Five-Minute Speech Sample Research Articles

Fatherhood experiences: A qualitative approach of cisgender and transgender fathers in assisted reproductive technologies (ART) situation with sperm donation

Assisted reproductive technologies have offered new ways and pathways to conceive a child. However, very few is known about insights into the complexities and challenges faced by trans fathers in contemporary parenthood journeys. This qualitative study explores the experiences of transgender and cisgender fathers who conceived children through donor sperm insemination (DSI) and natural conception (NC). The study will examine the recognition and challenges associated with paternal experiences. Seventy-nine interviews (one per child) were conducted with 16 transgender fathers who conceived trough DSI, 15 infertile cisgender fathers who conceived trough DSI, and 17 cisgender fathers who conceived through NC. The study employed thematic analysis and the Five-Minute Speech Sample to assess family dynamics. Results indicate that in the Trans-DSI group, fatherhood was often defined within the social role of masculinity, with some expressing ‘intranquility’ (i.e., feelings of unease or insecurity). The Cis-DSI group showed more tranquility but faced challenges regarding biological filiation. The NC group exhibited diverse experiences. Findings suggest that fathers' self-confidence, especially for transgender and non-biologically related fathers, can be challenged. Recognizing these challenges can guide better support for families navigating diverse parenthood journeys.

A replication and extension of adverse and benevolent childhood experiences along with contemporaneous social support and sociodemographic stress for perinatal mental health problems.

This study replicated and extended Narayan and colleagues' (2018) original benevolent childhood experiences (BCEs) study. We examined associations between adverse and positive childhood experiences and mental health problems in a second sample of low-income, ethnically diverse pregnant individuals (replication). We also examined effects of childhood experiences on perinatal mental health problems while accounting for contemporaneous support and stress (extension). Participants were 175 pregnant individuals (M = 28.07 years, SD = 5.68, range = 18-40; 38.9% White, 25.7% Latina, 16.6% Black, 12.0% biracial/multiracial, 6.8% other) who completed standardized instruments on BCEs, childhood maltreatment and exposure to family dysfunction, sociodemographic stress, and perinatal depression and post-traumatic stress disorder (PTSD) symptoms. They completed the Five-Minute Speech Sample at pregnancy and postpartum to assess social support from the other biological parent. Higher family dysfunction predicted higher prenatal depression symptoms, while higher BCEs and prenatal social support predicted lower prenatal PTSD symptoms. Prenatal depression and prenatal PTSD symptoms were the most robust predictors of postnatal depression and PTSD symptoms, respectively, although higher postnatal social support also predicted lower postnatal PTSD symptoms. Findings replicated many patterns found in the original BCEs study and indicated that contemporaneous experiences are also associated with perinatal mental health problems.

Automatic detection of expressed emotion from Five-Minute Speech Samples: Challenges and opportunities.

Research into clinical applications of speech-based emotion recognition (SER) technologies has been steadily increasing over the past few years. One such potential application is the automatic recognition of expressed emotion (EE) components within family environments. The identification of EE is highly important as they have been linked with a range of adverse life events. Manual coding of these events requires time-consuming specialist training, amplifying the need for automated approaches. Herein we describe an automated machine learning approach for determining the degree of warmth, a key component of EE, from acoustic and text natural language features. Our dataset of 52 recorded interviews is taken from recordings, collected over 20 years ago, from a nationally representative birth cohort of British twin children, and was manually coded for EE by two researchers (inter-rater reliability 0.84-0.90). We demonstrate that the degree of warmth can be predicted with an F1-score of 64.7% despite working with audio recordings of highly variable quality. Our highly promising results suggest that machine learning may be able to assist in the coding of EE in the near future.

Parental Expressed Emotion and Behavioural Outcomes in Autistic Children and Adolescents: A Systematic Review.

Growing interest in the links between parent-child relationships and child behavioural presentations in families of autistic children has led to an increased use of the Five Minute Speech Sample (FMSS) measure of parental expressed emotion (EE) in autism research. This review focuses on studies exploring the relationships between parental EE and behavioural outcomes in autistic children. Electronic searches of six databases and grey literature wielded eight studies that met eligibility criteria. Study designs were a mixture of cross-sectional and longitudinal and quality of studies was variable. Parental criticism was largely positively related to, and showed some predictive value for, child behaviour problems. Warmth was mostly negatively related to, and showed some predictive value for, child behaviour problems. Preliminary evidence from one study showed paternal warmth to be significantly related to child behaviours, whilst child behaviours were also significantly related to paternal warmth, suggesting a bidirectional relationship. Analysis of additional EE components produced variable results, however parental stress and depressive symptoms were consistently related to child behaviour, and preliminary evidence suggests a possible role of maternal education level and family cohesion. Outcomes were variable across FMSS coding systems and greater consistency in their application is needed in future research. The current findings suggest that parental EE has an important relationship with child behaviour and future intervention efforts may benefit from aiming to reduced EE in order to improve child outcomes.

How does kinship and foster care differ on caregiver-child relationship quality and child and caregiver mental health?

Internationally, there is an increasing preference to place children in kinship versus foster care. While research suggests that kinship care might promote better child mental health and placement stability than foster care, less is known about how these placement types compare on other factors of significance to family wellbeing in out-of-home care, including caregiver-child relationship quality and caregiver strain. We aimed to examine potential group differences on these outcomes in a sample of 101 kinship (N = 30), foster (N = 35), and birth (N = 36) caregivers of 7- to 16-year-olds in Australia. Caregivers completed measures on child mental health (behavioral and emotional adjustment, affect regulation), caregiver-child attachment, and caregiver strain, and a Five-Minute Speech Sample interview regarding their relational schemas (e.g., attitudes and feelings) about their child. Results showed that kinship and foster care families fared similarly on levels of child mental health, caregiver relational schemas, caregiver-child attachment, and caregiver strain. However, both groups displayed significantly more challenges in these domains than the birth family comparison sample. Sixty one percent of children in kinship and foster care experienced clinically significant mental health problems, yet many families–particularly kinship care families–had not received adequate professional supports for these challenges. Our findings suggest that families in kinship and foster care experience similar relational and mental health challenges, though they may require services tailored to their unique circumstances.

How do kinship and foster caregivers differ in their conceptualization of family connectedness?

BackgroundIn out-of-home care in Australia and internationally, there is an increasing preference to place children in kinship than foster care placements as it is assumed that kinship care promotes caregiver, family, and cultural connectedness. However, little research has examined whether and how the quality of these connections differ between kinship and foster care. ObjectiveWe utilized qualitative methodology to provide a richer, strengths-based exploration of caregivers' perspectives on the caregiver-child relationship and other connections (i.e., family, culture) in kinship compared to foster care. Participants and settingSixty-six kinship (N = 31) and foster (N = 35) caregivers of 8- to 16-year-olds in Australia. MethodsKinship and foster caregivers provided Five-Minute Speech Samples about their child and the caregiver-child relationship. Thematic analysis was used to explore the ways caregivers described family relationships and connectedness. ResultsResults highlighted the value caregivers place on strong attachment relationships with their children and the skills that help them develop a safe haven for children. Caregiver groups also differed in their discussions of commitment to the child and family and cultural connectedness, with kinship caregivers more likely to emphasize the strengths and challenges of birth family relations and the importance of cultural connectedness than foster caregivers. ConclusionsOur findings highlight the ways in which kinship and foster caregivers emphasize different aspects of family and cultural connectedness which can be used to inform policy and practice in an area currently lacking evidence.

Expressed Emotion in Families of Children with Neurodevelopmental Disorders: A Mixed-Method Approach.

Family interaction plays a pivotal role in the overall well-being of each member of a family unit. It is foreseeable that a family caring for an individual with a mental or physical health condition could experience negative family interactions for various reasons. Expressed emotion refers to the family environment based on the relatives' interaction with the individual diagnosed with a specific illness. Expressed emotion in the families of a person with any form of mental condition could pose potential psychological distress and burden to family members, notably the primary caregivers. The current study intends to explore the expressed emotion of the primary caregivers toward children with neurodevelopmental disorders (NDDs). The association between expressed emotion, stress experienced by the caregiver, and the self-sufficiency of the child diagnosed with neurodevelopmental disorders was examined. The Five-Minute Speech Sample (FMSS), Kingston Caregivers' Stress Scale (KCSS), and Waisman Activities of Daily Living (WADL) were used to assess expressed emotion, stress, and a child's self-sufficiency, respectively. The snowball sampling technique was adopted, and data were collected from 35 primary caregivers through telephonic interviews. A mixed-method research design was adopted, and the data were analyzed qualitatively and quantitatively. The findings reveal that there is a significant association between expressed emotion and caregivers' stress, expressed emotion, and the child's self-sufficiency and a significant relationship between the caregivers' stress and the child's self-sufficiency. The qualitative analysis suggests the influence of factors such as future concerns, family factors, and relationship strains contribute to expressed emotion. It can be concluded that those primary caregivers who reported extreme caregivers' stress and low self-sufficiency in their child exhibited high negative expressed emotion and diverse individual and systemic factors influenced the display of high expressed emotion within the family.

Augmenting family based treatment with emotion coaching for adolescents with anorexia nervosa and atypical anorexia nervosa: Trial design and methodological report

This article characterizes the design, recruitment, methodology, participant characteristics, and preliminary feasibility and acceptability of the Families Ending Eating Disorders (FEED) open pilot study. FEED augments family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) with an emotion coaching (EC) group for parents (i.e., FBT + EC). We targeted families high in critical comments and low warmth (assessed by the Five-Minute Speech Sample), known predictors of poor response in FBT. Eligible participants included adolescents initiating outpatient FBT, diagnosed with AN/AAN, ages 12–17, with a parent high in critical comments/low in warmth. The first phase of the study was an open pilot which demonstrated feasibility and acceptability of FBT + EC. Thus, we proceeded with the small randomized controlled trial (RCT). Eligible families were randomized to either 10 weeks of FBT + EC parent group treatment or the 10- week parent support group (control condition). The primary outcomes were parent critical comments and parental warmth, while our exploratory outcome was adolescent weight restoration. Novel aspects of the trial design (e.g., specifically targeting typical treatment non-responders), as well as recruitment and retention challenges in the context of the COVID-19 pandemic are discussed.

Caregiver Expressed Emotion and Pediatric Asthma: A Call for Culturally Specific Adaptations.

Background: Expressed emotion is the affective attitudes and behaviors of an individual toward another. In this preliminary study, we described expressed emotion among caregivers of children with asthma living in low-income urban area and evaluated its association with child asthma control. Methods: Forty-one children (90.2% African American/Black) and their caregivers participated. Measures included the Childhood Asthma Control Test and the Five-Minute Speech Sample coded for overall expressed emotion, emotional over-involvement, and criticism. Results: Most caregivers were rated borderline (31.7%) or high (48.8%) for expressed emotion, borderline (31.7%) or high (39.0%) for emotional overinvolvement, and low for criticism (73.2%). The association between criticism and asthma control neared statistical significance [U(Nlow = 30, NB/high = 11) = 100, z = -1.922, P = 0.055]. Conclusion: Findings suggest an examination into expressed emotion coding procedures for caregivers in low-income urban areas, and culturally specific adaptations may be necessary. Future research should confirm findings in a larger sample and consider how parental criticism affects children's asthma management.

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

BackgroundIrritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect.MethodsTwo hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits.DiscussionWe expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders.Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.

High Expressed Emotion (HEE), Assessed Using the Five-Minute Speech Sample (FMSS), as a Predictor of Psychiatric Relapse in Patients with Schizophrenia and Major Depressive Disorder: A Meta-Analysis and Meta-Regression.

Expressed Emotion (EE) describes the tone of a caregiver's response to a patient with a mental disorder, and it is used to predict relapse. The Five-Minute Speech Sample (FMSS) is a 5-min interview with a caregiver that evaluates only two EE dimensions. The present study aimed at evaluating HEE (High Expressed Emotion) as a predictor of relapse in patients with schizophrenia and major depressive disorder. Six studies were selected for the meta-analysis. In total, the studies included 297 subjects. The analyses included a random effects model; a meta-analysis excluding the study with the smallest sample; a cumulative meta-analysis; a meta-regression with random effects, using patient age and duration of illness as moderators; a leave-one-out meta-analysis; and a funnel plot to estimate publication bias. The FMSS emerged as a valid and reliable tool for measuring EE as a predictor of relapse in patients with schizophrenia and major depressive disorder. Patient age and duration of illness had no significant effect on the results. Future meta-analyses should include more studies to reduce publication bias. EE may be a good predictor of relapse when examined through a fast measurement technique such as the FMSS, which may also be useful to analyze the psychopathological structure of caregivers.

Expectant mothers' not fathers' mind-mindedness predicts infant, mother, and father conversational turns at 7months.

Parental mind-mindedness (MM), defined as the propensity to view one's child as an agent with thoughts, feelings, and desires, is associated with positive child outcomes (McMahon & Bernier, 2017) and can be assessed in expectant parents by using five-minute speech samples (Magaña etal., 1986). Individual differences in MM appear stable across the transition to parenthood (Foley etal., in press), offering an exciting intervention opportunity, as expectant mothers' thoughts and feelings about their unborn infants are associated with the quality of mother-infant interactions. To assess prenatal MM as a predictor of parent-infant conversation at 7months, we followed 93 low-risk British heterosexual couples across the transition to parenthood. Mothers' and fathers' MM was measured both in the third trimester of pregnancy and at 4months. Wearable LENA devices were used to gather detailed measures of mother-, father-, and infant-initiated conversations at 7months. Prenatal MM in both parents was associated with more frequent infant-initiated conversations at 7months, while prenatal maternal (not paternal) MM was also associated with more mother- and father-initiated conversations. While longitudinal research with more diverse samples is needed, these findings highlight the importance of parental mentalizing in the prenatal period for early family interactions.

A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury

BackgroundExpressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI).Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers.MethodWe examined Expressed Emotion levels of mother–daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12–20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38–56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS).ResultsAdolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10).ConclusionThe findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.

‘I just want my parenting to be able to be better than what it is’: A qualitative exploration of parenting strengths and needs of mothers experiencing homelessness

AbstractPerspectives of parents themselves should be central in framing services delivered to families experiencing homelessness. We explored the strengths and positive features of mother–child relationships and insight into mothers' views of the impact of living in shelters. We conducted qualitative coding of the Five‐Minute Speech Sample (FMSS) of 41 mothers of young children. Results revealed a wide variety of strategies that mothers used to promote their children's resilient functioning. This included focusing on their children's strengths, providing unconditional love and engaging in positive activities together. Mothers also voiced varied approaches to parenting, including many positive practices. Mothers' FMSS included ways that living in the shelter had a negative impact on their child's functioning, and they reported negative changes in their relationship with their child since moving into the shelter. Finally, mothers discussed ways in which living in the shelter had influenced their parenting styles and approaches to discipline. We discuss implications of the findings for supporting families residing in shelters, and we provide recommendations for further research.

Parental Expressed Emotion, Parenting Stress, and Behavioral Problems of Young Children with 22q11.2 Deletion Syndrome and Idiopathic Autism Spectrum Disorder.

This study examined the associations of parents' expressed emotion (EE) and parenting stress, with behavioral problems of children with 22q11.2 deletion syndrome, idiopathic autism (iASD) and typically developing (TD) children. Parents of children aged 3-8years completed the five-minute-speech-sample (FMSS), parental stress index and children behavioral checklist. Parents' FMSS-EE-criticism was higher among parents of children with 22q11DS and iASD compared to parents of TD children. FMSS-EE scores predicted children's behavioral problems, above and beyond parenting stress. The associations between FMSS-EE, parenting stress and children's behavioral problems were consistent across 22q11DS, iASD and TD children. These findings highlight the need for targeting parents' EE and parenting stress as integral elements in the screening and prevention of behavioral problems of young children with 22q11DS and iASD.

Paternal expressed emotion influences psychobiological indicators of threat and safety learning in daughters: A preliminary study.

This preliminary study examined the association of children's anxiety, paternal expressed emotion (EE), and their interaction with psychophysiological indices of children's threat and safety learning. Participants included 24 father-daughter dyads. Daughters (ages 8-13 years, 100% Latina) self-reported their anxiety levels and completed a differential threat conditioning and extinction paradigm, during which psychophysiological responding was collected. Fathers completed a Five-Minute Speech Sample, from which paternal EE (i.e., criticism, emotional overinvolvement) was assessed. Anxiety-dependent associations emerged between paternal EE and individual differences in daughters' psychophysiological responding to safety signals during threat conditioning. Paternal EE was positively associated with psychophysiological responding to safety in daughters with high and mean, but not low, levels of anxiety. Although previous work suggests that chronic harsh maternal parenting is a potential risk factor for children's general threat and safety learning, these preliminary findings implicate milder forms of negative parenting behavior in fathers, particularly for highly anxious children.

Machine learning approach to measurement of criticism: The core dimension of expressed emotion.

Expressed emotion (EE), a measure of the family's emotional climate, is a fundamental measure in caregiving research. A core dimension of EE is the level of criticism expressed by the caregiver to the care recipient, with a high level of criticism a marker of significant distress in the household. The Five-Minute Speech Sample (FMSS), the most commonly used brief measure of EE, requires time-consuming manual processing and scoring by a highly trained expert. In this study, we used natural language processing and supervised machine learning techniques to develop a fully automated framework to evaluate caregiver criticism level based on the verbatim transcript of the FMSS. The success of the machine learning algorithm was established by demonstrating that the classification of maternal caregivers as high versus low EE was consistent with the classification of these 298 maternal caregivers of adult children with schizophrenia using standard manual coding procedures, with area under the receiver operating characteristic curve (AUROC) of 0.76. Evidence of construct validity was established by demonstrating that maternal caregivers of adults with schizophrenia, who were classified as having a high level of criticism had higher levels of caregiver burden, reported that their child had more psychiatric symptoms and behaviors and perceived that their child had greater control over these symptoms and behaviors. Additionally, maternal caregivers who had high levels of criticism reported having a poorer quality of relationship with their child with schizophrenia than maternal caregivers low on criticism. Rapid measurement of criticism facilitates the incorporation of this dimension into research across a broad range of caregiving contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

6.26 Lost in Translation: Expressed Emotion and Social Functioning in Youth With Autism Spectrum Disorder

Existing studies substantiate a relationship between high familial expressed emotion (EE) and externalizing behaviors in children with autism spectrum disorder (ASD); however, little is known about the relationship between EE and the severity of core symptoms of ASD, specifically social communication and adaptive functioning. This study assesses the hypothesis that EE demonstrates significant relationships with measures of social cognition, perception of the quality of peer relationships, and adaptive functioning. A preliminary analysis includes 16 adolescents with ASD ages 13 to 17 years old, and 12.5% were female. The Social Responsiveness Scale, Second Edition (SRS-2) was administered to measure social interaction and communication deficits. The Child and Adult versions of the Reading the Mind in the Eyes Tests (RMET-C and RMET-A, respectively) were administered as measures of theory of the mind. The Adaptive Behavior Composite score from the Vineland-3 (VABS-3) assessed adaptive functioning. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measure was used to evaluate the perception of quality of peer relationships. EE was determined using the Five-Minute Speech Sample. There was a nonsignificant difference in the hypothesized direction between SRS-2 total score (p = 0.34), Social Communication subscale score (p = 0.34), and Social Communication and Interaction DSM-5–compatible subscale score (p = 0.36) between the high and low EE groups. On the RMET-C and -A, subjects with high caregiver EE had similar error rates as those with low EE (p = 0.18 for RMET-C and p = 0.36 for RMET-A). There was no significant difference between the groups on the VABS-3 (p = 0.86). High EE youth rated the quality of their peer relationships lower by 4.9 points on the PROMIS Peer Relationship scale than individuals with low EE (p = 0.16). Although these preliminary results do not support our hypotheses, the nonsignificant differences were in the hypothesized direction. Our sample size was small (N = 16) and likely lacking the power needed to identify significant differences in the social communication of youth with ASD living with low vs high degrees of caregiver EE. Directions for future study include reexamining these hypotheses with a larger sample size and identifying directionality in the association between EE and core deficits.

6.30 Biological and Psychosocial Correlates of Social Cognition in Adolescents with Autism Spectrum Disorder (ASD)

The dysfunctional immune responses in autism spectrum disorder (ASD) associated with increased impairments in social cognition and the impact of interpersonal and social stress in ASD on inflammatory pathways are well known. The connection between psychosocial stress, the immune system, and core deficits may provide greater insight into this debilitating disorder. Our major objectives include: 1) to examine the association of psychosocial stress with measures of social cognition; and 2) to assess the relationship between peripheral inflammatory and neurotrophic proteins, psychosocial stress, and social cognition. Preliminary analysis includes 30 adolescents ages 13 to 17 years old (N = 16 ASD; 12.5% female; N = 14 typically developed [TD; controls]; 21% female]. The Social Responsiveness Scale, Second Edition (SRS-2) was administered to measure social interaction and communication deficits. The Child and Adult versions of the Reading the Mind in the Eyes Tests (RMET-C and RMET-A, respectively) were administered as measures of theory of mind. Psychosocial stress measures included the Expressed Emotion (EE) assessed by the Five-Minute Speech Sample, NIH PROMIS scales. ProcartaPlex bead-based multiplex immunoassays were performed for simultaneous detection and quantitation of multiple protein targets in a subset of the plasma. Youth with ASD demonstrated higher familial EE than TD, although it was not statistically significant (p = 0.2). Parent-reported psychological stress in youth with ASD was significantly greater than TD (p = 0.001). Youth with ASD described greater impairments in peer relationships than TD youth (p = 0.004). Youth with ASD with greater psychological stress and impaired family and peer relationships demonstrated more errors on the RMET-A (p = 0.003, p = 0.03, and p = 0.009, respectively). Higher scores on the SRS-2 were seen in youth with ASD with greater psychosocial stress in EE and PROMIS measures, but this did not reach statistical significance. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) demonstrated significant associations with measures of psychological stress (p = 0.07 and p = 0.01, respectively), but no group differences were noted. The preliminary results are consistent with our hypotheses suggesting the presence of higher psychosocial stress in youth with ASD that contributes to greater impairments in social cognition and a dysregulated immune profile. Further analyses with the larger dataset could help identify risk factors that may affect the development and/or maintenance of these deficits and be prime targets for intervention.

6.27 Under Pressure: Expressed Emotion and Stress in Youth With Autism Spectrum Disorder

While underlying mechanisms linking expressed emotion (EE) to patient outcomes remain under investigation, it has been suggested that high EE constitutes a significant family-level stressor, leading to an increased likelihood of relapse and poor outcomes in vulnerable individuals, particularly those with autism spectrum disorder (ASD), who often have difficulty regulating their stress responses. High EE appears to be present in a significant proportion of families with an individual with neurodevelopmental disabilities (NDDs). The goal of the current study is to investigate our hypotheses: 1) EE is correlated with self-reported stress in both neurotypical (NT) youth and youth with ASD; 2) the correlation between EE and stress will be stronger in individuals with ASD compared to their neurotypical counterparts. The current analysis includes 30 adolescents aged 13 to 17 years (N = 16 ASD, 12.5% female; N = 14 NT, 21% female). The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Psychological Stress Experiences Form was administered to measure stress as experienced by the adolescents. EE was determined using the Five-Minute Speech Sample (FMSS) administered to the primary caregiver. In adolescents with ASD, those with high EE had significantly higher self-reported stress than those with low EE (p < 0.01). While a similar direction of effect was found between high EE and self-reported stress in the overall sample, this result did not reach statistical significance (p = 0.09). The correlation between EE and self-reported stress was not significantly different in adolescents with ASD compared to neurotypical subjects (p = 0.22). The significant association found between EE and self-reported stress in adolescents with ASD lays a foundation for future clinical work aimed at decreasing familial stress for youth with NDDs. While the association between high EE and self-reported stress in subjects overall did not reach statistical significance in our preliminary results, the trend mirrors existing literature demonstrating that neurotypical youth are also deleteriously affected by EE and suggests that future study with a larger sample size may uncover a significant association. Further investigation regarding the direction of these effects would provide additional insight into appropriate targets for stress reduction and clinical intervention.