The family environment and children with an autism spectrum disorder: A longitudinal examination of the relation between parental expressed emotion and child externalizing behaviors
The current study, a longitudinal study using Bader (2009) as Time 1 data, used questionnaire data to explore the longitudinal relation between parental expressed emotion, a well-established predictor of symptom relapse in various other disorders (e.g., schizophrenia, bipolar, and behavior disorders), with change in externalizing behaviors in 84 children, ages 8 to 18, with an autism spectrum disorder (ASD). Both components of expressed emotion, criticism/hostility and overinvolvement, were explored, though hypotheses were only made in regard to criticism/hostility. It was found that high levels of parental criticism/hostility, not parental overinvolvement, at Time 2 uniquely related to higher levels of externalizing behaviors in children with an ASD at Time 2, even after controlling for severity of ASD symptoms, parental distress, and parenting practices. It was also found that parental expressed emotion, specifically criticism/hostility at Time 1, significantly related to a change in externalizing behaviors from Time 1 to Time 2, even after controlling for Time 1 total family income, severity of ASD symptoms, parental distress, and parenting practices. That is, higher levels of parental criticism/hostility at Time 1 predicted higher levels of child externalizing behaviors at Time 2. However, the reverse was not found. Time 1 child externalizing behaviors did not predict a change in parental expressed emotion from Time 1 to Time 2. In looking at possible interactions with control variables, as exploratory analyses, very few findings were significant. This finding of a unidirectional relation between parental expressed emotion, specifically criticism/hostility, and child externalizing behaviors has important treatment implications as it indicates that a component addressing this high parental criticism/hostility would benefit the overall treatment aimed at reducing externalizing behaviors in children with an ASD.