ارتباط بین تنظیم احساسات، عملکرد اجتماعی و افسردگی در پسران مبتلا به ASD
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|38843||2013||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Research in Autism Spectrum Disorders, Volume 7, Issue 4, April 2013, Pages 549–556
Abstract Purpose Symptoms of depression are common in children and adolescents with an autism spectrum disorder (ASD), but information about underlying developmental factors is limited. Depression is often linked to aspects of emotional functioning such as coping strategies, but in children with ASD difficulties with social interactions are also a likely contributor to depressive symptoms. Methodology We examined several aspects of emotional coping (approach, avoidant, maladaptive) and social functioning (victimization, negative friendship interactions) and their relation to depression symptoms in children with ASD (N = 63) and typically developing (TD) peers (N = 57). Children completed a battery of self-report questionnaires. Results Less approach and avoidant, but more maladaptive coping strategies, and poor social functioning were uniquely associated with more symptoms of depression in children with ASD. Only less approach and more maladaptive coping were uniquely associated with depression severity in TD boys. Conclusions Unlike TD boys, boys with ASD who report using avoidant strategies to deal with stressful situations report fewer symptoms of depression, suggesting that this may be an adaptive emotion regulation strategy. However, understanding the role of over-arousal in this process, inferences about long-term effects of this strategy, its causality and direction of effects will require additional research.
1. Introduction Autism spectrum disorders (ASD) are associated with a wide range of psychiatric symptoms and disorders, of which depression appears to be relatively common (Gadow et al., 2012, Kim et al., 2000, Matson and Nebel-Schwalm, 2007 and Simonoff et al., 2008). In non-ASD individuals depression is generally characterized by a diminished interest in activities, feelings of worthlessness or guilt, and a diminished ability to concentrate or make decisions. Kim et al. (2000) found higher levels of depression in children with ASD based on parent-report. Owing to phenotypic overlap (e.g., prefers to be alone) and atypical manifestation of depression in ASD, it is difficult to accurately recognize and diagnose depression in these children. For example, depression in children with ASD could also be accompanied and therefore indicated by aggressive behavior, hyperactivity, self-injurious behavior, and regression of previously learned skills (Magnuson & Constantino, 2011). Although there is no longitudinal research on childhood depression in children with ASD, we know that in typically developing (TD) individuals’ onset of depression during childhood is associated with antisocial behavior, substance use, and suicide in later life (King et al., 2004, McGee and Williams, 1988 and Rao et al., 1993). Given the relatively high rate of depression symptoms in children with ASD it is important to identify factors that may contribute to the development of depression as potential targets of intervention with the possibility of preventing later-onset mental health concerns. 1.1. Coping strategies and depression In general, child self-reported symptoms of depression are strongly linked to certain aspects of emotion regulation such as coping strategies in both children with ASD and their TD peers (Rieffe et al., 2011 and Wright et al., 2010). Coping involves regulating the emotional impact of a stressful event (Lazarus & Folkman, 1984), which is a key element for adaptive functioning. Coping strategies can be divided into three categories; approach (e.g., seeking social support, trying to solve the problem), avoidant (e.g., cognitively restructuring a stressful event, distracting oneself from the problem, ignoring the problem), and maladaptive coping (internalizing, such as thinking something bad will happen again, or externalizing/acting out, such as screaming or hitting something). Whereas very young children mainly use avoidant coping strategies to distract or remove oneself from a stressor, older children are more likely to use approach strategies, such as problem solving (Fields & Prinz, 1997). Research in TD children has shown that ineffective coping strategies and self-reported depressive symptoms are inter-related. For example, Abela, Brozina, and Haigh (2002) showed that one maladaptive strategy, rumination, was related to an increase of depressive symptoms in children (8–12 years), whereas approach and avoidant strategies were not. Wright et al. (2010) also found that approach (but not avoidant) strategies were associated with fewer self-reported depressive symptoms in TD children (8–13 years), but the converse was true for maladaptive strategies. Importantly, Rieffe et al. (2011) found that children with ASD (9–13 years) used fewer self-reported adaptive strategies in terms of seeking social support and trying to find a solution, compared to TD children. Whereas adaptive strategies (e.g., approach strategies) were related to less depressive symptoms in the TD group, in children with ASD they were not. However, maladaptive strategies were related to more depressive symptoms in the ASD group (Rieffe et al., 2011). 1.2. Victimization and depression In children with ASD, it is likely that impaired social skills and negative social experiences with peers (e.g., victimization, negative friendship interactions) also contribute to dysphoria (Rieffe et al., 2012 and Whitehouse et al., 2009). Victimization is often associated with self-reported anxiety and depression (Fekkes et al., 2004 and Klomek et al., 2007) and includes such behaviors as physical pestering, name-calling, backbiting, and ignoring. Children with ASD are victimized more often than their TD peers, possibly due to their difficulties with social interactions, atypical interests, and overreactions to provocations (Cappadocia et al., 2012 and Rieffe et al., 2012). Whereas the relation between victimization and self-reported depression in TD children is well documented, Kelly, Garnett, Attwood, and Peterson (2008) did not find this to be the case in children with ASD. However, in their study both variables were assessed with parent-report, which may not be the best way to measure these constructs (Fekkes et al., 2005 and Moretti et al., 1985). For example, parents may be less able to distinguish typical adolescent mood problems from real depression. Furthermore, a large percentage of school-age children do not tell their parents if and when they are bullied (Fekkes et al., 2005). 1.3. Negative friendship interactions and depression Although friendships high in positive behaviors have a nurturing influence on children's mental health, friendships high in negative interactions such as domination, conflicts, and rivalry are related to depressive symptoms in TD adolescents (Berndt, 2002 and Kouwenberg et al., in press). Berndt (2002) hypothesizes, based on his earlier study showing a longitudinal relationship between negative friendship interactions and disruptive behaviors, that negative friendship interactions can lead children to adopt this interaction style in other social interactions. Therefore, they have fewer social successes, which in turn could lead to internalizing problems. Children with ASD are known for their difficulties in forming and maintaining peer relationships. For example, they score higher on self-reported negative friendship interactions such as conflict and betrayal compared to their TD peers (Whitehouse et al., 2009). Deficits in communication and social insight may prevent them from developing strategies to overcome interpersonal difficulties and conflicts (Carrington, Templeton, & Papinczak, 2003). Moreover, Whitehouse et al. (2009) found that peer conflicts and betrayal are indeed associated with symptoms of self-reported depressive symptoms in adolescents with ASD. 1.4. Present study The aim of this study is to examine the extent to which different aspects of self-reported emotional and social functioning are uniquely related to self-reported symptoms of depression in boys with ASD, as compared to TD boys. Specifically, we examined the interrelations among coping strategies, victimization, and negative friendship interactions. Based on previous research, we expected (1) more symptoms of depression in boys with ASD compared to TD boys (Kim et al., 2000, Matson and Nebel-Schwalm, 2007 and Simonoff et al., 2008). Furthermore, we expected (2) less use of approach strategies in boys with ASD compared to TD boys (Rieffe et al., 2011) but did not expect differences in the use of avoidant and maladaptive strategies (Rieffe et al., 2011). Additionally, (3) boys with ASD were expected to score higher on victimization (Cappadocia et al., 2012 and Rieffe et al., 2012) and negative friendship interactions (Locke, Ishijima, Kasari, & London, 2010) than their TD peers. In both groups, we expected higher levels of maladaptive strategies to be associated with higher levels of depression (Rieffe et al., 2011 and Wright et al., 2010). Whereas in the TD boys we expected higher levels of approach strategies to be associated with lower levels of depression, in ASD boys we did not expect a relation between approach strategies and the level of depression (Rieffe et al., 2011). We did not expect to find a relationship between avoidant strategies and depression in TD boys (Wright et al., 2010), yet examining the relationship between avoidant strategies and depression in the ASD group was exploratory. Furthermore, we expected positive associations between victimization and depression and between negative friendship interactions and depression in both groups of youth (Berndt, 2002, Hawker and Boulton, 2000, Kouwenberg et al., in press and Whitehouse et al., 2009). Lastly, because social deficits are a defining feature of ASD, we expected these variables to uniquely contribute to the prediction of depressive symptoms. In TD boys, we predicted that the relation between social problems and depressive symptoms is mediated by the child's ability to effectively regulate his emotions (i.e., coping strategies) (Wright et al., 2010).
نتیجه گیری انگلیسی
. Results 3.1. Differences between groups on the study variables All dependent variables showed moderate to good internal consistencies (Cronbach's α) in both groups (see Table 1). There were no differences between the groups for the three coping strategies. However, as expected, the reported levels of depression, t(118) = 2.01, p ≤ .05, d = .39, victimization, t(118) = 2.56, p ≤ .05, d = .45, and negative friendship interactions, t(118) = 2.21, p ≤ .05, d = .39, were higher in boys with ASD than in the control group. 3.2. Associations of depression with coping, victimization, and negative friendship features There were moderate to strong correlations between self-reported depressive symptoms and all the other variables in the ASD group. In the TD group, only approach coping and victimization correlated moderately with depression, and maladaptive coping correlated strongly with self-reported symptoms of depression in the TD group (Table 2). Table 2. Correlations and hierarchical multiple regression analyses predicting depression of coping strategies, victimization, and negative friendship features. Depression ASD TD r Adj. R2 β p r Adj. R2 β p Approach coping −.37** .52*** −.36 .000 −.30* .37*** −.23 .048 Avoidant coping −.34** −.29 .002 −.12 −.13 .243 Maladaptive coping .40** .24 .025 .57*** .44 .001 Victimization .54*** .26 .018 .43** .20 .105 Negative Friendship .37** .25 .012 .05 .00 .986 * p < .05. ** p < .01. *** p < .001. Table options Table 2 shows the regression analyses for ASD and TD groups separately. For boys with ASD, approach and avoidant coping negatively predicted symptoms of depression, but maladaptive coping positively predicted symptoms of depression. Independently of coping strategies, victimization and negative friendship interactions positively predicted symptoms of depression in ASD boys. These variables accounted for 52% of the variance in depression in the ASD group. In the TD group, only approach coping negatively predicted symptoms of depression, and maladaptive coping positively predicted symptoms of depression. These variables accounted for 37% of the variance in depression severity.