National Norms and Correlates of the PHQ-8 and GAD-7 in Parents of School-age Children

Anxiety and depressive disorders are global public health concerns, and research suggests that these disorders are common in parents and can adversely influence family functioning. However, little is known about normative levels of anxiety and depressive symptoms in parents of school-age children. The present study reports on generalized anxiety and depressive symptoms in 1570 parents and guardians of a nationally representative sample of children ages five to twelve years using two widely used and validated questionnaires: the eight-item variant of the Patient Health Questionnaire depression scale (PHQ-8) and the seven-item Generalized Anxiety Disorder scale (GAD-7). Moderate to severe levels of generalized anxiety symptoms were reported in 12.7% of the total sample and moderate to severe levels of depressive symptoms were reported in 14.1% of the sample; 17.7% of the sample reported moderate to severe levels of either generalized anxiety or depressive symptoms. This percentage was higher for females, younger parents and guardians, and parents and guardians reporting lower household incomes. These data, collected online in early 2018, may be useful for researchers and clinicians studying and treating anxiety and depression in parents. Further, these data provide a baseline for researchers currently studying the impact of changes related to the novel coronavirus (COVID-19) pandemic (e.g., school closures) on the mental health of parents of school-age children.

     

Parents' Involvement in ASD Treatment: What Is Their Role?

The rising prevalence of autism spectrum disorders (ASD) warrants a greater level of clinical attention to best treat those with ASD. The characteristics of ASD lead to impairment for both the child with the disorder and his/her family. To effectively treat children with ASD, parents need to be included in intervention efforts. Research suggests that parental involvement in treatment improves the generalizability of skills and increases the amount of intervention the child receives. Numerous benefits have been found in child and parent outcomes when parents are included in treatment. The purpose of this paper is to discuss the impact ASD can have on the parent-child relationship, the factors that influence treatment outcome, and the advantages of including parents in treatment. The different roles parents can have in treatment will also be discussed along with providing clinicians guidance on practical ways to involve parents in the treatment of children with ASD.     

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

Subjective Quality of Life for Parents of Children with Autism Spectrum Disorders in Croatia

The purpose of this study was to investigate the subjective quality of life (SQoL) of parents of children with autism spectrum disorders (ASD) who are primary carers. The study included 346 parents: 177 parents of children with ASD and 169 parents of non-disabled children comprised the control group. The Personal Wellbeing Index (PWI) was used to assess SQoL. Parents’ general health perception was assessed with a single question scored on a scale from 1 (poor health) to 5 (excellent health). Parents of children with ASD reported a significantly lower SQoL and general health perception with more physiological symptoms as compared to parents of non-disabled children. In Croatia parents of children with ASD, as primary caregivers, is an especially vulnerable part of the population and need increased social support and assistance in order to achieve and maintain the well-being of the whole family.     

Autism,Attachment and Parenting: A Comparison of Children with Autism Spectrum Disorder,Mental Retardation,Language Disorder,and Non-clinical Children

Children with Autism Spectrum Disorder (ASD) have severe and pervasive impairments in the development of social interaction, which may affect the attachment relationship with their parents and may have an impact on parenting. In the current investigation 89 families with young children (mean age 26.5 months) were involved, who were diagnosed as ASD, mentally retarded (MR), or language delayed (LD), or part of a non-clinical comparison group. Attachment security was observed with the Brief Attachment Screening Questionnaire, and several parental self-report questionnaires assessed the parenting style, parental efficacy, parental experiences of daily hassles, social support, and psychological problems. Children with ASD were rated as less secure compared to the other clinical and normal comparison groups. Parents of non-clinical children reported higher levels of authoritative parenting than parents in the ASD group and in the total clinical group, and they also received less social support. Parents of children with ASD coped remarkably well with the challenges of raising a child with ASD.     

Delineation of a spatial working memory profile using a non-verbal eye-tracking paradigm in young children with autism and Williams syndrome

Working memory deficits profoundly inhibit children’s ability to learn. While deficits have been identified in disorders such as autism spectrum disorder (ASD) and Williams syndrome (WS), findings are equivocal, and very little is known about the nature of these deficits early in development. A major barrier to advances in this area is the availability of tasks suitable for young children with neurodevelopmental disorders who experience difficulties with following verbal instructions or who are distressed by formal testing demands. To address these issues, a novel eye-tracking paradigm was designed based on an adaptation of the classic A not B paradigm in order to examine the early foundations of spatial working memory capabilities in 26 developmentally delayed preschool children with ASD, 18 age- and IQ-matched children with WS, and 19 age-matched typically-developing (TD) children. The results revealed evidence that foundational spatial working memory performance in ASD and WS was comparable with that of TD children. Performance was associated with intellectual ability in the ASD and TD groups, but not in the WS group. Performance was not associated with adaptive behavior in any group. These findings are discussed in the context of previous research that has been largely limited to older and substantially less developmentally delayed children with these neurodevelopmental disorders.     

Disentangling the Associations Between Autistic-Like and Internalizing Traits: A Community Based Twin Study

Internalizing difficulties are prevalent in children with autism spectrum disorders (ASD), yet little is known about the underlying cause of this comorbidity. It is also unclear which types of autistic-like and internalizing difficulties are most strongly associated. The current study investigated the phenotypic and etiological associations between specific autistic-like traits and internalizing traits within a population-based sample. Parent-reported data were analyzed from 7,311 twin pairs at age 7 to 8?years. Structural equation modeling revealed distinguishable patterns of overlap between the three autistic-like traits (social difficulties, communication problems and repetitive/restricted behaviors) and four subtypes of internalizing traits (social anxiety, fears, generalized anxiety, negative affect). Although all phenotypic associations were modest (rph?=?0.00-0.36), autistic-like communication impairments and repetitive/restricted behaviors correlated most strongly with generalized anxiety and negative affect both phenotypically and genetically. Conversely, autistic-like social difficulties showed little overlap with internalizing behaviors. Disentangling these associations and their etiological underpinnings may help contribute to the conceptualization and diagnosis of 'comorbidity' within ASD and internalizing disorders.     

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis

The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

The Disability Paradox Revisited: Quality of Life and Family Caregiving in Pediatric Cerebral Palsy

Parents who have children with cerebral palsy (CP) have been reported to have a more impaired QL and higher levels of burden than parents of typically developing children; however, little is known about the positive dimensions of their caregiving experience. In this study, WHOQOL-Bref and The Revised Burden Measure were administered to a sample of 105 parents of children/adolescents with CP (clinical group) and 117 parents of children/adolescents with no disabilities (control group). Despite the fact that parents of children with CP reported more Subjective Burden and less caregiving Uplifts, there were more similarities than differences in the variables compared between clinical and control groups. For parents of children with CP, the associations between Burden dimensions and QL, and between caregiving Uplifts and QL, were respectively moderate and weak. Caregiving Uplifts were found to moderate the links between Objective Burden and Psychological QL, and between Relationship Burden and Social QL. In addition, differential main effects of Burden dimensions and caregiving Uplifts were verified for Physical, Psychological and Social QL domains. These results highlight the adaptation variability of parents who have children with CP, as well as the importance of acknowledging caregiving uplifts as a resource that may attenuate the impact of burden on their QL.     

Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children

Few well-controlled studies have identified psychosocial profiles of families of boys with ADHD and boys with emotional disorders compared with normal controls. However, the clinical and theoretical literature pinpoints four domains in which distinctive profiles would be expected to occur. In this study, twenty-two mothers and thirteen fathers of twenty-two boys with ADHD; twenty mothers and fifteen fathers of twenty boys with a mood or anxiety disorder; and twenty-six mothers and sixteen fathers of twenty-seven normal controls were compared on: (1) stress, support and quality of life; (2) current family functioning; (3) parenting style and satisfaction in the family of origin and current family; and (4) current and past parental functioning. The two clinical groups showed higher levels of stress and lower levels of both social support and quality of life than did normal controls. Both clinical groups showed deficits in current family functioning, but contrary to expectations the ADHD and emotional disorder group did not show distinctly different profiles. Parents of ADHD children reported higher levels of authoritarian parenting styles, and parents from both clinical groups reported less parenting satisfaction than did normal controls in both their current families and their families of origin. Parents of children with ADHD and emotional disorders reported greater parenting satisfaction in their families of origin than in their current families. This discrepancy was greatest for parents of ADHD children. Parents of children with ADHD and emotional disorders reported greater psychological health problems and more childhood ADHD symptomatology than did normal controls. Parents of children with ADHD and emotional disorders have significant psychosocial difficulties in family and personal functioning. Family intervention is highly appropriate for families with children who are referred for help with both types of difficulties.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

自闭症谱系障碍的症状、诊断与干预

自闭症谱系障碍(autism spectrum disorders, ASD)是一种广泛发展障碍, 以社会交往障碍、言语和非言语交流缺陷、兴趣狭窄和行为刻板等为主要临床特征。对ASD的准确诊断是早期干预的关键, 也对患者的康复及其家庭幸福产生积极作用。日渐增长的发病率促进了对早期识别、诊断评估、以事实为基础干预的重视。在探索药物治疗ASD的基础上, 中国传统医学方法, 尤其是“靳三针”治疗ASD获得越来越多的实证支持。可以根据Simpson等人(2005)提出的指标体系对各种干预和治疗方法的疗效进行评价。今后研究将从认知神经科学的视角, 尤其是将眼动技术与ERP、fMRI相结合, 探索ASD的核心症状表征以及各亚类的特异性。     

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.     

Anxiety disorders in African-American and white children

There are little available data on African-American children with anxiety disorders. Treatment-seeking African-American (n=30) and white children (n=139), with a current DSM-III-R anxiety disorder, were compared on sociodemographic background variables, clinical characteristics, and lifetime rates of specific DSM-III-R anxiety disorders. Overall, results suggested that the anxiety-disordered African-American and white children who sought treatment from an outpatient mental health facility were more similar than different. The two groups did, however, differ somewhat on several variables (trend only), including rates of school refusal, severity of primary anxiety disorder, lifetime prevalence of posttraumatic stress disorder, and total scores on the Fear Survey Schedule for Children-Revised. More specifically, white children were more likely to present with school refusal and higher severity ratings, while African American children were more likely to have a history of posttraumatic stress disorder and score higher on the FSSC-R. The impact of these findings and the need for additional research are discussed.This study was supported in part by MH grant 40021 from the National Institute of Mental Health.