Factores de riesgo/resiliencia en familias con hijos con autismo. Asociación con la evolución en la adolescencia / Risk/resilience factors in families with children with autism. Association with evolution in adolescence

Resumen La influencia del estrés de los padres y el efecto moderador de las estrategias de afrontamiento y apoyo social en niños con autismo están bien documentados. El número de trabajos con un di seño transversal contrasta con la escasez de estudios con diseño longitudinal que permitirían profundizar en las relaciones entre las características del contexto familiar y la evolución del trastorno. El presente trabajo de seguimiento está dedicado al análisis de esas relaciones en el tiempo transcurrido desde la infancia (T1) a la adolescencia (T2), valorando además los resultados en diferentes dominios del desarrollo. Participaron 45 adolescentes con TEA divididos en dos grupos en función del ambiente familiar, de alto riesgo (AR; N= 18) y de bajo riesgo (BR; N=27). Los resultados confirman y extienden los que han aportado trabajos transversales, evidenciando la influencia negativa de un ambiente familiar de riesgo en la severidad del TEA y en el desarrollo de habilidades socio-adaptativas. La psicoeducación, la terapia cognitivo-conductual y el mindfulness han de mostrado que pueden disminuir el estrés de los padres y aumentar el sentimiento de auto-eficacia.

Abstract The influence of parental stress and the moderating effect of coping strategies and social support in children with autism is well documented. The number of works with a cross-sectional design contrasts with the scarcity of studies with a longitudinal design that would allow to deepen in the relationships between characteristics of the family context and the evolution of the disorder. The present follow-up study is devoted to the analysis of these relationships over time from childhood (T1) to adolescence (T2), also assessing the results in different developmental domains. Forty-five adolescents with ASD participated, divided into two groups according to family environment, high risk (HR; N=18) and low risk (LR; N=27). The results confirm and extend those obtained in cross-sectional work, showing the negative influence of a risky family environment on the severity of ASD and the development of socio-adaptive skills. Psychoeducation, cognitive-behavioural therapy and mindfulness have been shown to decrease parental stress and increase feelings of self-efficacy.

[Risk/resilience factors in families with children with autism. Association with evolution in adolescence]. / Factores de riesgo/resiliencia en familias con hijos con autismo. Asociación con la evolución en la adolescencia.

The influence of parental stress and the moderating effect of coping strategies and social support in children with autism is well documented. The number of works with a cross-sectional design contrasts with the scarcity of studies with a longitudinal design that would allow to deepen in the relationships between characteristics of the family context and the evolution of the disorder. The present follow-up study is devoted to the analysis of these relationships over time from childhood (T1) to adolescence (T2), also assessing the results in different developmental domains. Forty-five adolescents with ASD participated, divided into two groups according to family environment, high risk (HR; N=18) and low risk (LR; N=27). The results confirm and extend those obtained in cross-sectional work, showing the negative influence of a risky family environment on the severity of ASD and the development of socio-adaptive skills. Psychoeducation, cognitive-behavioural therapy and mindfulness have been shown to decrease parental stress and increase feelings of self-efficacy.

La influencia del estrés de los padres y el efecto moderador de las estrategias de afrontamiento y apoyo social en niños con autismo están bien documentados. El número de trabajos con un diseño transversal contrasta con la escasez de estudios con diseño longitudinal que permitirían profundizar en las relaciones entre las características del contexto familiar y la evolución del trastorno. El presente trabajo de seguimiento está dedicado al análisis de esas relaciones en el tiempo transcurrido desde la infancia (T1) a la adolescencia (T2), valorando además los resultados en diferentes dominios del desarrollo. Participaron 45 adolescentes con TEA divididos en dos grupos en función del ambiente familiar, de alto riesgo (AR; N= 18) y de bajo riesgo (BR; N=27). Los resultados confirman y extienden los que han aportado trabajos transversales, evidenciando la influencia negativa de un ambiente familiar de riesgo en la severidad del TEA y en el desarrollo de habilidades socio-adaptativas. La psicoeducación, la terapia cognitivo-conductual y el mindfulness han demostrado que pueden disminuir el estrés de los padres y aumentar el sentimiento de auto-eficacia.

Cognitive and behavioral profiles in children with autism spectrum disorder with and without Attention-Deficit/hyperactivity disorder.

BACKGROUND: Understanding the developmental trajectories of children with autism spectrum disorder (ASD) with and without comorbid ADHD is relevant to tailor care plans. This prospective study assessed, for the first time, cognitive, emotional, behavioral, and learning outcomes in adolescence of children with ASD-ADHD and in those with ASD+ADHD in childhood. Possible predictors of severity of ASD core symptoms in adolescence were also evaluated. METHODS: Forty-five adolescents without intellectual disability, 26 diagnosed in childhood with ASD-ADHD and 19 with ASD+ADHD, were evaluated at baseline (mean age: 8.6 ± 1.3) and at 5-year follow-up (mean age: 12.9 ± 0.9). Parents and teachers completed questionnaires on executive functions, theory of mind (ToM), emotional/behavioral difficulties (EBD), and learning style at both time points.. RESULTS: Overall different developmental trajectories for the two groups were found. In general, deficits in metacognition processes, ToM skills, EBD, and learning abilities were more pronounced in the ASD+ group. Over time, the ASD+ADHD group, but not the ASD-ADHD, tended to improve in EBD and metacognition but their level of development continued to be lower compared with ASD+ADHD. EBD in childhood were significant predictors of autism core symptoms of adolescents. CONCLUSIONS: Our findings highlight the importance of an early identification of comorbid ADHD symptoms in ASD to offer treatment strategies based on specific developmental trajectories.

Personal and Family Childhood Predictors of Functional Outcomes of Adolescents With Autism Spectrum Disorder.

BACKGROUND: The transition to adolescence can be challenging for children with autism spectrum disorder (ASD). The present study explored child and family variables that predict functional outcomes of adolescents with ASD in emotional/behavioral difficulties, socialization, daily living skills, and the transition to secondary education. METHOD: Forty-five individuals with ASD, without intellectual disability, were assessed during childhood (aged 7-11) and almost five years later. Child measures (executive functions, theory of mind, autism symptom severity) and parent measures (parenting stress, social support, coping strategies) were collected. RESULTS: In adolescence, the predictive power of childhood executive functions was important for academic and behavioral/emotional indicators whereas theory of mind mainly predicted adaptive and behavior/emotional outcomes. ASD symptoms had predictive value in all outcome domains. Parental educational level, social support and parenting distress predicted socialization, while the engagement coping strategy had a significant role in daily living skills. CONCLUSIONS: The findings raise several clinical considerations related to assessment and intervention in autism. Executive functions and theory of mind programs could help to improve behavior/emotional, adaptive outcomes, and adjustment to school. In addition, the study indicates the need for family-centered interventions based on positive parenting practices and principles of behavioral analysis along with parental support, stress management and coping strategies.

Personal and Family Childhood Predictors of Functional Outcomes of Adolescents With Autism Spectrum Disorder / Predictores Personales y Familiares de Resultados Funcionales de Adolescentes con Trastorno del Espectro del Autismo

Background: The transition to adolescence can be challenging for children with autism spectrum disorder (ASD). The present study explored child and family variables that predict functional outcomes of adolescents with ASD in emotional/behavioral difficulties, socialization, daily living skills, and the transition to secondary education. Method: Forty-five individuals with ASD, without intellectual disability, were assessed during childhood (aged 7-11) and almost five years later. Child measures (executive functions, theory of mind, autism symptom severity) and parent measures (parenting stress, social support, coping strategies) were collected. Results: In adolescence, the predictive power of childhood executive functions was important for academic and behavioral/emotional indicators whereas theory of mind mainly predicted adaptive and behavior/emotional outcomes. ASD symptoms had predictive value in all outcome domains. Parental educational level, social support and parenting distress predicted socialization, while the engagement coping strategy had a significant role in daily living skills. Conclusions: The findings raise several clinical considerations related to assessment and intervention in autism. Executive functions and theory of mind programs could help to improve behavior/emotional, adaptive outcomes, and adjustment to school. In addition, the study indicates the need for family-centered interventions based on positive parenting practices and principles of behavioral analysis along with parental support, stress management and coping strategies.(AU)

Antecedentes: el presente estudio exploró variables del niño y familiares que predicen el funcionamiento conductual/ emocional, adaptativo y transición a la Secundaria de adolescentes con trastorno del espectro autista (TEA). Método: se evaluó a 45 individuos con TEA sin discapacidad intelectual en la infancia y casi 5 años después, recogiendo información del niño (funciones ejecutivas, teoría de la mente, y síntomas de autismo), y de padres (estrés, apoyo social, estrategias de afrontamiento). Resultados: las funciones ejecutivas predijeron adaptación académica y dificultades en la adolescencia, mientras que la teoría de la mente predijo resultados en socialización y habilidades de la vida diaria. Los síntomas de autismo tuvieron valor predictivo en los cuatro dominios de resultados. El nivel educativo, el estrés de los padres y el apoyo social predijeron la socialización, mientras que la implicación predijo las habilidades de la vida diaria. Conclusiones: los hallazgos tienen connotaciones para la evaluación e intervención en autismo. Los programas en funciones ejecutivas y en teoría de la mente mejorarían resultados conductuales/emocionales, adaptativos y ajuste escolar. Además, el estudio señala la necesidad de incluir en las intervenciones con familias principios de paternidad positiva y de análisis conductual, junto con apoyo parental, manejo del estrés y estrategias de afrontamiento.(AU)

Exploring the profiles of children with autism spectrum disorder: association with family factors.

This study aimed to identify different profiles of children with autism spectrum disorder (ASD) without intellectual disability (ID) and maternal factors characteristic of these profiles. Participants were 89 children between 7 and 11 years old and their mothers, distributed in two groups, 52 children with ASD and 37 with typical development (TD). Based on the children's adaptive, behavioral, and pragmatic manifestations, three clusters were obtained in the ASD group. Children with the most serious difficulties in all the domains assessed were assigned to Cluster 1, whereas the children in Cluster 3 were characterized by relatively minor problems. Cluster 2 comprised children with moderate difficulties in the different domains. Compared to the TD group, group 1, with 'Serious Difficulties', and group 2, with 'Moderate Difficulties', showed significant differences on all the variables evaluated. Group 3, 'Slight Difficulties', was only significantly differentiated from the group with TD on ASD and attention deficit hyperactivity disorder (ADHD) symptoms, pragmatic competence, and applied theory of mind. Therefore, it was outlined as the purest group and basically manifested core ASD symptoms. In addition, mothers of children in the 'Serious Difficulties' group showed higher stress levels and less use of emotional and instrumental support and acceptance strategies, as well as more mental health problems, than mothers of children in the 'Slight Difficulties' group. The results support the need to assess the presentation of other possible problems in ASD children without ID, and design interventions for parents who may be at risk of experiencing higher levels of stress and have fewer coping strategies.

Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review.

LAY ABSTRACT: This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.

Developmental outcomes in adolescence of children with autism spectrum disorder without intellectual disability: A systematic review of prospective studies.

Individuals with Autism Spectrum Disorder (ASD) without intellectual disability (ID) represent approximately two-thirds of the ASD population. Here we focused on prospective research assessing different areas of functioning of children with ASD, without ID, until adolescence. Based on a pre-registered protocol (PROSPERO CRD42020189029), a systematic review of prospective studies (published between 01.01.2010 and 01.01.2020) was conducted. Twenty-eight studies met eligibility criteria. Findings indicated that ASD diagnosis and the Intelligence Quotient were highly stable over time across studies. Executive Functioning, Theory of Mind and Central Coherence processes tended to improve, although deficits remained when compared to typically developed controls. Adaptive difficulties and psychiatric comorbidity were relatively stable over time. We discuss potential implications of the findings for clinicians and educators and suggest recommendations for future research.

Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD.

BACKGROUND: Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors. METHODS: Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses). RESULTS: The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals. CONCLUSIONS: The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.

Contexto familiar de niños con autismo: Implicaciones en el desarrollo social y emocional / Family context of children with autism. Implications for emotional and social development

Las familias de niños con trastorno del espectro del autismo (TEA) pueden diferenciarse en función de indicadores sociodemográficos y del clima familiar caracterizado por el nivel de estrés parental, el uso de estrategias de afrontamiento y la búsqueda de apoyo social. El objetivo de este estudio fue analizar las diferencias conductuales, emocionales y sociales de niños con TEA en relación con distintas tipologías de familias caracterizadas en función de los factores de riesgo como de riesgo alto, moderado y bajo. Los participantes fueron 52 madres y sus hijos de entre 7 y 11 años, con TEA sin discapacidad intelectual, que aportaron información del desarrollo socioemocional de los hijos mediante el Cuestionario de Cualidades y Dificultades, que valora síntomas emocionales, problemas de conducta, hiperactividad/ problemas de atención, problemas de relación con los compañeros y conducta prosocial. Los análisis de comparación entre grupos que se llevaron a cabo, indicaron que los niños con familias de riesgo alto mostraron puntuaciones significativamente más bajas en conductas prosociales y experimentaron un nivel significativamente superior de problemas emocionales que los niños de las familias del grupo de bajo riesgo. Por consiguiente, los resultados mostraron la relación que tiene el contexto familiar con el desarrollo socioemocional de niños con TEA. Subrayan asimismo la importancia del asesoramiento a las familias para potenciar las habilidades de regulación emocional y las conductas prosociales, debido a su impacto en la adaptación social a largo plazo.

Families of children with autism spectrum disorder (ASD) can be differentiated according to socio-demographics and environmental risk factors characterized by stress parental, the use of coping strategies and social support. The aim of this study was to analyze the behavioral, emotional and social manifestations of children with ASD, related to different types of families characterized according risk factors as families with "high risk", with "moderated risk" and with "low risk". Participants were 52 mothers and their children between 7 and 11 years old with ASD without intellectual disability. All mothers provided information about children's behavior through the Strengths and Difficulties Questionnaire, which includes the following scales: emotional symptoms, behavioral problems, hyperactivity/inattention, peer problems and prosocial behavior. Comparisons analysis showed that children belonging to the high family risk group exhibited less prosocial behaviors and a higher level of emotional problems compared to the low risk group. The findings from the present study illustrate the importance of considering the characteristics of entire family system in the emotional and social development of children with ASD. The role of family counseling to enhance emotional regulation skills and prosocial behaviors is underlined due to their impact on long-term social adjustment.

Parenting Stress in Mothers of Children With Autism Without Intellectual Disability. Mediation of Behavioral Problems and Coping Strategies.

The present study investigated the mediating role of behavioral difficulties, coping strategies, and social functional support in the relationship between symptoms severity and parenting stress in mothers of children with ASD (autism spectrum disorder). The parenting stress questionnaire, coping orientation to problems experienced scale, strengths and difficulties questionnaire, and Duke-UNC social support questionnaire were administered to 52 mothers, who also estimated the ASD severity symptoms of their children. Correlation analyses revealed that parenting stress was positively correlated with the children's ASD symptoms and behavioral problems. On the other hand, parenting stress was negatively correlated with the engagement coping and social functional support reported by the mothers. Multiple mediation analysis indicated that engagement coping and behavioral difficulties were significant mediators in the relationship between ASD symptoms and parenting stress, with the engagement variable having a larger effect. The findings illustrate the need to promote the mothers' engagement coping orientation and the application of behavioral strategies with their children to help them to buffer the impact of stress.

[Family context of children with autism. Implications for emotional and social development]. / Contexto familiar de nin~os con autismo. Implicaciones en el desarrollo social y emocional.

Families of children with autism spectrum disorder (ASD) can be differentiated according to sociodemographics and environmental risk factors characterized by stress parental, the use of coping strategies and social support. The aim of this study was to analyze the behavioral, emotional and social manifestations of children with ASD, related to different types of families characterized according risk factors as families with "high risk", with "moderated risk" and with "low risk". Participants were 52 mothers and their children between 7 and 11 years old with ASD without intellectual disability. All mothers provided information about children's behavior through the Strengths and Difficulties Questionnaire, which includes the following scales: emotional symptoms, behavioral problems, hyperactivity/inattention, peer problems and prosocial behavior. Comparisons analysis showed that children belonging to the high family risk group exhibited less prosocial behaviors and a higher level of emotional problems compared to the low risk group. The findings from the present study illustrate the importance of considering the characteristics of entire family system in the emotional and social development of children with ASD. The role of family counseling to enhance emotional regulation skills and prosocial behaviors is underlined due to their impact on long-term social adjustment.

Las familias de niños con trastorno del espectro del autismo (TEA) pueden diferenciarse en función de indicadores sociodemográficos y del clima familiar caracterizado por el nivel de estrés parental, el uso de estrategias de afrontamiento y la búsqueda de apoyo social. El objetivo de este estudio fue analizar las diferencias conductuales, emocionales y sociales de niños con TEA en relación con distintas tipologías de familias caracterizadas en función de los factores de riesgo como de riesgo alto, moderado y bajo. Los participantes fueron 52 madres y sus hijos de entre 7 y 11 años, con TEA sin discapacidad intelectual, que aportaron información del desarrollo socioemocional de los hijos mediante el Cuestionario de Cualidades y Dificultades, que valora síntomas emocionales, problemas de conducta, hiperactividad/ problemas de atención, problemas de relación con los compañeros y conducta prosocial. Los análisis de comparación entre grupos que se llevaron a cabo, indicaron que los niños con familias de riesgo alto mostraron puntuaciones significativamente más bajas en conductas prosociales y experimentaron un nivel significativamente superior de problemas emocionales que los niños de las familias del grupo de bajo riesgo. Por consiguiente, los resultados mostraron la relación que tiene el contexto familiar con el desarrollo socioemocional de niños con TEA. Subrayan asimismo la importancia del asesoramiento a las familias para potenciar las habilidades de regulación emocional y las conductas prosociales, debido a su impacto en la adaptación social a largo plazo.