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The Psychophysiological and Health Corollaries of Child Problem Behaviours in Caregivers of Children with Autism and ADHD

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Title: The Psychophysiological and Health Corollaries of Child Problem Behaviours in Caregivers of Children with Autism and ADHD
Language: English
Authors: Lovell, B., Moss, M., Wetherell, M. A.
Source: Journal of Intellectual Disability Research. Feb 2015 59(2):150-157.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
Peer Reviewed: Y
Page Count: 8
Publication Date: 2015
Document Type: Journal Articles
Reports - Research
Descriptors: Correlation, Behavior Problems, Psychology, Psychological Patterns, Caregiver Child Relationship, Parent Child Relationship, Physiology, Physical Health, Metabolism, Caregivers, Parents, Attention Deficit Hyperactivity Disorder, Stress Variables, Surveys, Attitude Measures, Child Behavior, Emotional Disturbances, Intervention
DOI: 10.1111/jir.12081
ISSN: 0964-2633
Abstract: Background: The positive relationship between problem behaviours of children with additional complex needs and psychological distress in their caregivers has been widely evidenced. Fewer studies, however, have assessed the relationship between care recipients' problem behaviours and key physiological processes, relevant for the physical health status of their care providers. This study examined the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder. Methods: Caregivers (n?=?18) completed self-report measures of psychological distress, child problem behaviours and incidences of commonly occurring ailments. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected saliva samples at waking, 30?min post waking, 1200?h and 2200?h on two consecutive weekdays. Results: Data revealed a positive relationship between caregivers' perceived levels of stress and problems with child conduct behaviours. In addition, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol patterns characterised by flatter diurnal cortisol slopes and reduced cortisol awakening response magnitude. Subjective reports of commonly occurring ailments were also greater in caregivers experiencing more problems with child emotional behaviours. Conclusions: These findings have implications for interventions that aim to improve the psychophysiological well-being of the caregiver by targeting problem behaviours of the care recipient.
Abstractor: As Provided
Entry Date: 2015
Accession Number: EJ1049437
Database: ERIC
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  Value: <anid>AN0100320210;eul01feb.15;2018Jul09.15:23;v2.2.500</anid> <title id="AN0100320210-1">The psychophysiological and health corollaries of child problem behaviours in caregivers of children with autism and ADHD. </title> <p>Background: The positive relationship between problem behaviours of children with additional complex needs and psychological distress in their caregivers has been widely evidenced. Fewer studies, however, have assessed the relationship between care recipients’ problem behaviours and key physiological processes, relevant for the physical health status of their care providers. This study examined the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder. Methods: Caregivers (n = 18) completed self‐report measures of psychological distress, child problem behaviours and incidences of commonly occurring ailments. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected saliva samples at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays. Results: Data revealed a positive relationship between caregivers’ perceived levels of stress and problems with child conduct behaviours. In addition, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol patterns characterised by flatter diurnal cortisol slopes and reduced cortisol awakening response magnitude. Subjective reports of commonly occurring ailments were also greater in caregivers experiencing more problems with child emotional behaviours. Conclusions: These findings have implications for interventions that aim to improve the psychophysiological well‐being of the caregiver by targeting problem behaviours of the care recipient.</p> <p>autism; caregivers; child problem behaviours; common health problems; cortisol; ADHD</p> <p>The caregiver control model has been widely applied to assess the psychophysiological corollaries of chronic stress (Lovell & Wetherell [<reflink idref="bib29" id="ref1">29</reflink>] ). Caregivers of children with additional complex needs face demands that far exceed those of typically developing children such as: stigma, physical pressures, severe financial hardship and enduring social isolation (Kuster & Merkle [<reflink idref="bib26" id="ref2">26</reflink>] ; Seltzer et al. [<reflink idref="bib39" id="ref3">39</reflink>] ). Unsurprisingly, caregivers of children with additional complex needs have reported increased psychological distress, manifested by elevated anxiety and depression scores, relative to parents of typically developing children (Weiss [<reflink idref="bib46" id="ref4">46</reflink>] ; Gallagher et al. [<reflink idref="bib13" id="ref5">13</reflink>] ; Lovell et al. [<reflink idref="bib31" id="ref6">31</reflink>] ).</p> <p>As the final effector hormone of the hypothalamic–pituitary–adrenal (HPA) axis, cortisol displays a robust basal diurnal pattern. That is, concentrations typically reach an acrophase between 30 and 45 min post waking [cortisol awakening response (CAR)], decline steadily across the day (diurnal cortisol slope) and reach a trough at around midnight (Smyth et al. [<reflink idref="bib42" id="ref7">42</reflink>] ). The stress of caring for a child with additional complex needs has been linked with atypical patterns of cortisol secretion characterised by flatter diurnal cortisol slopes (Miller et al. [<reflink idref="bib33" id="ref8">33</reflink>] ; Seltzer et al. [<reflink idref="bib40" id="ref9">40</reflink>] ) and total hyposecretion of cortisol across the day (Bella et al. [<reflink idref="bib3" id="ref10">3</reflink>] ). Alterations in the immune response such as elevated markers of inflammation (Rohleder et al. [<reflink idref="bib38" id="ref11">38</reflink>] ), as well as greater subjective reports of commonly occurring ailments (Cohen & Pollack [<reflink idref="bib6" id="ref12">6</reflink>] ) have also been observed in caregivers of children with additional complex needs, relative to normative controls. Research has indicated, however, that problem behaviours of the care recipient might exacerbate the harmful effects associated with the caregiver experience. Indeed, higher levels of psychological distress (Baker et al. [<reflink idref="bib2" id="ref13">2</reflink>] ; Lecavalier et al. [<reflink idref="bib28" id="ref14">28</reflink>] ) and more frequent episodes of ill health (Eisenhower et al. [<reflink idref="bib11" id="ref15">11</reflink>] ) have been observed in caregivers who reported more child problem behaviours. Fewer studies, however, have assessed the relationship between problem behaviours of the care recipient and physiological outcomes, relevant for the physical health status of their care providers. To date, poorer antibody response to pneumococcal vaccination has been observed in caregivers of children with additional complex needs who reported more problems with the conduct behaviours of the care recipient (Gallagher et al. [<reflink idref="bib13" id="ref16">13</reflink>] ). Elderly caregivers experiencing more problems with patients’ behaviours have also displayed atypical patterns of cortisol secretion (De Vugt et al. [<reflink idref="bib8" id="ref17">8</reflink>] ) and reported more episodes of infectious illness (Dyck et al. [<reflink idref="bib9" id="ref18">9</reflink>] ).</p> <p>To add to the relatively small research base in this area, we assessed the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder (ADHD). On the basis of past work, we predicted: (<reflink idref="bib1" id="ref19">1</reflink>) greater levels of psychological distress, (<reflink idref="bib2" id="ref20">2</reflink>) atypical patterns of cortisol secretion, and (<reflink idref="bib3" id="ref21">3</reflink>) greater subjective reports of commonly occurring ailments in caregivers experiencing more child problem behaviours.</p> <hd id="AN0100320210-2">Methods</hd> <hd id="AN0100320210-3">Participants</hd> <p>All procedures received ethical approval by the Faculty of Health and Life Sciences Ethics Committee. Caregivers were recruited according to strict criteria, which included: (<reflink idref="bib1" id="ref22">1</reflink>) caring for one child (aged 3–21 years) with clinically verified autism and ADHD (without any secondary diagnoses), who was also (<reflink idref="bib2" id="ref23">2</reflink>) living at home on a full time basis (<reflink idref="bib3" id="ref24">3</reflink>) not pregnant, breast feeding, taking steroidal and/or hormone replacement medication, (<reflink idref="bib4" id="ref25">4</reflink>) not managing any form of chronic illness, and (<reflink idref="bib5" id="ref26">5</reflink>) not working night shift. Caregivers who satisfied these criteria were invited to provide informed consent. Caregivers (n = 18) were recruited from regional caregiver support groups, special schools and charities and recompensed £10.00 for taking part. Characteristics of the sample are presented in Table [NaN] .</p> <p>Characteristics of the sample ( n  = 18)</p> <p> <ephtml> <table><tr><td>Caregivers</td><td /></tr><tr><td>Children with autism</td><td>14 (78%)</td></tr><tr><td>Children with ADHD</td><td>4 (22%)</td></tr><tr><td>Gender</td><td /></tr><tr><td>Mothers</td><td>17 (94%)</td></tr><tr><td>Fathers</td><td>1 (6%)</td></tr><tr><td>Age, years (mean ± SD)</td><td>45.0 (5.4)</td></tr><tr><td>Weight, lbs (mean ± SD)</td><td>156.9 (39.1)</td></tr><tr><td>BMI (mean ± SD)</td><td>26.5 (5.6)</td></tr><tr><td>Ethnicity</td><td /></tr><tr><td>White British</td><td>18 (100%)</td></tr><tr><td>Annual household income (mean ± SD)</td><td>£42 384 (£29 943)</td></tr><tr><td>Exercise, days per week (mean ± SD)</td><td>3.7 (2.6)</td></tr><tr><td>Number of children in the home</td><td /></tr><tr><td>1 child</td><td>3 (17%)</td></tr><tr><td>2–3 children</td><td>13 (72%)</td></tr><tr><td>>3 children</td><td>2 (11%)</td></tr><tr><td>Marital status</td><td /></tr><tr><td>Partnered</td><td>12 (67%)</td></tr><tr><td>Not partnered</td><td>6 (33%)</td></tr><tr><td>Use of nicotine</td><td /></tr><tr><td>Smoker</td><td>1 (6%)</td></tr><tr><td>Non‐smoker</td><td>17 (94%)</td></tr><tr><td>Alcohol consumption (units per week)</td><td /></tr><tr><td><5</td><td>13 (72%)</td></tr><tr><td>5–10</td><td>3 (17%)</td></tr><tr><td>>10</td><td>2 (11%)</td></tr><tr><td>Use of antidepressants medications</td><td /></tr><tr><td>Yes</td><td>8 (44%)</td></tr><tr><td>No</td><td>10 (56%)</td></tr><tr><td>Child attributes</td><td /></tr><tr><td>Age of the care recipient (mean ± SD)</td><td>14.2 (4.4)</td></tr><tr><td>Number of siblings (mean ± SD)</td><td>1.0 (0.7)</td></tr></table> </ephtml> </p> <p>1 ADHD, attention deficit hyperactivity disorder; BMI, body mass index.</p> <hd id="AN0100320210-4">Procedures</hd> <p>Participants were asked to complete measures of psychological distress, commonly occurring ailments and child problem behaviours, and were provided materials to perform ambulatory collection of salivary cortisol. On any one day, diurnal cortisol measurement can be influenced to a large extent by state factors such as time of waking (Stalder et al. [<reflink idref="bib44" id="ref27">44</reflink>] ), quality and duration of sleep (Griefahn & Robens [<reflink idref="bib18" id="ref28">18</reflink>] ) and exposure to light in the morning (Thorn et al. [<reflink idref="bib45" id="ref29">45</reflink>] ). To increase the reliability of diurnal cortisol measurement, therefore, researchers have recommended that participants collect between four and six saliva samples and on two (or more) consecutive days (Hellhammer et al. [<reflink idref="bib21" id="ref30">21</reflink>] ). In the present study, caregivers were instructed to collect salivary cortisol at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays (Almeida et al. [<reflink idref="bib1" id="ref31">1</reflink>] ). Cortisol was sampled non‐invasively using the Salivette (Sarstedt Ltd, Niedersachsen, Germany). That is, caregivers were asked to chew sterile cotton swabs for 1–2 min and deposit saturated swabs into plastic collection tubes. Poor adherence with the saliva collection protocol can invalidate the reliability of resultant cortisol data. Indeed, delays >10 min between waking and collection of the waking cortisol sample can lead to erroneous interpretations of the CAR and diurnal cortisol slope (Kudielka et al. [<reflink idref="bib23" id="ref32">23</reflink>] ; Okun et al. [<reflink idref="bib36" id="ref33">36</reflink>] ). For the present study, all caregivers received detailed written instructions that emphasised the time sensitive nature of the hormone and were trained to accurately collect saliva using the Salivette. To encourage protocol adherence, caregivers were provided paper diaries and asked to record waking and sampling times as accurately as possible on both saliva collection days. Indeed, recent studies have indicated that self‐report measures (i.e. paper diaries) of timing compliance are not only preferred by participants (Kraemer et al. [<reflink idref="bib22" id="ref34">22</reflink>] ), but perform equally well when compared to more objective, electronic devices for evaluating adherence with the saliva collection protocol (Seltzer et al. [<reflink idref="bib39" id="ref35">39</reflink>] ; Okun et al. [<reflink idref="bib36" id="ref36">36</reflink>] ). A compliance window of >10 min between waking and collection of the waking sample was applied for the exclusion of erroneous cortisol data (Kunz‐Ebrecht et al. [<reflink idref="bib25" id="ref37">25</reflink>] ). Caregivers were also instructed to strictly abstain from behaviours known to affect the measurement of cortisol in saliva for 45 min prior to the collection of any sample. These included: (<reflink idref="bib1" id="ref38">1</reflink>) consumption of food, caffeinated and alcoholic beverages, (<reflink idref="bib2" id="ref39">2</reflink>) exercise, (<reflink idref="bib3" id="ref40">3</reflink>) use of nicotine, and (<reflink idref="bib4" id="ref41">4</reflink>) brushing teeth and/or use of mouthwash (Kudielka et al. [<reflink idref="bib24" id="ref42">24</reflink>] ). For the present study, all caregivers collected salivary cortisol within the stipulated time parameters and reported no other deviations from the agreed protocol. Data for all caregivers, therefore, was taken forward for statistical analysis.</p> <p>Caregivers were instructed to store all collected samples in a domestic freezer until returned, along with paper diaries, to the research team. Returned samples were stored frozen at −20°C. Assays were performed in house using the luminescence immunoassay method (IBL Hamburg, Germany). The mean intra and inter‐assay coefficients were 7.1%, and 10.7% respectively.</p> <hd id="AN0100320210-5">Psychological outcomes</hd> <p>Psychological distress was quantified using standardised questionnaires. The 10 item Perceived Stress Scale (PSS) was used to measure caregivers’ feelings of being overwhelmed over the last month (Cohen et al. [<reflink idref="bib7" id="ref43">7</reflink>] ). Scale responses range from 0 (never) to 4 (very often). A total PSS score is calculated by summing across all items and can range from 0 to 40.</p> <p>The Hospital Anxiety and Depression Scale (HADS) was used to assess caregivers’ levels of anxiety and depression (Zigmond & Snaith [<reflink idref="bib47" id="ref44">47</reflink>] ). The scale comprises 14 items, seven reflecting anxiety and seven reflecting depression, which are scored along a four‐point scale ranging from 0 (never) to 3 (considerable). Items for the two sub‐scales are summed to yield a total score with higher scores (range 0–21) indicating higher levels of anxiety and depression. Clinical guidelines indicate that anxiety and depression scores between 0 and 7 are normal. However, scores ranging from 8 to 10 indicate borderline mood disorder and scores >11 indicate probable mood disorder (Snaith [<reflink idref="bib43" id="ref45">43</reflink>] ).</p> <p>The Pennebaker Inventory of Limbic Languidness (PILL) was used to assess how frequently caregivers reported 54 commonly occurring ailments such as coughs, colds aches and pains (Pennebaker [<reflink idref="bib37" id="ref46">37</reflink>] ). Scale responses range from 1 (never/almost never) to 5 (more than once per week). Items experienced by the respondent more than once per month are summed to formulate an index of total complaint frequency.</p> <p>The 25‐item Strengths and Difficulties Questionnaire (SDQ) was used to quantify child problem behaviours (Goodman [<reflink idref="bib16" id="ref47">16</reflink>] ). The SDQ is composed of five sub‐scales, one that assesses pro‐social behaviour (e.g. often volunteers to help others) and four that assess different child problem behaviours: emotional symptoms (e.g. nervous or clingy in new situations), conduct problems (e.g. often fights with other children), hyperactivity behaviours (e.g. restless, overactive, cannot sit still for long) and peer relationships (e.g. generally liked by other children). For this study, only scores for problem behaviour sub‐scales were taken forward for statistical analyses. Caregivers were asked to rate whether child behaviours were 0 (not true), 1 (somewhat true) or 2 (certainly true). Total scores for each sub‐scale are calculated by summing across items with higher scores indicating more child problem behaviours. Scores ranging from 5 to 10 on the emotional behaviour sub‐scale have been routinely used to classify children as probable psychiatric ‘cases’. Similarly, scores ranging from 4 to 10 on the conduct and peer problem behaviour sub‐scales, and 7–10 on the hyperactivity sub‐scale have been used as a clinical indicator of mental health disorder (Goodman & Scott [<reflink idref="bib17" id="ref48">17</reflink>] ). All psychosocial measures have achieved excellent psychometrics (all α > 0.76) in previous research involving caregivers of children with additional complex needs (Gallagher et al. [<reflink idref="bib13" id="ref49">13</reflink>] ; Miller et al. [<reflink idref="bib34" id="ref50">34</reflink>] ) and internal consistency in the current sample was also high (all α > 0.86).</p> <hd id="AN0100320210-6">Physiological outcomes</hd> <p>To normalise distributions, raw cortisol values were log<subs>10</subs> transformed and data for each sampling day used to estimate indices of CAR magnitude, diurnal cortisol slope and mean cortisol output. The CAR was calculated as the difference between cortisol at waking and 30 min post waking, and mean cortisol output was estimated by summing all four cortisol values (Lovell et al. [<reflink idref="bib30" id="ref51">30</reflink>] ). To assess the diurnal cortisol slope, a regression line was fitted separately for each participant that predicted cortisol values from time since waking. Steeper slopes indicate greater rate of diurnal change and are represented by smaller β values (larger negative values). Higher β values (as they approach/cross zero) indicate flatter cortisol slopes and dysregulated cortisol secretion (Smyth et al. [<reflink idref="bib42" id="ref52">42</reflink>] ). In keeping with other recent studies, cortisol values for each sampling point were averaged across sampling days to provide more reliable markers of HPA activity (O'Connor et al. [<reflink idref="bib35" id="ref53">35</reflink>] ; Lovell et al. [<reflink idref="bib31" id="ref54">31</reflink>] ).</p> <hd id="AN0100320210-7">Results</hd> <hd id="AN0100320210-8">Preliminary analyses</hd> <p>Preliminary analyses revealed that caregivers of children with autism and ADHD were statistically indistinguishable on all psychophysiological outcomes which included: psychological distress (all Ps > 0.08), aspects of the diurnal cortisol pattern (all Ps > 0.20) and incidences of commonly occurring ailments (t (<reflink idref="bib16" id="ref55">16</reflink>) = 1.14, P = 0.27). In view of these findings, autism and ADHD caregivers were pooled into one caregiver group to maximise sample size.</p> <hd id="AN0100320210-9">Potential confounds</hd> <p>Demographic, behavioural and biomedical data were collected to assess the possibility that relationships between problem behaviours of the care recipient and psychophysiological outcomes in their caregivers might reflect the contribution of other variables. These included: gender, age, weight, ethnicity, body mass index (BMI), phase of the menstrual cycle, use of antidepressants and oral contraceptives, use of nicotine, alcohol consumption, frequency of exercise, annual household income and marital status. Data were also collected with respect to age of the care recipient and number of siblings. A significant inverse relationship was observed between perceived levels of stress and caregivers’ weight (r = −0.49, P = 0.05). Findings also revealed the diurnal cortisol slope (β values) was positively correlated with both caregivers’ weight (r = 0.51, P = 0.04) and body mass index (r = 0.51, P = 0.04). Caregivers who reported being married or in a de facto relationship also displayed flatter cortisol slopes (t (12.70) = 2.53, P = 0.03). To avoid spurious relationships emerging between problem behaviours of the care recipient and psychophysiological outcomes in their care providers, subsequent analyses adjusted for these variables.</p> <hd id="AN0100320210-10">Psychological outcomes and child problem behaviours</hd> <p>Questionnaire data revealed that caregivers’ appraisal of care recipients’ emotional, conduct, hyperactivity and peer behaviours all fell within the clinical range. Table [NaN] presents means and standard deviations for caregivers’ appraisal of child problem behaviours and psychophysiological outcomes. The SDQ, therefore, clearly differentiates between problem behaviours in children with additional complex needs and normative SDQ data (Meltzer et al. [<reflink idref="bib32" id="ref56">32</reflink>] ). Partial correlation, adjusting for weight, revealed a significant positive association between caregivers’ perceived levels of stress and problems with child conduct behaviours (r = 0.64, P < 0.01). Self‐reported incidences of commonly occurring ailments were also significantly greater in caregivers who reported more problems with child emotional behaviours (r = 0.47, P = 0.05). Table [NaN] presents correlation coefficients between scores on SDQ sub‐scales and psychophysiological outcomes.</p> <p>Means and standard deviations for psychological distress, cortisol indices and commonly occurring ailments in the sample</p> <p> <ephtml> <table><tr><td>SDQ sub‐scales (mean ± SD)</td><td /></tr><tr><td>Emotional behaviours</td><td>5.6 (2.4)</td></tr><tr><td>Conduct behaviours</td><td>4.2 (3.1)</td></tr><tr><td>Hyperactivity behaviours</td><td>7.4 (1.6)</td></tr><tr><td>Peer behaviours</td><td>6.1 (2.2)</td></tr><tr><td>Psychological measures (mean ± SD)</td><td /></tr><tr><td>Perceived stress</td><td>20.8 (7.4)</td></tr><tr><td>Anxiety</td><td>9.6 (4.9)</td></tr><tr><td>Depression</td><td>7.7 (4.4)</td></tr><tr><td>Commonly occurring ailments (mean ± SD)</td><td>14.5 (12.6)</td></tr><tr><td>Cortisol indices (mean ± SD)</td><td /></tr><tr><td>Waking (nmol/L)</td><td>14.9 (7.1)</td></tr><tr><td>30 min post waking (nmol/L)</td><td>17.7 (5.3)</td></tr><tr><td>1200 h (n/mol/L)</td><td>6.6 (3.9)</td></tr><tr><td>2200 h (n/mol/L)</td><td>2.3 (2.1)</td></tr><tr><td>CAR (nmol/L)</td><td>2.8 (5.8)</td></tr><tr><td>Diurnal cortisol slope (β)</td><td>−0.89 (0.1)</td></tr><tr><td>Mean cortisol output (nmol/L)</td><td>10.4 (3.6)</td></tr></table> </ephtml> </p> <p>2 SDQ, Strengths and Difficulties Questionnaire; CAR, cortisol awakening response.</p> <p>Correlation coefficients for caregivers’ assessments of child problem behaviours and psychophysiological outcomes</p> <p> <ephtml> <table><tr><th /><th align="center">SDQ sub‐scales</th></tr><tr><th>Emotional problems</th><th>Conduct problems</th><th>Hyperactivity problems</th><th>Peer behaviour problems</th></tr><tr><td>Psychological measures</td><td /><td /><td /><td /></tr><tr><td>Perceived stress</td><td>0.29</td><td>0.64</td><td>0.34</td><td>−0.16</td></tr><tr><td>Anxiety</td><td>0.31</td><td>−0.17</td><td>−0.06</td><td>0.19</td></tr><tr><td>Depression</td><td>0.30</td><td>−0.16</td><td>0.04</td><td>0.29</td></tr><tr><td>Commonly occurring ailments</td><td>0.47</td><td>−0.31</td><td>−0.34</td><td>0.46</td></tr><tr><td>Cortisol indices</td><td /><td /><td /><td /></tr><tr><td>CAR</td><td>0.16</td><td>0.05</td><td>−0.48</td><td>−0.33</td></tr><tr><td>Diurnal cortisol slope (β)</td><td>0.54</td><td>−0.15</td><td>−0.30</td><td>0.21</td></tr><tr><td> Mean cortisol output</td><td>0.11</td><td>0.03</td><td>0.28</td><td>0.29</td></tr></table> </ephtml> </p> <ulist> <item>3 * P ≤ 0.05, ** P ≤ 0.01.</item> <item>4 SDQ, Strengths and Difficulties Questionnaire; CAR, cortisol awakening response.</item> </ulist> <hd id="AN0100320210-11">Physiological outcomes and child problem behaviours</hd> <p>Partial correlation, adjusting for weight, BMI and marital status, revealed significantly flatter cortisol slopes in caregivers who reported more problems with child emotional behaviours (r = 0.54, P = 0.05). Bivariate correlation also revealed that CAR magnitude was significantly diminished in caregivers who reported more problems with child hyperactivity behaviours (r = −0.48, P = 0.04). Analyses, however, failed to detect statistically meaningful relationships between mean cortisol output and scores on the SDQ sub‐scales (all Ps > 0.24). Thus, dysregulated HPA activity, as indexed by flatter cortisol slopes and an attenuated CAR, was observed in caregivers of children with a greater number of emotional and hyperactivity problems.</p> <hd id="AN0100320210-12">Discussion</hd> <p>Data indicated that perceived levels of stress were greater in caregivers who reported more problems with child conduct behaviours. These findings are commensurate with other studies that have observed a positive relationship between problem behaviours of the care recipient and psychological distress in their care providers (Baker et al. [<reflink idref="bib2" id="ref57">2</reflink>] ; Lecavalier et al. [<reflink idref="bib28" id="ref58">28</reflink>] ; Gallagher et al. [<reflink idref="bib13" id="ref59">13</reflink>] ). Moreover, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol secretion patterns characterised by flatter cortisol slopes and reduced CAR magnitude. These findings are in accordance with other studies that have observed dysregulation of the HPA axis in the context of caring for a child with additional complex needs (Seltzer et al. [<reflink idref="bib39" id="ref60">39</reflink>] , [<reflink idref="bib40" id="ref61">40</reflink>] ). Abnormal patterns of cortisol secretion have been linked with a broad catalogue of deleterious health outcomes. For example, flatter cortisol slopes have implicated in the aetiology of poorer mental and physical well‐being (Sjögren et al. [<reflink idref="bib41" id="ref62">41</reflink>] ; Hagger‐Johnson et al. [<reflink idref="bib19" id="ref63">19</reflink>] ), while attenuation of the CAR has been linked with functional somatic syndromes such as burnout and vital exhaustion (Heim et al. [<reflink idref="bib20" id="ref64">20</reflink>] ). Given the immunomodulatory influence of cortisol (Elenkov [<reflink idref="bib12" id="ref65">12</reflink>] ), atypical patterns of cortisol and associated alterations in immune efficacy, might underlie the positive relationship between problem behaviours of the care recipient and incidences of commonly occurring ailments in their caregivers reported here. Indeed, CAR dysfunction (De Vugt et al. [<reflink idref="bib8" id="ref66">8</reflink>] ), alterations in the immune response (Gallagher et al. [<reflink idref="bib14" id="ref67">14</reflink>] ) and greater episodes of infectious illness (Dyck et al. [<reflink idref="bib9" id="ref68">9</reflink>] ) have been observed in caregivers experiencing more problems with patients’ behaviours.</p> <p>Quality of life for the care recipient is contingent on the health and happiness of the care provider (Burgess & Gutstein [<reflink idref="bib4" id="ref69">4</reflink>] ). Indeed, the harmful effects of caregiver stress can seriously impede the ability of the caregiver to provide the consistency and quality of care needed by a child with additional complex needs (Edworthy [<reflink idref="bib10" id="ref70">10</reflink>] ; Byrne et al. [<reflink idref="bib5" id="ref71">5</reflink>] ). To this end, future research might build on preliminary findings that have demonstrated positive psychological adjustments, as well as adaptive changes in immune parameters in caregivers taught to more effectively manage care recipients’ problem behaviours (Garand et al. [<reflink idref="bib15" id="ref72">15</reflink>] ).</p> <p>The findings of the study must be discussed in the context of its limitations. Clinical diagnosis of autism and ADHD in the present study was based on parent report only. Failure to incorporate a uniformly determined and standardised assessment protocol to verify autism and ADHD diagnoses was a significant limitation (Le Couteur et al. [<reflink idref="bib27" id="ref73">27</reflink>] ). In addition, effect sizes indicated that the small sample might have prevented the observation of statistically meaningful associations between problem behaviours of the care recipient and some psychophysiological outcomes. These findings, therefore, should be regarded as preliminary until substantiated with a larger sample. Findings reported here might have been confounded as a result of unmeasured attributes of the care recipient. That is, child attributes such as intelligence have been associated with the psychophysiological well‐being of the care provider (Eisenhower et al. [<reflink idref="bib11" id="ref74">11</reflink>] ). The study, however, does have unique strengths in terms of its methodology. Indeed, research has demonstrated how single day assessment can bias diurnal cortisol measurement to state, rather than trait characteristics (Hellhammer et al. [<reflink idref="bib21" id="ref75">21</reflink>] ). To optimise the reliability cortisol measurement, therefore, participants collected saliva at four time points and on two consecutive weekdays (Stalder et al. [<reflink idref="bib44" id="ref76">44</reflink>] ).</p> <p>In conclusion, findings indicate that problem behaviours of autism and ADHD children have negative implications for the psychophysiological well‐being of their caregivers. That is, psychological distress was elevated in caregivers who reported more problems with child conduct behaviours. Atypical patterns of cortisol secretion and increased reports commonly occurring ailments were also observed in caregivers experiencing more problems with child emotional and hyperactivity behaviours. In view of these findings, interventions that target child problem behaviours might, by improving the psychophysiological well‐being of the care provider, enhance quality of life for the care recipient.</p> <ref id="AN0100320210-13"> <title>References</title> <blist> <bibl id="bib1" idref="ref19" type="bt">1</bibl> <bibtext>Almeida D. M., Piazza J. R. & Stawski R. S. ( 2009 ) Interindividual differences and intraindividual variability in the cortisol awakening response: an examination of age and gender. Psychology and Aging 24, 819 – 827. </bibtext> </blist> <blist> <bibl id="bib2" idref="ref13" type="bt">2</bibl> <bibtext>Baker B. L., Blacher J. & Olsson M. B. ( 2005 ) Preschool children with and without developmental delay: behaviour problems, parents’ optimism and well‐being. 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  Data: The Psychophysiological and Health Corollaries of Child Problem Behaviours in Caregivers of Children with Autism and ADHD
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Feb 2015 59(2):150-157.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
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  Data: 8
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Psychology%22">Psychology</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Caregiver+Child+Relationship%22">Caregiver Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22Metabolism%22">Metabolism</searchLink><br /><searchLink fieldCode="DE" term="%22Caregivers%22">Caregivers</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Measures%22">Attitude Measures</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Disturbances%22">Emotional Disturbances</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink>
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  Data: 10.1111/jir.12081
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  Data: 0964-2633
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  Data: Background: The positive relationship between problem behaviours of children with additional complex needs and psychological distress in their caregivers has been widely evidenced. Fewer studies, however, have assessed the relationship between care recipients' problem behaviours and key physiological processes, relevant for the physical health status of their care providers. This study examined the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder. Methods: Caregivers (n?=?18) completed self-report measures of psychological distress, child problem behaviours and incidences of commonly occurring ailments. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected saliva samples at waking, 30?min post waking, 1200?h and 2200?h on two consecutive weekdays. Results: Data revealed a positive relationship between caregivers' perceived levels of stress and problems with child conduct behaviours. In addition, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol patterns characterised by flatter diurnal cortisol slopes and reduced cortisol awakening response magnitude. Subjective reports of commonly occurring ailments were also greater in caregivers experiencing more problems with child emotional behaviours. Conclusions: These findings have implications for interventions that aim to improve the psychophysiological well-being of the caregiver by targeting problem behaviours of the care recipient.
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  Data: 2015
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  Data: EJ1049437
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      – Type: doi
        Value: 10.1111/jir.12081
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 150
    Subjects:
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Psychology
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Caregiver Child Relationship
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Physiology
        Type: general
      – SubjectFull: Physical Health
        Type: general
      – SubjectFull: Metabolism
        Type: general
      – SubjectFull: Caregivers
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Attitude Measures
        Type: general
      – SubjectFull: Child Behavior
        Type: general
      – SubjectFull: Emotional Disturbances
        Type: general
      – SubjectFull: Intervention
        Type: general
    Titles:
      – TitleFull: The Psychophysiological and Health Corollaries of Child Problem Behaviours in Caregivers of Children with Autism and ADHD
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            NameFull: Lovell, B.
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            NameFull: Moss, M.
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            NameFull: Wetherell, M. A.
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              Y: 2015
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              Value: 0964-2633
          Numbering:
            – Type: volume
              Value: 59
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of Intellectual Disability Research
              Type: main
ResultId 1