自闭症儿童家庭中的应对紧张生活事件：与心理健康的纵向关联及认知灵活性的调节作用

作者：

Leno, VC (Carter Leno, Virginia); Wright, N (Wright, Nicola)  等；

摘要：

Mental health problems are prevalent in autistic youth, but the underpinning mechanisms are not well explored. In neurotypical youth, stressful life events are an established risk factor for mental health problems. This study tested longitudinal bidirectional associations between family-level stressful life events and mental health problems and whether these were moderated by cognitive flexibility, in a cohort of autistic children (N = 247). Family-stressful life events, assessed using the parent-reported Family Inventory of Life Events and Changes, and mental health problems, assessed using the teacher-reported Child Behavior Checklist Internalizing and Externalizing Symptoms subscales, were measured at multiple points between 7 and 11 years. Analyses showed no significant pathways from internalizing or externalizing symptoms to family-stressful life events or from family-stressful life events to internalizing or externalizing symptoms. There was some evidence of moderation by cognitive flexibility; the family-stressful life events to internalizing symptoms pathway was non-significant in the group with typical shifting ability but significant in the group with clinically significant shifting problems. Information about family-level stressful life event exposure and cognitive flexibility may be helpful in identifying autistic youth who may be at higher risk of developing mental health problems. Established risk factors for mental health problems in neurotypical populations are relevant for understanding mental health in autistic youth. Lay abstract Experiencing stressful life events, such as a parent having had serious illness, parental divorce, bullying and victimization, is known to increase risk for mental health difficulties in neurotypical children. However, few studies have looked at whether stressful life events have a similar impact in autistic youth and if any individual characteristics may moderate the impact of said life events. In this study, we tested whether in autistic children aged 7-11 years, exposure to family-level stressful life events predicted later mental health symptoms (and vice versa). We also tested whether associations between stressful life events and mental health symptoms differed depending on the child’s level of cognitive flexibility. We found stressful life events only predicted internalizing symptoms (such as anxiety and depression) in children with clinically significant difficulties in cognitive flexibility (as rated by their parents). Mental health symptoms did not predict future exposure to stressful life events. Results suggest that information about exposure to stressful life events and cognitive inflexibility may be helpful in identifying autistic children who may be at risk of developing anxiety and depression symptoms.

自闭症青年普遍存在心理健康问题，但其基本机制尚未得到充分探索。在神经典型青少年中，应对紧张生活事件是心理健康问题的已知风险因素。本研究在一组自闭症儿童（N = 247）中测试了家庭级紧张生活事件与心理健康问题之间的纵向双向关联，并探讨了认知灵活性在其中的调节作用。使用父母报告的家庭生活事件及变化量表进行家庭级紧张生活事件评估，并使用教师报告的儿童行为量表内在化和外在化症状子量表进行心理健康问题评估，评估时间跨越了7至11岁之间的多个时间点。分析结果显示，从内在化或外在化症状到家庭级紧张生活事件，或从家庭级紧张生活事件到内在化或外在化症状的路径均不显著。一些证据表明，认知灵活性具有调节作用；在典型转换能力组中，家庭级紧张生活事件到内在化症状的路径是不显著的，但在临床上存在转换问题的组中是显著的。关于家庭级紧张生活事件暴露和认知灵活性的信息可能有助于识别可能更容易发展心理健康问题的自闭症青年。在神经典型人群中已知的心理健康问题风险因素对理解自闭症青年的心理健康具有相关性。