A Brief Report: Community Supportiveness May Facilitate Participation of Children With Autism Spectrum Disorder in Their Community and Reduce Feelings of Isolation in Their Caregivers

Children with autism spectrum disorder (ASD) participate at lower rates in their community, and their caregivers experience higher levels of stress, in comparison to families of typically developing (TD) children. The social model of disability positions the environment as the central issue when children with disabilities are unable to participate, yet little is known about the relationship between poor community support, reduced community participation in children with ASD, and caregiver stress. This study examined caregiver perceptions of community supportiveness for the community participation of 48 children with ASD (aged 5–12 years), alongside caregiver-reported child ASD symptom severity, adaptive functioning, and caregiver stress. Community supportiveness predicted child involvement, but not attendance, when child characteristics were held constant. Caregiver perceptions of low community supportiveness significantly predicted caregiver feelings of isolation. The importance of modifying community programs to better support inclusion of children with ASD is discussed

An investigation of attachment and emotion-processing in autism spectrum disorders during middle childhood

Autism Spectrum Disorders (henceforth referred to as ASD) are a cluster of neurodevelopmental disorders marked by deficits in social and communicative ability, as well as the presence of restricted and repetitive patterns of behaviour and interests. Empirical research is increasingly being undertaken to further characterise the profile and correlates of a range of socio-emotional impairments seen in ASD beyond the core deficits, given findings of poorer health-related quality of life in psychological, emotional, and social domains in children with ASD than children without ASD. One such area of functioning in which children with ASD have been found to experience impairments is that of emotion-processing. Emotion-processing encompasses the ability to recognize and understand others’ and one’s own emotional states, as well as to regulate one’s own emotional states and behaviour to attain a goal or to fit a context. Furthermore, research has found that impairments in emotion-regulation, particularly the regulation of negative emotions such as anger or sadness, often underlie clinical presentations of internalizing and externalizing difficulties. Given the heterogeneity in the severity of emotion-recognition and regulation deficits across groups of children with ASD as a function of cognitive ability, for the purposes of this thesis, the focus was on children with normative cognitive functioning (FSIQ ≥ 70), commonly referred to in the literature as children with high-functioning ASD. While the development of secure attachment relationships has consistently been linked to the ability to understand, express, and regulate emotion appropriately in typical development, the role of attachment in influencing emotion-processing in children with ASD is relatively unexplored. Furthermore, the majority of studies to date investigating the profile of the various organized attachment classifications (secure, insecure avoidant, and insecure ambivalent) in ASD populations have incorporated samples of toddlers and young children. Consequently, the profile and characteristics of organized secure and insecure attachments in middle childhood in ASD is currently unclear, although a small number of studies have begun to address this gap in the literature (eg. Bauminger, Solomon, & Rogers, 2010; Chandler & Dissanayake, 2013). The clarification of the nature of attachment relationships and their emotional correlates in ASD has the potential to drive a deeper understanding of the interplay of environmental and organic factors influencing emotion-processing difficulties and consequently, a more holistic approach to formulations and interventions for clinical presentations of these difficulties in school-aged children with ASD. Thus, the aims of this thesis were: 1. To investigate the profile of the various organized attachment classifications in children with ASD relative to typically-developing children during the middle childhood period. 2. To explore the role of attachment in emotion-processing in children with ASD during middle childhood. Specifically, the studies presented aimed to clarify the influence of organized attachment classifications and attachment relationships on the ability to recognise, understand, and regulate emotions. 3. To further consolidate the profile of emotion-processing deficits in children with ASD in middle childhood, through the investigation of emotion-recognition, emotion-regulation, theory of mind, and broader internalizing and externalizing difficulties seen in this group. Study 1 explored group differences on dimensional measures of attachment classifications, specifically attachment security, avoidance, and ambivalence, in an ASD sample and a typically-developing group similar on age and cognitive ability, as examined by self-report measures. This study also examined the relationships that organized attachment classifications had with emotion-recognition and theory of mind in each group, alongside the contribution of executive functioning ability, specifically working memory and inhibition, which have been found to be impaired in children with ASD. Study 2 explored the relationships that the various attachment classifications had with internalizing and externalizing symptomatology in children with ASD as well as in the typically-developing group. In Study 3, qualitative interviews of mothers of children with ASD were undertaken for an in-depth exploration of the role of attachment relationships in the regulation of negative emotion in ASD. The qualitative study examined the nature of attachment relationships in children with ASD beyond formal attachment classifications. Findings from Study 1 suggested that levels of attachment security, avoidance and ambivalence, as measured by self-report measures of formal attachment classifications, may be similar in children with high-functioning ASD relative to TD groups. Study 3 further complemented this finding by indicating that children with high-functioning ASD demonstrate similar distress-signalling and comfort-seeking behaviours to theoretical and empirical accounts of TD children within the mother-child attachment relationship. Nevertheless, the qualitative investigations in Study 3 also revealed a range of subtle characteristics of interaction within ASD dyads which may differentiate dynamics of attachment behaviour between ASD and TD groups when experiencing negative emotion, particularly relating to the child’s social and communicative difficulties in the context of signalling distress as well as seeking and responding to comfort within the mother- child attachment relationship. Findings from Study 1 of unimpaired performance on emotion-recognition and theory of mind tasks relative to the typically-developing group, together with correlations that executive functioning had with these measures, corroborates the current empirical notion that high-functioning groups with ASD may use compensatory cognitive strategies to pass structured, behavioural measures of emotion-processing. Consistent with the current literature, Study 2 found that children with ASD demonstrated higher rates of internalizing and externalizing symptomatology, while Study 3 indicated impairments in emotion-regulation, particularly in the experience of highly intense negative emotions, mood fluctuations, and poor frustration tolerance. Furthermore, a positive relationship between levels of attachment ambivalence and rule-breaking behavior was found in the ASD group in Study 2. Taken together, the current studies suggest that organized attachment orientations of security or insecurity may not be linked to performance on structured, behavioural measures of emotion-processing, but that attachment orientations, and more broadly, the dynamics of interaction within attachment relationships, may influence presentations of everyday emotional functioning, particularly, in the regulation of negative emotions as well as in clinical presentations of externalizing symptomatology. Findings from the collection of studies presented provide support for the role of attachment in emotion-regulation and broader emotional functioning in children with high-functioning ASD as seen in TD groups, and consequently, highlight the need for the further characterization of the interplay of factors influencing the relationship between attachment and emotion-processing in ASD. The use of qualitative methodologies exploring attachment relationships alongside measures of formal attachment classifications are warranted in order to capture the nuanced dynamics of attachment relationships in ASD dyads and consequently gain a deeper and more holistic understanding of the role of attachment in the everyday emotion-processing difficulties seen in ASD

An investigation of attachment and emotion-processing in autism spectrum disorders during middle childhood

Autism Spectrum Disorders (henceforth referred to as ASD) are a cluster of neurodevelopmental disorders marked by deficits in social and communicative ability, as well as the presence of restricted and repetitive patterns of behaviour and interests. Empirical research is increasingly being undertaken to further characterise the profile and correlates of a range of socio-emotional impairments seen in ASD beyond the core deficits, given findings of poorer health-related quality of life in psychological, emotional, and social domains in children with ASD than children without ASD. One such area of functioning in which children with ASD have been found to experience impairments is that of emotion-processing. Emotion-processing encompasses the ability to recognize and understand others’ and one’s own emotional states, as well as to regulate one’s own emotional states and behaviour to attain a goal or to fit a context. Furthermore, research has found that impairments in emotion-regulation, particularly the regulation of negative emotions such as anger or sadness, often underlie clinical presentations of internalizing and externalizing difficulties. Given the heterogeneity in the severity of emotion-recognition and regulation deficits across groups of children with ASD as a function of cognitive ability, for the purposes of this thesis, the focus was on children with normative cognitive functioning (FSIQ ≥ 70), commonly referred to in the literature as children with high-functioning ASD. While the development of secure attachment relationships has consistently been linked to the ability to understand, express, and regulate emotion appropriately in typical development, the role of attachment in influencing emotion-processing in children with ASD is relatively unexplored. Furthermore, the majority of studies to date investigating the profile of the various organized attachment classifications (secure, insecure avoidant, and insecure ambivalent) in ASD populations have incorporated samples of toddlers and young children. Consequently, the profile and characteristics of organized secure and insecure attachments in middle childhood in ASD is currently unclear, although a small number of studies have begun to address this gap in the literature (eg. Bauminger, Solomon, & Rogers, 2010; Chandler & Dissanayake, 2013). The clarification of the nature of attachment relationships and their emotional correlates in ASD has the potential to drive a deeper understanding of the interplay of environmental and organic factors influencing emotion-processing difficulties and consequently, a more holistic approach to formulations and interventions for clinical presentations of these difficulties in school-aged children with ASD. Thus, the aims of this thesis were: 1.To investigate the profile of the various organized attachment classifications in children with ASD relative to typically-developing children during the middle childhood period. 2. To explore the role of attachment in emotion-processing in children with ASD during middle childhood. Specifically, the studies presented aimed to clarify the influence of organized attachment classifications and attachment relationships on the ability to recognise, understand, and regulate emotions. 3.To further consolidate the profile of emotion-processing deficits in children with ASD in middle childhood, through the investigation of emotion-recognition, emotion-regulation, theory of mind, and broader internalizing and externalizing difficulties seen in this group. Study 1 explored group differences on dimensional measures of attachment classifications, specifically attachment security, avoidance, and ambivalence, in an ASD sample and a typically-developing group similar on age and cognitive ability, as examined by self-report measures. This study also examined the relationships that organized attachment classifications had with emotion-recognition and theory of mind in each group, alongside the contribution of executive functioning ability, specifically working memory and inhibition, which have been found to be impaired in children with ASD. Study 2 explored the relationships that the various attachment classifications had with internalizing and externalizing symptomatology in children with ASD as well as in the typically-developing group. In Study 3, qualitative interviews of mothers of children with ASD were undertaken for an in-depth exploration of the role of attachment relationships in the regulation of negative emotion in ASD. The qualitative study examined the nature of attachment relationships in children with ASD beyond formal attachment classifications. Findings from Study 1 suggested that levels of attachment security, avoidance and ambivalence, as measured by self-report measures of formal attachment classifications, may be similar in children with high-functioning ASD relative to TD groups. Study 3 further complemented this finding by indicating that children with high-functioning ASD demonstrate similar distress-signalling and comfort-seeking behaviours to theoretical and empirical accounts of TD children within the mother-child attachment relationship. Nevertheless, the qualitative investigations in Study 3 also revealed a range of subtle characteristics of interaction within ASD dyads which may differentiate dynamics of attachment behaviour between ASD and TD groups when experiencing negative emotion, particularly relating to the child’s social and communicative difficulties in the context of signalling distress as well as seeking and responding to comfort within the mother- child attachment relationship. Findings from Study 1 of unimpaired performance on emotion-recognition and theory of mind tasks relative to the typically-developing group, together with correlations that executive functioning had with these measures, corroborates the current empirical notion that high-functioning groups with ASD may use compensatory cognitive strategies to pass structured, behavioural measures of emotion-processing. Consistent with the current literature, Study 2 found that children with ASD demonstrated higher rates of internalizing and externalizing symptomatology, while Study 3 indicated impairments in emotion-regulation, particularly in the experience of highly intense negative emotions, mood fluctuations, and poor frustration tolerance. Furthermore, a positive relationship between levels of attachment ambivalence and rule-breaking behavior was found in the ASD group in Study 2. Taken together, the current studies suggest that organized attachment orientations of security or insecurity may not be linked to performance on structured, behavioural measures of emotion-processing, but that attachment orientations, and more broadly, the dynamics of interaction within attachment relationships, may influence presentations of everyday emotional functioning, particularly, in the regulation of negative emotions as well as in clinical presentations of externalizing symptomatology. Findings from the collection of studies presented provide support for the role of attachment in emotion-regulation and broader emotional functioning in children with high-functioning ASD as seen in TD groups, and consequently, highlight the need for the further characterization of the interplay of factors influencing the relationship between attachment and emotion-processing in ASD. The use of qualitative methodologies exploring attachment relationships alongside measures of formal attachment classifications are warranted in order to capture the nuanced dynamics of attachment relationships in ASD dyads and consequently gain a deeper and more holistic understanding of the role of attachment in the everyday emotion-processing difficulties seen in ASD

Parent and clinician perspectives on the participation of children with cerebral palsy in community-based football: a qualitative exploration in a regional setting

The current study aimed to qualitatively explore parent and clinician perspectives on the factors influencing participation in a community-based Australian-Rules Football program for five to 12-year-old children with cerebral palsy (CP) in a regional setting. Six allied-health clinicians and two parents of children with CP participated in focus groups exploring factors influencing participation. Thematic analysis indicated seven key factors influencing participation—of which, six were environmental factors and one was related to child characteristics. Environmental factors included resources, communication, knowledge and previous experience, attitudes and expectations, game factors and community relevance. Child characteristics included age, preferences, confidence, as well and cognitive and physical functioning. Notwithstanding limitations, the current study highlights the central role of ‘people factors’ in the child’s environment, in facilitating participation in community-based physical activity

Problem behavior in autism spectrum disorder: considering core symptom severity and accompanying sleep disturbance

In addition to the core symptoms that define autism spectrum disorder (ASD), many individuals experience broader problem behavior at a level significant enough for families to seek further clinical assessment and intervention. We define “problem behavior” as any significant emotional or behavioral issue captured by the Child Behavior Checklist (CBCL) including anxiety, depression, withdrawal, somatic complaints, problems with socialization, thought or attention, rule-breaking, and aggression. While greater ASD symptom severity and accompanying sleep disturbance have each been linked with more severe problem behavior, there is little understanding about how these two key factors interact; that is, it is unclear whether the severity and type of sleep disturbance an individual experiences differentially influences the relationship between ASD symptom severity and problem behavior. The aim of the current study was, thus, to explore whether the link between greater ASD symptom severity and clinically elevated problem behavior is moderated by the presence/degree of accompanying sleep disturbance. Forty males with ASD, aged 5-12, participated in the study. The Social Responsiveness Scale, CBCL, and Children\u27s Sleep Habits Questionnaire were administered to obtain information about ASD symptom severity, problem behavior, and sleep habits, respectively. Results indicated that the relationship between ASD symptom severity and problem behavior differed among individuals with ASD depending on the degree of sleep disturbance they experienced. Specifically, there was a significant positive relationship between ASD symptom severity and problem behavior for individuals with no sleep disturbance or milder sleep disturbance (i.e., in these cases, individuals with severe ASD symptoms experienced clinically elevated problem behavior, while those with milder ASD symptoms experienced milder problem behavior). In contrast, there was no significant relationship between ASD symptom severity and problem behavior for individuals with moderate-to-severe sleep disturbance; rather, clinically significant problem behavior was apparent across all individuals irrespective of ASD symptom severity. Follow-up analyses indicated that disturbances in sleep duration, disordered breathing, and daytime sleepiness were related to clinically elevated problem behavior even among those with milder ASD symptoms. These findings emphasize the importance of routinely assessing for accompanying sleep disturbance in this population regardless of whether individuals present with mild, moderate, or severe ASD