A longitudinal examination of mental health and marital functioning of mothers and fathers of autistic adolescents during COVID-19.

LAY ABSTRACT: Parents of autistic children may be especially vulnerable to the negative effects of COVID-19. The current study examined changes in mental health and marital functioning of mothers and fathers of autistic children across three time points between April and October 2020. The study also explored whether pre-COVID factors could predict outcomes during the pandemic. Participants were 94 mothers and 58 fathers of autistic children drawn from a larger study about family relationships and autistic children's mental health that began prior to the pandemic. Results indicated that mothers reported higher levels of mental health problems compared to fathers in July and October 2020. Levels of mental health and marital functioning did not change between April and October 2020. Pre-pandemic child functioning and marital satisfaction predicted changes in mother's ratings of marital satisfaction. The findings have implications for ways to best support families during challenging periods.

Remote vs. In-person Schooling during the COVID-19 Pandemic and Internalizing Symptoms among Children on the Autism Spectrum.

Background: Children on the autism spectrum encountered interruptions to their education due to the COVID-19 pandemic (White et al., 2021). This study examined the extent to which autistic children's anxiety and depressive symptoms during the pandemic were associated with the school format they attended in October 2020 (remote, in-person/hybrid, homeschool), controlling for their pre-pandemic symptoms. Pre-pandemic peer victimization and autism symptom characteristics were tested as moderators. Method: Participants were 81 verbally-fluent autistic children (Mage = 14.71 years, 77.8% males), without an intellectual disability, and their mothers; families were part of an ongoing, longitudinal study that began before the pandemic. Results: School format did not significantly predict children's anxiety or depressive symptoms. Results indicated that the only significant predictors of children's anxiety and depressive symptoms during the pandemic were their pre-pandemic symptom levels. Conclusions: School format did not significantly contribute to variability in children's anxiety and depressive symptoms during the pandemic, over and above their pre-pandemic symptoms. The results contribute quantitative findings to the growing body of research on pandemic-related effects on autistic children, and underscore the need to account for pre-pandemic child functioning when drawing conclusions about pandemic-level effects.

A Pilot Study of Responses to Interparental Conflict in Children with Autism Spectrum Disorder.

Research supports that parents of children with ASD experience higher rates of marital conflict compared to parents of neurotypically developing (NT) children; however, no known research examining reactions to interparental conflict in children with ASD exists. This study compared emotional, behavioral, and physiological responses to interparental conflict in ASD (n = 21) and NT children (n = 29). Children were presented with videotaped interactions (constructive vs. destructive conflict) of actors and their reactions were measured. Children with ASD reported higher levels of negative emotions following constructive conflict compared to NT children. Parents of children with ASD rated their child's emotional and behavioral responses to interparental conflict more negatively than parents of NT children. Comparable levels of physiological reactivity were found across both groups.

Children's self-blame appraisals about their mothers' depressive symptoms and risk for internalizing symptoms.

Maternal depressive symptoms are a robust predictor of children's risk for internalizing symptoms, yet not all children are negatively affected by exposure to their mothers' symptoms. The present study tested children's self-blame appraisals as a moderator of the association between maternal depressive symptoms and children's internalizing symptoms, controlling for children's negative attributional style. We hypothesized that the relation between maternal depressive symptoms and children's internalizing symptoms would be stronger for children who blamed themselves more for their mothers' symptoms. Participants were 129 mother-child dyads (M child age = 13.63, SD = 2.2; 52.7% female; 38.8% White, 31% African American, 22.5% Latinx/Hispanic) recruited from the community. Results indicated that maternal depressive symptoms were associated with higher levels of children's internalizing symptoms for children who reported higher, but not lower, levels of self-blame appraisals. Results were consistent using mothers' or children's reports of their own and each other's symptoms. The findings highlight the importance of assessing children's appraisals about their mothers' depressive symptoms, and suggest that preventive interventions should target children who endorse higher levels of self-blame appraisals. Furthermore, children's self-blame appraisals about mothers' depressive symptoms should be considered as a target of treatment for child internalizing disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Attachment security differs by later autism spectrum disorder: A prospective study.

Although difficulties with social relationships are key to autism spectrum disorder (ASD), no previous study has examined infant attachment security prior to ASD diagnosis. We prospectively assessed attachment security at 15 months in high-risk infants with later ASD (high-risk/ASD, n = 16), high-risk infants without later ASD (high-risk/no-ASD, n = 40), and low-risk infants without later ASD (low-risk/no-ASD, n = 39) using the Strange Situation Procedure. High-risk/ASD infants were disproportionately more likely to be classified as insecure (versus secure) and more likely to be classified as insecure-resistant (versus secure or avoidant) than high-risk/no-ASD and low-risk/no-ASD infants. High-risk infants with insecure-resistant attachments were over nine times more likely to receive an ASD diagnosis than high-risk infants with secure attachments. Insecure-resistant attachment in high-risk infants suggests a propensity toward negative affect with the parent in conditions of stress. Insecure-resistant attachment may prove useful as a potential early index of propensity toward ASD diagnosis in high-risk siblings, while insecure-resistant attachment in the context of emergent autism may contribute to difficulties experienced by children with ASD and their families.

Toddler affect with mothers and fathers: the importance of infant attachment.

The present study examined the degree to which toddlers' affect at 20 months during the Parent Ignore Toddler Situation (PITS), a modified still-face paradigm, with mothers and fathers was predicted by attachment (12 and 14 months), temperamental negative reactivity (3, 5, 7, 12, and 14 months), and attachment X negative reactivity during infancy. Parents (N = 135) were predominantly Caucasian (90.3% of mothers and 87.4% of fathers). Results from multi-level models, controlling for baseline affect and current parent sensitivity, indicated several effects involving attachment, but not temperament. An Episode X Avoidant attachment interaction indicated that toddlers who were classified as avoidant with either parent during infancy showed a flattened pattern of positive affect across the PITS episodes compared with those classified as secure. In contrast, a Parent X Ambivalent attachment interaction indicated that toddler negative affect was higher when they had an ambivalent attachment with mothers but not fathers.

Religiosity/Spirituality and Mental Health Outcomes in Mothers of Children with Autism Spectrum Disorder: The Mediating Role of Positive Thinking.

This study examines associations between dimensions of religiosity/spirituality (R/S) and anxiety symptoms in mothers of children with autism spectrum disorder (ASD). Mothers' positive ways of thinking and romantic relationship satisfaction were examined as mediators of associations. The extent to which child ASD symptom severity and maternal broad autism phenotype (BAP) behaviors predicted interactions with religious community members was also examined. Seventy-three Christian mothers of a child with ASD completed online surveys. Higher levels of spirituality were associated with viewing their child with ASD as providing a positive contribution to the family. These positive views were, in turn, associated with less anxiety symptoms. Mothers of children with more severe ASD symptoms also reported greater negative interactions with members of their congregation.

Relationship between the broad autism phenotype, social relationships and mental health for mothers of children with autism spectrum disorder.

This study aimed to examine the mechanisms responsible for the association between the broad autism phenotype and depressive symptoms in mothers of a child with autism spectrum disorder. A total of 98 mothers who had a child with autism spectrum disorder between the ages of 2 and 16 years completed assessments of maternal broad autism phenotype, child behavior problems, romantic relationship satisfaction, friend support, family support, and maternal depressive symptoms. Results indicated that only romantic relationship satisfaction was a significant mediator of the relationship between maternal broad autism phenotype social abnormalities and maternal depressive symptoms, where greater broad autism phenotype social abnormalities were associated with lower relationship satisfaction, which in turn was associated with increased depressive symptoms. Child behavior problems were directly related to increased depressive symptoms. Implications regarding maternal mental health outcomes within this population as well as intervention implications are discussed.

Associations Between Resilience and the Well-Being of Mothers of Children with Autism Spectrum Disorder and Other Developmental Disabilities.

There is variability in the extent to which mothers are affected by the behavior problems of their children with developmental disabilities (DD). We explore whether maternal resilience functions as a protective or compensatory factor. In Studies 1 and 2, using moderated multiple regression models, we found evidence that maternal resilience functioned as a compensatory factor-having a significant independent main effect relationship with well-being outcomes in mothers of children with DD and autism spectrum disorder. However, there was no longitudinal association between resilience and maternal well-being outcomes. There was little evidence of the role of resilience as a protective factor between child behavior problems and maternal well-being in both studies.

Brief Report: The Development of Compliance in Toddlers at-Risk for Autism Spectrum Disorder.

Parents of children with autism spectrum disorder (ASD) report concerns with child compliance. The development of compliance in 24-, 30-, and 36-month-old high-risk children with ASD outcomes (n = 21), high-risk children without ASD (n = 49), and low-risk children (n = 41) was examined. The High-Risk/ASD group showed greater passive noncompliance at 24-months than the non-ASD groups and a smaller increase in compliance than the High-Risk/No ASD group. The High-Risk/ASD group also showed a smaller decline in active noncompliance than the Low-Risk group. After controlling for receptive language, the passive noncompliance findings were nonsignificant whereas compliance and active noncompliance findings retained significance. The growth of compliance is attenuated in children with ASD, while changes in passive noncompliance are in part associated with language comprehension.

Helicopter Parenting, Autonomy Support, and College Students' Mental Health and Well-being: The Moderating Role of Sex and Ethnicity.

Whereas parental involvement is consistently linked with positive child outcomes throughout development, parental involvement that is not developmentally appropriate and intrusive--a style of parenting called helicopter parenting--can be problematic for their child's adjustment and well-being. Helicopter parenting can be particularly harmful during emerging adulthood when young adults are working toward developmental goals of self-reliance and autonomy. The purpose of this study was to examine sex differences in the relation between helicopter parenting and autonomy support on college students' mental health and well-being. A secondary aim was to explore the extent to which there were ethnic differences (non-Hispanic White vs. Hispanic) in associations between parenting and college students' outcomes. We examined several domains of mental health, including dysphoria symptoms, social anxiety, and general well-being. A sample of 118 undergraduate students (Mage = 19.82 years, SD = 1.38; 83.1% female; 57% European American) completed measures of parenting and mental health and well-being. The results showed that higher levels of helicopter parenting predicted lower levels of well-being for females, whereas higher levels of autonomy support predicted lower levels of dysphoria symptoms and social anxiety among males. No ethnic differences were found. The findings highlight that parents' behavior continues to predict their child's well-being even in emerging adulthood, and that parenting may differentially predict male and female college students' mental health outcomes.

Predictors of Daily Relationship Quality in Mothers of Children with Autism Spectrum Disorder.

Mothers of children with autism spectrum disorder (n = 70) completed online measures of global constructs (i.e., stable individual characteristics measured at time 1), which included resilience, depressive symptoms, and family functioning, followed by 14 daily questionnaires assessing relationship quality and affect on a given day. The global constructs were examined as predictors of daily relationship quality using multilevel modeling. Daily affect was examined in association with daily relationship factors (partner conflict, support from partner, and relationship happiness). Depressive symptoms and family flexibility predicted daily relationship quality. On a daily level, affect was associated with relationship quality. Results emphasize the potential of interventions to improve the quality of parents' relationships by addressing maternal mental health, family functioning, and daily affect.

The Relationship Between Optimism, Coping, and Depressive Symptoms in Hispanic Mothers and Fathers of Children with Autism Spectrum Disorder.

This study examined gender differences in the relationship between dispositional optimism, coping, and depressive symptoms of Hispanic mothers (n = 46) and fathers (n = 43) of children with autism spectrum disorder. Coping was hypothesized to mediate the relationship between optimism and depressive symptoms. The results revealed that mothers reported greater depressive symptoms and greater use of positive and support coping than fathers; however, both mothers and fathers reported similar levels of optimism and use of avoidant coping. In addition, positive and avoidant coping strategies mediated the association between optimism and depressive symptoms for both mothers and fathers. Clinical implications for this study include interventions for improving optimistic outlooks as well as interventions that improve parents' coping skills and therefore reduce negative outcomes.

The impact of maternal, child, and family characteristics on the daily well-being and parenting experiences of mothers of children with autism spectrum disorder.

This study utilized a daily diaries method to explore the global factors that impact daily general affect and daily parenting interactions of mothers of children with autism spectrum disorder. Eighty-three mothers of a child with autism spectrum disorder between the ages of 3 and 13 years completed global assessments of maternal depressive symptoms, child autism spectrum disorder symptom severity, and family functioning. Mothers then reported on their daily negative and positive affect as well as their daily positive and frustrating parenting interactions for 14 consecutive days. The results indicated that higher levels of maternal depressive symptoms were related to decreased daily positive affect, whereas greater child social motivation impairments were related to increased daily positive affect. Only maternal depressive symptoms were associated with increased daily negative affect. Furthermore, higher levels of family cohesion were related to increased daily positive parenting interactions. Finally, higher maternal depressive symptoms as well as family rigidity were related to increased daily frustrating parenting interactions. Implications for interventions focused on the family system are discussed.

Death concerns and psychological well-being in mothers of children with autism spectrum disorder.

PURPOSE: Utilizing a terror management theory perspective, the present research examined whether having a child with autism spectrum disorder (ASD) is associated with underlying cognitions and explicit worries about death, and their roles in psychological well-being. METHOD: 147 mothers of children with ASD (n=74) and typically developing children (n=73) completed a fear of death scale, as well as measures of death-thought accessibility, positive and negative affect, depression, and anxiety. RESULTS: Following previous research, mothers of children with ASD reported worse psychological health. Additionally, they evidenced greater death-thought accessibility compared to mothers of typically developing children, but did not differ in explicit worries about mortality. Greater death-thought accessibility, in turn, mediated the influence of ASD diagnosis on negative affect, depression, and anxiety. CONCLUSION: The current study offers an initial understanding of the association between mortality concerns and psychological health for mothers of children with ASD. Further, it underscores the importance of health care providers' efforts to attend to, and educate parents about, their thoughts of mortality, even if the parent does not acknowledge such concerns. WHAT THIS PAPER ADDS: The present study examined the impact of both implicit and explicit worries about death in parents of children with Autism Spectrum Disorder (ASD). Specifically, we were able to demonstrate that increased death-thought accessibility among mothers of children with ASD was associated with worse psychological health. While it is possible for parents of children with ASD to report conscious worries about death, there were no observed differences on this measure. As far as we know, this work is the first to empirically examine the prevalence of mortality-related concerns in this population and the subsequent effects of death-thought accessibility on psychological health. This is an important avenue of research as parents of children with ASD may experience greater worries about leaving their children upon death with no one to care for them, or to leave their children in the care of individuals who may not understand their son or daughter's unique needs. Additionally, the current findings highlight the importance of addressing mortality-related concerns, even when they may not be explicitly recognized, among parents of children with ASD. Given the effectiveness of parent education programs for children with ASD, a primary avenue for intervention may be education. Training care providers in ways to better discuss thoughts of death may help to alleviate stress and foster greater psychological well-being.

The Power of Positivity: Predictors of Relationship Satisfaction for Parents of Children with Autism Spectrum Disorder.

The current study uses the actor-partner interdependence model to examine the predictors of relationship satisfaction for mothers and fathers of children with autism spectrum disorder. Sixty-seven couples completed measures of optimism, benefit finding, coping strategies, social support, and relationship satisfaction. Results indicated that parent's positive strengths predicted better personal relationship satisfaction. Moreover, parents' benefit finding, use of emotional support, and perceived social support from their partner also predicted their partner's relationship satisfaction. The results of this study highlight the importance of focusing on positive factors that can enhance relationship quality. Implications for the development of parent-focused interventions are discussed.

Attachment in the making: mother and father sensitivity and infants' responses during the Still-Face Paradigm.

This study examined the extent to which infant and parent response trajectories during the Still-Face Paradigm (SFP) in early infancy predicted later infant-mother and infant-father attachment. Families (N=135) participated in the SFP when infants were 3, 5, and 7 months of age and participated in the Strange Situation procedure when infants were 12 months of age (mothers) and 14 months of age (fathers). Multilevel models showed that parent sensitivity assessed during the SFP was related to infants' affective and behavioral response trajectories during the SFP and that sensitivity and infant response trajectories predicted attachment. Results from the current study support the notion that parent and infant responses in the SFP with mothers and fathers during Bowlby's attachment in the making phase provide insight into the developing parent-child attachment relationship.

Developmental Trajectories of Emotion Regulation Across Infancy: Do Age and the Social Partner Influence Temporal Patterns?

The ability to effectively regulate emotions is a critical component of early socio-emotional development. This longitudinal study examined the developmental trajectories of emotion regulation in a sample of 3-, 5-, and 7-month-olds during an interaction with mothers and fathers. Infants' negative affect and use of behavioral strategies, including distraction, self-soothing, and high intensity motor behaviors were rated during the still-face episode of the Still-Face Paradigm. Longitudinal mixed-effects models were tested to determine whether strategies were followed by an increase or decrease in negative affect. Results from mother-infant and father-infant dyads indicated that focusing attention away from the unresponsive parent and engaging in self-soothing behaviors were associated with a subsequent decline in negative affect and the strength of these temporal associations were stable across infancy. In contrast, high-intensity motor behaviors were followed by an increase in negative affect and this effect declined over time. No significant effects were found for the behavioral strategy of looking at the parent. Results underscore the importance of considering infant age and the social partner when studying the effectiveness of emotion regulatory strategies in early infancy.

Emotional expression and heart rate in high-risk infants during the face-to-face/still-face.

In infants, eye constriction-the Duchenne marker-and mouth opening appear to index the intensity of both positive and negative facial expressions. We combined eye constriction and mouth opening that co-occurred with smiles and cry-faces (respectively, the prototypic expressions of infant joy and distress) to measure emotional expression intensity. Expression intensity and heart rate were measured throughout the face-to-face/still-face (FFSF) in a sample of infants with prenatal cocaine exposure who were at risk for developmental difficulties. Smiles declined and cry-faces increased in the still-face episode, but the distribution of eye constriction and mouth opening in smiles and cry-faces did not differ across episodes of the FFSF. As time elapsed in the still face episode potential indices of intensity increased, cry-faces were more likely to be accompanied by eye constriction and mouth opening. During cry-faces there were also moderately stable individual differences in the quantity of eye constriction and mouth opening. Infant heart rate was higher during cry-faces and lower during smiles, but did not vary with intensity of expression or by episode. In sum, infants express more intense negative affect as the still-face progresses, but do not show clear differences in expressive intensity between episodes of the FFSF.