Parent-child interactions and children with autism: A novel perspective

Transcription

1 Parent-child interactions and children with autism: A novel perspective Siva priya Santhanam Lynne E. Hewitt Bowling Green State University Bowling Green, OH ASHA Convention, November 2013

2 Disclosure Statement We have no financial or nonfinancial relationships relevant to the content of this presentation. 3/13/2014 2

3 Agenda Introduction: Parent-child interactions a transactional perspective Child-related factors that influence parents Activity Current day intervention practices Recommendations Wrap up Q & A 3/13/2014 3

4 Parent-child interactions A Transactional perspective Transaction when the characteristics of one individual affect the characteristics of another, or create a change in behavior in another, transaction is said to have occurred. (Sameroff & Chandler, 1975) 3/13/2014 4

5 Positive interactions positive outcomes 5. Child's communication develops 1. Child initiates communication 4. Parent becomes more responsive 2. Parent responds to child 3. Child responds to parental reactions

6 Parenting children with autism Interactional factors supporting language and social interaction in children with autism: Positive, warm, contingent, prompt, appropriate and consistent responses Haebig, McDuffie, & Weismer (2013) Kaiser & Roberts (2013) Parental language input that is synchronous to child s object focus or activity Siller and Sigman (2002, 2008) 3/13/2014 6

7 Parenting children with autism Factors potentially inhibiting parents from providing support: The nature of the disability presents demands that can be overwhelming for parents Ogsten, Mackintosh, & Myers (2011) Delay in developmental social, adaptive, cognitive, and communication skills, and presence of maladaptive behaviors e.g. Kasari & Sigman (1997); Irwin, Carter, Briggs- Gowan (2002) 3/13/2014 7

8 Historical perspective Early incorrect causative theories of parenting and ASD posited that parent behavior caused ASD Focus on parents, neglect of concept that parent-child relationship is reciprocal Parent influences child Child influences parent 3/13/2014 8

9 How does the child with autism affect the interaction? Parent mental health Parent selfefficacy Child with autism Parent physical health Parental responsiveness Parent-child interaction 3/13/2014 9

10 Child-related factors Problem behaviors Adaptive functioning Social interaction Communicative competence & joint engagement Attachment patterns Temperament 3/13/

11 Research evidence Elevated stress levels in parents of children with autism is associated with presence of maladaptive behaviors, limited social interaction and adaptive functioning skills e.g. Davis & Carter (2008); Dawson et al., (1998) Reduced parental responsiveness and reduced self-efficacy associated with lack of reciprocal social communication and/or limited communicative competence (Karst et al., 2012; Siller & Sigman, 2002, 2008) 3/13/

12 Attachment The affectional bond that is formed between parents and children Cassidy (1999) Attachment develops within the framework of parent-child interaction Secure attachment during early childhood predicts later developmental outcomes Thompson (1999). 3 types secure, insecure, and disorganized Ainsworth et al., (1978) 3/13/

13 Attachment in children with autism Difference in attachment security between children with and without autism only 5% greeted parents on reunion Bakermans-Kranenburg et al.,(2003) 40% of the children displayed secure attachment, and the remaining exhibited disorganized attachment Capps, Sigman, & Mundy (1994) 4 studies found low percentage of secure children with autism and 6 studies showed high proportion of secure attachment or no difference between comparison groups Rutgers et al.,(2004) 3/13/

14 Attachment cont. A meta-analysis of 16 studies Rutgers et al.,(2004) Children displayed less secure attachment patterns However, this was not the case for children with less severe symptoms or higher cognitive development 3/13/

15 Effects of children s attachment on parents Attachment patterns between children with autism and their parents is mixed. When children with autism have less severe symptoms, their attachment relationships with parents is secure. Severe ASD symptoms Less secure attachment patterns Negative impact on parent-child interactions 3/13/

16 Temperament Temperament is an initial state that leads to individual differences in behavior and links the manifesting behavior to underlying neural networks Rothbart (2007) Environmental influences on temperament have been proposed However, Children s temperament is an innate disposition that is biologically determined Rothbart & Bates (1988) 3/13/

17 Aspects of children s temperament Rothbart (2007) s classification 1. Effortful control 2. Negative affectivity 3. Extraversion/surgency A child s temperament influences parents responsiveness and interactions and in turn his/her own developmental outcomes. 3/13/

18 Temperament in children with autism Children with ASD have reduced affect extraversion, negative affect, and are difficult with effortful control Hepburn & Stone (2006) They demonstrate low adaptability and more distress in novel situations De Pauw et al., (2011) High negative affectivity and low effortful control observed in sample of 111 children with autism, per parent report Adamek et al., (2011) 3/13/

19 Effect of child temperament on parents Parents of children with ASD who have difficult temperaments demonstrate increased stress, low self-efficacy, and reduced responsiveness Bostrom, Broberg, & Bodin (2011); Leerkes & Crockenberg (2002) Parent-child interactions are negatively impacted Crockenburg (1981); Hoppes & Harris (1990) 3/13/

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21 Impact on parents By the time the child is 2 years old, there is a high degree of perceived negative impact on the parents Marcovich et al. (1987); Bostrom, Broberg, & Bodin (2011) The perceived negative impact continues as the child moves to adolescence Bishop et al., (2007); Carr & Lord, (2012) 3/13/

22 Activity Video 1 3/13/

23 Activity Video 2 3/13/

24 Current day intervention practices Parent training is a direct focus of some approaches to intervention for children with ASD e.g., Aldred, Green, & Adams (2004); Girolametto & Weitzman, (2006); Mahoney & Perales (2005); Yoder & Stone (2006) Interventions may indirectly attempt to modify caregiver behavior - include parent counseling or home-based generalization ideas 3/13/

25 Intervention practices cont. The negative impact created on parents even before the child receives intervention neglected Intervention programs for children with ASD must address how parenting a child with autism affects parent-child interactions Directly consider and address parent experience in planning interventions 3/13/

26 Recommendations More detailed models of child-parent interaction that capture the transactional perspective are needed Santhanam (in preparation) Intervention must consider parental effects on children, and children s influence on parental behaviors Mahoney & Nam (2011) 3/13/

27 Recommendations cont. Interview parents regarding available supports, coping strategies, and concerns before enrollment in intervention so that clinicians can address their needs. Design realistic goals for parents during intervention - consistent, active involvement. Measure parental outcomes in addition to measuring child outcomes following intervention. 3/13/

28 Recommendations cont. Incorporate assessments for temperament during evaluation such as the Carey Temperament Scale and/or the Children s Behavior Questionnaire. Take efforts to reduce parental stress and enhance self-efficacy by referring parents to seek support from allied professionals such as counseling psychologists. 3/13/

29 Recommendations, cont. Provide access to multiple sources of support for parents - Formal support groups that educate parents on learning effective coping strategies, and reducing the use of maladaptive coping strategies. - Online support groups or social forums (e.g. myautismteam.com) 3/13/

30 Thank you! 3/13/

31 References Bishop, S. L., Richler, J., Cain, A. C., & Lord, C. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorders. American Journal of Mental Retardation, 112(6), Bostrom, P. K., Broberg, M., & Bodin, L. (2011). Child's positive and negative impacts on parents- A person-oriented approach to understanding temperament in preschool children with intellectual disabilities. Research in Developmental Disabilities, 32, Capps, L., Sigman, M., & Mundy, P. (1994). Attachment security in children with autism. Development and Psychopathology, 6, Carr, T., & Lord, C. (2012). Longitudinal study of perceived negative impact in African American and Caucasian mothers of children with autism spectrum disorder. Autism, doi: / De Pauw, S. S., Mervielde, I., Van Leeuwen, K. G., & De Clercq, B. J. (2011). How temperament and personality contribute to maladjustments in children with autism. Journal of Autism and Developmental Disorders, 41, /13/

32 Girolametto, L., & Weitzman, E. (2006). It takes two to talk-the Hanen program for parents: early language intervention through caregiver training. In R. McCauley, & M. Fey (Eds.), Treatment of language disorders in children (pp ). Baltimore, MD: Paul H. Brookes Publishing Co. Hastings, R. P., & Brown, T. (2002). Behavior problems of children with autism, parental self-efficacy, and mental health. American Journal of Mental Retardation, 107(3), Haebig, E., McDuffie, A., & Weismer, S. E. (2013). The contribution of two categories of parent verbal responsiveness to later language for toddlers and preschoolers on the autism spectrum. American Journal of Speech- Language Pathology, 22, Hepburn, S. L., & Stone, W. L. (2006). Using Carey temperament scales to assess behavioral style in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model of intervention evaluation. Clinical Child and Family Psychological Review, 15, doi: /s /13/

33 Kaiser, A. P., & Roberts, M. Y. (2013). Parent-implemented Enhanced-Milieu- Teaching with preschool children who have intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56, Kasari, C., Sigman, M., Mundy, P., & Yirmiya, N. (1988). Caregiver interactions with autistic children. Journal of Abnormal Child Psychology, 16(1), Mahoney, G., & Nam, S. (2011). The parenting model of intervention. International Review of Research in Developmental Disabilities, Mahoney, G., & Perales, F. (2005). Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: A comparative study. Journal of Developmental and Behavioral Pediatrics, 26(2), Rothbart, M., & Bates, J. (1998). Temperament. In W. Damon, & N. Eisenberg (Eds.), Handbook of Child Psychology: Social, emotional, and personality development (Vol. III, pp ). New York: Wiley. Rutgers, A. H., Bakermams-Kranenburg, M. J., van IJzendoorn, M. H., & van Bercklear-Onnes, I. A. (2004). Autism and attachment: a meta-analytic review. Journal of Child Pscyhology and Psychiatry, 45(6), /13/

34 Sameroff, A. J., & Chandler, M. J. (1975). Reproductive risk and the continuum of caretaking casualty. In F. D. Horowitz, M. Hetherington, S. Scarr-Salapatek, & G. Siegel (Eds.), Review of Child Development Research (Vol. 4, pp ). Chicago, IL: The University of Chicago Press. Warren, S. F., & Brady, N. (2007). The role of maternal responsivity in the development of children with intellectual disabilities. Mental Retardation and Developmental Disabilities, 13, Yoder, P., & Stone, W. L. (2006). Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 74, /13/