Psychology (Functional Area: Clinical-Developmental)

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Open Access
Longitudinal Neurocognitive Trajectories In Perinatal Arterial Ischemic Stroke
(2024-10-28) Bondi, Bianca Christina; Pepler, Debra
Perinatal stroke occurs between 20 weeks gestation and 28 days postnatally, with arterial ischemic strokes (AIS) the most common subtype. Research regarding neurocognitive outcomes following perinatal AIS has been primarily cross-sectional with contradictory results given methodological variability (small cohorts, varying age at assessment, differing/non-standardized measures, limited follow-up, mixed populations). No research has characterized neurocognitive trajectories across multiple time points spanning critical developmental periods. Methods: These studies were the first evaluation of neurocognitive trajectories for individuals followed longitudinally at The Hospital for Sick Children across: 1) infancy and early childhood (Study 1; N=40; neonatal AIS), and 2) early and late childhood, adolescence, and early adulthood (Study 2; N=208; perinatal AIS). For Study 1, children underwent developmental assessment(s) at 18- and/or 36-months (Bayley) and neuropsychological assessment(s) from ages 4-13 years (WPPSI/WISC/WASI). For Study 2, individuals underwent neuropsychological assessment(s) from ages 2-25 years (WPPSI/WISC/WASI/WAIS). Predictors included sex, lesion volume, lesion laterality, seizure disorder, neurological diagnoses, medical comorbidities, perinatal AIS type, and early screening. Exploratory multilevel growth curve modelling was used to assess longitudinal neurocognitive trajectories, and to examine main or moderating effects of predictors. Results: Despite age-appropriate functioning statistically extrapolated at stroke occurrence, neurocognitive decline was found across 1) infancy and early childhood and 2) early and late childhood, adolescence, and early adulthood. For neonatal AIS and perinatal AIS, lesion volume moderated neurocognitive change. For neonatal AIS, medical comorbidities (congenital heart disease, genetic conditions) negatively impacted neurocognition at stroke occurrence (main effect) and early screening in infancy positively impacted neurocognition over time. For perinatal AIS, seizure disorder status and perinatal AIS type moderated neurocognitive change. Conclusions: In keeping with the early vulnerability hypothesis, neurocognitive decline was observed across development following perinatal AIS. Lesion volume and seizure disorders had moderating effects on neurocognition whereas medical comorbidities had a main effect; however, differences were apparent for perinatal AIS types. Perinatal AIS type moderated neurocognition such that presumed perinatal AIS involved rapid neurocognitive decline initially followed by improvements relative to neonatal AIS, which demonstrated consistent decline. Understanding neurocognitive trajectories and relevant predictors will inform the early identification of high-risk groups and the implementation of precision-based interventions.
Open Access
Influence of Lifetime Mild Traumatic Brain Injury and Repetitive Head Impact Exposure on the Aging Brain
(2024-10-28) Echlin, Holly; Wojtowicz, Magdalena
This dissertation aims to examine associations between remote mild traumatic brain injury (mTBI), and cortical thickness, subcortical volumes, and cognitive functioning via a systematic literature review and retrospective data analyses. Study 1 consisted of a systematic review of the literature investigating long-term brain impacts, assessed in vivo using neuroimaging methods, of exposure to mTBI and repetitive head impacts (RHIs) during adulthood. Findings from the systematic review showed that remote mTBI/RHI exposure was associated with neurological abnormalities revealed by neuroimaging across several modalities (i.e., diffusion tensor imaging, magnetoencephalography, magnetic resonance spectroscopy, positron emission tomography, spectral domain optical coherence tomography, and several magnetic resonance imaging techniques), though conclusions are limited due to methodological constraints in the studies examined. Given the gaps in the literature identified in Study 1 (i.e., a lack of research on long-term mTBI exposures in veteran samples), Study 2 consisted of analyses to examine associations between mTBI exposure and cortical thickness across the brains of Vietnam War Veterans. Data from this sample of service members was obtained from the Alzheimer’s Disease Neuroimaging Initiative - Department of Defense (ADNI-DOD). Participants included 47 male veterans with mTBI exposures (mean age = 69.43, SD = 5.02) and 82 controls (veterans without mTBIs; mean age = 68.51, SD = 4.69). Associations between mTBI, age, education, cognitive status, PTSD symptoms, and cortical thickness were examined. Three regions, i.e., the left caudal middle frontal and bilateral superior frontal cortices, showed greater cortical thickness for the mTBI group. These findings indicate potential regions for future analyses examining long-term mTBI sequelae. Finally, given the close association between TBI and Alzheimer’s disease pathology, study 3 examined the impact of mTBI on cortical thickness and subcortical volumes in AD-vulnerable regions, as well as memory functioning in this cohort. Narrowing ROIs to those implicated in AD revealed several regions that were associated with mTBI exposures (i.e., left lateral temporal cortex, right posterior cingulate cortex, right amygdala, and right inferior frontal cortex). These studies show that mTBI can have long-term but circumscribed effects on the brain.
Open Access
Autobiographical Memory in Youth with Stroke
(2024-10-28) Sehra, Ramandeep Kaur; Desrocher, Mary E.
Autobiographical memory (AM) consists of both memory for specific past personal events (episodic memory) and personal facts (semantic memory). An increasing amount of research has explored short term memory in youth following pediatric arterial ischemic stroke (AIS), however little work has been done examining long-term memory such as AM in this population. In the current study 28 youth with stroke and 32 age and sex-matched controls were administered the Children’s Autobiographical Memory Interview (cAMI). Youth with stroke showed deficits in the recall of episodic AM, and overall memory recall in comparison to controls. Furthermore, there were significant relationships between area of stroke, lesion lateralization, and time since stroke and specific memory scores. This study unveils, to our knowledge that pediatric stroke is associated with a selective deficit in AM. These results have implications for the adjustment of youth following pediatric stroke, so that earlier diagnosis of memory deficits can occur and early implementation of intervention programs can be put in place to allow these youth to function maximally.
Open Access
Twelve women and their stories: A thematic analysis of the pre and post self-narratives of female survivors of childhood sexual abuse who underwent hospital-based group trauma therapy
(2024-07-22) Rependa, Sara Lynn; Muller, Robert Tom
The importance of treating women with histories of childhood abuse has been well established. The efficacy of the Women Recovering from Abuse Program (WRAP) has also been investigated and established. The aim of the current qualitative study was to understand how women with a history of childhood abuse experienced WRAP, an intensive group treatment program based out of Women’s College Hospital in Toronto, Ontario. Thirteen women were interviewed pre- and post- treatment using the Self Assessment Interview (SAI). A thematic analysis was conducted on both the pre- and post- interviews that identified theme hierarchies for these two sources of data. These findings deepen our understanding about how participants view their trauma histories, relationships, self-concept, hopes for treatment, symptoms, met or unmet expectations, goal attainment, and impressions of the therapy itself. Theoretical and clinical implications are discussed.
Open Access
A Telepsychology-Based Social Competence Intervention for Youth with Learning Disabilities and Mental Health Difficulties During the COVID-19 Pandemic
(2024-07-18) Diplock, Benjamin David; Pepler, Debra J.
Youth with learning disabilities (LDs) have a heightened risk for co-occurring mental health difficulties. The co-occurrence of LDs and mental health difficulties (LDMH) is associated with further risk of adverse impacts on cognitive and academic performance. Therefore, the availability of effective social competence interventions for youth with LDMH is essential to scaffold skill development and prevent cascading difficulties into adulthood. That said, the onset of the COVID-19 pandemic led to the immediate pause of most in-person therapeutic services. In response to worsening of youths’ mental health difficulties and the significant challenges that the pandemic created for mental health service delivery, the Child Development Institute in Ontario, Canada, transitioned their in-person Social Awareness, Competence, Engagement, & Skills (ACES) intervention service to virtual implementation. I conducted two studies with the purpose of gathering qualitative and quantitative data to examine the feasibility, acceptability, and effectiveness of the telepsychology-based adaptations of Social ACES from the clinician, caregiver, and youth perspectives. Methods: Data collection occurred through in-depth semi-structured interviews of nine Social ACES clinicians (Study 1), four caregivers and four youth who partook in the telepsychology-based intervention (Study 2); lived experiences were analysed using the qualitative approach of Interpretative Phenomenological Analysis. For a mixed-methods perspective, I also examined outcomes of the intervention through quantitative parent ratings of their child’s social competence pre- post-treatment, augmented by clinicians’ reports (Study 2). The data was triangulated to provide a deeper perspective of the youths’ progress through the program and challenges experienced. Results: The findings resulted in the emergence of four (Study 1) and two (Study 2) major themes, as well as elucidating four integrated youth case studies, to help clarify clinicians’, caregivers, and youths’ perceptions of the adaptation. Conclusions: These studies provided preliminary evidence for the feasibility, acceptability, and effectiveness of virtual Social ACES. The findings have implications for the future of mental health service delivery, raise further questions about the effectiveness of social competence programming during and after a time of significant disruption, and point to several lines of inquiry for future critical research on virtual interventions for children and youth.
Open Access
The Role of Self-Concept in a Community-Based Study of the Effectiveness of Trauma-Focused Cognitive Behavioural Therapy with Trauma-Exposed Children
(2024-07-18) Konanur, Sheila; Muller, Robert Tom
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a widely used treatment model for trauma (Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program was a multi-site community-based study which evaluated the effectiveness of TF-CBT with trauma-exposed school-aged children in a diverse Canadian city (Muller & DiPaolo, 2008). Using data from the Healthy Coping Program, the role of children’s self-concept, and its relationship to posttraumatic stress (PTS) symptoms were examined. Self-report data were collected from a total of 111 trauma-exposed children referred for a trauma-focused intervention (assessment and TF-CBT). Children’s self-concept was measured using the short form version of the Tennessee Self-Concept Scale – Second Edition (Fitts & Warren, 1996). Children’s PTS was measured using the Trauma Symptom Checklist for Children (Briere, 1996). Trauma-exposed children’s self-concept was found to have a decreasingly significant negative relationship with PTS symptoms over the course of assessment and TF-CBT. Self-concept was significantly more dysfunctional amongst trauma-exposed children compared to a normative sample of children. Significant improvements in trauma-exposed children’s self-concept were observed after receiving trauma-focused intervention. Trauma-exposed children’s self-concept moved from a clinically dysfunctional range to the clinically functional range over the course of the assessment and continued to improve during TF-CBT. Further, these improvements were maintained at a six-month follow-up. These findings support the effectiveness of TF-CBT in improving trauma-exposed children’s self-concept and underscore the importance of considering how children view themselves after trauma. Clinical implications are discussed.
Open Access
The Romantic Relationships of Girls in Child Protective Services: Perceptions of Personal Agency
(2024-03-16) Benvenuto, Katherine Alexandra; Connolly, Jennifer A.
During late adolescence romantic relationships emerge as a critical context whereby teens exercise agency to promote their own development. However, expressions of agency within the romantic context have only been studied among adolescents who have normative parental relationships known to support their romantic development. Thus, this study explored expressions of agency within the context of romantic relationships among girls who experience ruptured parental relationships. Twenty-two girls (Mage =18.5) placed in out of home care by CPS were interviewed regarding their romantic relationships. A content analysis was conducted on their responses. Results showed that girls selected romantic relationships that satisfied normative and unique needs, that some girls reflected on and learned from their experiences, and that girls adapted their behaviour in the face of unmet needs. These finding suggest girls in care enact agency within romantic relationships to support their development and hold implications for the positive value of romantic relationships.
Open Access
Lived Experiences of First Nations Girls: Exploring the Developmental Processes of Identity Formation Through Narrative Interviews
(2024-03-16) McKenzie, Stephanie Daniella; Pepler, Debra J.
Through narrative interviews, I explored the developmental and relational processes associated with identity formation of 16 First Nations (Anishinaabe) adolescent girls aged 12 to 18 years. I used an inductive thematic analysis approach to prioritize the girls’ voices in their stories. The girls shared developmental and relational ways of understanding themselves in relationship to others and their world. Based on the analyses of the girls’ interviews, I proposed three themes of identity development processes: Being (present development), Becoming (active exploration), and Envisioning (future-oriented lens of what is to come). In all these processes, the girls commented close relationships that were vital in supporting their emerging understanding of themselves. The results point to a wholistic and integrated model of Anishinaabe girls’ processes of identity development in which their personal and relational selves were integrated, there is an understanding of the continuity of the self, and a recognition of the key influences from their close relationships. For Indigenous youth, elucidating the processes of identity carries utility in understanding the strength, preservation, and continuity of the self, withstanding 500 years of colonialism (Pitawanakwat, 2006; Chandler et al., 2013).
Open Access
A Two-Eyed Seeing Approach to Evaluating an eIntervention for Inuit Youth Using Inuit Qaujimajatuqangit
(2024-03-16) Oskalns, Megis; Bohr, Yvonne M.
Inuit youth have one of the highest suicide rates in the world. Presently, there is no culturally appropriate suicide intervention for this population. This study aimed to evaluate the process of developing the I-SPARX CBT e-Intervention, and its content, using Two-Eyed Seeing. Four data sets from the 2018-2019 I-SPARX project were used in this study from four communities across Nunavut: Iqaluit (n=22), Qamani’tuaq (n=3), and Kinngait (n=4). One focus group was held in Tkaronto (n=5) with youth from Iqaluktuuttiaq. Thematic Analysis explored responses to research questions as grounded in the two frameworks —three Inuit Qaujimajatuqangit (IQ) principles and western CBT skills. Results demonstrated that features of the process of collaboratively developing I-SPARX met principles set out in the IQ framework. Aspects of the process of adapting fit with IQ, with Piliriqatigiingniq (Collaborative Relationships) being the most prominent IQ. Features of CBT underlying the I-SPARX game met principles set out in the IQ framework: the most prominent principles reflected in the content were Pilimmaksarniq (Skills and Knowledge Acquisition) and Qanuqtuurunnarniq (Problem Solving). Both the process and content of the I-SPARX project met criteria for a Two-Eyed Seeing evaluation, meshing IQ principles with western CBT applications. Limitations of this study, that engaged a small sample of Inuit youth, are discussed. Recommendations for future research, include incorporating additional IQ principles to expand on Inuit cultural perspectives. Preliminary results suggest that I-SPARX could be efficacious for contributing to Inuit cultural research in development and evaluation of mental health and wellness e-interventions for Inuit youth.
Open Access
The Teachabi Professional Development Module: A Mixed Method Analysis of Change in Open-Ended Case Study Responses
(2023-12-08) DuPlessis, Danielle Caroline; Desrocher, Mary E.
Background. Educators have limited knowledge of acquired brain injury (ABI). This work evaluates an online professional development module, TeachABI. Objective. To explore and evaluate educators’ knowledge change following completion of TeachABI using a mixed-method approach. Method. Case study responses were analyzed before and after 49 elementary-level educators reviewed TeachABI. Results. After completing TeachABI, educators conceptualized ABI more accurately and were more likely to identify ABI as a factor for classroom challenges, χ^2(1, N=49) = 8.64, p < .01. Teachers described a variety of procedural steps and classroom strategies to support students with ABI. Post-module, educators outlined a greater diversity, z = 4.7, p < .01, and number, t(49) = 3.2, p < .01, d = .46, of steps and a greater number of classroom, z = 3.1. p < .01, r = .5. Conclusions. TeachABI was an effective professional development tool and improved educators’ approaches to the case study.
Open Access
Mental Health and Autism Symptom Severity of Autistic Youth who Received Early Intensive Behavioural Intervention
(2023-12-08) Magnacca, Carly Antoinette; Perry, Adrienne
Autism involves social communication difficulties and engagement in restricted and repetitive behaviours and interests. Many autistic youth experience co-occurring mental health conditions. Unfortunately, treatment history is rarely reported in this sample, resulting in ambiguity in the relationship between treatment history and later mental health functioning. Limited research has explored the long-term mental health and education outcomes of Early Intensive Behavioural Intervention (EIBI). The purpose of this study was to describe the mental health, autism symptom severity, medication use, and education outcomes of youth who previously received EIBI. Thirty-two parents completed questionnaires about their child’s mental health (i.e., Child Behavior Checklist), autism symptom severity (i.e., Social Responsiveness Scale), education outcomes, and medication use. Scores of mental health measures were higher than the normative sample but lower than scores from other studies of autistic participants. Though uncontrolled, this suggests that autistic youth who received EIBI do not show severe mental health difficulties.
Open Access
An investigation of parenting responses to toddler distress: Interactions between parent physiology, behaviour, and socioemotional context
(2023-12-08) Badovinac, Shaylea Danica; Pillai Riddell, Rebecca
This dissertation examined physiological, behavioural, and psychological aspects of parents’ responses to children’s distress across infancy and toddlerhood through a series of three studies. Study 1 is a systematic review and narrative synthesis of the literature that characterized parents’ physiological responses to infants’ and toddlers’ (0-3 years) distress during experimental and naturalistic distress paradigms and examined concurrent associations between parents’ physiological and behavioural responses. General trends in parents’ physiological responses varied as a function of methodological factors including the physiological outcome (i.e., cortisol, cardiac outcomes, skin conductance, salivary alpha amylase), distress paradigm (e.g., fear-related distress, frustration-related distress), and baseline comparison condition used. Studies 2 and 3 used data from a sample of caregiver-toddler dyads (N=234) studied in a naturalistic high-distress context (i.e., toddler routine vaccination) to address the limitations and gaps in the literature identified in Study 1. Study 2 described the validation of a measure of insensitive (i.e., distress-promoting) caregiver behaviour during routine vaccination. Measure validity and reliability were investigated with correlations and autoregressive cross-lagged path analysis. Study 3 characterized the trajectory of caregivers’ physiological (i.e., high-frequency heart rate variability) responses during routine vaccination and associations of the trajectory with parents’ concurrent behaviour and psychological stress. Findings across all three studies are discussed in the context of the extant literature and relevant theoretical models. Clinical implications and directions for future research are offered.
Open Access
Maternal Fluoride Exposure and Offspring IQ: An Investigation of the Potential Mediating Role of Thyroid Dysfunction in Pregnancy
(2023-12-08) Hall, Meaghan Kathleen; Till, Christine
Objective: Fluoride exposure has been associated with thyroid dysfunction; however, no studies to date have examined whether fluoride disrupts thyroid function in pregnant women. We evaluated the potential thyroid-disrupting effects of fluoride exposure in pregnancy and tested whether thyroid disruption in pregnancy would mediate the association between maternal fluoride exposure and child IQ in Canadian mother-child dyads. Methods: Maternal thyroid dysfunction was estimated using both categorical measures of thyroid health status (i.e., euthyroid, subclinical, and primary hypothyroid) and continuous measures of thyroid hormone levels (i.e., TSH, FT4, and TT4). Results: We observed a statistically significant association between water fluoride concentration and greater risk of primary hypothyroidism, and between primary hypothyroidism in pregnancy and lower IQ among male offspring. Further, higher urinary fluoride concentration was associated with higher TSH among women pregnant with female, but not male fetuses. Maternal thyroid hormone levels were not associated with offspring IQ. Conclusion: Results suggest that maternal thyroid dysfunction in pregnancy may be one mechanism underlying the association between fluoride exposure in pregnancy and offspring IQ.
Open Access
Neurocognitive Outcome and Psychological Adjustment Following Pediatric Ischemic and Hemorrhagic Stroke
(2022-10) Champigny, Claire Marie; Desrocher, Mary E.
Pediatric stroke is an important cause of acquired brain injury in youth associated with neurological sequelae, including complex neurocognitive impairments. Neurocognitive deficits may impact psychological adjustment post-injury by hindering emotional and behavioural regulation, psychosocial functioning, academic advancement, quality of life, and mental health. Despite awareness of the devastating and long-term sequelae following pediatric stroke, research in this domain is lacking. Using a mixed methods approach, my doctoral dissertation contains two clinical studies that address these gaps. Study 1 used a cross-sectional design to investigate the role of eight factors identified in the literature as possible predictors of neurocognitive outcome in pediatric stroke. Ninety-two patients with a history of pediatric stroke participated in this project. Statistical analyses examined relationships between each predictor and neurocognitive outcome measures. Results indicated that large lesions, ischemic stroke, and lower socioeconomic status were associated with worse neurocognitive outcomes compared to small to medium lesions, hemorrhagic stroke, and higher socioeconomic status. Graphs showed U-shaped trends suggesting worse outcomes across most neurocognitive domains when stroke occurred at five to ten years of age. Participants with seizures had more severe executive functioning impairments than participants without seizures. We found little to no evidence of associations between the other predictors and neurocognitive outcomes. Study 2 used an inductive qualitative methodology to provide a personal lens through which to understand the day-to-day impact of neurocognitive impairments, among other sequelae, on adjustment following stroke. Fourteen adolescents and young adults with a history of childhood stroke were interviewed one-on-one to share their lived experience regarding adjustment and coping. Following thematic analysis, five overarching themes were identified: (1) Processing the Story, (2) I’ve Changed, (3) Loss and Challenges, (4) Keys to Recovery, and (5) Adjustment and Acceptance. Findings underscored a need for mental health support for survivors of stroke, as well as important strengths and sources of support drawn upon by survivors. Overall, this dissertation contributed to the advancement of developmental neuropsychology by providing novel insights into neurocognitive outcomes and adjustment following pediatric stroke. Findings should inform clinical practice and the development of services aimed at enhancing recovery and fostering optimal development for youth with stroke.
Open Access
Building a Specialized Model of Care for Youth at Risk of Sexual Exploitation in the Child Welfare System: A Systematic Review and Exploratory Program Evaluation
(2023-10-03) McDonald, Kyla Patricia; Connolly, Jennifer A.
Sex trafficking is a global issue with the true prevalence of this crime being unknown. Youth are at heightened risk for sexual exploitation due to normative developmental vulnerabilities such as the desire for romantic relationships and their developing cognitive abilities. Child welfare samples indicate even higher prevalence rates, as traffickers target these youth related to their adverse childhood experiences. Despite the critical need, few programs exist to support youth who are at risk of sex trafficking. The present dissertation sought to identify components critical to a model of care for youth in the child welfare system, at risk of sexual exploitation. Chapter 1 introduces the issue of sex trafficking among youth in care, particularly in Canada, and provides a brief review of relevant literature and the critical need to support youth in this population through relevant programming. Chapter 2 (McDonald, Fisher, & Connolly, 2023, Child Abuse and Neglect) draws on multiple forms of evidence including a systematic literature review and interviews with experts-by-experience (i.e., survivors and child welfare personnel) to identify convergent and divergent evidence for best practices and components important for a model of care. Findings support a model comprised of two overarching components: 1) wraparound supports, and 2) trained caregivers and supported foster homes. Experts also uniformly expressed that an appropriate model of care would require child welfare agencies to take a preventative stance on the issue, such as conducting early coordinated risk assessments on all youth in care. Recommendations were provided to collaborating child welfare agencies. Chapter 3 (submitted to the Journal of Child and Family Social Work) is a multi-case qualitative evaluation of the exploratory START with the YOUTH (STAR-Y) program for three youth who were at risk of sex trafficking, and their families. Results indicated successful program implementation; a reduction in youth risk factors over time related to sexual exploitation including youth no longer engaging in concerning Internet behaviour. Wraparound supports and the foster parent-youth relationship appeared important in the decrease of risk over time. Chapter 4 concludes the dissertation through a review of the study findings, associated theoretical models, and future clinical and research directions. Overall this dissertation contributes to clinical research and practice through exploring ways in which we can support youth in the child welfare system at risk of and possibly engaged in sex trafficking.
Open Access
Sex Difference of Pre- and Post-Natal Exposure to Six Developmental Neurotoxicants on Intellectual Abilities: A Systematic Review and Meta-Analysis of Human Studies
(2023-01) Goodman, Carly Victoria; Till, Christine
Objective: To examine sex-specific effects of exposure to developmental neurotoxicants on IQ in a systematic review and meta-analysis. Method: We screened abstracts published before December 31, 2021, for empirical studies of six neurotoxicants (lead, mercury, polychlorinated biphenyls, polybrominated diphenyl ethers, organophosphates, and phthalates) that (1) used an individualized biomarker; (2) measured exposure during the prenatal period or before age six; and (3) provided effect estimates on general, nonverbal, and/or verbal IQ by sex. We performed separate random effect meta-analyses by sex with subgroup analyses by neurotoxicant. Results: Fifty-one studies were included in the systematic review and 22 in the meta-analysis. Prenatal exposure to neurotoxicants was associated with decreased general and nonverbal IQ in males, especially for lead. No significant effects were found for females or verbal IQ. Conclusion: During fetal development, males may be more vulnerable than females to general and nonverbal intellectual deficits from neurotoxic exposures, especially from lead.
Open Access
Therapeutic Process Factors in Mental Health Treatment for Autistic Youth
(2023-10-03) Albaum, Carly Sarah; Weiss, Jonathan
Psychosocial interventions can be beneficial for addressing mental health challenges for some autistic youth, but a sizeable portion of youth who take part in mental health treatment do not demonstrate clinically meaningful improvement. Examining therapeutic process factors may provide insight as to why some youth benefit from treatment, while others do not. The current research aimed to evaluate the role of various therapeutic process factors in mental health treatment for autistic children and adolescents through two studies. The first study involved a systematic review and a narrative synthesis of the literature on how therapeutic process factors have been measured and the association with treatment outcome following psychosocial intervention addressing mental health challenges for autistic youth. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. The second study examined indicators of child engagement in relation to treatment outcome for autistic children who participated in cognitive behaviour therapy for emotion regulation. Indicators of child engagement included observational ratings of in-session involvement, and therapist ratings of therapeutic alliance between therapist and child and homework completion. Each indicator of engagement was measured at early, middle, and late stages of therapy. After controlling for pre-treatment scores, in-session involvement significantly predicted some aspects of post-treatment emotion regulation, whereas therapeutic relationship and homework completion did not. This dissertation addresses key gaps in research on mental health treatment for autistic youth by providing a detailed summary on what is currently known about therapeutic process factors and process-outcome associations in psychotherapy, and offers original findings that highlight the importance of child in-session involvement for therapeutic success. Research should continue to focus on relatively well-examined factors, such as therapeutic alliance, and explore factors that are less understood, such as client beliefs about treatment and parent involvement. Clinicians working with autistic clients should actively strive to form therapeutic alliance with youth and parents, and support positive treatment engagement for the full duration of therapy to enhance the likelihood of successful outcomes.
Open Access
Technology Behaviours and Attitudes in Youth: Correlates with Cognitive and Real-World Behaviours
(2022-08) Doidge, Joshua Leon; Toplak, Maggie E.
Technology use, which has become ubiquitous in the lives of adolescents, has both positive and negative aspects. In the judgment and decision-making literature, the Cognitive Reflection Test is a measure of the tendency to override an incorrect response and to engage in further reflection that leads to the correct response (Toplak et al., 2014a). Navigating optimal technology use often requires resisting miserly tendencies, as measured by the Cognitive Reflection Test. The purpose of the current project was to examine technology behaviours and attitudes that are either adaptive or maladaptive through the lens of judgment and decision-making and cognitive reflection in a set of two studies with community samples of adolescents. The associations between these technology behaviours and cognitive reflection, cognitive ability, and real-life outcomes of antisocial behaviours and academic achievement were examined. Study 1 (in-person sample) served as a pilot study, demonstrating that several technology behaviours were measurable in adolescents and were significantly correlated with antisocial behaviours and academic achievement. The purpose of Study 2 (online sample) involved creating several additional items of technology behaviours and attitudes, and used exploratory factor analyses (EFA) to understand the associations among these behaviours and attitudes, and examined gender differences among these behaviours and attitudes. Both cognitive reflection and cognitive ability had small to moderate positive correlations with several technology behaviour factors. Cognitive ability significantly predicted some of the maladaptive technology behaviour factors. While cognitive reflection significantly predicted the adaptive technology attitude factor related to practical managing of technology use, suggesting a potentially important relationship between these attitudes and cognitive reflection. Furthermore, several technology factors significantly predicted antisocial behaviours and academic achievement. The results are further discussed along with implications and future directions for studying technology use by adolescents.
Open Access
The Impact of Toxic Chemicals on Neurodevelopment: A Turn Towards Prevention
(2023-06) Green, Rivka Ruth; Till, Christine
Exposure to toxic chemicals can adversely impact children’s neurodevelopment. Yet, remarkably few resources are dedicated to preventing these adverse effects. We developed a developmental neurotoxicological knowledge translation (KT) tool, the PRevention of Toxic Chemicals in the Environment for Children Tool (PRoTECT), and evaluated the efficacy of a KT video, Little Things Matter: The Impact of Toxins on the Developing Brain. In study one, PRoTECT was refined via focus groups and implemented with 190 participants of childbearing age for development via exploratory factor analysis. We found evidence for a four-factor model, of which 16 of the 18 items had adequate loadings > 0.40 on a derived factor. In study two, we evaluated responses of 15,594 international participants to validate PRoTECT’s conceptual dimensionality and general response patterns across various demographic characteristics. Seventeen items fit into a three-factor model with factors, or subscales, representing (1) preferences to lower exposure and increase prevention, (2) knowledge of the regulation of toxic chemicals by government and industry, and (3) knowledge of developmental neurotoxicology. Scores on subscales 1 and 3 tended to be higher among participants from India, participants with higher education, and parents and pregnant women, indicating stronger preferences to lower exposure and increase prevention and greater knowledge of developmental neurotoxicology, whereas scores on subscale 2 tended to be higher among participants from the United States, indicating less trust in government and industry. In study three, a randomized controlled trial was conducted, whereby participants were assigned to either watch the KT video (experimental group) or serve in the control group. Scores on PRoTECT and other behavioural items were examined at baseline and six-week follow-up. At baseline, participants in the experimental group showed greater changes in scores on PRoTECT and a greater intent to reduce exposure than the control group, but the differences were much smaller at six-week follow up; no meaningful changes in behaviour were noted. This dissertation addresses KT gaps in developmental neurotoxicology. While we wait for legislation to reduce exposure to toxic chemicals, we must find ways to effectively communicate these risks with the hope of advocating for stricter regulations.
Open Access
Parent Outcomes Following Participation in Cognitive Behaviour Therapy for Autistic Children in a Community Setting
(2023-06) Ibrahim, Alaa; Weiss, Jonathan
Parents of autistic children are at higher risk for mental health problems, including anxiety, depression and stress. Cognitive behaviour therapy (CBT) that targets children’s emotion regulation problems may have an indirect influence on parent outcomes, especially if they play a supporting role in the intervention. However, the majority of the implemented CBT interventions were carried out in highly controlled research settings and no study has examined the parent outcomes of child-focused CBT in a community setting. The current study examined parent outcomes (i.e., mental health, mindful parenting and parenting practices) following a community-based CBT program with concurrent parent involvement for autistic children, as well as associations between parent and child outcomes (i.e., autism symptoms and emotion dysregulation) using change scores. Participants included 77 parent-child dyads across 7 community organizations in Ontario, Canada. Parents reported improved mindful parenting and positive parenting practices post intervention, and no significant change for their mental health. Multiple mediation analyses revealed that parent positive changes were associated with child positive changes in emotion regulation, with changes in parenting practices mediating the relationship between mindful parenting and child emotion regulation. This research suggests mutual beneficial outcome for all the stakeholders including children, parents, community organizations and public policy.