Behavioral Functioning Research Articles

Loneliness or Solitude: Which Will We Experience?

Loneliness, social isolation, aloneness, and solitude are frequently used interchangeably but are actually different. Loneliness is particularly salient now, due to the international restrictions on social activities imposed as a result of COVID-19, which brought loneliness into open discussion worldwide. The article highlights loneliness as a multidimensional construct and reviews its impact on cognitive, behavioral and affective functioning. In doing so, particular attention is given to loneliness as it manifests through the various life stages, as well as how personal predisposition and contextual factors may exacerbate it. in this article we also review solitude, and a clear distinction between loneliness and solitude is established. Finally, we conclude by addressing the global claims of loneliness during the pandemic and its implications. We offer a point of view which may assist in coping with it.

Perceived Effectiveness of Components of Interventions to Support People Bereaved By Suicide.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Self-perceptions of aging predict adjustment during the COVID-19 pandemic.

Individuals faced extraordinary challenges during the COVID-19 pandemic. However, psychosocial strengths may promote individuals' adjustment during times of challenge. Positive self-perceptions of aging (SPA) have been found to predict a variety of health and well-being indicators outside the context of the pandemic. In the present study, we examined SPA (measured prior to the pandemic) as a prospective predictor of COVID-19-related behavior, adaptation, and functioning in a sample of 3,620 adults (Mage = 65.88; 61.1% women; 65.4% White) from the 2016 to 2020 waves of the Health and Retirement Study. Linear regressions revealed that more positive SPA in 2016 were associated with a higher likelihood of socially distanced behavior (β = .07, p < .001), less worry (β = -.27, p < .001), less stress (β = -.24, p < .001), less loneliness (β = -.27, p < .001), and greater positive functioning (β = .20, p < .001) during the first year of the pandemic (2020). Confounding variables explained SPA's associations with preventive behavior and (to an extent) socially distanced behavior. Findings support SPA theories, suggesting linkages between SPA and flexible, adaptive behaviors and outcomes in the face of external challenges. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The influence of sibling relationship quality on the social, emotional, and behavioral functioning of children and adolescents: a scoping review

ABSTRACT Families play a pivotal role in the development of social-emotional outcomes. Recent research indicates that sibling relationship quality plays a particularly important role in child and adolescent social, emotional, and behavioral development. To date, there are few studies that have translated this information in a manner that is useful for professionals working with children, adolescents, and their families. The present scoping review aims to fill this gap in the literature. Twenty-three empirical studies published between 1990 and 2021 were reviewed and synthesized. Results highlighted the unique ways that sibling negativity and positivity influence the development of social, emotional, and behavioral outcomes. Namely, sibling negativity was found to play a primary role in influencing adverse outcomes, such as internalizing problems, externalizing problems, and social difficulties. However, in some cases, sibling positivity was found to decrease the incidence of these outcomes. Sibling positivity was also found to be a protective factor in the context of adverse life events, such as trauma. Results indicate a need for assessment strategies aimed at identifying problematic sibling relationship qualities. Additionally, results support the need for interventions that reduce sibling negativity and promote sibling positivity that can be delivered by professionals as well as families.

Latent profiles of home behaviour problems in Trinidad and Tobago.

Caregivers who interact with children at home can provide a critical, complementary perspective on a child's behaviour functioning. This research used a parent-administered measure of problem behaviours to study perceptions of child behaviours across home situations. We applied latent profile analysis to identify subgroups of children with common behavioural tendencies in a nationally representative sample (N = 709) of 4- to 13-year-old children in Trinidad and Tobago. This study (a) identified latent profiles of children's over- and underactive behaviour problems in varied home settings and (b) examined how profile membership predicted academic skills and teacher-observed problem behaviours. The best-fitting four-profile model included one profile of adjusted behaviours (56%), one of the elevated attention-seeking behaviours (21%), a profile featuring withdrawn and disengaged behaviours (15%) and a relatively rare profile emphasising aggressive behaviours (8%). Children classified in the last profile displayed the poorest academic outcomes and the highest levels of teacher-observed behaviour problems.

Rasch analysis of quality of life in children with vernal keratoconjunctivitis (QUICK) questionnaire

ABSTRACT Clinical relevance A validated questionnaire measures the construct accurately, helps clinician to support decision making, facilitates assessment and monitoring of patients, guides clinical trial and promotes patient-centred care. Background To assess the psychometric properties of the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire among Indian children with Vernal Keratoconjuntivitis (VKC) using Rasch analysis. Methods This study used a questionnaire validation study design. The QUICK questionnaire for VKC was translated to two local languages using back translation process and administered to the Indian children (aged 5–15 years) diagnosed with VKC between June 2021 and March 2022. The study took place at a tertiary eye care hospital in Chennai, India. The psychometric properties were assessed based on six indicators namely rating scale behaviour, measurement precision, item fit, unidimensionality, targeting and Differential Item Functioning (DIF). Results Fifty six children with VKC (mean age 10.5 years and 77.8% males) filled the questionnaire. The analysis of overall QUICK questionnaire (16 items) revealed an ordered threshold for the rating scale, no noticeable DIF and excellent person-item targeting (0.15). However, the questionnaire showed inadequate person separation (PSI 1.82 and PSR 0.77), four misfit items and lack of unidimensionality (eigenvalue 2.80). Eliminating misfit items and contrasting items resolved multidimensionality, leaving nine items related to the symptoms domain in the questionnaire. However, the person separation (PSI 1.52 and PSR 0.70) remained below 2.0. Conclusion The resultant 9-item QUICK questionnaire discriminates only low and high performers among VKC patients. Thus, it may be used solely to assess the symptoms domain in Health Related Quality of Life (HRQoL). This questionnaire requires addition of items in other domains pertaining to HRQoL to make it holistic.

Maternal high-dose docosahexaenoic acid supplementation and neurodevelopment at 5 Years of preterm children

Background & AimsDocosahexaenoic acid (DHA) is the most abundant omega-3 fatty acid in the brain and is accumulated by the fetal brain during the last trimester of pregnancy. Our objective was to determine whether high-dose DHA supplementation during the neonatal period, vs. placebo, improves behavioral functioning at 5 years in children born very preterm. MethodsThis is a follow-up at 5 years corrected age of a subset of children who participated in a multicenter randomized controlled trial. The participants received a high-dose DHA supplementation, or a placebo, through maternal breast milk until 36 weeks’ postmenstrual age. Primary outcome was child behavioral functioning, assessed by the Total Difficulties Score from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes included behavioral scores from the SDQ, executive functions assessment and global developmental performance. Neurodevelopmental outcomes were assessed through interviews with parents. Mean differences between DHA and placebo groups were estimated using mixed linear models. Subgroup analyses were conducted for sex and gestational age (GA) at birth. ResultsAmong 177 eligible children, 132 (74.6%) completed neurodevelopmental assessment at 5 years (DHA, N=64, placebo, N=68). Total Difficulties Score did not differ between the DHA and placebo groups (mean differences, -0.9 [95% confidence interval, -2.7 to 0.8], P=0.30), nor any of the secondary outcomes. There was no significant interaction between treatment groups and sex, nor GA, for the primary outcome. However, significant interactions between treatment groups and sex or GA were found for some secondary outcomes. ConclusionsIn very preterm infants, high-dose DHA supplementation did not improve behavioral functioning at 5 years. Clinical Trial RegistrationClinicalTrials.gov, NCT02371460, https://clinicaltrials.gov/study/NCT02371460

Positive psychological traits in the association between family functioning and problematic behavior among secondary vocational students: a parallel mediation model

ABSTRACT The present study explored the effect of family functioning on secondary vocational students’ problematic behavior, and the mediating roles of positive psychological traits (hope, gratitude and grit). A total of 3049 secondary vocational students (15.87 ± 1.00 years old) participated in the current research by completing measures of family functioning, problematic behavior, hope, gratitude and grit. The results indicated that family functioning was negatively correlated with problematic behavior. Secondary vocational students from families with better functioning exhibited less problematic behavior. Furthermore, structural equation analysis revealed that hope, gratitude and grit played parallel mediating roles in the association between family functioning and problematic behavior. Pairwise contrasts suggested grit exerted strongest indirect effect among the three mediators. The current research highlighted the role of positive psychological traits in the comprehension of how family environment affects behavioral development among adolescents from secondary vocational school.

Siamese Neural Network for Speech-Based Depression Classification and Severity Assessment

The evaluation of an individual’s mental health and behavioral functioning, known as psychological assessment, is generally conducted by a mental health professional. This process aids in diagnosing mental health conditions, identifying suitable treatment options, and assessing progress during treatment. Currently, national health systems are unable to cope with the constantly growing demand for such services. To address and expedite the diagnosis process, this study suggests an AI-powered tool capable of delivering understandable predictions through the automated processing of the captured speech signals. To this end, we employed a Siamese neural network (SNN) elaborating on standardized speech representations free of domain expert knowledge. Such an SNN-based framework is able to address multiple downstream tasks using the same latent representation. Interestingly, it has been applied both for classifying speech depression as well as assessing its severity. After extensive experiments on a publicly available dataset following a standardized protocol, it is shown to significantly outperform the state of the art with respect to both tasks. Last but not least, the present solution offers interpretable predictions, while being able to meaningfully interact with the medical experts.

Neurodevelopmental outcomes of school-age children conceived after hysterosalpingography with oil-based or water-based iodinated contrast: long-term follow-up of a nationwide randomized controlled trial.

Does preconceptional exposure to oil-based iodinated contrast media during hysterosalpingography (HSG) impact children's neurodevelopment compared with exposure to water-based alternatives? Our study found no large-sized effects for neurodevelopment in children with preconceptional exposure to oil-based iodinated contrast media during HSG compared with water-based alternatives. HSG is widely used as a diagnostic tool in the female fertility work-up. Tubal flushing with oil-based iodinated contrast has been shown to enhance fertility outcomes in couples with unexplained infertility, increasing the chances of pregnancy and live birth compared with water-based alternatives. However, oil-based contrast contains higher doses of iodine and has a longer half-life, and concerns exist that iodinated contrast media can affect women's iodine status and cause temporary (sub)clinical hypothyroidism in mothers and/or foetuses. Considering that thyroid hormones are vital to embryonal and foetal brain development, oil-based contrast media use could increase the risk of impaired neurodevelopment in children conceived shortly after HSG. Here we examine neurodevelopmental outcomes in school-aged children conceived after HSG. This is a long-term follow-up of the H2Oil trial in which oil-based or water-based contrast was used during HSG (Netherlands; 2012-2014; NTR3270). Of 369 children born <6 months after HSG in the study, we contacted the mothers of 140 children who gave consent to be contacted for follow-up. The follow-up study took place from January to July 2022 (NCT05168228). The study included 69 children aged 6-9 years who were conceived after HSG with oil-based (n = 42) or water-based contrast (n = 27). The assessments targeted intelligence (Wechsler Intelligence Scale for Children), neurocognitive outcomes (computerized neurocognitive tests), behavioural functioning (parent and teacher questionnaires), and academic performance. Linear regression models, adjusted for age, sex, and parental educational attainment were employed to compare groups. School-aged children born to mothers after oil-based contrast HSG did not significantly differ from children born to mothers after water-based contrast HSG, in regards to intelligence, neurocognitive functioning, behavioural functioning, or academic performance, with the exception of better performance for visuomotor integration functions in children exposed to oil-based contrast preconception. After exploratory correction for multiple comparisons, none of the group differences was statistically significant. The small sample size of this follow-up study limited statistical power. This study provides evidence for the absence of large-sized differences between preconceptional exposure to the two contrast media types but does not rule out more subtle effects on neurodevelopment compared to naturally conceived children without preconceptional exposure to HSG. This study contributes to our knowledge about the long-term effects of different types of iodinated contrast media used in fertility work-up, indicating that choosing oil-based over water-based iodinated contrast media is unlikely to have major effect on the long-term neurodevelopmental outcomes of children conceived shortly after HSG. However, further research should focus on the overall safety of iodine exposure during HSG, comparing children conceived after HSG to those conceived naturally as both types of contrast contain high amounts of iodine. The original H2Oil randomized controlled trial was an investigator-initiated study that was funded by the two academic hospitals now merged into the Amsterdam University Medical Centre. The current follow-up study (Neuro-H2Oil) is funded through a research grant awarded to the authors by the Amsterdam Reproduction & Development (AR&D) research institute. S.K. is funded by a AMC MD/PhD Scholarship from the Amsterdam UMC. S.K. reports holding voluntary roles in the civil society organizations Universities Allied for Essential Medicines and People's Health Movement. V.M. reports receiving travel and speaker fees as well as research grants from Guerbet, Merck and Ferring. K.D. reports receiving travel and speaker fees as well as research grants from Guerbet. BWM is supported by a NHMRC Investigator grant (GNT1176437) and reports consultancy, travel support and research funding from Merck, consultancy for Organon and Norgine, and holding stock from ObsEva. The other authors report no conflict of interest. NCT05168228.

303P A longitudinal study on cognitive and behavioural functioning in Duchenne muscular dystrophy

303P A longitudinal study on cognitive and behavioural functioning in Duchenne muscular dystrophy

Further Evidence on Online Video-Feedback Intervention: Enhancing Parent-Child Interactions and Reducing Disordered Eating in Children.

This study evaluated the effectiveness of an online intervention designed to improve parent-child interactions and address disordered eating behaviors in children. Using remote video-feedback sessions based on observations of mother-child feeding interactions, the intervention offers a cost-effective and environmentally friendly alternative to traditional in-person methods. The study aimed to assess the impact of online intervention on the quality of mother-child interactions during feeding and its effectiveness in reducing psychopathological symptoms in both mothers and children. The intervention was conducted entirely online, with improvements measured using SVIA scores for mother-child interactions and the SCL-90/R Global Severity Index (GSI) for maternal psychopathological symptoms, alongside evaluations of children's emotional and behavioral functioning, particularly anxiety, depression, and aggression. The intervention significantly improved the quality of mother-child interactions across all SVIA subscales and led to reductions in maternal symptoms of depression and anxiety, as well as decreases in children's emotional and behavioral symptoms. These findings suggest that online video-feedback interventions can effectively enhance mother-child relationships and reduce psychopathological symptoms in both mothers and children, although further research with larger sample sizes and more robust statistical analyses is needed to confirm these results.

Power Outage Perils: Assessing the Impact of load-Shedding on SMEs in Enoch Mgijima Local Municipality, South Africa.

This qualitative case study delves into the profound impact of load-shedding, the deliberate and temporary interruption of electricity supply, on small and medium (SMEs) in the Enoch Mgijima Local Municipality (EMLM) of South Africa. The study, conducted within an interpretive research paradigm and a qualitative methodology, provides a nuanced understanding of how institutional forces shape SMEs' behavior, decision-making, and overall functioning in the face of energy disruptions. The persistent power cuts due to load-shedding have had a substantial toll on the survival of SMEs in the EMLM, with businesses across diverse sectors, including hospitality, beauty, manufacturing, retail, and services, struggling to maintain operations. The study brings to light the multifaceted challenges SMEs face, such as disruptions to daily activities, equipment damage, and significant financial losses. It also presents a concerning trend of layoffs by SMEs in the region, contradicting the National Development Plan’s (NDP) employment creation goals. The findings provide valuable insight for policymakers, researchers, and stakeholders, underlining the urgent need for collaborative efforts to develop tailored programs, promote alternative energy sources, and advocate for policies that prioritize the energy needs of SMEs. The study acknowledges limitations related to geographical specificity, temporary constraints, and data source reliance and recommends further research to extend the geographical scope, conduct longitudinal analyses, and incorporate diverse data collection methods. By addressing these limitations, further studies can contribute to a more comprehensive understanding of the broader challenges and potential solutions faced by SMEs amid energy-related crises.

B - 8 Preemie-Pediatric Left Middle Cerebral Arterial Cerebrovascular Accident and Comorbid Focal Left Central Epilepsy: a Case Study

Abstract Objective Literature regarding neurocognitive functioning in pediatric middle cerebral arterial (MCA) is limited. The aim of this study was to enhance the field’s knowledge and understanding of the presentation and impact of preemie-pediatric left MCA in utero with comorbid left-brain epilepsy in overall neurocognitive and behavioral functioning. Method The subject is a 12-year-old left-handed male with history of previously described events. The purpose of this evaluation was to determine current levels of neurocognitive and behavioral functioning as it relates to his medical history, treatment planning, and prognosis. Data collection was part of a pre-surgical consult to reduce epileptic activity. Results Results suggest overall cognitive functioning fell within the average range. However, relative difficulties in areas of attention and executive functioning were indicated. While all other domains were grossly intact, his profile indicates strengths in visual compared to verbal memory. Interestingly, the patient performed better on verbal tasks after a delay both with and without cuing. This suggests the presentation of a unique trait of pediatric epilepsy in that due to slowed processing speed as seen on the WISC, this patient is likely to remember more information over time. His academic achievements also fell within age-expectations. Conclusions This study impresses the importance of prompt neuropsychological evaluation in providing insight to the patient’s impairments and contribute to adaptive neurocognitive functioning moving forward. While idiopathic, this case demonstrates the need for continued research in pediatric-infantile infarct and provides the opportunity to improve the field’s understanding of the interpretation of similar cases.

A - 75 Clarifying the Complex: International Adoptees as Exemplars of Culturally-Informed Neuropsychological Assessment

Abstract Objective School-age international adoptees are underrepresented in the literature despite their unique cultural, linguistic, and academic experiences. The lack of representative norms paired with reduced cultural exposure in the United States requires special consideration from the neuropsychologist. This case report of an internationally adopted child with cerebral palsy illuminates the varying responsiveness of measures to changing levels of acculturation, language acquisition, and educational intervention. Method Patient was adopted at age 10 from China. He experienced lifelong institutionalization and limited formal education; he was illiterate at time of adoption. Brain MRI was consistent with his diagnosis of diplegic cerebral palsy (GMFCS Level I). Beginning approximately one year after adoption, he underwent three neuropsychological evaluations over five years. Testing accommodations to support language, behavior, and executive functioning were provided across evaluations. Results Patient’s initial neuropsychological evaluation demonstrated below age expectation performance across nearly all domains of cognitive functioning. Subsequent evaluations evidenced notable improvements across language, memory, mood, behavior, and adaptive functioning, with many areas revealing age appropriate abilities. Improvements across domains commonly affected by cerebral palsy were more limited, and academics were a longstanding, refractory area of difficulty. Conclusions Traditional administration and interpretation of neuropsychological measures can have difficulty characterizing the cognitive skills of medically involved, international adoptees. Thoughtful measure selection, administration, and interpretation are needed to differentiate underlying ability from performance. Interpreting assessment data can be challenging due to dynamic levels of language acquisition, academic proficiency, and acculturation. Rate of skill acquisition/development across multiple evaluations may be a better indicator of underlying ability than normative comparisons.

B - 4 The Neuropsychological Impact of Myocardial Infarction Induced Cerebral Hypoxia and Acute Encephalitis Following Electrocution: a Case Study

Abstract Objective Cerebral hypoxia and acute encephalitis subsequent to myocardial infarction (MI) are often associated with a decline in cognitive functioning (Wang et al., 2022; Caplan, 2004). While this relationship is well documented in existing literature, less research has investigated the potential nuanced cognitive and behavioral impacts of hypoxia and encephalitis due to electrocution-induced atrial fibrillation (AFib). The present case study uses neuropsychological assessment to clarify further the impact of significant electrocution and subsequent morbidities on cognition. Method We present a case study of a 30-year-old right-handed transgender female with 12 years of education who was referred for neuropsychological assessment pursuant to mental status changes manifested by disorientation and amnesia (the patient believed it was ten years prior) following the MI due to electrocution complicated by an estimated period of 10–15 minutes of non-responsiveness and anoxic encephalopathy. Results Neuropsychological assessment revealed difficulties with cognitive efficiency, language functioning, sequencing, problem-solving, complex attention, and semantic fluency. Overall, performance was inconsistent with education-weighted norms and estimated premorbid functioning. An objective measure of psychological functioning reflected a negative self-evaluation, depression, thoughts of self-harm, anxiety, and personality difficulties marked by fluctuating emotions. Findings supported a diagnosis of cognitive impairment and altered mental status associated with anoxic brain injury from the above-noted MI. Conclusion This case highlights the consequences of anoxic encephalopathy from MI subsequent to electrocution on cognitive, emotional, and behavioral functioning. Neuropsychological assessment provided clear evidence of cognitive impairment beyond the initial diagnoses, and further defined cognitive and behavioral correlates not explained by other dispositional variables.

A - 116 A Neuropsychological Testing Protocol for Assessing Lecanemab Eligibility for Alzheimer’s Disease: the First Fifty Patients

Abstract Objective Since the FDA approved lecanemab for Alzheimer’s disease (ad) treatment in 2023, neuropsychology’s role in the treatment eligibility determination process has become increasingly important. Not only is objective evidence of cognitive impairment required for the diagnosis of mild cognitive impairment (MCI) and mild dementia, but testing can be used to measure treatment efficacy and monitor for adverse effects. Our center developed a specialized protocol to assess cognitive and behavioral functioning for assisting in the eligibility determination process. Method Fifty adults (Mean Age = 73.8 years) underwent neuropsychological testing, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), as a part of their eligibility workup. Caregiver questionnaires were used to assess behavioral functioning. Test scores and patient outcomes were explored. Results Thirteen patients (26%) were prescribed lecanemab. Another 13 patients were deemed ineligible (five due to their cognitive results), eight patients (16%) were undecided, and 16 patients (32%) had not yet completed their workup. Of those who initiated lecanemab, eight patients (62%) had a diagnosis of MCI and six were diagnosed with mild dementia. Of these patients, eight (82%) showed an amnestic pattern on testing (RBANS Delayed Recall Standard Score Mean = 46.8). Additional analyses involving ad biomarkers, neuroimaging, and APOE status, were conducted. Conclusion Over one quarter of patients referred for neuropsychological testing as a part of their eligibility determination initiated lecanemab treatment for ad. Cognitive testing was directly related to determining ineligibility in 10% of patients. This review of an initial lecanemab treatment cohort highlights the importance of neuropsychology in the eligibility determination process.

A - 34 CBT Improves Cognitive Functioning in ADHD, Mixed Type

Abstract Objective To further expand on previous smaller study (with 25 participants) that found that children with ADHD, Mixed Type, improved their cognitive functioning after 12 weeks of CBT. Method In the current study 68 children (20 girls) diagnosed with ADHD, mixed type, between the ages of 9 and 12 (M = 10.25, SD = 1.88) were assessed with the WISC-V, CBCL, TEA-Ch2, and CPT-2, clinical interview with parents and teachers before the beginning of CBT. The same assessment was repeated 14 weeks later, following 12, weeks of individualized CBT. CBT included thought restructuring, impulse control exercises, relaxation techniques, and mindfulness exercises. Results Average Based Change (ABC) was employed and significant improvements, with large Cohen’s d (&amp;gt;. 80) effect size, were detected for Working Memory, Hyperactivity, Externalizing Behavior, Impulsivity, Selective, Sustained, and Everyday Attention. Ratings, during interviews, by teachers, psychologists, and parents agreed also that there was a significant clinical improvement. Conclusion In agreement with the first study, and other literature, CBT seems to be an important tool in helping significantly children with ADHD, Mixed Type, improve in behavior and cognitive functioning. More studies with younger and older children are needed to cement the utility of CBT with children and teens.

Parent Facilitation of Child Emotion Regulation in ASD: An Ecological Momentary Assessment Study.

Parents play a substantial role in their children's emotion regulation (ER) abilities. Children with autism spectrum disorder (ASD) often have difficulties regulating their emotions, which can manifest as externalizing behavioral issues. Parents of children with ASD facilitate their children's ER development in response to unique challenges and stressors, often developing resiliency but other times contributing to their children's dysregulation and behavioral challenges. It is unclear how much momentary stress attenuates parents' emotional facilitation of child ER and its effect on child behavioral functioning. Using an ecological momentary assessment approach, the current study explores this process by considering how parents of children with ASD facilitate child ER through (1) parent ER ability, (2) emotion socialization style, and (3) expressed emotion. Multilevel models explored the relative influences of parent ER facilitation on the association between momentary parent stress and behavioral intensity. Results suggest that parent ER abilities and specific emotion socialization styles interact with momentary parent stress and child behavior, whereas emotional climate of the home impacts child behavior more directly. The role of parent ER facilitation in the context of parent stress and children with ASD and behavioral problems is complex and multifaceted. Implications for further supporting children's emotional development via parent involvement are discussed.

Behavioral characteristics of toddlers later identified with an autism diagnosis, ADHD symptoms, or combined autism and ADHD symptoms.

Autism commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD), but less is known regarding how ADHD symptoms impact the early presentation of autism. This study examined early behavioral characteristics of a community sample of toddlers later identified with autism diagnosis, ADHD symptoms, combined autism and ADHD symptoms, or neither condition. Participants were 506 toddlers who were part of a longitudinal study of children's behavioral development. Parents completed questionnaires about their children's behavior at two time points. Four groups were identified based on study measures or medical record: autism diagnosis (n = 45), elevated ADHD symptoms (n = 70), autism and ADHD symptoms (n = 30), or neurotypical development (n = 361). Relationships between early parent report of autism- and ADHD-related behaviors, social-emotional and behavioral functioning, and caregiver experience and subsequent group designation were evaluated with adjusted linear regression models controlling for sex. Significant group differences were found in measures of autism-related behaviors, ADHD-related behaviors, externalizing and internalizing behaviors, and parent support needs (p < .0001). Pairwise comparisons indicated toddlers later identified with combined autism diagnosis and ADHD symptoms had higher levels of autism-related behaviors, externalizing and internalizing behaviors, and autism-related parent support needs compared to the other groups. Toddlers with subsequent elevated ADHD symptoms or combined autism diagnosis and ADHD symptoms exhibited similar levels of ADHD-related behaviors, while both groups displayed more ADHD-related behaviors than toddlers subsequently identified with autism or those with neither condition. In this community sample, toddlers for whomcombined autism diagnosis and ADHD symptoms were subsequently identified showed a distinct presentationcharacterized by higher early autism-related behaviors, broader behavioral concerns, and higherparent support needs. Presence of ADHD symptoms (alone or in combination with autism) was associated with higher parent-reported ADHD-related behaviors during toddlerhood. Results indicate that ADHD-related behaviors are manifest by toddlerhood, supporting screening for both autism and ADHD during early childhood.