自闭症特征与家庭功能之间的关系在自闭症儿童和非自闭症儿童中

作者：ten Hoopen, LW (ten Hoopen, Leontine W.); de Nijs, PFA (de Nijs, Pieter F. A.) ; Slappendel, G (Slappendel, Geerte); van der Ende, J (van der Ende, Jan) ; Bastiaansen, D (Bastiaansen, Dennis) ; Greaves-Lord, K (Greaves-Lord, Kirstin) ; Hakkaart-van Roijen, L (Hakkaart-van Roijen, Leona)  ; Hillegers, MHJ (Hillegers, Manon H. J.)

摘要：To explore associations between autism traits and family functioning over time, we studied longitudinal data of a mixed group of 168 clinically referred autistic and non-autistic children. Cross-lagged models showed a significant association between fewer autism traits at the diagnostic assessment and better family functioning 1 year later for the whole group, independently of children’s internalizing or externalizing behavior. When splitting the group into autistic children (58%) and non-autistic children (42%) based on an autism diagnosis, this association was only significant in the subgroup of non-autistic children with autism traits. We hypothesized that the needs of families experiencing difficulty understanding and adjusting to their children with autism traits, but no clinical autism diagnosis, might be unmet without the training or support facilities offered to families with autistic children. Although further research is needed to explore this association, clinicians may also consider supporting families of non-autistic children with autism traits to prevent family functioning problems. Because high autism trait levels in non-autistic children may be of a different origin than autism, for example, other neurodevelopmental or mental health problems, family training or support should be tailored to the child’s underlying difficulties. Lay Abstract Little is known about family functioning over time when raising a child with autism traits, with or without a clinical autism diagnosis. Therefore, we asked caregivers-mostly parents-of a group of 168 children about the family functioning and the child’s emotional and behavioral characteristics, as well as autistic traits, twice with about 1 year in between. For numerous reasons, the children were referred to youth mental health care centers, including child and adolescent psychiatric services. Care as usual was offered after the diagnostic assessment if a clinical diagnosis was the assessment outcome. Caregivers reported less problematic family functioning in children with fewer autism traits over time. The child’s additional emotional or behavioral characteristics did not seem to influence this relation. Furthermore, we split the whole group into autistic children with a clinical autism diagnosis (58%) and non-autistic children with autism traits but without a clinical diagnosis (42%) to see whether we would find the same results in both groups. Surprisingly, the relation between family functioning and the level of a child’s autism traits only held for the subgroup of non-autistic children with autism traits. Thus, raising children with autism traits without a clinical diagnosis may affect family functioning over time. We think that families might have difficulty understanding and adjusting to the autism traits of their children but are lacking the support that is exclusively offered to families of children with a clinical autism diagnosis. We must be cautious because we do not know whether there is a causal relation. Although further research is needed to explore and learn to understand this result, clinicians might consider offering support to families of children with subthreshold autism to prevent problems in family functioning. Because high autism trait levels in non-autistic children may be of a different origin than autism, for example, other neurodevelopmental or mental health problems, family training or support should be tailored to the child’s underlying difficulties.

为了探索自闭症特征与家庭功能之间的关联，我们研究了 168 名临床转诊的自闭症和非自闭症儿童的混合组的纵向数据。交叉滞后模型显示，诊断评估中较少的自闭症特征与1年后整个组的家庭功能较好之间存在显着关联，与儿童的内化或外化行为无关。当根据自闭症诊断将该组分为自闭症儿童（58%）和非自闭症儿童（42%）时，这种关联仅在具有自闭症特征的非自闭症儿童亚组中显着。我们假设，如果没有为有自闭症儿童的家庭提供的培训或支持设施，难以理解和适应具有自闭症特征但没有临床自闭症诊断的家庭的需求可能无法得到满足。虽然需要进一步的研究来探索这种关联，但临床医生也可以考虑支持具有自闭症特征的非自闭症儿童的家庭，以防止家庭功能问题。由于非自闭症儿童的高自闭症特质水平可能与自闭症不同，例如其他神经发育或心理健康问题，因此应根据儿童的潜在困难量身定制家庭培训或支持。外行摘要 在抚养具有自闭症特征的孩子时，无论是否被临床诊断为自闭症，对家庭功能随着时间的推移知之甚少。因此，我们向一组 168 名儿童的照顾者（主要是父母）询问了家庭功能、孩子的情绪和行为特征以及自闭症特征，两次之间大约有 1 年的时间。由于种种原因，这些儿童被转介到青少年精神保健中心，包括儿童和青少年精神科服务机构。如果临床诊断是评估结果，则在诊断评估后照常提供护理。照顾者报告说，随着时间的推移，自闭症特征较少的儿童的家庭功能问题较少。孩子的其他情绪或行为特征似乎并没有影响这种关系。此外，我们将整个组分为临床诊断为自闭症的自闭症儿童（58%）和具有自闭症特征但没有临床诊断的非自闭症儿童（42%），看看我们是否会在两组中找到相同的结果。令人惊讶的是，家庭功能与儿童自闭症特征水平之间的关系仅适用于具有自闭症特征的非自闭症儿童亚组。因此，在没有临床诊断的情况下抚养具有自闭症特征的儿童可能会随着时间的推移影响家庭功能。我们认为，家庭可能难以理解和适应孩子的自闭症特征，但缺乏专门为临床自闭症诊断儿童家庭提供的支持。我们必须谨慎，因为我们不知道是否存在因果关系。尽管需要进一步的研究来探索和学习理解这一结果，但临床医生可能会考虑为阈下自闭症儿童的家庭提供支持，以防止家庭功能问题。由于非自闭症儿童的高自闭症特质水平可能与自闭症不同，例如其他神经发育或心理健康问题，因此应根据儿童的潜在困难量身定制家庭培训或支持。