Psychology (Functional Area: Clinical-Developmental)

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Open Access
Executive Functioning and Emotion Regulation in Children with Autism Spectrum Disorder: Understanding Heterogeneity in Presentation and Interventions
(2023-03-28) Ferland, Melissa; Bebko, James M.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by social communication deficits and restricted patterns of behaviours and interest. Children with ASD present with a wide range of neurocognitive abilities, including challenges in emotion regulation (ER: ability to identify and modulate one’s own emotional response to situations) and executive functions (EF: cognitive processes involved in self-regulation, goal-directed behaviours, and higher order thinking). Given that ER and EF skills are essential in everyday functioning, gaining a better understanding of the presentation of these cognitive processes in children with ASD and how they can be targeted in interventions could have important implications. The current manuscript aimed to: (1) understand the broad presentation of everyday EF and ER skills in children with ASD by using a person-centered approach analysis (Study 1), and (2) examine the evidence and existing support for targeted interventions in these areas by conducting a systematic review of the literature (Study 2). Results from Study 1 indicated that individuals with ASD present with heterogeneous EF and ER abilities, ranging from impaired to developing as expected, as assessed through an informant-based measure. The latent profile analyses revealed three profiles: broadly affected, narrowly affected, and intact EF and ER skills, demonstrating that being on the autism spectrum is not sufficient to infer challenges in EF or ER. Results from Study 2 identified 22 studies assessing interventions targeting ER and/or EF skills in children with ASD. Three types of interventions were identified as showing promising results: (1) cognitive behavioural interventions targeting ER specifically, (2) mindfulness-based interventions, and (3) group-based martial arts interventions. However, more research is required before these are considered evidence-based practices. Additionally, most interventions were assessed on a narrow range of children with ASD, primarily school-age males with no significant cognitive delays, thus limiting the generalizability of results across the entire autism spectrum. Taking a person-centered approach when working with this population is extremely important. It is hoped that information from this manuscript can be used to inform future research in EF and ER in ASD and the development of targeted intervention programs specific to this clinical group.
Open Access
Differential Effects of Multisystemic Factors on the Developmental Trajectories of Emotion Regulation
(2023-03-28) Mc Donald, Krysta Michelle Genevieve; Rawana, Jennine
The current study investigated the development of emotion regulation (i.e., managing one’s emotions in order to meet a goal; Gross et al., 2019) within a multisystemic context across the sensitive periods of adolescence and emerging adulthood. It adds to current literature by including the entire sensitive period (i.e., age 12-29 years), incorporating the influence of multisystemic factors on different emotion regulation developmental pathways, and extending investigations of posttraumatic adjustment within an integrated framework. Participants were a subsample from the National Longitudinal Study of Adolescent Health (Add Health; N = 13414), a longitudinal nationally representative database that follows youth from adolescence into adulthood. Growth mixture modelling was applied to elicit unique trajectories of emotion regulation development (i.e., depressive symptoms) each with unique relationships to multisystemic covariates (i.e., biological sex, pubertal timing, self-esteem, adverse childhood experiences [ACEs], parent closeness, friendship support, parental socioeconomic status, neighbourhood safety, changes in household parental figures). Four non-linear trajectories were found: low (normative), low-increasing, increasing-decreasing, and high-decreasing. The multisystemic factors had differential effects on each pathway that, with the exception of ACEs, tend to wane in influence as youth age. Self-esteem, perceived parental closeness, and perceived neighbourhood safety most tended to be protective, whereas seeking support from a friend, experiencing (an) ACE(s), and changes to household parental figures tended to confer vulnerability. Emotion regulation development and posttraumatic adjustment do vary, with lasting impacts. A multisystemic, integrated framework showed what factors confer risk or protection within these trajectories, and helps explain previously mixed findings. Implications for identifying at-risk youth, preventative measures, and intervention are also discussed.
Open Access
Characterizing the Neuropsychological profile and Examining the Role of Cognitive Reserve in Pediatric-Onset Multiple Sclerosis Using a Computerized Battery
(2023-03-28) Barlow-Krelina, Emily Marguerite; Till, Christine
Multiple sclerosis (MS) is a chronic demyelinating and degenerative condition of the central nervous system. While the majority of affected individuals show their first symptoms between the ages of 25-35 years, 3-5% of people have a pediatric-onset (POMS) of the disease, with a first attack occurring prior to age at 18. POMS leads to a range of physical and cognitive symptoms that impact everyday functioning and development, however, further research is needed to understand the cognitive profile and predict outcomes. The overall objective of this program of research was to better understand processes facilitating protection against the cognitive presentation of neuropathology in POMS, with a specific focus on cognitive reserve (CR) and its domain-specificity. Areas of deficit in POMS were first clarified, with delineation of dysfunction in speed and accuracy across cognitive domains using a computerized neurocognitive battery. In Study 1, we found that deficits in working memory, attention/inhibition, visuospatial processing, verbal recognition memory and verbal reasoning exist separately from and in addition to slowed speed of processing in individuals affected by POMS. Furthermore, we found that individuals with POMS are afforded some protection by CR (as estimated by parental education) in Study 2, however, these affects appeared weaker than what has been observed in adults. CR effects were strongest for tasks of executive functioning, where patients demonstrated greatest deficit relative to controls, and were not observed for tasks of information processing speed, potentially owing to differential availability of compensatory strategies in these networks. These findings highlight differences in vulnerability to cognitive dysfunction in individuals with POMS, given impacts of the disease on developing functions and reserves. We propose that cognitive screening should be expanded beyond assessment of simple processing speed to identify a greater proportion of youth affected by the cognitive sequelae of MS. While the mechanisms contributing to the development of CR remain to be elucidated, engagement in a range of physically and cognitively enriching activities, as well as a focus on mental health may be helpful towards better cognitive outcomes for youth with POMS. Further research is needed with direct comparison to adults with MS to understand how the developmental context influences the profile of cognitive deficits and role of protective factors in POMS.
Open Access
An Examination of the Role of Interpersonal Emotion Regulation On the Link Between Social Anxiety and Well-being
(2022-12-14) Onorato, Paolina Rose; Rawana, Jennine
Although there has been a recent shift to investigating interpersonal emotion regulation (IER), there are still key aspects of IER to understand generally and in the context of the COVID-19 pandemic. Examining how individuals, including those with social anxiety, utilize and think about IER can provide insights into how this type of emotion regulation can impact well-being. It is crucial to investigate IER during the pandemic since in-person interpersonal interactions may have been disrupted due to physical distancing. Thus, the current study examined the relations between social anxiousness, IER, and well-being during this time. Emerging adults (n = 674) completed measures related to social anxiousness (social interaction, performance, and scrutiny anxiety as well as avoidance), IER (tendency and efficacy for positive and negative emotions), and well-being (subjective happiness, life satisfaction, and flourishing). Through a structural equation mediation model, it was demonstrated that social anxiousness is inversely linked to well-being and IER, and IER is positively linked to well-being in the context of the pandemic. Importantly, IER acted as a partial mediator on the link between social anxiousness and well-being. These results have implications for intervention including the development of student IER workshops to enhance the well-being of socially anxious university students while transitioning back to in-person learning.
Open Access
Understanding Patterns of Caregiver-Toddler Biological Attunement in a Distress Context
(2022-12-14) Di Lorenzo, Miranda Gabrielle; Riddell, Rebecca
This dissertation consists of three studies that examine caregiver-toddler biological attunement within distress contexts in toddlerhood. Study 1 is a published systematic review (Di Lorenzo et al., 2021) that synthesizes the direction and magnitude of the relations between caregiver and young child (0 to 3 years of age) biological outcomes according to different methodology used to measure distress. Majority of articles examined cortisol outcomes of caregivers and their children in distress contexts. The magnitude of the association between caregiver and child cortisol indicators were moderate to large; however, results differed depending on the analysis used and measurement epochs examined. Relations between caregiver and child cardiac, saliva alpha amylase (sAA), and electroencephalography (EEG) outcomes were generally weak or inconsistent. Limitations of methodological approaches used to study caregiver-child attunement likely contribute to the heterogeneity of findings. To address limitations highlighted in Study 1, we used parallel process growth mixture modelling in Study 2 (Di Lorenzo-Klas et al., 2022a) to capture the dynamic nature of the attunement process and discern various patterns of caregiver-toddler coregulatory trajectories in a vaccination context during the second year of life. Three groups of dyads were discerned, with one group (80% of the sample) that demonstrated an adaptive regulatory attunement pattern (i.e., most regulated), and two groups (20% of the sample) that showed either a lack of attunement or misattunement between dyad members which demonstrated less adaptive child regulation from pain-related distress. To better understand what is driving the patterns of regulatory attunement, Study 3 (Di Lorenzo-Klas et al., 2022b) examined whether caregiver distress (operationalized as caregiver worry associated with their toddler's vaccination) and child distress (operationalized as behavioural pain-related distress) are associated with patterns of caregiver-toddler attunement discerned in Study 2. Findings from Study 3 revealed that caregivers who experience higher distress associated with their toddlers' vaccination demonstrated higher probability of being associated with groupings reflecting lack of attunement or misattunement with their toddlers during vaccination, and these toddlers are at risk of experiencing higher levels of behavioural pain-related distress. Clinical implications and suggestions for future research are discussed.
Open Access
The Effects of Parenting and Emotion Socialization on Emerging Adults' Well-Being: The Mediating Effect of Emotion Regulation
(2022-12-14) Lee, Kate Youngun; Rawana, Jennine
Emerging adulthood is characterized by major changes in many life domains. Thus, emerging adults are at risk for reduced well-being compared to other developmental age groups. Parents uniquely contribute to their child’s developmental outcomes in many ways such as, supporting the development of emotion regulation (ER), which is the ability to manage emotions and is essential for healthy psychosocial functioning. This study aims to investigate the relations between perceived parental emotion socialization, parental warmth, parental control, and resilience and well-being, and whether emotion dysregulation mediates these associations. Undergraduate students (n = 695) participated in an online survey. Results indicated that emotion dysregulation mediated the relationships between unsupportive parental emotion socialization and resilience and well-being, as well as the relationship between parental warmth and each of resilience and well-being. These findings suggest that specific parental responses to emotions are associated with emerging adult resilience and well-being through emotion regulation ability.
Open Access
Associations of Age, Anxiety, Cognitive Functioning and Social Impairment with Aggression in Youth with Autism
(2022-12-14) Rinaldo, Ethan Jon; Perry, Adrienne
Previous research has indicated that aggression in children with autism is associated with anxiety, cognitive functioning, age, and social functioning although most samples only include parent-report measures and participants without intellectual disability. The aim of this study was to clarify the relationships between these variables and aggression in youth with autism in a large, cognitively diverse sample, with parent- and teacher-report measures, and a wide age range. I found that age and intellectual disability presence/severity had small positive relationships with teacher-measured aggression while anxiety and social impairment severity had strong relationships with aggression when measured by parents and teachers. In a regression analysis anxiety and social communication problems had the strongest positive relationships with aggression while social motivation problems had a negative relationship with aggression. These results indicate the importance of anxiety and social problems, particularly in social communication and motivation, when studying and treating aggression in youth with autism.
Open Access
Coherence of Parental Representations Following Therapy for Autistic Children
(2022-12-14) Vashi, Nisha; Weiss, Jonathan
Autistic children and youth experience high rates of mental health challenges, and links have been demonstrated between child mental health and the parent-child relationship in this population. As parents of autistic children are often actively involved in their child’s treatment, it is important to consider aspects of the parent-child relationship within this context. The present study investigated changes in a component of the parent-child relationship, the coherence of parental representations, following participation in a 10-week cognitive behavioural therapy intervention designed to address autistic children’s mental health challenges. Relationships were examined between baseline levels of coherence and child characteristics (i.e., autism symptoms, mental health), and associations with child treatment outcomes (i.e., mental health). Participants included 81 children (89% boys) aged 8 to 13 years and their parents (85% mothers) aged 35 to 54 years. Results revealed that baseline levels of coherence were related to children’s mental health symptoms, but not autism symptoms. Although there were no significant changes in overall coherence across therapy, subscale-level improvements (i.e., concern, acceptance) emerged. Pre-intervention levels of coherence were not associated with child treatment outcomes. Changes in coherence across therapy were linked with children’s post-intervention behavioural symptoms and were approaching significance for internalizing problems, but were not associated with externalizing problems. It is critical to investigate factors that shape the coherence of parents’ representations of their children, as this may provide insight into potential targets for intervention. Moreover, ascertaining whether participation in therapy improves parental coherence, and consequently child treatment outcomes, can advocate for parent-involved therapy, which will ultimately benefit the well-being of autistic children.
Open Access
Child-Led Emotion Regulation Behaviours during Toddler Vaccinations: Building Understanding through a Dyadic Lens
(2022-12-14) Gennis, Hannah Gabrielle; Riddell, Rebecca
Vaccination of infants and young children is a routine procedure requiring regulation of high distress. While infants rely heavily on their caregivers for regulating distress, in toddlerhood, children begin to build a repertoire of their own emotion regulation (ER) skills to modulate their distress. The current dissertation consists of three studies to better understand toddler-led ER during vaccination. Study 1 is a published systematic review and meta-analysis (Gennis et al., 2022) aimed at understanding the concurrent relationships between child-led ER behaviours and distress in the first three years of life. Findings indicated that disengagement of attention and physical self-soothing strategies were typically regulatory (i.e., had negative relationships with distress), whereas parent-focused behaviours (e.g., orienting to the caregiver) were associated with more distress, suggesting a signalling function to gain support. With the exception of physical self-soothing, which showed a clear negative association in the first year, relationships between regulatory behaviours and distress were strongest in the second year. Study 2 (Gennis, Flora, Norton et al., submitted) used auto-regressive cross-lagged models to assess the concurrent and predictive relationships between three child-led ER behaviour clusters (disengagement of attention, physical self-soothing, and parent-focused behaviours) and pain-related distress responses during 12- and 18-month vaccinations. Findings indicated that disengagement of attention and physical self-soothing generally had negative relationships with pain-related distress, suggesting a possible regulatory role, whereas parent-focused behaviours were related to higher pain-related distress, suggesting a signalling role for parent support. With the exception of physical self-soothing, relationships were generally stronger at 18 months. Study 3 (Gennis, Flora, McMurtry, et al., submitted) used growth curve modelling to understand the associations between child-led ER behaviours and the change in pain scores across the appointment (regulation) at 12- and 18- months, after accounting for parent regulatory behaviours and pre-needle distress. Pre-needle distress consistently predicted regulation and parent regulatory behaviours played an increasing role in older toddlers. Findings suggest that after accounting for pre-needle distress and parent regulatory behaviours, child-led parent-focused behaviours predicted less regulation post-needle. Children seek their parent when they are struggling to regulate, suggesting continued need to understand vaccination as a dyadic context.
Open Access
Examining the Relationships Among Motor, Cognitive, and Mental Health Outcomes after Pediatric Arterial Ischemic Stroke
(2022-12-14) Ledochowski, Justine Maya; Desrocher, Mary E.
Pediatric arterial ischemic stroke (AIS) is an important cause of neurological disability in children with motor, cognitive, and behavioural sequelae. Motor impairments are one of the most common adverse outcomes after pediatric AIS, yet little is known about the impact of motor functioning on neuropsychological functioning. This dissertation consists of three studies examining relationships between motor functioning and neuropsychological outcomes after pediatric AIS. Study 1 examined relationships between motor functioning assessed with the Pediatric Stroke Outcome Measure at two timepoints and intellectual abilities. Results showed that motor functioning assessed during early recovery was associated with aspects of intellectual functioning, whereas later motor functioning was not. Different patterns of associations between motor functioning and intellectual abilities were observed in perinatal and childhood AIS groups. Features associated with poor motor outcome were combined cortical+subcortical lesions, hemiparesis, seizures, and utilizing rehabilitation services. Studies 2 and 3 focused on children with acquired dystonia, a movement disorder characterized by involuntary muscle contractions, after AIS involving subcortical regions. Study 2 compared symptoms of anxiety and depression between children with subcortical AIS, with and without dystonia, as well as associations among motor functioning and cognitive and mental health outcomes. Results supported the presence of greater levels of symptoms of anxiety and depression in children with post-stroke dystonia. There were no significant associations between motor and neuropsychological outcomes in the dystonia group, whereas motor and cognitive outcomes were associated in the no dystonia group. Study 3 examined whether there were differences in infarct characteristics on acute neuroimaging between children with and without dystonia and subcortical AIS. There was a significantly higher proportion of children with dystonia with lesions involving the putamen, caudate nucleus, and anterior limb of the internal capsule. More children with dystonia had severe cortical involvement and infarct volumes were significantly larger. Regression analyses showed involvement of the putamen significantly predicted dystonia and intellectual outcome. Overall, results support an association between motor and neuropsychological functioning after pediatric AIS that may be related to maladaptive neural reorganization involving cortico-subcortical networks. Clinical implications and suggestions for future research are discussed.
Open Access
Relationships Between Eye Tracking and Functional Outcomes in Autism Spectrum Disorder
(2022-12-14) Porthukaran, Alex Ignatius; Bebko, James M.
Autism spectrum disorder (ASD) is marked by social dysfunction with a wide range of impairment. Deficits in visual attention have been identified as a key mechanism involved in observed social difficulties. Children with ASD typically do not attend to pertinent areas when viewing social interactions, and therefore do not obtain crucial information for social learning. Over the course of development, this leads to compounding difficulty in acquiring and learning from social situations. Eye tracking studies provide a window into the child’s visual attention that allows researchers to precisely identify what is being attended to. This dissertation includes three studies that examine visual attention in children with ASD through eye tracking studies. In the first study, I use a combination of eye tracking and a simple language measure to discriminate between ASD and related disorders. Linear discriminant analyses were used to demonstrate that eye tracking and language variables were able to differentiate groups at a comparable level to standard measures of autism. The second study uses eye tracking variables (i.e., proportion of time that attention is focused on the eyes) to longitudinally predict specific areas of social dysfunction. That is, it is proposed that deficits in visual attention mechanistically lead to social deficits, which results in observed behaviors that typify ASD which are most accurately predicted by eye tracking variables early in development (compared to non-core symptoms of ASD). Consistently, the variables best predicted by eye tracking at an early age were those at the core of ASD (i.e., eye contact, gaze integration, joint attention). Finally, in the third study, eye tracking variables are used to understand more nuanced social behaviour. Specifically, according to the Social Information Processing model, children with ASD first have difficulty encoding information (operationalized as eye tracking variables in this study), which leads to difficulties with interpretation (i.e., children’s understanding of the situation). Generally, the pattern of results was consistent: those children, typically developing or with ASD, who attended the least to informative areas formed the most problematic interpretations. These three studies highlight the impact of eye tracking on social dysfunction in ASD.
Open Access
The Role of Thriving in Well-Being Among Youth and Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic
(2022-12-14) Sellitto, Teresa Marie; Weiss, Jonathan
People with intellectual and developmental disabilities (IDD) have been found to be at a greater risk of experiencing mental health problems, especially during the COVID-19 pandemic. Aspects of thriving have been suggested to buffer against negative outcomes among youth and young adults without IDD. Ecological resources have been linked to thriving and the experience of fewer mental health problems. The current study examined how thriving may mediate the association between ecological resources in the community and mental health problems among youth and adults with IDD, and if it acts as a protective factor in the face of COVID-19 stressors. The sample consisted of caregivers of 171 youth and adults with IDD ages 12 to 35. A mediation analysis revealed that community resources were negatively associated with mental health problems and thriving partially mediated this association. The moderation analysis revealed that although thriving did not moderate the positive association between COVID-19 stressors and mental health problems, thriving was negatively associated with mental health problems. Our findings suggest that community resources and thriving may be important targets for mental health supports for people with IDD.
Open Access
Metacognitive Ratings of Task Difficulty, Effort Exerted, Effort Required and Affective Experience of Effort on an Unstructured Performance Task in a Community Sample of Children
(2022-12-14) Butterfield, Kaitlyn Marie; Toplak, Maggie E.
Metacognitive ratings of effort are typically assessed by asking participants to indicate their mental effort on a performance-based task. Executive functions enable problem solving and goal attainment. Historically, EFs have been assessed using performance-based measures and rating scales. Research has shown a lack of association between these two methods. One framework used to understand this difference is the structure provided on performance-based measures and not provided on rating scales. This study investigated the role of structure by examining a novel Unstructured Performance-based Task (UPT-2) and metacognitive ratings of effort. Ninety-eight children between the ages of five and 11 years (M = 9.33, SD = 1.75, 47 females) from an independent school were recruited in Fall 2018. Significant associations emerged between the UPT-2, EF tasks and ratings, academic abilities, and metacognitive ratings of effort. The rating of effort required emerged as a predictor of performance on the UPT-2. Results suggest the UPT- 2 may be a promising measure to assess EF-related difficulties and provide an understanding of children’s behaviors in unstructured environments. Further, these findings consider the importance of specific reference points in rating scales. Finally, developmental sensitivity must be considered in future UPT-2 research to better understand the contribution of metacognitive ratings of effort and performance on an unstructured task.
Open Access
Cerebellar White Matter Microstructure and Cognition in Pediatric-Onset Multiple Sclerosis
(2022-12-14) De Somma, Elisea Carmela Emilia; Till, Christine
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that results in neurodegeneration in the central nervous system. The cerebellum is commonly affected in MS and contributes to disease-related impairment. As such, the cerebellum can be studied to provide insights into potential disease mechanisms and treatment in MS. Interest in the functional impact of cerebellar atrophy in MS has increased, as the cerebellum’s role in higher-order cognitive processes has been elaborated upon in healthy populations, and cognitive impairment has been widely studied in MS. A gap in the literature exists with respect to exploring how the cerebellum contributes to cognition in pediatric-onset MS. The current study aimed to 1) test whether patients with pediatric-onset MS demonstrate reduced cognitive efficiency compared with healthy age-/sex-matched controls; 2) determine if patients and controls differ with respect to cerebellar volume and microstructural integrity; and 3) determine if patients and controls differ with respect to the association between cerebellar white matter microstructure and cognitive efficiency. Patients demonstrated reduced efficiency on a computerized cognitive battery, relative to healthy controls, most notably on tasks that were timed, or where participants were instructed to respond quickly. Reduced integrity of major cerebellar white matter tracts in patients relative to controls was observed; these findings were driven by patients with pathology in proximity to the cerebellum (i.e., infratentorial lesions). Finally, this study was the first of its kind to provide evidence of a positive association between cerebellar white matter microstructure and cognition in pediatric-onset MS. This relationship was contingent upon infratentorial atrophy. That is, patients with preserved cerebellar microstructure (i.e., without infratentorial lesions) demonstrated a positive association between cerebellar white matter and cognitive efficiency. This association was not present in patients with infratentorial pathology. The current study suggests that MS patients with infratentorial lesions did not demonstrate this association due to disrupted cortico-cerebellar connection (i.e., “network collapse”). We postulate that patients without infratentorial lesions demonstrated this association due to sustained network efficiency due to milder disease burden and intact cortico-cerebellar connectivity. Future research should continue to investigate the structural and functional impacts of this under-studied brain region in pediatric-onset MS.
Open Access
Repetitive and Restricted Behaviors and Interests in Autism Spectrum Disorder: Relation to Psychopathology
(2022-12-14) Jasim, Sara; Perry, Adrienne
Repetitive and restricted behaviors and interests (RRBIs) in Autism Spectrum Disorder (ASD) have significant negative impacts on well-being and daily functioning. RRBIs vary as a function of an individual’s sex, age, and cognitive level as well as the presence of comorbid psychopathology. However, findings on these relationships have been ambiguous, partly due to the use of broad categorizations of RRBIs (e.g., lower- vs higher-order) rather than specific RRBIs (e.g., stereotypy) and the use of age-corrected cognitive level (i.e., IQ). The purpose of this study was to examine the patterns of specific RRBIs, obtained via the Repetitive Behavior Scale–Revised (RBS-R), in different sex, age, and raw cognitive level groups, as well as the relationship of RRBIs with internalizing and externalizing behaviors. Secondary data analyses were conducted using the Simons Simplex Collection (SSC) dataset, which included 2,758 participants ranging in age from 4 to 18 years. Across all RBS-R subtypes, results revealed no sex differences. However, older children demonstrated higher rates of Ritualistic/Sameness behaviors than younger children and adolescents, whereas younger and older children showed more Stereotypy than adolescents. In terms of cognitive level differences, the lower cognitive level groups showed higher rates of RBS-R subtypes except for Ritualistic/Sameness. After controlling for age and cognitive level, RBS-R subtypes accounted for a substantial amount of variance in internalizing and externalizing behaviors (23% and 25%, respectively). Specifically, Ritualistic/Sameness and Self-Injurious Behavior both predicted internalizing and externalizing behaviors, whereas Stereotypy only predicted internalizing behavior. These findings have key clinical implications that emphasize not only the consideration of sex, age, and cognitive level, but also specific RRBIs and associated psychopathology, when assessing for ASD and designing individualized interventions. Limitations of the present study and future directions are discussed.
Open Access
Domestic Sex Trafficking of Minors in Care of Child Protective Services: Exploring the Opportunities and Challenges in the Protection of Youth
(2022-12-14) Baird, Kyla Antonietta; Connolly, Jennifer A.
Domestic sex trafficking is a growing concern across Canada with the majority of victims being minors under the age of 18. Youth in care of Child Welfare (CW) are particularly at risk for exploitation. Much of the extant research on sex trafficking is American based, leaving gaps in our knowledge as to why CW youth are at risk within the Canadian geopolitical and cultural context. With police being central agents in the extraction and protection of victims, they offer unique insights into issues of recruitment, approaches to support victims and barriers to exiting sex trafficking that have not previously been explored. This dissertation consists of three studies examining issues of the domestic sex trafficking of minors. Study 1 is a published systematic review (Baird & Connolly, 2021) that synthesizes literature from 23 peer-reviewed articles on the exploitation processes and tactics used by traffickers in the sex trafficking of minors in Canada and the US. Study 1 describes a sexual exploitation continuum comprising three distinct components; the recruitment context, entrapment strategies used by traffickers, and enmeshment tactics used to prolong exploitation. The reviewed articles highlight the ways traffickers cater their approach to the specific vulnerabilities of the youth they exploit. Study 2 is a published file review (Baird, McDonald, & Connolly, 2020) that narrows the focus of sex trafficking to the Canadian context. Using secondary data from a police agency in southern Ontario, data from 223 victims were examined to explore the elevated risk status of CW involved youth who are victims of sex trafficking compared to non-CW victimized youth. Findings from Study 2 underscore the high-risk status of CW youth, with these youth being recruited at a younger age, more likely to use drugs and alcohol, to have experience of childhood maltreatment, and to have lived in a group home. Traffickers were described to use online platforms and relationships to recruit youth. Study 3 expands on the results of Study 2, by exploring the perceptions of police officers on a specialized human trafficking team on issues related to CW youth risk for recruitment, barriers to exiting, and their specific approaches to prevention and intervention. This team provided cohesive insights on the unique vulnerabilities of CW youth making them visible to traffickers and invisible within the CW system, various emotional and systemic barriers that prolong exploitation or increase risk for re-entry, and the relationship-focused and victim-centered approaches the team takes in their efforts to extract youth from the sex trade. Implications for practice, policy and research are discussed.
Open Access
Environmental, Cognitive, and Neurological Predictors of Mental Health Following Pediatric Stroke: A Mixed Methods Framework
(2022-12-14) Deotto, Angela Christine; Desrocher, Mary E.
The current project explored mental health outcomes in pediatric stroke and the personal and environmental factors that can influence psychological risk or resilience. The investigation was approached from quantitative (Study 1) and qualitative (Study 2) paradigms in order to attain both breadth and depth of understanding. Study 1: Thirty-one children between the ages of 8-18 years with a history of ischemic stroke and 34 demographically-equivalent controls participated. Information on participants’ psychosocial functioning was collected via standardized questionnaires. Children also underwent performance-based testing of cognitive abilities. Medical record review provided information on stroke patients’ neurological, diagnostic/clinical, and brain injury characteristics. All parents completed inventories of parent mental health and family functioning. Statistical comparisons revealed that the stroke group was significantly more likely to have physical disability, learning disability, poorer executive functioning, and emotion regulation concerns. Clinically elevated anxiety symptoms were present in 45.2% of stroke participants. In the stroke group, linear regression models revealed that higher internalizing symptoms were predicted by poorer executive functioning, learning and language problems, reduced fine-motor speed, bullying, reduced social support, perinatal/neonatal stroke, and greater time since stroke. Parent mental health was the strongest environmental predictor of childhood behaviour. Results highlight internalizing symptomatology risk in pediatric stroke and the converging roles of neurological, cognitive, and social factors in determining psychological outcomes. Study 2: Individual interviews were conducted with 14 children with stroke history, and aimed to capture the lived experience of pediatric stroke survivors. Interviews were audio recorded, transcribed verbatim, and qualitatively analyzed using reflexive Thematic Analysis methodology. Coding, theme generation, and data visualization were completed using NVivo12 software. Prominent psychosocial themes encompassed social anxiety, test anxiety, hiding sadness, trouble with thinking, missing out, bullying, and isolation. Insight into adaptive coping mechanisms and personal values was present, as was emphasis on the importance of supportive peers and family. Taken together, findings across studies illustrate the profound impact that pediatric stroke can have on children’s psychosocial functioning, cognition, personal identity, and self-efficacy. Focus should be given to the coordination of services to meet multiple, complex needs in pediatric stroke patients at heightened risk for poor mental health outcomes.
Open Access
Effectiveness of the Trauma Practice Approach for Adults in Trauma Treatment
(2022-12-14) Wyers, Cassandra Rita; Muller, Robert Tom
This study examined the therapeutic outcomes of a tri-phasic approach to trauma therapy, Trauma Practice (TP), in a community setting. TP creates a technique toolbox for clinicians, combining empirically supported cognitive behavioural therapy (CBT)-based techniques to be used throughout the different phases of therapy (i.e., safety and stabilization, working through trauma, and reconnection). TP’s theoretical framework utilizes reciprocal inhibition and cognitive restructuring techniques to address common areas of trauma impairment, including the body, thoughts, behaviour, and emotion/relationships. Clinicians for this study were recruited from the community. Clinical training in TP was provided through an online training model as well as in-person didactics. Model fidelity was ensured through regular supervision meetings. Participants were recruited through their clinicians and were asked to fill out questionnaires at four time points throughout the course of therapy, and again six-months after therapy termination. History of traumatic event exposure was also captured during baseline. Results of this study were the first to provide empirical support of the effectiveness of TP. Over the course of the intervention, significant decreases in PTSD symptoms, trauma-symptom distress, and workplace impairment were seen. These gains were demonstrated to be maintained at follow-up; however, follow-up sample sizes were small. In addition, high levels of therapeutic alliance were maintained throughout the course of treatment. Results support the clinical utility of the tri-phasic model and provide evidence of effective trauma therapy. Clinical implications are discussed.
Open Access
Parent Therapeutic Factors in Mental Health Treatment for Autistic Children
(2022-08-08) Ting, Victoria Elizabeth; Weiss, Jonathan
Cognitive behaviour therapy (CBT) is an effective treatment for many autistic children who experience mental health problems, and parents are particularly involved in their psychotherapy. The current research is the first to use a mixed-method approach to investigate how parents contribute to the therapeutic process in mental health treatment for autistic children. Study 1 used a grounded theory-informed approach to develop a conceptual framework of the therapeutic process factors associated with successful parent involvement in CBT for autistic children. Seventeen therapists and 11 mothers participated in individual semi-structured interviews about their involvement in a CBT program for autistic children ages 8-13 years, where parents attended 10 weekly sessions with their child. The conceptual framework depicts how parent involvement varies depending on child-, parent-, and environmental factors. Parents' contributions to the therapeutic process were grouped into five main functions: logistical coordinator, co-facilitator, coach and cheerleader, companion and teammate, and complementary helper. Parents' beliefs and attitudes toward therapy (i.e., therapy commitment, criticalness, and flexibility) also influenced their involvement. Study 2 examined the development and psychometric properties of a novel observational measure of parent therapeutic factors in parent-involved CBT for autistic children, which was developed based on Study 1's findings. Following pilot coding, two coders coded three videotaped CBT sessions for 60 parent-child dyads. The Parent Therapeutic Factors Observational Rating Scale (PTFORS) therapeutic functions subscale had adequate interrater reliability, internal consistency, and item stability. Preliminary evidence supporting content, discriminant, and predictive validity is discussed. The current research addresses two significant gaps in the literature by identifying and defining relevant parent therapeutic factors, and creating an observational measure to examine parent involvement in therapy. With further evidence supporting its validation, the PTFORS may be a useful tool to improve our understanding of how to maximize child treatment gains in parent-involved psychotherapy for autistic children. Clinicians may also seek to use the conceptual framework to guide formulation and treatment planning in their work with families.
Open Access
Girls in Child Protective Services: A Mixed Methods Exploration of Self-Perceptions, Interpersonal Connections, and Academic Resilience
(2022-03-03) Wincentak, Katherine Jessica; Connolly, Jennifer A.
Aim: The aim of the present study was to advance the understanding of academic resilience among girls in the care of child protective services. Using a developmental framework of resilience this research examined: the academic experiences of girls in care, the capacity of girls in care to form positive self- perceptions, as well as secure, supportive relationships, and the influence of self-perceptions and interpersonal connections on academic resilience. Method: A mixed methods design was used, where 44 adolescent girls in care completed interviews and questionnaires. Their caseworkers provided additional background information. Qualitatively, academic resilience was examined through girls' accounts of their educational experiences and their views of self and others in relation to their academic progress. Quantitative indicators of academic resilience included enrollment history, attendance, engagement, achievement, and progress through the standard curriculum. Analyses included an integration of qualitative and quantitative data. Results: A thematic analysis indicated that participants' accounts of their academic / career path fell along a spectrum. Five sub-themes capturing different sets of experiences were defined: diverted, stuck behind, catching up, on track, and succeeding. Resilience was interrelated with self-perceptions and interpersonal connections as participants described experiencing helplessness, dependence, self-reliance, or autonomy through connection. Quantitative findings indicated that participants views of their own academic progress were correlated with external indicators of academic progress. As predicted, higher self-esteem and more secure relational styles were also linked with academic resilience. A content analysis revealed that the presence of a more extensive support network, and the experience of autonomy in one's own academic / career path, were associated with multiple markers of academic resilience. Discussion: Findings from the present study reinforce the importance of using mixed methods designs when working with vulnerable populations. Findings suggest that conditions supporting resilience are optimized when the need to feel worthy and autonomous functions in harmony with the need to be connected to others who are supportive and safe. Strategic, developmentally grounded interventions promoting the development of adaptive self-perceptions and secure relationships within broader networks of caring individuals have the potential to mitigate poor educational outcomes and enhance the lives of girls in care.