پیش بینی سبک اثر متقابل والدین و فرزندان در زوج مبتلا به اوتیسم

Parent synchrony has been shown to be developmentally important for the growth of communication skills in young children with autism. Understanding individual-differences in parent synchrony and other associated features of dyadic interaction therefore presents as an important step toward the goal of appreciating how and why some parent–child dyads come to adopt more optimal interaction styles, while for others, parent interaction is more asynchronous and less developmentally facilitative. Within the large, well-characterized Preschool Autism Communication Trial (PACT) cohort, baseline parent–child interaction samples were coded for three key aspects of dyadic interaction style; – Parent Synchrony, Child Initiation, and Shared Attention. We explored associations among these measures, demographic characteristics and standardized child assessment scores. While various child factors were associated with each of the interaction measures, very few associations were observed with parent/familial factors. Child language age-equivalence was a significant positive predictor of variation in each interaction measure, while child repetitive symptoms predicted reduced Shared Attention. The three interaction measures were moderately positively inter-related. In the context of childhood autism, variation in dyadic interaction style appears to be driven more by child language and repetitive behaviors than age, social-communication symptoms and non-verbal ability. Parent/family factors contributed little to explaining variability in parent–child interaction, in the current study.

Social impairments, such as deficits in orienting toward or sharing attention with others, are core early features of autism spectrum disorders (ASD; Adamson, Deckner & Bakeman, 2010). Language is often delayed, intentional communication is markedly reduced (Doussard-Roosevelt et al., 2003 and van IJzendoorn et al., 2007) and, if present, communicative signaling is often weak and/or poorly timed (Wetherby, Prizant & Hutchinson, 1998). However, substantial heterogeneity exists, with variation in communication skills associated with symptom severity and developmental level, and with early skills predictive of intervention gains and later abilities (Gillespie-Lynch et al., 2012, Kasari et al., 2012 and Sigman and Ruskin, 1999). Features of ASD also influence the behavior of interaction partners. For example, children with ASD present few leads for partners to follow and their weak/poorly-timed signals are easily missed (Dolev et al., 2009 and van IJzendoorn et al., 2007). Caregivers may attempt to compensate for their child's limited interactive contribution, by directing the child's attention rather than following the child's focus or actions to support mutual attention (Adamson et al., 2010, Freeman and Kasari, 2013, Meirsschaut et al., 2011 and Siller and Sigman, 2002). This directive parental style may further limit opportunities for children with ASD to improve their communicative skills. As such, children with ASD may require enhanced experience of interaction with a higher proportion of sensitive and supportive partner responses for optimal growth in communication skills, than is necessary for typically developing (TD) children (Adamson et al., 2010 and McDuffie and Yoder, 2010). Although observational studies demonstrate concurrent and longitudinal benefits of supportive parental interaction style for growth in language/communication skills in children with ASD (Haebig et al., 2012 and Mahoney et al., 2007), there is wide variability in parent interaction style for children with ASD (see Siller & Sigman, 2002; 2008). More synchronous parental style describes the tendency for the adult interaction partner to respond to and support the child's own interests and attentional foci, making communicative contributions which are in keeping with what the child is already doing. On the other hand, more asynchronous style describes the tendency for the adult to act and communicate in ways which seek to redirect the child's focus of attention or to modify his/her behavior or activities (e.g., see Aldred, Green and Adams, 2004). Alongside the evidence from observational studies, some recent parent-mediated intervention trials (Dawson et al., 2010, Green et al., 2010 and Kasari et al., 2010; but not others, e.g., Oosterling et al., 2010 and Rogers et al., 2012) have also demonstrated effects of increases in parental synchrony for gains in child communication skill. Given the apparent developmental significance of parental interaction style for young children with autism, it seems important to strive toward an understanding of precisely how and why some dyads might come to adopt more or less beneficial interaction styles. Understanding the extent and significance of individual-differences in key features of interaction style which vary among parent–child dyads – including relative parent synchrony, child initiated contributions, and mutual shared attention – presents a promising first step toward this goal.

This study sought to better understand individual variability in dyadic interaction style and the potential predictors of such variation. We employed the Dyadic Communication Measure for Autism (DCMA) to characterize three key aspects of parent–child interaction during free-play: Parent synchronous communication acts were defined as those seeking to support the child's current attentional focus or activity; Child initiations were communicative acts arising spontaneously/without prompting from the parent; Shared attention comprised sustained episodes of parent and child coordinating attention on a common focus, activity or conversational topic. A number of child factors were found to associate with the three key DCMA scales, but only child language ability and repetitive symptoms carried significant predictive value. The DCMA scales, Parent Synchrony, Child Initiation, and Shared Attention, were moderately highly inter-correlated, each accounting for significant variation in the others, suggesting that the elements of dyadic interaction style may be self-sustaining, once established. With the exception of occupational level within the family, parent and demographic/family factors contributed relatively little to determining interaction style, and the effects of attachment bond, whilst associated with interaction style, carried no unique predictive value. Parent-mediated intervention approaches (e.g., Green et al., 2010), with their capacity to alter parental style and improve child social-communication skills, should in principle therefore be well suited to individuals across a range of personal circumstances.