A systematic review of parental expressed emotion and child behavioural and emotional outcomes in autistic spectrum disorder and an empirical study of impact of an attachment and trauma-informed training intervention for social care professionals

Green, Corinne 2023. A systematic review of parental expressed emotion and child behavioural and emotional outcomes in autistic spectrum disorder and an empirical study of impact of an attachment and trauma-informed training intervention for social care professionals. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

The Five Minute Speech Sample (FMSS) is a method of assessing a range of attitudes and perspectives an individual holds about another, by exploring the way they speak about them. The FMSS requires someone to speak about another person and their relationship to them for five minutes without interruption. The speech is then coding using different coding systems for the attitudes or perspectives of interest. One of the most commonly used coding system is that of expressed emotion, which describes the level of criticism, warmth and emotional overinvolvement the individual displays in the tone and content of their speech. While this was initially used to evaluate the level of expressed emotion (EE) parents exhibited towards their children, it has since been used in many other contexts, including the exploration of professionals’ attitudes towards individuals they work with. With the expansion of contexts in which the FMSS has been used, alternative coding systems have been developed including autism-specific and preschool-specific coding systems for EE. Additional coding systems have also been developed for other areas of interest such as reflective functioning (RF), which describes an individuals’ ability to understand another person’s behaviour in the context of their mental state and to consider the relationship to their own mental state. Over recent years the FMSS has been used to understand the relationship between parents, caregivers, and professionals’ attitudes towards young people and the emotional and behavioural outcomes for young people, and preliminary research suggests that levels of EE and RF can be altered by psychoeducation and therapy interventions. This thesis explored aimed to expand the FMSS literature by systematically reviewing the literature around the relationship between parental EE and child behavioural and emotional outcomes in Autism Spectrum Disorder (ASD), and empirically testing the impact of an attachment and trauma-informed training intervention for social work professionals on their attitudes towards the young people they work with. The aim of the systematic review was to identify and synthesise the current literature exploring relationships between parental EE measured by the FMSS and child behavioural and emotional outcomes in child and adolescents with ASD, whilst considering additional factors that may be related to these outcomes. Eight eligible papers were identified and synthesised. The review found that increased parental criticism was often related to increased behavioural problems in children and adolescents, and showed some evidence of increased criticism predicting increased behaviour problems. Increased parental warmth was mostly found to be related to lower levels of behaviour problems, and showed some evidence of predicting lower behaviour problems. One study showed evidence towards these relationships occurring in both directions, with higher levels of child behaviour problems predicting higher criticism and lower warmth. While most studies explored mothers’ EE, there was also some evidence towards fathers’ level of warmth being related to child outcomes. Additional variables of parental stress, parental depressive symptoms, maternal educational level, and family cohesion were also found to be related to child outcomes. Several different coding systems were used across studies which produced variable outcomes, therefore it may be beneficial for a consistent approach to coding to be used in future research. The findings suggest parental EE plays an important role in child behavioural and emotional outcomes and could be the focus of future interventions. The aim of the empirical paper was to evaluate the impact of an attachment- and trauma-informed training package for social work professionals on their EE and RF using the FMSS alongside the impact upon their attitudes relating to trauma-informed care (ARTIC) and their knowledge, confidence and worries about using trauma-informed approaches. A new FMSS coding system was developed to assess their ability to take an attachment-informed stance, which showed good code-recode and inter-rater reliability. A nonrandomised waitlist control trial design was utilised. One group of social work professionals received two days of training, while another group remained on a waiting-list to receive training. Both groups completed FMSS interviews and questionnaires roughly two weeks apart, with the training group completing the measures before and after their training. Increases in knowledge, confidence, EE warmth and ARTIC scores were found for the training group from pre- to post-training. Significant increases across time were also found for RF and attachment-informed stance but these were not significantly different across the two groups. These findings suggest that while training may improve professionals’ attitudes towards, and their knowledge and confidence in, trauma-informed care, these changes may not translate to differences in the way they speak about young people other than increasing the warmth of their tone.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	4 September 2023
Last Modified:	04 Sep 2024 01:30
URI:	https://orca.cardiff.ac.uk/id/eprint/162224

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