Family accommodation of anxiety in a community sample of children on the autism spectrum

A preliminary study of factors associated with accommodation of obsessive-compulsive symptoms by romantic partners

OBJECTIVES

The accommodation of symptoms of obsessive-compulsive disorder (OCD) by loved ones is highly prevalent and impactful on treatment outcomes; however, little is known about factors that influence accommodation by romantic partners of OCD sufferers. The aim of this preliminary investigation was to explore such correlates.

METHODS

A community sample of 50 patients self-identifying with OCD (Mage = 29.3; SD = 9.3; 74% female) and 20 individuals self-identifying as the partner of someone with OCD (Mage = 32.1; SD = 12.4; 65% female) participated in this study via an online questionnaire.

RESULTS

Associations were found between partner accommodation of OCD and a range of obsessions and compulsions across the patient and partner samples, as well as patient-reported symptom severity, functional impairment and negative emotion states. Neuroticism was also positively associated with partner accommodation in the patient sample but did not contribute to its prediction over and above other known correlates of family accommodation. In the partner sample, extraversion was found to be a unique negative correlate of partner accommodation.

CONCLUSIONS

These findings highlight the vital role both patient and partner factors play in the accommodation of OCD behaviours by romantic partners and the importance of involving loved ones in the treatment of individuals with OCD.

The association between intolerance of uncertainty and psychological burden among caregivers of children with autism and the impact on their quality of life

Introduction

Caregivers of children with Autism Spectrum Disorder (ASD) often face significant stressors, including financial strain, social stigma, emotional exhaustion, and unpredictable daily routines. These challenges can severely impact their quality of life (QoL). This study aimed to examine the relationship between intolerance of uncertainty, caregiver burden, and QoL among caregivers of children with autism.

Methods

A cross-sectional study was conducted with 59 caregivers from six branches of the Obour Company for Human Development in Riyadh. Data were collected electronically using a sociodemographic data sheet, the Intolerance of Uncertainty Scale, the Zarit Burden Interview (short form), and the World Health Organization Quality of Life Scale (brief form).

Results

Findings revealed that two-thirds of caregivers experienced high to moderate levels of intolerance to uncertainty and a moderate burden, while 13.6% reported a high burden. Nearly 60% of participants reported low overall QoL, particularly in the psychological and social domains. A significant positive correlation was found between intolerance of uncertainty and caregiver burden. Additionally, significant negative associations were observed between QoL scores and both intolerance of uncertainty and caregiver burden, except in the environmental domain. Intolerance of uncertainty emerged as a significant inverse predictor of overall QoL.

Discussion

These results emphasize the psychological toll of caregiving for children with ASD. Interventions such as family- and community-based support programs and child behavioral training are essential to reduce caregiver burden and enhance QoL. Tailored services should be prioritized in clinical practice to support caregivers more effectively.

A Systematic Review of Family Accommodation in Autistic Youth: Anxiety Disorders, Obsessive-Compulsive Disorder, and Restricted and Repetitive Behaviors

Family accommodation (FA) is a term describing the change in behavior seen in parents and caregivers as they attempt to effect change in their child or adolescent's anxious behavior-usually by allowing avoidance, attempting distraction, or attempting to manage distress. FA has been well-documented in children and adolescents with anxiety and obsessive-compulsive disorders; however, there has been less summarized on the degree to which autistic youth and families engage in accommodation. This review aims to establish the phenomenology of FA in autistic youth related to comorbid anxiety, obsessive-compulsive disorders, and restricted and repetitive behaviors (RRBs). This review also aims to summarize how FA is currently addressed in treatment within this population. Using PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic youth, (b) there was a clearly delineated autism participant group, and (c) at least one quantitative outcome measure of FA was included. Seventeen articles were included in the review. Several themes emerged including (1) high rates of FA in autistic youth across OCD, anxiety, and RRBs, (2) some form of parental involvement in treatment, and (3) decreased rates of FA post-treatment. Overall, family accommodation appears to be present to at least the same degree, if not more so, in families of anxious autistic children and adolescents as their non-autistic but anxious counterparts. Family accommodation also often appears to be an important consideration with treatments for anxiety and OCD in autistic youth.

A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism

Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.

Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis

Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.

Development and Preliminary Validation of the Accommodations & Impact Scale for Developmental Disabilities

The lives of caregivers can be deeply impacted by having a child with a developmental disability (DD). To offset those impacts, caregivers may engage in accommodations, or strategies to bolster everyday functioning. The nature and extent of these accommodations can provide insight into how the family is doing and what supports are needed from a family-centered perspective. This paper presents the development and preliminary validation of the Accommodations & Impact Scale for Developmental Disabilities (AISDD). The AISDD is a rating scale that measures day-to-day accommodations and impacts of raising a child with a DD. A sample of 407 caregivers of youth with DDs (Mage = 11.7 years; 63% males) completed the AISDD, along with measures of caregiver strain, daily challenges, child adaptive behavior, and behavior and emotional regulation. The AISDD is a unidimensional, 19-item scale with excellent internal consistency (ordinal alpha = .93) and test-retest (ICC = .95) reliability. Scores were normally distributed and sensitive to age (r = - .19), diagnosis (ASD + ID > ASD > ID), adaptive functioning (r = - .35), and challenging behaviors (r = .57). Finally, the AISDD showed excellent convergent validity with similar measures of accommodations and impacts. These findings support the use of the AISDD as a valid and reliable tool for measuring accommodations among caregivers of individuals with DDs. This measure shows promise in its ability to identify which families may need additional support for their children.

Coping with uncertainty in everyday situations (CUES©) to address intolerance of uncertainty in autistic children: an intervention feasibility trial

BACKGROUND

Anxiety related to uncertainty is common in autism. Coping with Uncertainty in Everyday Situations (CUES©) is a parent-mediated group intervention aiming to increase autistic children's tolerance to uncertain situations. A pilot study was conducted to test its feasibility and acceptability.

METHODS

Parents of 50 autistic children were randomised to receive CUES© or enhanced services as usual.

RESULTS

All children met the clinical threshold for at least one anxiety disorder. Of the 26 participants randomised to CUES©, 72% attended 4-8 sessions. Parents and therapists reported they found CUES© useful and acceptable.

CONCLUSIONS

Families were willing to be recruited and randomised, the format/content was feasible to deliver, and the outcome measures were acceptable. CUES© should be evaluated in a clinical and cost effectiveness randomised controlled trial.

Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism

Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child's life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and severity and impact of their child's anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.

Factors and experiences that influence school mobility for autistic students: A systematic review

BACKGROUND

Autistic students are reported to move schools at a high rate, but little is understood about why this is happening. What is known is that the effects of school mobility can negatively impact both short- and long-term outcomes, particularly the child's learning, behaviours, mental health and school retention.

AIMS

The aim of this systematic review was to synthesize the research on factors and experiences which influence the family's decision to move their autistic child to another school.

METHODS

A protocol was registered with PROPERO (ID: CRD4202120794). Searches were conducted with ERIC, Scopus and Web of Science and seven studies were identified.

RESULTS

The studies focused on three main types of mobility: mainstream-to-mainstream school moves, moving between mainstream and segregated schools, and moving between mainstream and homeschool. Parents' concerns for their child's learning, social experiences and mental health, as well as their own interactions with their child's school, influenced the decision to leave. Whilst there were similarities across the studies for reasons to move, there were also differences based upon the settings between which students moved.

CONCLUSION

The findings highlight the need for further research across all school mobility types to better understand the reasons underpinning high rates of school mobility for autistic students.

Child and Parental Mental Health as Correlates of School Non-Attendance and School Refusal in Children on the Autism Spectrum

Children on the autism spectrum miss more school than their peers, but limited work has explored why this may be. This study aimed to document the frequency at which children on the autism spectrum miss half and full days of school and the reasons for these absences. Parents of 106 school-aged children on the autism spectrum completed online questionnaires on rates of school non-attendance, family factors, child anxiety, and parental mental health. On average across a four week period, children missed 6 full days of school. The most common reason for full-day absences was school refusal and for half-day absences was medical/therapy appointments. Parental employment status, increased child age, child anxiety, and differing aspects of parental mental health were identified as correlates of specific subtypes of school non-attendance.

Protocol for a longitudinal study investigating the role of anxiety on academic outcomes in children on the autism spectrum

BACKGROUND

Children on the autism spectrum are consistently reported to underachieve compared to ability. In typically developing children, anxiety is a strong predictor of poor school performance. Despite the high prevalence of anxiety disorders among children on the spectrum, the impact of their anxiety on academic achievement is under-researched. The main aim of this project is to determine the moderating role anxiety may have in the development of academic learning behaviours (academic enablers) in children on the spectrum. This project addresses a gap in knowledge about the possible associations between anxiety and academic achievement in children on the spectrum. Understanding these associations opens up the possibility of new intervention pathways to enhance academic outcomes through anxiety reduction/prevention.

METHODS

This longitudinal study will aim to recruit 64 children on the spectrum aged 4-5 years and their parents. Information will be gathered from children, parents and teachers. Children will be randomly assigned to one of two conditions in order to experimentally manipulate anxiety levels in the sample: experimental (to receive an anxiety reduction/prevention program, N = 32) or control (no intervention/treatment as usual, N = 32). The primary outcome measures are child academic skills and enabling behaviours assessed using the Academic Competence Evaluation Scales and the WIAT-II. Anxiety will be assessed through parent and teacher report. Assessments will be conducted at baseline, post-experimental manipulation of anxiety, and within the first year of formal schooling. It is hypothesised that anxiety will moderate the relationship between autism characteristics and academic enablers.

DISSEMINATION

Results will be disseminated through peer-reviewed manuscripts and conference presentations. Lay summaries will be provided to all participants and available on the research centre website.

Caregiver perspectives on the impact of uncertainty on the everyday lives of autistic children and their families

LAY ABSTRACT

Anxiety is common in autistic children. Research shows that this may be related to intolerance of uncertainty, which is a tendency to react negatively to uncertain situations. Understanding when, why and how autistic children respond to uncertainty is important in the development of anxiety programmes. We asked 53 (including 3 dyads) parents of autistic children about the types of uncertain situations that cause difficulties for their child and how uncertainty impacts on daily life for them and their families. We found that uncertain situations made autistic children and their families feel sad, worried, frustrated and angry through the themes: child's reactions to uncertainty, trying to reduce uncertainty, the impact of difficulties with uncertainty, the impact of uncertainty on parenting and the impact on parents. There are lots of situations that are anxiety provoking for autistic children because of uncertainty, such as school. Programmes to reduce anxiety and increase autistic children's ability to cope with everyday uncertain situations could improve quality of life for autistic children and their families.

The Impact of Anxiety in Children on the Autism Spectrum

The recognition of anxiety as one of the most commonly co-occurring diagnoses for individuals on the autism spectrum has led to increased research on symptomatology and treatment, but there is limited research documenting the impact of this anxiety. To address this, this study reports on the Child Anxiety Life Interference Scale (CALIS, parent version) in a community sample of 121 parents of children on the autism spectrum. Scores indicate that the anxiety is impacting upon the child's engagement in activities both in and outside of home as well as impacting upon parent life. Explanatory variables differed for CALIS subscales. As the child's difficulties with uncertainty and parent level of anxiety were the variables that explained the most variance, these may be important foci for effective interventions.

The Impact of Anxiety on the Participation of Children on the Autism Spectrum

Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6-13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children's participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.