Risk factors for the development and outcome of childhood psychopathology

Boomsma, D.I. [Promotor]Middeldorp, C.M. [Copromotor]Bartels, M. [Copromotor

Emotion Regulation in Children with Autism Spectrum Disorder: The Role of Parent Co-Regulation and its Relations with Externalizing and Internalizing Problems

Children with autism spectrum disorder (ASD) often exhibit internalizing and externalizing problems, which may be explained by emotion regulation (ER) difficulties. Parent co-regulation (i.e., supporting their child’s emotional development through scaffolding, and helping their child regulate emotions) may help improve child ER, and internalizing and externalizing problems. This study investigated the relationships amongst parent co-regulation, child ER, and internalizing and externalizing problems in a sample of 35 parents and school-aged children with ASD prior to an ER-focused Cognitive Behavior Therapy intervention. Active co-regulation strategies (e.g., prompting, redirection of attention), and scaffolding during an anxious situation were associated with parent-reported levels of internalizing problems. Although child ER did not emerge as a significant mediator or moderator, parent scaffolding and child ER were significant predictors of externalizing problems. Suggestions for future research on parent involvement in the emotional development of children with ASD are discussed, as well as implications for ER-focused interventions

Adapted Cognitive Behavioral Therapy for School-Aged Children with Autism Spectrum Disorders and Interfering Anxiety: Impact on Caregiver-Defined Goals

Central challenges for children with autism spectrum disorder (ASD) can include difficulties with social communication, symptoms of emotional dysregulation, and pervasive effects of rigid and repetitive behaviors (Cuccaro et al., 2003; Matson & Nebel-Schwalm, 2007; Samson et al., 2014). Further, the heterogeneous phenotypes of individuals with ASD are often typified by additional forms of psychopathology. Nearly 40% of children with ASD are estimated to present with clinically elevated levels of anxiety (Van Steensel et al., 2011). Psychotherapy is a commonly used treatment for school-aged children with ASD and co-occurring anxiety. This secondary data analysis of a multisite randomized clinical trial (Wood et al., 2019) compared two variants of cognitive behavioral therapy (CBT) to explore the most efficacious treatment for addressing specific caregiver-defined goals. In this study, adapted CBT (BIACA; Wood et al., 2009) and standard-of-practice CBT (Coping Cat; Kendall & Hedtke, 2006) were compared: (1) to better understand the varying types of clinical needs that children with ASD and anxiety present with, and (2) to investigate which CBT approach is best suited to support these varying clinical needs. In this study’s subsample, children with ASD and clinical levels of anxiety (N=148; aged 7-13 years, Mage=9.90, SD=1.78) were randomly assigned to a treatment condition (BIACA or Coping Cat). Both treatments provided 16 therapy sessions. BIACA personalized treatment through the utilization of a modular design which apportioned evidence-based treatment elements based on each child’s clinical need. Coping Cat provided CBT in a prescriptive format regardless of child’s overall clinical presentation. The primary outcome measure was parent severity ratings on caregiver-defined goals throughout treatment (Youth Top Problems; Weisz et al., 2011). BIACA outperformed Coping Cat on the primary outcome measure (p=.005). The findings from this study can inform clinicians about the benefits of personalized treatment plans as well as which caregiver-defined goals are better served by the modular/personalized format of adapted CBT. Further research should explore the feasibility of implementation by clinicians in varying contexts

Parenting practices and experiences in families of children with and without autism spectrum disorder, cerebral palsy or Down syndrome : a mixed-methods inquiry

When a child is growing up with a social, physical, or intellectual disability, due to a developmental disability, parents face additional challenges in the process of raising their child, such as providing the needed care for their child and uncertainties about their child’s development and future. Therefore, current family research among parents raising a child with a developmental disability mainly focuses on how parents feel (i.e., parental stress and well-being) and primarily studies the challenges these parents experience. The current dissertation aims to broaden this perspective by applying three innovative approaches. First, this dissertation attempts to broaden the focus on how parents feel by also examining what parents do in interacting with their child (i.e., specific parenting behavior). Second, this thesis adopts a more balanced perspective by focusing on the variation in both 'challenging' (e.g., need-thwarting parenting behavior, child behavioral and emotional problems, parental stress, experiences of need frustration) and 'positive’ aspects (e.g., need-supportive parenting behavior, child psychosocial strengths, positive family climate, experiences of need satisfaction) in parenting experiences and children’s psychosocial development. Third, this dissertation applies an innovative 'cross-disability' approach, mapping parenting processes and children’s psychosocial development across four groups: parents of children with autism spectrum disorder, cerebral palsy, Down syndrome, and a reference group of parents raising a child without a disability. This approach offers the possibility to identify important generic parenting processes, but also leaves room to highlight more disability-specific sensitivities, which can further inform parental support and family interventions

Therapeutic Alliance in Cognitive Behaviour Therapy for Children with Autism

This study aimed to determine child pre-treatment variables, therapist behaviours and treatment outcomes associated with early and late therapeutic alliance in cognitive behaviour therapy for children with autism. Data were collected from 48 children with autism (91.7% male) who demonstrated average verbal IQ. Therapists included 22 post-doctoral fellows or graduate trainees (90.9% female). Therapeutic alliance and therapist behaviours were measured using observational coding of early and late sessions. Pre-treatment and outcome measures included multiple informant reports of child emotional and behavioural functioning. Results indicate some relation between emotion regulation and symptom severity, and the quality of alliance. Early therapist behaviours were associated with late therapeutic bond. Pushing the child to talk early on predicted later task-collaboration. Early therapeutic alliance did not predict treatment change. Late task-collaboration predicted improvements in emotion regulation. Future research should further examine the role of task-collaboration as a mechanism of treatment change for children with autism

The italian version of the Alexithymia Questionnaire for Children (AQC). Factor structure and reliability

The aims of the study were to investigate factor structure and reliability of the Alexithymia Questionnaire for Children (AQC), originally validated by Rieffe et al. (2006), on an Italian population. A total sample of 1265 participants, ranging in age from 8 to 14 years, filled in the Italian version of the AQC and 160 children also completed the Youth Self Report (YSR), during school time. A sub-sample (N = 60) was retested after eight weeks for an assessment of the measure’s stability. The three-factor model reported good fit indices on the total sample, even though not all items loading on the Externally Oriented Thinking (EOT) factor appeared statistically relevant. Moreover, the model was only partially invariant across gender and age groups: analysis indicated developmental gender-specific differences on Difficulty Identifying Feelings (DIF) and EOT factors. Significant correlations were found between AQC scores and the YSR internalizing and externalizing symptomatology scales. In conclusion, the three-factor model was confirmed and some evidence emerged concerning its generalization to gender and age-group