, which can be expensive and traumatic. Because of this, we wanted to understand mental health-related hospitalizations among autistic young people aged 10-20. We found that the main mental health reasons for the hospitalization of autistic young people were neurodevelopmental, disruptive, depressive, and bipolar disorders. These hospitalizations cost an average of US$7401.23 per stay, for a total of US$106 million in service delivery costs in 2016. Mental health-related hospitalizations were compared between young people with autism, young people with complex and chronic conditions, and young people with no chronic conditions. Autistic young people were almost 11 times more likely to be hospitalized for mental health reasons than young people with complex and chronic conditions, and two times more likely than young people with no complex and chronic conditions. We believe the United States needs better community-based mental health care for young people with autism.

Parents and Peers in Child and Adolescent Development: Preface to the Special Issue on Additive, Multiplicative, and Transactional Mechanisms.

Parents and peers play critical roles in the socialization of children and adolescents, yet investigations on the role played by parents vs. peers have been largely separate for many years. To address this problem, we invited leading scholars in the field to collectively tell a complex story of the part that parents and peers together play in the development of children and adolescents. The resulting Special Issue is a collection of papers highlighting current conceptualizations and empirical work in this area, with a focus on additive, multiplicative, and transactional mechanisms that link parent and peer relational contexts to each other and to child/adolescent social and emotional development. Two papers present new conceptual models, six illustrate empirical work in the field, and one paper that provides a comprehensive review of the literature. The stories that are conveyed in the issue are both innovative and complex.

Stress response asymmetries in African American emerging adults exposed to chronic social adversity.

Chronic stress is linked to social adversity and underlies many health disparities among ethnic minorities. Cortisol and salivary alpha-amylase (sAA) reflect sensitivity to adversity and are related to health outcomes. Our aim was to understand how social adversity influences biological responses to experimental and daily stressors in a sample of low-income African American emerging adults. In the three-week study, participants completed questionnaires, the Trier Social Stress Task (TSST), and provided four salivary samples. In week 2, participants collected saliva at home immediately after waking and just before bed for three days. Results demonstrated an asymmetrical pattern between cortisol and sAA reactivity that was related to experiences with racism and interpersonal trauma. Further, daily stress was related to lower morning and higher nighttime cortisol, indicating atypical diurnal rhythm. These findings are consistent with other forms of social adversity that lead to long-term changes in the HPA axis response pattern.LAY SUMMARYAfrican American emerging adults showed divergent cortisol and sAA responses.Social adversity predicted an asymmetrical response pattern for sAA and cortisol.Atypical diurnal rhythms were found for participants reporting high daily stress.

Adrenocortical attunement, reactivity, and potential genetic correlates among parent-daughter dyads from low-income families.

Examining the multitude of influences on the development of adolescent stress responses, especially among low-income families, is a critical and understudied topic in the field. The current study examined cortisol attunement between adolescent girls and parents (mostly mothers) from predominantly low-income, single parent, ethnic minority families before and after an in-laboratory disagreement discussion task. The sample consisted of 118 adolescents (Mage  = 13.79 years, 76.3% ethnic minorities, 23.7% European Americans) and primary caregivers (Mage  = 40.62 years; Mdn yearly income = $24,000; 43.2% single parents; 50% living below poverty line). We investigated oxytocin receptor (OXTR rs53576) gene variations as a potential contributor to attunement within the dyad. Results showed that parents and adolescents showed stress system attunement across the disagreement task, but that parent and adolescent oxytocin receptor genotype did not impact attunement. Future studies should detail biological factors that contribute to the calibration of stress response systems of adolescents across a variety of samples, particularly those experiencing a combination of stressors.

Longitudinal links between maternal and peer emotion socialization and adolescent girls' socioemotional adjustment.

Although research has demonstrated that both parents and peers influence adolescent development, it is not clear whether these relationships also serve as contexts for emotion socialization. In the current longitudinal study, we investigated whether maternal and peer emotion socialization were related to adolescent girls' daily emotions, emotion regulation, and social and emotional adjustment. The sample included 160 adolescent girls from low-income families followed across 2 years. At Time 1 (T1), girls reported on maternal and peer emotion socialization practices during laboratory visits. At Time 2 (T2), girls reported on daily negative and positive affect using ecological momentary assessment across 2 weeks. Emotion regulation, internalizing problems, and prosocial behavior were assessed during laboratory visits at both T1 and 2 years later (Time 3 [T3]). Results demonstrated that higher levels of maternal and peer emotionally supportive socialization practices were associated with lower levels of girls' daily negative affect. Mothers' supportive practices also predicted increases in girls' emotion regulation over time. Both maternal and peer unsupportive practices predicted more internalizing problems, and peer unsupportive practices predicted less prosocial behavior over time. This study supports and expands Eisenberg's heuristic model by demonstrating that both maternal and peer emotion socialization are associated with adolescent girls' emotional and behavioral outcomes, and maternal and peer emotion socialization have differential effects. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

RSA reactivity in response to viewing bullying film and adolescent social adjustment.

This study assessed adolescent respiratory sinus arrhythmia (RSA) reactivity while watching a bullying film clip from Boyz'n the Hood. We emphasized the importance of considering measurement context of RSA and examined whether RSA reactivity moderated the links between environmental factors (i.e., neighborhood violence, parental psychological control, and parental acceptance) and adolescent social adjustment. Data were collected from 57 adolescents and their primary caregivers. Electrocardiogram (ECG) and respiration data were obtained from adolescents. Results indicated that neighborhood violence was positively associated with aggressive behavior but only among adolescents showing RSA augmentation, not suppression. Among youth displaying RSA suppression, parental acceptance was positively linked to prosocial behavior. We propose that, in the specific context of watching a bullying film clip, RSA suppression may relate to physiological regulation of emotion, which may differentially influence adolescents' responses to socialization.

Are Negative Peer Influences Domain Specific? Examining the Influence of Peers and Parents on Externalizing and Drug Use Behaviors.

Most studies tend to characterize peer influences as either positive or negative. In a sample of 1815 youth from 14 different schools in Caracas, Venezuela, we explored how two types of peer affiliations (i.e., deviant and drug-using peers) differentially mediated the paths from positive parenting to youth's externalizing behavior and licit and illicit drug use. We used Zero Inflated Poisson models to test the probability of use and the extent of use during the past 12 months. Results suggested that peer influences are domain specific among Venezuelan youth. That is, deviant peer affiliations mediated the path from positive parenting to youth externalizing behaviors, and peer drug-using affiliations mediated the paths to the drug use outcomes. Mediation effects were partial, suggesting that parenting explained unique variance in the outcomes after accounting for both peer variables, gender, and age. We discuss implications for the development of screening tools and for prevention interventions targeting adolescents from different cultures.

Neural responses to maternal praise and criticism: Relationship to depression and anxiety symptoms in high-risk adolescent girls.

BACKGROUND: The parent-child relationship may be an important factor in the development of adolescent depressive and anxious symptoms. In adults, depressive symptoms relate to increased amygdala and attenuated prefrontal activation to maternal criticism. The current pilot study examined how depressive and anxiety symptoms in a high-risk adolescent population relate to neural responses to maternal feedback. Given previous research relating oxytocin to maternal behavior, we conducted exploratory analyses using oxytocin receptor (OXTR) genotype. METHODS: Eighteen females (ages 12-16) listened to maternal praise, neutral, and critical statements during functional magnetic resonance imaging. Participants completed the Mood and Feelings Questionnaire and the Screen for Child Anxiety Related Emotional Disorders. The OXTR single nucleotide polymorphism, rs53576, was genotyped. Linear mixed models were used to identify symptom or allele (GG, AA/AG) by condition (critical, neutral, praise) interaction effects on brain activation. RESULTS: Greater symptoms related to greater right amygdala activation for criticism and reduced activation to praise. For left amygdala, greater symptoms related to reduced activation to both conditions. Anxiety symptoms related to differences in superior medial PFC activation patterns. Parental OXTR AA/AG allele related to reduced activation to criticism and greater activation to praise within the right amygdala. CONCLUSIONS: Results support a relationship between anxiety and depressive symptoms and prefrontal-amygdala responses to maternal feedback. The lateralization of amygdala findings suggests separate neural targets for interventions reducing reactivity to negative feedback or increasing salience of positive feedback. Exploratory analyses suggest that parents' OXTR genetic profile influences parent-child interactions and related adolescent brain responses.

Direct and Indirect Links between Peer Factors and Adolescent Adjustment Difficulties.

The purpose of the current investigation was to examine the role of emotion regulation in the link between peer factors and adolescent adjustment difficulties. The sample consisted of 206 adolescents (ages 10-18 years) and parents. Peer factors (i.e., peer antisocial behavior, peer co-rumination, peer emotion regulation) and youth depressive symptoms were based on youth reports. Youth emotion regulation and antisocial behavior were assessed using parent and youth ratings. Results showed that peer antisocial behavior was directly (but not indirectly) related to youth antisocial behavior and depressive symptoms, whereas peer emotion regulation was indirectly (but not directly) related to both adolescent outcomes. In addition, peer co-rumination was indirectly related to youth antisocial behavior and directly and indirectly related to youth depressive symptoms. In general, the results indicated little evidence of moderation by adolescent age, sex, or ethnic differences. Implications for peer relationships as socialization contexts are discussed.

Link between Monitoring Behavior and Adolescent Adjustment: An Analysis of Direct and Indirect Effects.

The purpose of the current investigation was to explore whether monitoring behavior (i.e., parental solicitation, child disclosure, and parental involvement) was directly and indirectly (via parental knowledge and parent-youth openness) related to adolescent adjustment (i.e., antisocial behavior, substance use, and school grades). The sample consisted of 206 families with adolescents (ages 10-18 years) from predominantly low-income, high-risk neighborhoods. Monitoring behavior (parent reports), parental knowledge and parent-youth openness (youth reports), and adolescent adjustment (parent and youth reports) were all based on questionnaire data collected during a laboratory assessment. Results showed that when the monitoring behavior factors were examined simultaneously, only child disclosure was significantly and inversely related to youth antisocial behavior. In contrast, only parental involvement was significantly associated with less substance use. Moreover, school grades were significantly and incrementally predicted by both child disclosure and parental involvement. Parental solicitation was not significantly related to any of the adolescent outcomes. The findings also demonstrated evidence of indirect effects (via parental knowledge) in the link between monitoring behavior and adolescent adjustment. Implications regarding the socialization process during adolescence are discussed.

Dynamic changes in parent affect and adolescent cardiac vagal regulation: a real-time analysis.

The current study explored the role of parents' negative and positive affect in adolescent respiratory sinus arrhythmia (RSA) reactivity during a parent-adolescent conflict discussion task and the moderating effects of adolescent sex and age. Questionnaire data were collected from 206 adolescents (10-18 years of age; M = 13.37 years) and their primary caregivers (83.3% biological mothers). Electrocardiogram and respiration data were collected from adolescents, and RSA variables were computed. Parent affect was coded during the conflict discussion task. Multilevel modeling was used to distinguish the between- and within-individual effects of parent affect on adolescent RSA. Results indicated that observed within-parent-teen dyad anger was negatively associated with adolescent RSA, controlling for previous-minute RSA level, particularly among adolescents 13 years and older. In addition, observed between-dyad positive affect was positively linked to RSA for both boys and girls when previous-minute RSA level was controlled. Within-dyad positive affect was positively related to girl's RSA only. These findings suggest that expressions of positive affect may be related to better vagal regulation (RSA increases), whereas expressions of anger may be related to poor vagal regulation (RSA decreases) during social engagement.

Adolescent RSA responses during an anger discussion task: Relations to emotion regulation and adjustment.

The current study examined associations between adolescent respiratory sinus arrhythmia (RSA) during an angry event discussion task and adolescents' emotion regulation and adjustment. Data were collected from 206 adolescents (10-18 years of age, M age = 13.37). Electrocardiogram (ECG) and respiration data were collected from adolescents, and RSA values and respiration rates were computed. Adolescents reported on their own emotion regulation, prosocial behavior, and aggressive behavior. Multilevel latent growth modeling was employed to capture RSA responses across time (i.e., linear and quadratic changes; time course approach), and adolescent emotion regulation and adjustment variables were included in the model to test their links to RSA responses. Results indicated that high RSA baseline was associated with more adolescent prosocial behavior. A pattern of initial RSA decreases (RSA suppression) in response to angry event recall and subsequent RSA increases (RSA rebound) were related to better anger and sadness regulation and more prosocial behavior. However, RSA was not significantly linked to adolescent aggressive behavior. We also compared the time course approach with the conventional linear approach and found that the time course approach provided more meaningful and rich information. The implications of adaptive RSA change patterns are discussed.

Parental Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion Regulation.

OBJECTIVE: This study investigated associations between parental psychological control and aggressive behavior and depressive symptoms among adolescents from predominantly disadvantaged backgrounds. The indirect effects of psychological control on adolescent adjustment through adolescent emotion regulation (anger and sadness regulation) were examined as well as the moderating effects of adolescent emotion regulation. DESIGN: 206 adolescents (ages 10-18) reported on parental psychological control and their own depressive symptoms, and parents and adolescents reported on adolescent emotion regulation and aggressive behavior. Indirect effect models were tested using structural equation modeling; moderating effects were tested using hierarchical multiple regression. RESULTS: The associations between parental psychological control and adolescent aggressive behavior and depressive symptoms were indirect through adolescents' anger regulation. Moderation analyses indicated that the association between parental psychological control and adolescent depressive symptoms was stronger among adolescents with poor sadness regulation and the association between psychological control and aggressive behavior was stronger among older adolescents with poor anger regulation. CONCLUSIONS: Psychological control is negatively associated with adolescent adjustment, particularly among adolescents who have difficulty regulating emotions. Emotion regulation is one mechanism through which psychological control is linked to adolescent adjustment, particularly anger dysregulation, and this pattern holds for both younger and older adolescents and for both boys and girls.

Antecedents and outcomes of joint trajectories of mother-son conflict and warmth during middle childhood and adolescence.

This study investigated the development of mother-son relationship quality from ages 5 to 15 in a sample of 265 low-income families. Nonparametric random effects modeling was utilized to uncover distinct and homogeneous developmental trajectories of conflict and warmth; antecedents and outcomes of the trajectory groups also were examined. Four conflict trajectory groups and 3 warmth trajectory groups were identified. Difficult temperament in early childhood discriminated both conflict and warmth trajectory group membership (TGM), and adult relationship quality in early childhood was related to warmth trajectories. In addition, conflict TGM differentiated youth antisocial behavior during adolescence, and warmth trajectories predicted adolescent peer relationship quality and youth moral disengagement. Implications for socialization processes are discussed.

Reciprocal relations between parents' physical discipline and children's externalizing behavior during middle childhood and adolescence.

Using data from two long-term longitudinal projects, we investigated reciprocal relations between maternal reports of physical discipline and teacher and self-ratings of child externalizing behavior, accounting for continuity in both discipline and externalizing over time. In Study 1, which followed a community sample of 562 boys and girls from age 6 to 9, high levels of physical discipline in a given year predicted high levels of externalizing behavior in the next year, and externalizing behavior in a given year predicted high levels of physical discipline in the next year. In Study 2, which followed an independent sample of 290 lower income, higher risk boys from age 10 to 15, mother-reported physical discipline in a given year predicted child ratings of antisocial behavior in the next year, but child antisocial behavior in a given year did not predict parents' use of physical discipline in the next year. In neither sample was there evidence that associations between physical discipline and child externalizing changed as the child aged, and findings were not moderated by gender, race, socioeconomic status, or the severity of the physical discipline. Implications for the reciprocal nature of the socialization process and the risks associated with physical discipline are discussed.

Trajectories of physical discipline: early childhood antecedents and developmental outcomes.

This study examined childhood antecedents and developmental outcomes associated with trajectories of mild and harsh parental physical discipline. Interview, questionnaire, and observational data were available from 499 children followed from ages 5 to 16 and from 258 children in an independent sample followed from ages 5 to 15. Analyses indicated distinct physical discipline trajectory groups that varied in frequency of physical discipline and rate of change. In both samples, family ecological disadvantage differentiated the trajectory groups; in the first sample, early child externalizing also differentiated the groups. Controlling for early childhood externalizing, the minimal/ceasing trajectory groups were associated with the lowest levels of subsequent adolescent antisocial behavior in both samples and with parent-adolescent positive relationship quality in the second sample.

Growth and Predictors of Parental Knowledge of Youth Behavior During Early Adolescence.

The current study examines latent growth models of parental knowledge of boys' behavior from ages 10 to 15, and whether earlier child or family characteristics are related to intercept and growth in parental knowledge. As part of an ongoing longitudinal study on the precursors of antisocial behavior, 288 boys completed interviews at ages 10, 11, 12, and 15 years. Boys' reports started low, increased and plateaued at age 12. High levels of maternal responsivity in early childhood were associated with a high initial status in knowledge. Growth was predicted only by high levels of boys' prior externalizing problems. Results are discussed with respect to differences in factors that predict initial status versus growth in parental knowledge during the transition to adolescence.

Developmental Trajectories and Antecedents of Distal Parental Supervision.

Groups of adolescents were identified on the basis of developmental trajectories of their families' rules and their parents' knowledge of their activities. Characteristics of the adolescent, peer antisociality, and family context were tested as antecedents. In sum, 404 parent-adolescent dyads provided data for adolescents aged 10-16. Most adolescents were classified into groups characterized by low levels and reductions in family rules over time. However, low socioeconomic status and residence in unsafe neighborhoods increased membership in the group characterized by consistently high levels of family rules. Most adolescents were assigned membership in groups characterized by relatively stable moderate-to-high levels of parental knowledge of their activities. However, greater externalizing problems and peer antisociality, as well as residence in an unsafe neighborhood, increased membership in the group characterized by low and decreasing levels of knowledge. Results suggest that personal and contextual risk antecedes nonnormative decreases in parental knowledge, whereas contextual risk inhibits normative reductions in family rules.