Development and Use of an Observational Measure of Parent-Child Interaction in Autism Spectrum Disorder: Relationships with Parent and Child Mental Health
Children with Autism Spectrum Disorder (ASD) and their parents are at increased risk for mental health problems (MHP). Evidence from the general population suggests the reciprocal relationship between parent and child MHP may be mediated by parent-child interaction (PCI). Despite progressing research on this topic in the field of ASD, most studies rely on parent-report measures of own behavior and MHP, and those of their child.
As part of the Improving Autism Mental Health (IAMHealth) research programme, we aimed to: (1) develop an observational instrument suitable for assessing PCI in autistic adolescents and their parents; (2) validate this instrument against existing measures of parental discipline strategies, expressed emotion (EE) regarding the child and household disorganization; (3) investigate concurrent associations with parent and child MHP.
The QUEST study is a well-characterized community cohort of children with ASD and their parents. At child age 11 to 15 years, we administered a videotaped Etch-a-Sketch (EAS) task to a subset of 59 families. The task required collaboration on drawing a picture of a house on the EAS toy, using one control each. Fifty-four adolescents had the functional ability to access the task as intended, 63% male and of a wide IQ range (27-129). Videos were rated using a coding scheme adapted previously employed in general population research, assessing aspects of child behavior (e.g. task persistence and engagement with the parent) and parent behavior (e.g. physical and verbal control, approval of, disapproval of and engagement with the child). Parental EE was assessed using a researcher-rated autism-specific five-minute speech sample (AFMSS), during which parents talked about their child. Parents self-reported on discipline strategies, household disorganization and own MHP. Child MHP were measured by parent- and teacher-report questionnaires.
Inter-rater reliability, assessed on 31 randomly-selected cases, was good (average intra-class correlation coefficient .76; range .48-1.00). Exploratory item factor analysis (n=54) of reliable parent behavior codes produced a two-factor solution (Figure 1). Parental “warmth” was indexed by behaviors including approval, engagement and autonomy-granting, whereas parental “control” was indexed by instruction, control-seeking and disapproval. These factors showed a significant negative correlation of -.34 (p=01), whereby parents showing more warmth showed less control. Child behaviors loaded onto one factor conceptualized as “co-operation”.
Parental warmth correlated positively with parental praise in the AFMSS (ρ=.35, p<.05), whereas parental control correlated positively with self-reported ineffective discipline strategies (r=.31, p<.05) and household disorganization (r=.38, p<.01). Neither parent factor related to child autism symptom intensity; however, high warmth related to higher child IQ (r=.44, p<.01). Greater child co-operation related to both higher IQ (r=.51, p<.001) and lower autism symptom intensity (r=-.50, p<.001). PCI factors were not associated with parent or child MHP.
The PCI instrument captured variance in parent and child behavior across families that was adequately reliable across raters and showed meaningful relationships with existing measures of parenting and household management style. The lack of association with child or parent MHP may reflect true independence in the relationship, inadequate power or failure to capture related aspects of behavior.