Psychometric Properties of the Dutch Contextual Assessment of Social Skills (CASS): An Independent Observational Outcome Measure of Social Skills in Autistic Adolescents

The goal of this study was to translate and adapt the original 9-item of the Contextual Assessment of Social Skills (CASS) to a Dutch version and assess its psychometric qualities. Autistic adolescents aged 12 to 18 years (n = 99) took part in a randomized controlled trial. In this study, pre-intervention data were utilized. The original CASS was adapted to ensure cultural relevance and the content validity was assessed. Data was used to assess reliability and structural validity, using confirmatory factor analysis. 4-item were added to the CASS during the adaptation to better align with the objectives of the experimental intervention. The original 9-item had inter-item correlations between .01 and .70. The Cronbach's alpha for the original 4-item total score was moderate (α = .69), while for a 7-item total score, it was high (α = .86). This 7-item total score had a sufficient model fit (Comparative Fit Index = .90). This total score had a significant correlation with the Assertion subscale of the Social Skills Improvement System-Adolescent (SSIS-A) (r = 0.26, p < .01), and the Social Responsiveness Scale-2 (SRS-2) total score (r = - .21, p = .04) indicating sufficient convergent validity. The CASS total score was not correlated with the Repetitive and Restricted Behavior scale of the SRS-2 (r = - .08, p = .43), indicating sufficient divergent validity. The Dutch CASS can be considered a conceptually sound and reliable observational instrument for assessing social conversational skills in Dutch autistic youth. Further evaluation of its feasibility when implemented in practice, outside of clinical research, is needed.Trial registration: Dutch trail register NTR6255 (NL6117) 08/02/2017 https://www.trialregister.nl/trial/6117.

Conception and Development of the Warmth/Affection Coding System (WACS): A Novel Hybrid Behavioral Observational Tool for Assessing Parent-to-Child Warmth

A vast body of research and theory underscores the importance of parental warmth/affection (hereby 'warmth' and 'warmth/affection' are used interchangeably) as a distinct relational process that is fundamental to core developmental processes including parent-child attachment, socialization, emotion recognition and responsivity, and empathic development. The increasing focus on parental warmth as a viable transdiagnostic and specific treatment target for Callous-Unemotional (CU) traits highlights the critical need for a reliable and valid tool for measuring this construct within clinical contexts. However, existing assessment methods have limitations in their ecological validity, clinical utility, and the comprehensiveness of their coverage of core warmth subcomponents. In response to this clinical and research need, the observational Warmth/Affection Coding System (WACS) was developed to comprehensively measure parent-to-child warmth/affection. This paper chronicles the conception and development of the WACS, which adopts a hybrid approach of utilizing both microsocial and macro-observational coding methods to capture key verbal and non-verbal subcomponents of warmth that are currently underrepresented or poorly captured by existing assessment tools. Recommendations for implementation and future directions are also discussed.

Teachers' perception of aggressive student behavior through the lens of chronic worry and resignation, and its association with psychophysiological stress: An observational study

Aggressive student behavior is considered a leading risk factor for teacher stress. However, teachers' coping styles may affect how they perceive and respond to aggressive student behavior. This study tests whether teachers' perceptions of aggressive student behavior mainly mirror objectively observed aggression in presence of the teacher (as coded by external observers) or whether teachers' perception of aggressive student behavior primarily reflects teachers' avoidant coping styles, such as chronic worry and resignation. Finally, we examine whether observed and teacher-perceived aggression relates to increased vital exhaustion and psychophysiological stress among teachers (i.e., higher hair cortisol concentration). In an ambulatory assessment study, we administered self-reports to 42 Swiss teachers to assess perceived student aggression, chronic worry, resignation, and vital exhaustion. Additionally, four consecutive lessons per teacher were filmed, and aggressive student behavior in presence of the teacher was coded by four trained external observers. The concentration of cortisol was assessed in hair samples. Results showed that teacher-perceived and observed aggression were moderately associated. Observed aggression was related to teacher perceptions to a much lesser extent than teachers' avoidant coping styles, that is, chronic worry and resignation. While teacher-perceived student aggression was associated with teachers' self-reported vital exhaustion, we did not find any significant association with hair-cortisol concentration. Our findings suggest that teachers perceive student aggression through the lens of their coping styles. Teachers' dysfunctional coping styles are associated with an overestimation of student aggression. Teachers' overestimation of student aggression relates to higher levels of vital exhaustion. Therefore, it is crucial to identify and change teachers' dysfunctional coping styles to prevent a vicious cycle of dysfunctional teacher-student interactions.

Using Observational Dyadic Methods in Youth Mentoring Research: Preliminary Evidence of the Role of Actors' and Partners' Self-disclosure in Predicting Relationship Quality

Self-disclosure builds high quality relationships, but knowledge of self-disclosure in youth mentoring relationships is limited by a lack of research and reliance on self-reports. To demonstrate the value of observational methods and dyadic modeling of mentoring communication processes, this study examined the associations between behavioral observation of self-disclosure and self-reported relationship quality in 49 mentee-mentor dyads (mentees: 73.5% female; x̄ age = 16.2, range = 12-19; mentors: 69.4% female; x̄ age = 36.2, range = 19-59). Video-recorded observations of disclosure were coded on three dimensions: amount (number of topics and detail of disclosure), intimacy (disclosure of personal or sensitive information), and openness (willingness to disclose). More intimate mentor disclosure was associated with higher mentee relationship quality, whereas higher amount of mentor disclosure combined with low intimacy was associated with lower mentee relationship quality. Greater mentee openness correlated with higher mentor relationship quality, but more intimate mentee disclosures were associated with lower mentee relationship quality. These preliminary findings illustrate the potential of methods that enable in-depth investigation of dyadic processes to advance understanding of how behavioral processes may influence mentoring relationships.

A randomized controlled trial to examine the effectiveness of the Dutch version of the Program for the Education and Enrichment of Relational Skills (PEERS®)

BACKGROUND

This study examines the effectiveness of the culturally adapted Dutch version of The Program for the Education and Enrichment of Relational Skills (PEERS®), utilizing a randomized control trial (RCT) with an active treatment control condition.

METHODS

106 adolescents with ASD, aged 12-18 years, were randomly assigned to one of two group interventions: the experimental condition (PEERS®; n = 54) or the active treatment control condition (Regulation, Organization and Autonomy Didactics; ROAD; n = 52). Effects of interventions on social skills were primarily assessed using an observational measure (CASS - Contextual Assessment Social Skills). Secondary indices of social skills were self, parent and teacher reported questionnaire data (i.e., Social Responsiveness Scale; SRS, and Social Skills Improvement System; SSIS). Treatment satisfaction was also obtained from adolescents and their parents.

RESULTS

Results on the observational measure of social skills revealed improvements in positive affect, overall quality of rapport, as well as starting and ending a conversation, irrespective of condition. Compared to ROAD, PEERS® participants showed increased overall self-reported social skills (SSIS). Parent reports showed decreased overall social skill impairment (SRS) as well as improved social communication (SSIS subscale), with significantly more progress in the PEERS® group. Furthermore, parents of adolescents in the PEERS® group were significantly more satisfied with the intervention (M = 8.20, SD = 1.46) than parents of adolescents in the ROAD group (M = 7.52, SD = 1.45). The self-reported treatment satisfaction of adolescents did not differ between conditions. Teacher data showed decreased social skill impairment as measured with the SRS, irrespective of condition.

CONCLUSIONS

This study reveals promising indications that the Dutch version of PEERS® enhances social skills in adolescents with ASD. Yet, further research is needed into how effectiveness can be optimized.

TRIAL REGISTRATION

Dutch trail register NTR6255 (NL6117) 08/02/2017 https://www.trialregister.nl/trial/6117.

Behavioral drivers and observation of face covering use during the COVID-19 pandemic among outpatients and visitors at a tertiary hospital in Thailand

BACKGROUND

Use of face covering may help prevent COVID-19 transmission. However, there is a lack of data on behavioral drivers of face covering use and compliance to mandatory face covering policy at health facilities. This study aimed to describe behavioral drivers and observed face covering use among outpatients and visitors at a tertiary hospital in Southern Thailand during the COVID-19 pandemic.

MATERIALS AND METHODS

We conducted a hospital-based, cross-sectional study in June 2020. We developed, pilot-tested and finalized an interview questionnaire in Thai. We also developed a structured observation questionnaire. Two trained enumerators recruited outpatients and visitors at the hospital's internal medicine outpatient department (OPD), surgery OPD, and the pharmacy using the convenience sampling. Another enumerator conducted structured observation of face covering use among outpatients and visitors when interviews were not taking place. We analyzed the data using the descriptive statistics.

RESULTS

A total of 206 persons that our interview enumerators approached agreed to participate (n = 206; response rate = 62.4%). Nearly all participants stated that the use of face covering was beneficial in preventing COVID-19 infection from others and preventing others from being infected (94.0% and 98.0%, respectively). Common barriers included inconvenience in breathing and speaking (19.7%) and pain at the ears (9.6%). Structured observation of 408 outpatients and visitors showed that nearly everyone (>99%) had a face covering on their person, most of whom (94.6%) covered both their nose and mouth.

CONCLUSION

We found near-universal perceived benefits and compliance, but variations in perceived barriers, cues, and social norms for the use of face coverings. The findings of this study can inform future intervention programs on face covering use promotion.

Best practices for Electronically Activated Recorder (EAR) research: A practical guide to coding and processing EAR data

Since its introduction in 2001, the Electronically Activated Recorder (EAR) method has become an established and broadly used tool for the naturalistic observation of daily social behavior in clinical, health, personality, and social science research. Previous treatments of the method have focused primarily on its measurement approach (relative to other ecological assessment methods), research design considerations (e.g., sampling schemes, privacy considerations), and the properties of its data (i.e., reliability, validity, and added measurement value). However, the evolved procedures and practices related to arguably one of the most critical parts of EAR research-the coding process that converts the sampled raw ambient sounds into quantitative behavioral data for statistical analysis-so far have largely been communicated informally between EAR researchers. This article documents "best practices" for processing EAR data, which have been tested and refined in our research over the years. Our aim is to provide practical information on important topics such as the development of a coding system, the training and supervision of EAR coders, EAR data preparation and database optimization, the troubleshooting of common coding challenges, and coding considerations specific to diverse populations.

Feeding practices demonstrated by parents of toddlers: An observational analysis of breakfast, lunch, dinner, and snacks

The aims of the current study were to compare feeding practices and the eating environment (other people present, other people eating, and screen use) observed in families of toddlers across breakfast, lunch, dinner, and snacks. 60 families with toddlers (12-36 months; M = 24.7 months) video recorded all occasions over the course of a day when the toddler ate or drank. Videos were coded for a variety of feeding practices (e.g., prompts to eat, restriction), other people present and eating, and screen use. Prompts to eat were grouped into autonomy-supportive prompts (ASP) and coercive-controlling prompts (CCP). Results of the study showed different patterns of consistency between meals and snacks depending on the feeding practice examined. CCP were correlated across all eating occasions, including meals and snacks, but ASP, interference, and instruction were only correlated across the primary meals (all p-values < .05). ASP and praise were also more frequently demonstrated during the primary meals compared to snacks (p-values < .05). Parents also used more interference at dinner compared to both breakfast and snacks. Furthermore, mothers and siblings commonly ate with the toddler, especially during lunch and dinner, but family members infrequently ate with the child during snacks. The percentage of families using a screen was similar for breakfast (38%), lunch (39%), and dinner (33%), but slightly higher for snacks (47%). Together, the results of this study demonstrate notable differences in feeding practices and environmental factors during meals compared to snacks.

Maternal feeding practices and children's food intake during an ad libitum buffet meal: Results from the GUSTO cohort

Parents' feeding practices have been shown to be associated with children's food intake and weight status, but little is known about feeding practices in Asian countries. This study used behavioral observation to explore the feeding practices of 201 mothers of 4.5 year-old children in Singapore during an ad libitum buffet lunch. Feeding practices were coded from videos, focusing on behaviors used to prompt the child to eat more food (autonomy-supportive and coercive-controlling prompts to eat, suggesting items from buffet), those to reduce intake (restriction, questioning food choice), and those related to eating rate (hurrying or slowing child eating). Child outcome measures included energy consumed, variety of food items selected, and BMI. Maternal restriction and trying to slow child eating rate were associated with higher energy consumed by the child (r = 0.19 and 0.13, respectively; p < 0.05). Maternal autonomy-supportive prompts and restriction were associated with a greater variety of items selected by children (r = 0.19 and 0.15, respectively; p < 0.05). The frequency of maternal feeding practice use differed across ethnic groups, with Malay mothers using the most prompts to eat (p < 0.05), Chinese mothers most likely to question a child's food choice (p < 0.01), and Indian mothers the last likely to tell the child to eat faster (p < 0.001). There were no differences between ethnic groups for other feeding practices. No associations were found between feeding practices and child BMI. It is possible that feeding practices related to restriction and slowing child eating are adopted in response to children who consume larger portions, although longitudinal or intervention studies are needed to confirm the direction of this relationship and create local recommendations.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

Young adult couples' behavioral and physiological responses to the infant simulator: A preliminary illustration of coparenting

This exploratory application of the infant simulator with two couples is designed to illustrate individual reactivity and coparenting behaviors in young couples in serious relationships who do not yet have children. A 35-min protocol with standardized onsets and offsets of inconsolable baby cries was used to capture partner's individual behavioral and physiological responses as well as the couple's joint efforts to soothe the crying baby. Task feasibility was demonstrated by couples' persistent and wide-ranging efforts to calm the baby including rocking, feeding, changing, talking to the baby, and singing. Within-person fluctuations in ongoing heart rate (HR) and electrodermal activity (EDA) through the protocol suggested evidence of heightened physiological reactivity during baby crying compared to silence. During bouts of crying, higher HR also was evidenced when participants took the lead in caregiving as contrasted with assisting or busying themselves in another task. Behavioral observations indicated that this task elicited examples of coparenting behaviors including cooperation, support, undermining, and negotiating the division of labor. These preliminary pilot data demonstrate the potential of infant simulator paradigms with couples who are not yet pregnant but envision being future parents, and set the stage for future research to identify how individual and couple characteristics might impact reactions to shared baby caregiving.

Reliable and Valid Coding of Thin Slices of Video Footage: Applicability to the Assessment of Mother-Child Interactions

When using behavioral-observation methods for coding video footage, it is unknown how much time of an interaction needs to be coded to gain results that are representative for the behavior of interest. The current study examined this problem using the INTAKT, a standardized observational measure for assessing the quality of mother-child interactions. Results from coding only 10 min of each video (i.e., thin slices) were compared with results from coding the remaining parts (averaging about 40 min) of the interaction. Inter-rater agreement for the short versions taken from the beginning or the middle, but not the end of the interactions indicated satisfactory observer accuracy. Coding results did not differ between short and long video sequences, when sequences were taken from the middle of the interactions. Importantly, characteristic differences between different interactive situations were equally well represented in the short and long video sequences. Therefore, our results show that coding only 10 min of an interaction is as reliable and valid as coding full-length videos, if those short sequences are taken from the middle of an interaction. Our findings support the idea that for every method, it is necessary to individually determine the window duration that is long enough to gain results that are reliable and valid.

Liver X receptor-β improves autism symptoms via downregulation of β-amyloid expression in cortical neurons

Background

We study the effect of liver X receptor β (LXRβ) on β-amyloid (Aβ) peptide generation and autism behaviors by conducting an animal experiment.

Methods

In autistic mice treated with LXRβ agonist T0901317, enzyme linked immunosorbent assay was used to measure Aβ in brain tissue homogenates. Western blot was used to detect Aβ precursors, Aβ degradation and secretase enzymes, and expression of autophagy-related proteins and Ras/Raf/Erkl/2 signaling pathway proteins in brain tissue. Changes in autism spectrum disorder syndromes of the BTBR mice were compared before and after T0901317 treatment.

Results

Compared with the control group, autistic mice treated with LXRβ agonist T0901317 showed significantly lower Aβ level in brain tissue (P < 0.05), significantly higher Aβ degradation enzyme (NEP, IDE proteins) levels (all P < 0.05), significantly lower Aβ secretase enzyme BACE1 protein level (P < 0.05), and significantly lower Ras, P-C-Raf, C-Raf, P-Mekl/2, P-Erkl/2 protein levels (all P < 0.05). BTBR mice treated with T0901317 showed improvements in repetitive stereotyped behavior, inactivity, wall-facing standing time, self-combing time and center stay time, stayed longer in platform quadrant, and crossed the platform more frequently (all P < 0.05).

Conclusions

LXRβ could potentially reduce brain Aβ generation by inhibiting Aβ production and promoting Aβ degradation, thereby increasing the expression of autophagy-related proteins, reducing Ras/Raf/Erkl/2 signaling pathway proteins, and improving autism behaviors.

Prompts to eat novel and familiar fruits and vegetables in families with 1-3 year-old children: Relationships with food acceptance and intake

Toddlers often go through a picky eating phase, which can make it difficult to introduce new foods into the diet. A better understanding of how parents' prompts to eat fruits and vegetables are related to children's intake of these foods will help promote healthy eating habits. 60 families recorded all toddler meals over one day, plus a meal in which parents introduced a novel fruit/vegetable to the child. Videos were coded for parent and child behaviors. Parents completed a feeding style questionnaire and three 24-h dietary recalls about their children's intake. Parents made, on average, 48 prompts for their children to eat more during the main meals in a typical day, mostly of the neutral type. Authoritarian parents made the most prompts, and used pressure the most often. In the novel food situation, it took an average of 2.5 prompts before the child tasted the new food. The most immediately successful prompt for regular meals across food types was modeling. There was a trend for using another food as a reward to work less well than a neutral prompt for encouraging children to try a novel fruit or vegetable. More frequent prompts to eat fruits and vegetables during typical meals were associated with higher overall intake of these food groups. More prompts for children to try a novel vegetable was associated with higher overall vegetable intake, but this pattern was not seen for fruits, suggesting that vegetable variety may be more strongly associated with intake. Children who ate the most vegetables had parents who used more "reasoning" prompts, which may have become an internalized motivation to eat these foods, but this needs to be tested explicitly using longer-term longitudinal studies.

Contextual variation in young children's observed disruptive behavior on the DB-DOS: implications for early identification

BACKGROUND

Contextual variation in child disruptive behavior is well documented but remains poorly understood. We first examine how variation in observed disruptive behavior across interactional contexts is associated with maternal reports of contextual variation in oppositional-defiant behavior and functional impairment. Second, we test whether child inhibitory control explains the magnitude of contextual variation in observed disruptive behavior.

METHODS

Participants are 497 young children (mean age = 4 years, 11 months) from a subsample of the MAPS, a sociodemographically diverse pediatric sample, enriched for risk of disruptive behavior. Observed anger modulation and behavioral regulation problems were coded on the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) during interactions with parent and examiner. Oppositional-defiant behavior, and impairment in relationships, with parents and nonparental adults, were measured with the Preschool Age Psychiatric Assessment (PAPA) interview with the mother. Functional impairment in the home and out-and-about was assessed with the Family Life Impairment Scale (FLIS), and expulsion from child care/school was measured with the baseline survey and FLIS.

RESULTS

Observed disruptive behavior on the DB-DOS Parent Context was associated with oppositional-defiant behavior with parents, and with impairment at home and out-and-about. Observed disruptive behavior with the Examiner was associated with oppositional-defiant behavior with both parents and nonparental adults, impairment in relationships with nonparental adults, and child care/school expulsion. Differences in observed disruptive behavior in the Parent versus Examiner Contexts was related to the differences in maternal reports of oppositional-defiant behavior with parents versus nonparental adults. Children with larger decreases in disruptive behavior from Parent to Examiner Context had better inhibitory control and fewer attention-deficit/hyperactivity disorder symptoms.

CONCLUSIONS

The DB-DOS showed clinical utility in a community sample for identifying contextual variation that maps onto reported oppositional-defiant behavior and functioning across contexts. Elucidating the implications of contextual variation for early identification and targeted prevention is an important area for future research.

Who reports it best? A comparison between parent-report, self-report, and the real life social behaviors of adults with Williams syndrome

Given the reliance on self-report in studies of adults with intellectual disabilities, this study examined individual vs. parental reports concerning the social approach behaviors of adults with Williams syndrome (WS) across a hypothetical and a live behavioral setting. Individuals with WS (N = 30) were asked whether they would approach strangers in two hypothetical, laboratory tasks (yes/no questionnaire vs. judging facial stimuli of individuals with different emotional expressions). Similarly, their parents also responded to a rating scale of their child's social approach behavior toward strangers displaying various emotions. Then, in a community setting, behavioral coders recorded actual social approaches of individuals with WS toward strangers. Although self-report ratings were consistent across measures, these measures did not correspond to the individuals' actual behaviors during the community observations. Conversely, parental reports did not correspond to their child's self-report measures, but parents did more accurately predict their child's real-life social approach behaviors. Implications are discussed for both research and practice.

Rett syndrome: a preliminary analysis of stereotypy, stress, and negative affect

Rett syndrome (RTT) is a neurodevelopmental disorder primarily affecting females. It is characterized by apparently normative development of motor and communicative abilities followed by deterioration in these domains. Stereotypic hand movements are one of the core diagnostic criteria for RTT. There is some anecdotal but limited scientific evidence that changes in hand stereotypy may be a sign of increased anxiety or arousal (i.e., a 'stress response') in RTT. Understanding stress responsivity is difficult in RTT because almost all individuals are nonverbal or otherwise severely communicatively impaired. This study used direct behavioral observation to quantify and compare the frequency of hand stereotypy and signs of negative affect during presumed periods of high and low stress associated with functional analysis conditions (negative reinforcement ['escape'] and control ['free play'], respectively) for 5 females with RTT (mean age=17.8; range 4-47). Negative affect was more likely to occur during negative reinforcement ('stress') conditions for each participant whereas hand stereotypies did not differ across conditions for any of the participants. Although preliminary, the results suggest that hand stereotypy may not be a valid behavioral 'stress-response' indicator in females with RTT. Alternatively, the approach we used may have been limited and not sufficient to evoke a stress response. Either way, more work with direct relevance to improving our understanding of hand stereotypy and anxiety in RTT in relation to social context appears warranted.