Developmental associations between motor and communication outcomes in Fragile X syndrome: Variation in the context of co-occurring autism.

LAY ABSTRACT: Fragile X syndrome (FXS), the leading heritable cause of intellectual disability, has a co-occurrence rate of autism spectrum disorder (ASD) estimated at ~60%. Children with FXS experience delayed achievement and slower development of key motor abilities, which happens to an even greater extent for children with both FXS and ASD. A multitude of studies have demonstrated that motor abilities are foundational skills related to later communication outcomes in neurotypical development, as well as in the context of ASD. However, these associations remain unexamined in FXS, or FXS + ASD. In this study, we aimed to determine the associations between early motor skills and their rate of development on communication outcomes in FXS. Furthermore, we investigated whether these associations varied in the context of co-occurring FXS + ASD. Results revealed within-FXS variation in the context of co-occurring ASD between some aspects of motor development and communication outcomes, yet within-FXS consistency between others. Findings provide evidence for variability in developmental processes and outcomes in FXS in the context of co-occurring ASD and offer implications for intervention.

Spotlighting racism in schools: Teacher mentors and the mediating effect of school safety.

Youth are more likely to succeed when they feel safe at school and have access to caring relationships with adults. Systemic racism interrupts access to these assets. Within schools, racially/ethnically minoritized youth encounter policies rooted in racism, leading to decreased perceptions of school safety. Having a teacher mentor may mitigate some of the harmful effects of systemic racism and discriminatory practices. Yet, teacher mentors may not be accessible to all students. In this study, the authors tested a putative explanatory hypothesis for differences between Black and white children's access to teacher mentors. Data from the National Longitudinal Study of Adolescent Health were used. Linear regression models were used to predict access to teacher mentors, and a mediational analysis was conducted to determine the effect of school safety on the relationship between race and teacher mentor access. Results indicate that students from higher SES backgrounds and those with parents who have greater educational attainment are more likely to have a teacher mentor. Furthermore, Black students are less likely than white students to have a teacher mentor, and school safety mediates that relationship. The implications of this study suggest that challenging institutional racism and structures may improve perceptions of school safety and teacher mentor accessibility.

Striving for safety, impact, and equity: A critical consideration of AJCP publications on formal youth mentoring programs.

In this virtual special issue (VSI) we curate and reflect upon 22 articles on formal youth mentoring previously published in the American Journal of Community Psychology (AJCP). First, we provide historical context and highlight AJCP's 2002 special issue on mentoring, which played an important role in establishing youth mentoring as a vibrant area of research. Next, we review and discuss findings from subsequent AJCP studies in three interrelated lines of inquiry: (1) the importance of facilitating high-quality mentoring relationships; (2) associations among youth's presenting needs, relationship quality, and outcomes; and (3) program practices leading to stronger, more impactful relationships. Throughout, we highlight and expand upon critical commentary from AJCP contributors, calling on the field to move away from paternalistic models that overly localize risk with youth and families without interrogating structural oppression. Our recommendations include: (1) centering critical consciousness, racial equity, and social justice in program curricula and mentor trainings; (2) respectfully engaging grassroots programs developed for and by communities of color that are underrepresented in research; (3) making meaningful efforts to recruit mentors from marginalized communities and removing barriers to their participation; and (4) examining youth's racial, ethnic, and other areas of identity development processes during mentoring.

Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review.

The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.

Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions.

At present, the mental healthcare system cannot meet the demand for services, and the need-to-access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism-targeted programs that have shown promise in increasing the reach of effective, evidence-based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor-delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre-existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence-based mental health services. In this paper, we discuss the anticipated benefits of mentor-delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions.

The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.

Supporting autonomy in youth mentoring relationships.

The preference for and exercise of autonomous decision-making in adolescence is a normative developmental process. Yet, increased autonomy is associated with both risks and benefits. Connection to others through positive relationships, including mentoring relationships, is one context that predicts healthy autonomous decision-making. In other ways, such relationships can interfere or stifle the development of autonomy. In synthesizing the existing scientific literature on autonomy development and autonomy-supportive practices, we propose a framework for considering the role of mentors in supporting autonomy through five domains of influence: role modeling, encouraging, providing access to resources, relationships, and experiences, advocacy, and conversations about behavior change. We provide suggestions for research and practice.

Back to the Future: Mentoring as Means and End in Promoting Child Mental Health.

Youth mentoring is a potentially powerful tool for prevention and intervention, but it has garnered little attention from clinical child and adolescent psychologists. For decades, the practice of youth mentoring has out-paced its underlying science, and meta-analytic studies consistently reveal modest outcomes. The field is now at an important crossroads: Continue to endorse traditional, widely used models of mentoring or shift to alternative models that are more in line with the tenets of prevention science. Presented here is a bilateral framework to guide the science and practice of mentoring going forward. Our premise is that mentoring relationships can serve as both means to a targeted end and as a valued end unto itself. We present a functional typology of current mentoring programs (supportive, problem-focused, & transitional) and call for greater specification of both the process and expected outcomes of mentoring. Finally, we argue that efforts to leverage mentoring relationships in service of youth development and the promotion of child and adolescent mental health will likely require disrupting the science, practice, and policy that surrounds youth mentoring.

A National Study of Mentoring Program Characteristics and Premature Match Closure: the Role of Program Training and Ongoing Support.

Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely may have negative consequences for youth. Previous research has investigated match-level indicators of premature match closure, highlighting possible individual mentor- or mentee-level characteristics that might influence the match staying together. However, less work has investigated the importance of program-level variables in match retention. Mentor training and support may be one key modifiable program-level feature that could curtail the risk of premature match closure. In this study, we used data from a national survey of youth mentoring programs (N = 1451) to examine training and other potential predictors of premature match closures (Garringer et al. 2017). We used a Bayesian Additive Regression Trees (BART) model to predict program-reported premature match closure rates from a set of four training-related variables and 26 other covariates (e.g., program size, budget, demographic composition). Findings indicate that the set of predictors explained about one-fifth of the variation in reported rate of premature match closure (cumulative pseudo R2 = .21), and the strongest, and only statistically significant, predictor of premature match closure was the frequency of ongoing training and support contacts per month. Overall, findings indicate that there is substantial noise in predicting program-reported premature match closure, but program-reported provision of ongoing training and support seems to emerge as a relatively stable signal in the noise.

Pilot randomized trial of brief school-based mentoring for middle school students with elevated disruptive behavior.

We report a pilot study of a brief (i.e., 10 sessions) goal-focused mentoring program for middle school students with elevated disruptive behavior. Students with high levels of school misconduct (n = 67) were randomly assigned to the program or school as usual. We collected multi-informant emotional, behavioral, and academic functioning assessments pre- and postintervention. Results indicate that the program produced significant positive changes in school behavioral infractions, math grades, students' report of emotional symptoms, and school problems. Mentors found the curriculum acceptable, understood the material from the manual, found implementing the curriculum feasible, and felt the program was congruent with the school mission. Mentors of less impaired students indicated that they desired additional support implementing the manual, perhaps indicating the program is overengineered for students with higher levels of impairment. The manuscript concludes with a discussion of considerations for future research and implementation, including the importance of integrating mentoring programs into existing support systems (e.g., multitiered systems of support) within the school context.

Emergence and rate of autism in fragile X syndrome across the first years of life.

Prospective longitudinal studies of idiopathic autism spectrum disorder (ASD) have provided insights into early symptoms and predictors of ASD during infancy, well before ASD can be diagnosed at age 2-3 years. However, research on the emergence of ASD in disorders with a known genetic etiology, contextualized in a developmental framework, is currently lacking. Using a biobehavioral multimethod approach, we (a) determined the rate of ASD in N = 51 preschoolers with fragile X syndrome (FXS) using a clinical best estimate (CBE) procedure with differential diagnoses of comorbid psychiatric disorders and (b) investigated trajectories of ASD symptoms and physiological arousal across infancy as predictors of ASD in preschoolers with FXS. ASD was not diagnosed if intellectual ability or psychiatric disorders better accounted for the symptoms. Our results determined that 60.7% of preschoolers with FXS met the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) criteria for ASD using the CBE procedure. In addition, 92% of these preschoolers presented with developmental delay and 45.4% also met criteria for psychiatric disorders, either anxiety, ADHD, or both. ASD diagnoses in preschoolers with FXS were predicted by elevated scores on traditional ASD screeners in addition to elevated autonomic arousal and avoidant eye contact from infancy.

Early negative affect in males and females with fragile X syndrome: implications for anxiety and autism.

BACKGROUND: Fragile X syndrome (FXS) is a genetic disorder that is highly comorbid with anxiety and autism spectrum disorder (ASD). Elevated negative affect in young children has been associated with increased risk for both anxiety and ASD; however, these relations remain poorly understood in FXS. METHODS: The present prospective longitudinal study examined the trajectory of negative affect from infancy through preschool in males and females with FXS and typical development and its relation to anxiety and ASD. RESULTS: Results indicate a complex association reflecting group, developmental, and sex effects. Specifically, the group with FXS displayed a trajectory of increasing negative affect across age that was distinct from the typical controls. This atypical trajectory of negative affect in FXS was driven by sex effects in that males showed lower negative affect during infancy followed by steep increases across the toddler and preschool years whereas the females displayed a flatter trajectory. Finally, elevated negative affect predicted anxiety symptoms in males, but not females, with no relationship to ASD in males or females with FXS. CONCLUSIONS: The current work addresses the importance of studying the development of psychopathology in a specific neurogenetic population. Temperamental negative affect was shown to be an important early marker for anxiety in young children with FXS, with subtle differences observed between males and females.

Infant Social Avoidance Predicts Autism but Not Anxiety in Fragile X Syndrome.

Objective: Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety are three of the most common childhood psychiatric disorders. Early trajectories of social avoidance have been linked with these psychiatric disorders in previous studies, but it remains unclear how social avoidance differentially predicts comorbid disorders in a high-risk genetic subgroup. Here, we delineate the association between trajectories of social avoidance from infancy and subsequent ASD, ADHD, and anxiety outcomes at preschool in children with fragile X syndrome (FXS), a well-characterized single-gene disorder highly associated with social avoidance as well as elevated rates of ASD, ADHD, and anxiety. Method: Males with FXS (n = 78) aged 4-62 months participated in a longitudinal study resulting in 201 assessments. The Social Avoidance Scale (SAS) documented socially avoidant behaviors from infancy in three domains-physical movement, facial expression, and eye contact during both the first minute and the last hour of an interaction. ASD, ADHD, and anxiety symptom outcomes at preschool were measured via parent-report questionnaires. Results: Increased social avoidance across infancy and preschool predicted elevated ASD symptom severity but reduced ADHD and anxiety symptom severity in males with FXS. Conclusion: ASD, ADHD, and anxiety symptoms relate inconsistently to social avoidance behaviors, providing new insight toward the debate of independence or overlap among these disorders in FXS and other disorders (i.e., ASD). The results suggest that the nuanced profile of the developmental and temporal aspects of social avoidance may inform more the accuracy of differential diagnoses of comorbid psychiatric disorders in FXS.

Using latent class analysis to identify treatment-use subgroups among parents of children with autism spectrum disorder.

Among parents of 2,582 children (ages 4-17 years old) with autism spectrum disorder (ASD), we used latent class analysis to identify subgroups and profiles of treatment users and included annual household income in the specification of the models, then described characteristics of each subgroup. Based on three indicators of fit (Akaike's Information Criterion, Bayesian Information Criterion, and Lo-Mendell-Rubin), six latent classes of treatment users emerged. Subgroups included users of: (a) mostly private and school speech and occupational therapies; (b) nearly all treatment types; (c) mostly speech and occupational therapies, plus intensive behavioral and "other" treatments, but little medication use; (d) private therapies almost exclusively; (e) primarily psychotropic medications; and (f) mostly school-based therapies. Income significantly predicted class differences for all but one latent class. Probabilities of families' lifetime use of nine treatment types varied depending on latent classification. Proportions of families reporting having observed children's developmental regression were largest in those with the highest overall treatment use, and these children also had the lowest cognitive and adaptive-functioning scores and the highest ASD symptom scores. Understanding patterns of treatment use among families of children with ASD is an important first step in enhancing treatment-related selection and implementation. Autism Research 2019, 12: 843-854. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We identified six different groups of treatment users to help explain patterns in treatment implementation among parents of children and adolescents with autism. These included families who used: (a) mostly used private and school speech and occupational therapies; (b) nearly all treatment types (private and school therapies, intensive behavioral, biomedical, psychotropic medications, and other treatments); (c) mostly speech and occupational therapies, plus intensive behavioral and "other" treatments, but little medication use; (d) private therapies almost exclusively; (e) primarily psychotropic medications; and (f) mostly school-based therapies.

Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training.

In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as on-demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre-baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.

Risks and rewards of school-based mentoring relationships: A reanalysis of the student mentoring program evaluation.

In the United States, school-based mentoring programs are a large and widely funded form of mentoring. Despite widespread support, meta-analyses indicate that the effects of school-based mentoring programs are small. One hypothesis for these results is that school-based mentors are not able to develop a sufficiently high-quality relationship with mentees to produce the hypothesized positive effects. This study presents a reanalysis of a large randomized controlled trial of school-based mentoring and examines the estimated effect of mentoring as a function of mentee-reported relationship quality using a novel statistical approach. Although we found that average effect sizes were near zero and consistent with researchers' original findings, our findings also indicate that low relationship quality is associated with some harmful effects, particularly on misconduct, and that as relationship quality improves, so do effects. However, we found that this association decelerates and resulted in small, positive effects for some outcomes. These results suggest that that poor relationship quality may produce harmful effects and a strong relationship may not be sufficient to produce moderate, positive academic and behavioral outcomes in a school-based mentoring context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Finding the Sweet Spot: Investigating the Effects of Relationship Closeness and Instrumental Activities in School-based Mentoring.

School-based mentoring programs are popular prevention programs thought to influence youth development; but rigorous evaluations indicate that these programs often have small effects on youth outcomes. Researchers suggest that these findings may be explained by (a) mentors and mentees failing to develop a close relationship and (b) mentors not setting goals or focusing on specific skills necessary improve outcomes. We assessed these explanations using data from approximately 1360 mentor and mentee pairs collected through a national study of school-based mentoring (called, "The Student Mentoring Program"). Specifically, we tested the influence of mentee-reported relationship quality and mentor-reported use of goal-setting and feedback-oriented activities on academic, behavioral, and social-emotional outcomes. Results suggested that youth reported relationship quality was associated with small to medium effects on outcomes. Moreover, goal-setting and feedback-oriented activities were associated with moderate to large effects on outcomes. We also found significant interactions between relationship quality and goal-setting and feedback-oriented activities on youth outcomes. We conclude that there appears to be a "sweet-spot" wherein youth outcomes are maximized. The results of this study suggest a need for school-based mentoring programs to monitor and support mentors in developing a close relationship while also providing opportunities to set goals and receive feedback.

Maternal Depression and Parent Management Training Outcomes.

This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.

Physiological Correlates of Maternal Responsivity in Mothers of Preschoolers With Fragile X Syndrome.

The present study examined the relationship between salivary cortisol and maternal responsiveness in mothers of boys with fragile X syndrome (FXS). Maternal responsivity is strongly associated with child outcomes, and children with FXS are at risk for compromised development due to intellectual disability and problem behavior. Increased understanding of the nature and underlying mechanisms of maternal responsivity in FXS is important to optimize outcomes in children with FXS and contribute to improved family cohesion. Data from 36 mother-child dyads indicated a complex age effect with elevated cortisol levels associated with high maternal responsivity scores when children are young and low responsivity scores when children are older. Implications of these findings and directions for future research are discussed.

Temperament factor structure in fragile X syndrome: the children's behavior questionnaire.

Early patterns of temperament lay the foundation for a variety of developmental constructs such as self-regulation, psychopathology, and resilience. Children with fragile X syndrome (FXS) display unique patterns of temperament compared to age-matched clinical and non-clinical samples, and early patterns of temperament have been associated with later anxiety in this population. Despite these unique patterns in FXS and recent reports of atypical factor structure of temperament questionnaires in Williams Syndrome (Leyfer, John, Woodruff-Borden, & Mervis, 2012), no studies have examined the latent factor structure of temperament scales in FXS to ensure measurement validity in this sample. The present study used confirmatory factor analysis to examine the factor structure of a well-validated parent-reported temperament questionnaire, the Children's Behavior Questionnaire (Rothbart, Ahadi, Hershey, & Fisher, 2001), in a sample of 90 males with FXS ages 3-9 years. Our data produced a similar, but not identical, three-factor model that retained the original CBQ factors of negative affectivity, effortful control, and extraversion/surgency. In particular, our FXS sample demonstrated stronger factor loadings for fear and shyness than previously reported loadings in non-clinical samples, consistent with reports of poor social approach and elevated anxiety in this population. Although the original factor structure of the Children's Behavior Questionnaire is largely retained in children with FXS, differences in factor loading magnitudes may reflect phenotypic characteristics of the syndrome. These findings may inform future developmental and translational research efforts.