Coping, Context And Family Mental Health Within CBT For Autistic Children

Autistic children experience elevated emotional-behavioural difficulties; links have been identified between these struggles and parent distress. Although parent-involved cognitive behavioural therapy (CBT) helps many autistic children improve overall emotional distress, there is a critical lack of understanding as to the role of children’s coping ability within this process, and the systemic factors that may impact change. To address this gap, this dissertation investigated the impact of family and child moderators of coping skill change within CBT for autistic, school-age children. Data was pooled from three related CBT interventions administered to 186 autistic children ages 8 – 13 years and their families, from 2013 – 2021.

In Study 1, Exploratory Item Factor Analysis was conducted with pre-treatment data to investigate the dimensionality of the ERSSQ-P. A multidimensional structure with three factors was identified as the most appropriate fit, comprised of a 10-item subscale within the emotion regulation domain (Coping: a child’s ability to modulate distressing feelings in stressful contexts), and two subscales within the social communication domain (Initiating and Interacting). Validity for the subscales was confirmed based on associations with measures of emotion regulation, depression and social communication.

Study 2 used the Coping subscale and multilevel modeling to investigate how pre-treatment child and family factors impact coping skill change for autistic children across three timepoints, and whether these relationships varied according to treatment type (individual vs. small group). Results indicated that on average, all children experienced the same, small level of improvement in coping ability, regardless of treatment type. However, pre-treatment systemic factors (child depression, restricted interests and repetitive behaviours, parent distress, family stress related to child behaviour) were related to lower initial coping ability, suggesting that children experiencing higher levels of difficulties at the beginning of treatment were also likely to finish the program at a relatively lower skill level. Although these relationships do not appear to be a barrier to statistical improvement, meaningful change may require longer than 10 weeks. Greater support for parents may also be warranted. Overall, findings present preliminary, yet practical considerations for clinicians and community agencies that can assist with targeted, strength-based treatment planning.