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Stressors, coping, and emotional and behavioural problems in high-functioning adolescents with ASD: a preliminary approach using EMA
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posted on 27.02.2017by Khor, Angela Stewart
Behaviour and emotional problems are common in individuals with high-functioning autism and Asperger’s Disorder (High-Functioning Autism Spectrum Disorders, HFASD), with onset frequently occurring during adolescence. Stressful experiences and coping are important predictors of mental health outcome in nonclinical populations, yet few studies have investigated these relationships in individuals with HFASD. One methodology used to assess coping in typically developing individuals is Ecological Momentary Assessment (EMA), which involves having participants complete multiple reports of a target behaviour in their natural environment. EMA may increase the accuracy of data by minimising the time between occurrence of a behaviour and its reporting, hence decreasing the impact of recall biases that affect traditional pen and paper questionnaires. Only one prior study has used EMA with individuals with HFASD, and its feasibility and validity have not been examined. The overarching aims of this thesis were to investigate the feasibility and validity of having adolescents with HFASD report about their mood, coping and stressors using EMA, and to examine the relationships between these variables and behaviour and emotional problems. These aims were examined over three studies, using the same sample of 31 adolescents with HFASD, who completed a mobile phone-based EMA program that assessed their mood, stressors and coping up to four times a day for two weeks. Parents reported their children’s stressors and coping from their perspective during this two-week period via questionnaires. In addition, adolescents, their parents and teachers completed questionnaires assessing the adolescents’ behaviour and emotional problems and coping. The first study examined the feasibility and validity of using EMA to investigate the stressors and coping of adolescents with HFASD. Moderate compliance with the EMA program was achieved that was comparable to rates found within nonclinical populations. Some convergent validity was found for the Involuntary Engagement coping style, but not for the other coping styles assessed. When Involuntary Engagement was assessed via EMA, it was moderately correlated with traditional questionnaires assessing this coping style that were completed by the parent and the adolescents. The second study examined the relationships between daily hassles, coping and behaviour and emotional problems using EMA and questionnaires. The Disengagement coping style was consistently associated with more behaviour and emotional problems regardless of whether it was assessed via EMA or questionnaires and independent of the observer of the coping style (self- or parent-report). Perceived frequency of hassles was also generally associated with higher levels of behaviour and emotional problems. The third study examined the temporal relationships between mood, coping and behaviour and emotional problems in young people with HFASD. There was a positive correlation between pre-existing behaviour and emotional problems measured at baseline and Disengagement coping during the EMA period. Disengagement and Secondary Control Engagement coping were negatively correlated with subsequent negative mood (i.e. resulted in better mood). Taken together, the findings from these three interrelated studies suggest that psychological interventions that target coping strategies may be valuable for individuals with HFASD who have behaviour and emotional problems. The findings also suggest that adolescents with HFASD are capable of completing EMA and self-report questionnaires about abstract constructs such as their mood and coping. These initial findings suggest EMA may be a feasible and valid methodology for use with adolescents with HFASD.