Parenting Practices and Externalizing Behaviors in Autistic Children: A Systematic Literature Review

There is limited recent research on the association between parenting practices and externalizing behaviors in autistic children. To address this gap, the current systematic review examined the associations between parenting practices and externalizing behaviors in autistic children, along with the mediating and moderating effects of parent and child variables (PROSPERO registration number CRD42022268667). Study inclusion criteria were (1) Peer-reviewed journals, (2) Participants included parents of autistic children and their children, (3) Quantitative measures of both parenting practices or behaviors/style and child externalizing behaviors, (4) Cross-sectional or longitudinal studies only, and (5) Studies published in English. Study exclusion criteria were: (1) Qualitative studies, (2) Published in a language other than English, (3) Participants included non-human participants, (4) Participants that did not include parents and their autistic children as participants or did not report this group separately, (5) Systematic review and meta-analyses, and (6) No quantitative measures of parenting practices and/or child externalizing behaviors. Quality appraisal and risk of bias were conducted using the McMaster Tool and results were synthesized in Covidence and Excel. Thirty studies were included in the review. Results demonstrated that mindful parenting was associated with fewer or lower levels of externalizing behaviors; positive parenting practices had non-significant associations with externalizing behaviors; specific parenting practices had differing associations with externalizing behaviors; and negative parenting practices were associated with higher levels of externalizing behaviors. We are unable to draw causal relationships due to focus on cross-sectional and longitudinal articles only. The potential for future research to target specific parent practices to support children's externalizing behaviors is discussed.

The protective value of trait mindfulness for mothers' anxiety during the perinatal period

OBJECTIVES

Anxiety is highly prevalent in the perinatal period and can have negative consequences for the mother and the child. Extensive research has been done on risk factors for anxiety during the perinatal period, but less is known about protective factors. The current study aims to determine the relative contribution of trait mindfulness as a protective factor for anxiety.

METHODS

A longitudinal study design was used, with four measurement points: 12, 22, and 32 weeks of pregnancy (T0, T1, and T2, respectively), and 6 weeks postpartum (T3). General anxiety was measured at T1, T2, and T3, pregnancy-specific distress was measured at T1 and T2, mindfulness facets (acting with awareness, non-reacting, and non-judging) and partner involvement were measured at T1, and other known risk factors for anxiety were measured at T0. Multilevel regression models were used for statistical analyses.

RESULTS

Mindfulness facets measured at T1 were negatively associated with anxiety at T1, T2, and T3, and pregnancy-specific distress at T1 and T2. Of the mindfulness facets, non-judging was shown to have the largest protective effect against anxiety and pregnancy-specific distress. Also compared to partner-involvement and known risk factors, non-judging showed the largest effect on anxiety and pregnancy-specific distress.

CONCLUSIONS

For pregnant women who are at risk for developing or experiencing high levels of anxiety, it may be beneficial to participate in a mindfulness training with special attention for the attitudinal aspects of mindfulness.

A brief online mindful parenting program: Feasibility and initial effects pilot in a community sample

Mindful parenting programs are effective in reducing parenting stress. More efficient offerings may increase accessibility. The current single case study aimed to determine the feasibility, acceptability and initial effects of a brief, online mindful parenting program. Six parents, recruited from the community, completed a 4-week online mindful parenting program (Two Hearts). Feasibility and acceptability were assessed by participant program evaluation, retention, engagement with program materials (i.e., videos), and home practice. Parents completed primary outcome measurements of parenting stress, and general distress, at pre- and post-intervention, and 4-week follow-up. Individual level reliable change index and clinically significant change were calculated for outcome measures. All parents were retained through the study; all participants reported obtaining something of lasting value from the training. Program adherence varied over time. At post-intervention, four parents reported 40-50 minutes practice per week; two parents reported 10-15 minutes practice per week. At follow-up, 50% of parents reported 30-50 minutes practice per week. Three parents showed a reliable reduction in parenting stress; two of these parents demonstrated clinically significant change. Improvements in parent general distress were indicated in half the sample. Two parents experienced a clinically significant increase in parenting stress and/or general distress. In conclusion, the Two Hearts program demonstrated good acceptability, and may be a feasible and effective program for some parents. Program adherence and dosage require further investigation. The role of acute stressors (e.g., COVID-19) must be also considered.

Are failures to suppress obsessive-intrusive thoughts associated with working memory?

BACKGROUND AND OBJECTIVES

Obsessive compulsive disorder (OCD) is characterised by repeated attempts to suppress obsessive-intrusive thoughts (OITs). Nonclinical individuals also regularly engage in thought suppression. Attempts to suppress OITs are often unsuccessful and there is wide variation in suppression abilities across nonclinical and clinical samples. Understanding the mechanisms that explain variations in suppression abilities could enhance our understanding of OCD. This study aimed to investigate one potential mechanism - working memory - using a comprehensive thought suppression task.

METHODS

Eighty-three nonclinical participants completed a computerized thought dismissibility task (in which they replaced an obsessive-intrusive thought with a neutral thought), and a computerized working memory task. Participants also completed measures of OCD and negative mood.

RESULTS

None of the suppression variables (OIT frequency, mean OIT duration, mean latency to return, total OIT duration) were correlated with working memory capacity. Obsessive-compulsive symptoms were correlated with total OIT duration, but the relationship was not significant after controlling for negative mood.

LIMITATIONS

The thought dismissibility task does not account for differences in motivation to suppress OITs. The sample was non-clinical and mostly female.

CONCLUSION

An individual's ability to suppress OITs is not associated with their working memory capacity, suggesting poor working memory does not explain persistent OITs in individuals with OCD.

Mindfulness interventions in schools: Integrity and feasibility of implementation

Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qualitative designs. The results draw comparison across the identified MBIs in relation to intervention integrity, and teacher training and competence according to existing standards. The findings indicate a poor alignment to all standards; for example, intervention integrity was indicated in 45% of studies that included core mindfulness practices, and standards of teacher training were met in 26% of studies. In addition, the feasibility design of studies is critiqued against recommended standards. Despite claims from many studies, feasibility has not yet been established for school settings. Feasibility studies have failed to adequately assess organizational factors that influence implementation. The lack of detail and consistency in reporting across studies is a particular limitation of the field of research, which may have disadvantaged the assessment of studies against stringent guidelines. The ongoing challenges to developing an evidence base for school-based MBIs as well as to implementation are discussed. Recommendations for future directions in implementation science of mindfulness interventions within a school context are provided.

A systematic review of the role of parents in the development of anxious cognitions in children

Anxious cognitions and parental behavior are important in the development of child anxiety. The current review aims to appraise the literature on the relationship between parental factors and chid anxious cognitions. Online database searches of PsycInfo, Scopus, ProQuest Dissertations and Web of Science were systematically searched using key terms related to 'parent', 'child', 'anxiety' and 'cognitions'. Included studies (N = 13) were quality assessed and study findings were appraised in line with cognitive behavioral frameworks of the parental pathways to the development of anxious cognitions in children. Reviewed studies confirmed that parental factors have a role in the development of their children's anxious cognitions by modelling fearful responses, reducing their child's autonomy, and indirectly via their own expectations about their child. Limitations of the literature are considered, including issues of measurement. Future research should consider multi-modal assessment of parental factors and examine parental behavior and child anxious cognitions in the context of real-life threatening events.

The Role of Experiential Avoidance and Parental Control in the Association Between Parent and Child Anxiety

Parenting behavior and practices contribute to the intergenerational relationship between parent and child anxiety, with parental control being a consistent predictor of child anxiety. Parental experiential avoidance refers to how a parent copes with their internal world in the context of parenting. Little is known about how this relatively new parenting concept relates to child anxiety. The current study tested the indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance; the indirect effect of parent anxiety on parental control through parental experiential avoidance; and the moderating effect of parental experiential avoidance on the relationship between parental control and child anxiety. Using a cross-sectional design, parents (N = 85) from a community sample of 8–12-year-old children self-reported on a survey measuring parent anxiety, child anxiety, parental control, and parental experiential avoidance. A hierarchical regression indicated that parental experiential avoidance significantly predicted child anxiety and accounted for further variance in child anxiety, over, and above parental control. There was an indirect effect of parent anxiety on child anxiety through parental control and parental experiential avoidance. Parental experiential avoidance moderated the relationship between parental control and child anxiety, such that the relationship was only significant at high levels of parental experiential avoidance. The current study provides support for the role of parental experiential avoidance in an intergenerational understanding of anxiety. Future research should replicate the study with a clinical sample. Theoretical and practice implications are considered.

Self-compassion Improves Parental Well-being in Response to Challenging Parenting Events

Shame and guilt are common during the course of parenting and can reflect feelings of "bad self "and "bad behaviour" in relation to parenting events. Self-compassion is known to be beneficial for well-being by reducing negative emotions, yet there is little research examining whether self-compassion might reduce parental guilt and shame. The current study examined the effects of dispositional and induced self-compassion on guilt and shame in a sample of 167 parents (Mage = 37.23, SD = 6.73, 83.1% female) of children ≤12 years recruited online. After completing baseline measures, parents were randomly assigned to recall a guilt versus shame provoking parenting event, and randomly allocated to either a self-compassion prompt versus a control condition. Analyses confirmed that those who received the self-compassion prompt reported higher levels of self-compassion, and reduced feelings of guilt and shame compared to the control group. Effects did not differ as a function of the guilt versus shame instructions. Multivariate analyses revealed that, when controlling for dispositional self-compassion, and baseline guilt and shame, differences between conditions were maintained for post-manipulation guilt and shame. Findings extend our understanding of the role of self-compassion for improving well-being when dealing with the challenges of parenting.

A systematic review of self-report measures of paranoia

Paranoia can be conceptualized as consisting of a hierarchy of cognitions, ranging from commonly experienced thoughts about less severe perceived threats, up to less common, persecutory thoughts about extreme threats, which are associated with distressing psychosis. This review systematically appraises self-report paranoia questionnaires validated for use among the general population; the type of paranoia assessed, measurement or psychometric properties, and subsequent validation with clinical samples are all considered. A systematic literature search was performed using PubMed, Web of Science, and PsycINFO databases. Study methodologies and measurement properties were evaluated according to COnsenus-based Standards for the selection of health-based Measurement Instruments (Mokkink et al., 2012). Twenty-six studies, describing the validation of nine paranoia-related questionnaires, were identified. Questionnaires were reviewed in relation to the hierarchy of paranoia; with 2 questionnaires assessing "low-level" paranoia, 4 assessing persecutory thoughts, and the remainder assessing paranoia across this continua. Questionnaires assessing the full hierarchy of paranoid thoughts, alongside associated dimensions such as preoccupation, conviction, and distress, offer the most comprehensive assessment of paranoia in both nonclinical and clinical populations. Of the measures which do this, the Green et al. (2008) Paranoid Thoughts Scale had the strongest evidence for its measurement properties and is, therefore, recommended as the most reliable and valid self-report assessment of paranoia currently available. However, this review illustrated that generally paranoia questionnaires lack high quality evidence for their measurement properties. Implications of these findings for clinical practice and research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Testing for an Effect of a Mindfulness Induction on Child Executive Functions

Several sessions of mindfulness practice can exert positive gains for child executive functions (EF); however, the evidence for effects of a mindfulness induction, on EF for adults, is mixed and this effect has not been tested in children. The immediate effect of an age appropriate 3-min mindfulness induction on EF of children aged 4-7 years was tested. Participants (N = 156) were randomly assigned to a mindfulness induction or dot-to-dot activity comparison group before completing four measures of EF. A composite score for EF was calculated from summed z scores of the four EF measures. A difference at baseline in behavioural difficulties between the mindfulness induction and comparison group meant that data was analysed using a hierarchical regression. The mindfulness induction resulted in higher average performance for the composite EF score (M = 0.12) compared to the comparison group (M = - 0.05). Behavioural difficulties significantly predicted 5.3% of the variance in EF performance but participation in the mindfulness or comparison induction did not significantly affect EF. The non-significant effect of a mindfulness induction to exert immediate effects on EF fits within broader evidence reporting mixed effects when similar experimental designs have been used with adults. The findings are discussed with consideration of the extent to which methodological differences may account for these mixed effects and how mindfulness inductions fit within broader theoretical and empirical understanding of the effects of mindfulness on EF.

Which Facets of Mindfulness Protect Individuals from the Negative Experiences of Obsessive Intrusive Thoughts?

Obsessive intrusive thoughts (OITs) are experienced by the majority of the general population, and in their more extreme forms are characteristic of obsessive–compulsive disorder (OCD). These cognitions are said to exist on a continuum that includes differences in their frequency and associated distress. The key factors that contribute to an increased frequency and distress are how the individual appraises and responds to the OIT. Facets of mindfulness, such as nonjudgment and nonreactivity, offer an alternative approach to OITs than the negative appraisals and commonly utilised control strategies that often contribute to distress. Clarifying the role of facets of mindfulness in relation to these cognitions offers a means to elucidate individual characteristics that may offer protection from distress associated with OITs. A sample of nonclinical individuals (n = 583) completed an online survey that assessed their experiences of OITs, including frequency, emotional reaction and appraisals, and trait mindfulness. The findings from a series of multiple regression analyses confirmed that specific facets of mindfulness relating to acting with awareness and acceptance (nonjudgment and nonreactivity) consistently predicted less frequent and distressing experiences of OITs. In contrast, the observe facet emerged as a consistent predictor of negative experiences of OITs. These findings suggest that acting with awareness and acceptance may confer protective characteristics in relation to OITs, but that the observe facet may reflect a hypervigilance to OITs. Mindfulness-based prevention and intervention for OCD should be tailored to take account of the potential differential effects of increasing specific facets of mindfulness.

The Relationship Between Adult Attachment Orientation and Mindfulness: a Systematic Review and Meta-analysis

Mindfulness can be measured as an individual trait, which varies between individuals. In recent years, research has investigated the overlap between trait mindfulness and attachment. The aim of the present review and meta-analysis was to investigate the current evidence linking adult attachment dimensions to trait mindfulness dimensions, and to quantitatively synthesize these findings using meta-analyses. A systematic literature search was conducted using five scientific databases of which, upon review, 33 articles met inclusion criteria. Inclusion criteria were peer-reviewed journals and dissertations published in English that relied on quantitative methods using reliable and validated self-report measures where study participants were aged 16 years and older. Random-effects model meta-analytic procedures were used to investigate the relationship between both constructs. Cross-sectional studies found significant negative correlations between adult attachment insecurity, on either dimension (anxiety or avoidance) and both total mindfulness score and all five sub-dimensions of mindfulness (act with awareness, observe, describe, non-reacting, and non-judging), with the exception of a non-significant positive correlation between attachment anxiety and observe. The effect size of the relationships ranged from small to medium. The overall mean effect sizes were moderate (anxiety, r+ = .34; avoidance, r+ = -.28), with both attachment dimensions associated with lower levels of total mindfulness. Results are discussed in relation to theory and research. Implications for future research include the need to utilize longitudinal design to address causality and mechanisms of the relationship between these constructs.

Teaching Mindfulness to Teachers: a Systematic Review and Narrative Synthesis

School teachers report high levels of stress which impact on their engagement with pupils and effectiveness as a teacher. Early intervention or prevention approaches may support teachers to develop positive coping and reduce the experience and impact of stress. This article reviews research on one such approach: mindfulness-based interventions (MBIs) for school teachers. A systematic review and narrative synthesis were conducted for quantitative and qualitative studies that report the effects of MBIs for teachers of children aged 5–18 years on symptoms of stress and emotion regulation and self-efficacy. Twelve independent publications were identified meeting the inclusion criteria and these gave a total of 13 samples. Quality appraisal of the identified articles was carried out. The effect sizes and proportion of significant findings are reported for relevant outcomes. The quality of the literature varied, with main strengths in reporting study details, and weaknesses including sample size considerations. A range of MBIs were employed across the literature, ranging in contact hours and aims. MBIs showed strongest promise for intermediary effects on teacher emotion regulation. The results of the review are discussed in the context of a model of teacher stress. Teacher social and emotional competence has implications for pupil wellbeing through teacher–pupil relationships and effective management of the classroom. The implications for practice and research are considered.

Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions

BACKGROUND

Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD.

METHOD

Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed.

RESULTS

The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'.

CONCLUSIONS

The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.

Corrigendum: Social Daydreaming and Adjustment: An Experience-Sampling Study of Socio-Emotional Adaptation During a Life Transition

[This corrects the article on p. 13 in vol. 7, PMID: 26834685.].

Social Daydreaming and Adjustment: An Experience-Sampling Study of Socio-Emotional Adaptation During a Life Transition

Estimates suggest that up to half of waking life is spent daydreaming; that is, engaged in thought that is independent of, and unrelated to, one’s current task. Emerging research indicates that daydreams are predominately social suggesting that daydreams may serve socio-emotional functions. Here we explore the functional role of social daydreaming for socio-emotional adjustment during an important and stressful life transition (the transition to university) using experience-sampling with 103 participants over 28 days. Over time, social daydreams increased in their positive characteristics and positive emotional outcomes; specifically, participants reported that their daydreams made them feel more socially connected and less lonely, and that the content of their daydreams became less fanciful and involved higher quality relationships. These characteristics then predicted less loneliness at the end of the study, which, in turn was associated with greater social adaptation to university. Feelings of connection resulting from social daydreams were also associated with less emotional inertia in participants who reported being less socially adapted to university. Findings indicate that social daydreaming is functional for promoting socio-emotional adjustment to an important life event. We highlight the need to consider the social content of stimulus-independent cognitions, their characteristics, and patterns of change, to specify how social thoughts enable socio-emotional adaptation.

Helping the heart grow fonder during absence: Daydreaming about significant others replenishes connectedness after induced loneliness

People are known to engage in behaviours aimed at replenishing social connectedness after their sense of belonging is threatened. We explored whether the mental strategy of daydreaming about significant others could have similar effects by acting as an imaginary substitute when loved ones are unavailable. Following a loneliness induction, participants (N = 126) were asked to either daydream about a significant other, daydream about a non-social scenario or complete a control task. Social daydreamers showed significantly increased feelings of connection, love and belonging compared to non-social daydreamers and control participants. Consistent with the proposition that social daydreaming replenished connectedness, social daydreamers also behaved more pro-socially and expressed less of a desire to interact with others after daydreaming. These findings demonstrate that through imagination, social daydreaming can replenish connectedness providing a potential strategy for enhancing socio-emotional well-being.