Richard P. Hastings

Meta-Analysis of Early Intensive Behavioral Intervention for Children With Autism

A systematic literature search for studies reporting effects of Early Intensive Behavioral Intervention identified 34 studies, 9 of which were controlled designs having either a comparison or a control group. We completed a meta-analysis yielding a standardized mean difference effect size for two available outcome measures: change in full-scale intelligence and/or adaptive behavior composite. Effect sizes were computed using Hedgess g. The average effect size was 1.10 for change in full-scale intelligence (95% confidence interval = .87, 1.34) and .66 (95% confidence interval = .41, .90) for change in adaptive behavior composite. These effect sizes are generally considered to be large and moderate, respectively. Our results support the clinical implication that at present, and in the absence of other interventions with established efficacy, Early Intensive Behavioral Intervention should be an intervention of choice for children with autism.

Parental Stress and Behaviour Problems of Children with Developmental Disability.

The present paper focuses on the integration of two research foci in the field of developmental disability: models of the development and maintenance of childrens problem behaviours, and parental stress associated with child characteristics. I propose a simple model whereby childrens behaviour problems, parental stress, and parenting behaviour are related. Evidence is found for a central part of this model (that child behaviour problems lead to parental stress), but other aspects are as yet untested in the developmental disability field. Future refinement of the model is discussed, with an emphasis on the role of parental appraisal processes in understanding the mechanisms by which child behaviour problems affect parental well being. Finally, the practical implications of integrating research on childrens behaviour problems and parental stress are briefly considered.

Coping strategies in mothers and fathers of preschool and school-age children with autism:

Despite the theoretical and demonstrated empirical significance of parental coping strategies for the wellbeing of families of children with disabilities, relatively little research has focused explicitly on coping in mothers and fathers of children with autism. In the present study, 89 parents of preschool children and 46 parents of school-age children completed a measure of the strategies they used to cope with the stresses of raising their child with autism. Factor analysis revealed four reliable coping dimensions: active avoidance coping, problem-focused coping, positive coping, and religious/denial coping. Further data analysis suggested gender differences on the first two of these dimensions but no reliable evidence that parental coping varied with the age of the child with autism. Associations were also found between coping strategies and parental stress and mental health. Practical implications are considered including reducing reliance on avoidance coping and increasing the use of positive coping strategies.

Early Intensive Behavioral Intervention: Outcomes for Children With Autism and their Parents after Two Years.

An intervention group (n=23) of preschool children with autism was identified on the basis of parent preference for early intensive behavioral intervention and a comparison group (n=21) identified as receiving treatment as usual. Prospective assessment was undertaken before treatment, after 1 year of treatment, and again after 2 years. Groups did not differ on assessments at baseline but after 2 years, robust differences favoring intensive behavioral intervention were observed on measures of intelligence, language, daily living skills, positive social behavior, and a statistical measure of best outcome for individual children. Measures of parental well-being, obtained at the same three time points, produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it.

Maternal Distress and Expressed Emotion: Cross-Sectional and Longitudinal Relationships with Behavior Problems of Children with Intellectual Disabilities.

Mothers of children with intellectual disability were assessed at two time points, 2 years apart (n = 75 at Time 1, n = 56 at Time 2). Data were gathered on maternal distress, mental health, expressed emotion, and the childs internalizing and externalizing behavior problems. Consistent with previous research with families of children who have intellectual disability, maternal distress and childrens behavior problems entered into a bidirectional relationship over time. This relationship was found to be specific to externalizing problems. Exploratory analyses also suggest that maternal distress and depression had a bidirectional longitudinal relationship. In terms of maternal expressed emotion, criticism and not emotional over-involvement was cross-sectionally but not longitudinally related to childrens externalizing behavior problems and to maternal distress.

Development of sexually abusive behaviour in sexually victimised males: a longitudinal study

BACKGROUND Sexual maltreatment is one of the most common forms of child abuse. To identify risk factors for sexually abusive behaviour by adults, we prospectively assessed childhood experiences and personal characteristics of male child victims who became abusers in later life. METHODS In a longitudinal study (7-19 years duration), we included 224 former male victims of sexual abuse. Risk factors contemporaneous with the abuse, and putative protective influences, were identified from social service and clinical records. Evidence of later criminal acts was obtained from a nationwide search of official records. FINDINGS Of the 224 former victims, 26 had subsequently committed sexual offences (victim-abusers), in almost all cases with children, mainly outside their families. Risk factors during childhood for later offending included material neglect (odds ratio 3.4, 95% CI 1.2-9.7), lack of supervision (3.0, 1.1-8.3), and sexual abuse by a female person (3.0, 1.1-8.7). Victim-abusers had more frequently witnessed serious intrafamilial violence (3.1, 1.0-10.0). Six (29%) of 21 victim-abusers on whom we had relevant data had been cruel to animals (7.9, 2.0-31.4). No single putative protective factor, nor a composite protective index, significantly reduced the risk of paedophilic behaviour. INTERPRETATION Most male victims of child sexual abuse do not become paedophiles, but particular experiences and patterns of childhood behaviour are associated with an increased risk of victims becoming abusers in later life. Our findings have implications for the design of selective interventions with a vulnerable subgroup of male victims, aimed at reducing the risk of paedophilic behaviour in later life.

A population-based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability

BACKGROUND While research indicates elevated behavioural and emotional problems in children with autism spectrum disorders (ASD) and decreased well-being in their parents, studies do not typically separate out the contribution of ASD from that of associated intellectual disabilities (ID). We investigated child behavioural and emotional problems, and maternal mental health, among cases with and without ASD and ID in a large population-representative sample. METHODS Cross-sectional comparison of child behavioural and emotional problems and maternal mental health measures among 18,415 children (5 to 16 years old), of whom 47 had an ASD, 51 combined ASD with ID, 590 had only ID, and the remainder were the comparison group with no ASD or ID. RESULTS The prevalence of likely clinical levels of behavioural and emotional problems was highest among children with ASD (with and without ID). After controlling for age, gender, adversity, and maternal mental health, the presence of ASD and ID significantly and independently increased the odds for hyperactivity symptoms, conduct, and emotional problems. Emotional disorder was more prevalent in mothers of children with ASD (with or without ID). The presence of ASD, but not ID, significantly increased the odds for maternal emotional disorder. As has been found in previous research, positive maternal mental health was not affected by the presence of ASD or ID. CONCLUSIONS ASD and ID are independent risk factors for behavioural and emotional problems. ASD (but not ID) is positively associated with maternal emotional disorder. Approaches to diagnosing hyperactivity and conduct problems in children with ASD may need to be reconsidered.

Brief Report: Behavioral Adjustment of Siblings of Children with Autism

Existing research studies have shown mixed results relating to the impact upon children of having a sibling with a disability. However, siblings of children with autism may be more at risk than siblings of children with other disabilities. In the present study, data were gathered on 22 siblings of children with autism. These children were rated by their mothers as having more behavior problems and fewer prosocial behaviors than a normative sample. Analysis of variables predicting sibling behavioral adjustment revealed that boys with siblings who have autism, and also those younger than their sibling with autism, engaged in fewer prosocial behaviors. Psychological adjustment of mothers (stress) and the child with autism (behavior problems) were not predictive of sibling behavioral adjustment.

Coping, burnout, and emotion in staff working in community services for people with challenging behaviors

Staff in mental retardation services identify challenging behavior as a significant source of work-related stress. However, there has been little examination of the psychological processes that may explain an association between challenging behavior and staff stress. In the present study, direct-care staff (N = 83) from five community services completed a questionnaire on their emotional reactions to aggressive behavior, the coping strategies that they employ, and their experience of burnout. Staff more frequently reported using adaptive strategies than maladaptive ones to cope with aggressive behavior. Regression analyses showed that staff disengagement and adaptive coping strategies and their emotional reactions to aggressive behavior predicted burnout scores. Implications of these results for future research and for staff mental health are discussed.

Do Challenging Behaviors Affect Staff Psychological Well-Being? Issues of Causality and Mechanism

Little explicit attention has been given to the potential impact of client challenging behavior on staff psychological well-being. Relevant research was critically reviewed according to criteria required to establish a causal relationship. Reasonable evidence was found for an association between challenging behavior and staff stress, and some evidence for temporal precedence. However, few researchers had analyzed data enabling alternative explanations to be eliminated. Thus, empirical evidence of a causal relationship between challenging behavior and staff stress is weak. A fourth causality criterion was addressed by suggestion of a mechanism by which challenging behavior may have its effects. I propose that staff negative emotional reactions mediate the impact of challenging behaviors on staff stress and evaluate research evidence for this theory.