Thesis advisor: Penny Hauser-Cram / This dissertation utilized data from the Early Intervention Collaborative Study (EICS), a longitudinal study of children with developmental disabilities (DD) and their families (Hauser-Cram, Warfield, Shonkoff, & Krauss, 2001). The sample for this dissertation consisted of 170 children with DD, their parents, and their teachers. During home visits at ages 2 and 3, mothers and fathers reported on indicators of the home and family environment, and interactions between children and their mothers were observed. At ages 3, 5, 8, 10, and 15, teachers reported on children's levels of classroom-based adaptive functioning. Multilevel modeling was used to examine children's trajectories of classroom-based adaptive functioning. Indicators of the early childhood home and family environment were explored as predictors of these trajectories. The following research questions were addressed: (1) What are the trajectories of classroom-based adaptive functioning among children with DD from ages 3 to 15? (2) Are levels of adaptive functioning in the classroom stable over time, between the ages of 3 and 15? (3) Is there variability in rates of change in adaptive functioning over time, with some children developing more rapidly than others? (4) Do characteristics of the early childhood home and family longitudinally predict children's adaptive functioning in the classroom at age 3 and from ages 3 to15? (5) Which domains of classroom adaptive functioning are predicted by characteristics of the home and family? Results indicated that children's classroom-based adaptive functioning raw scores increase over time. In each domain of adaptive functioning (socialization, communication, and daily living skills) there was significant variability in initial status and rate of change. As hypothesized, quality of early childhood mother-child interaction was predictive of adaptive functioning, with higher quality mother-child interaction associated with more positive functioning. Contrary to hypotheses, the number of negative life events experienced by the family during early childhood was also positively related to classroom adaptive functioning, with more events related to higher levels of functioning. Overall, the findings indicated the influence of the early childhood home and family environment on classroom-based adaptive functioning over time. Policy implications and areas for future research are discussed. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Purpose: Research has shown that children who stutter (CWS) demonstrate poor adaptive functioning, or poor functional, social, and psychological skills, when compared to children who do not stutter (CWNS). Previous work has also shown that preschool CWS demonstrate significantly lower effortful control than CWNS. High effortful control, or the ability to inhibit a dominant response, is predictive of high adaptive functioning in children who are exposed to a range of adversities. The purposes of this study were fourfold: (a) to investigate if the differences between preschool CWS and CWNS in effortful control extended to school-aged children; (b) to determine if effortful control could uniquely explain adaptive functioning after controlling for a diagnosis of stuttering; (c) to investigate whether effortful control was more influential to CWS than to CWNS; and (d) to investigate whether effortful control uniquely explained adaptive functioning in CWS after controlling for stuttering frequency. Methods: Effortful control and seven core areas of adaptive functioning were investigated in 46 school-age CWS and 46 CWNS. Eight independent two tailed t-tests were used to assess whether CWS demonstrated lower effortful control than CWNS and lower adaptive functioning than CWNS in seven adaptive functioning areas: communication competence, peer competence, internalizing behaviors, externalizing behaviors, general anxiety, social anxiety, and depression. Correlation and hierarchical regression analyses were used to examine the extent to which each component of adaptive functioning was related to effortful control when controlling for age, intelligence, parent-child relationship, and stuttering group membership. Hierarchical regression analyses were used to assess the extent to which each separate component of adaptive functioning was related to effortful control in CWS only. Results: CWS demonstrated significantly lower effortful control when measured by the Early Adolescent Temperament Questionnaire (a parent report measure of hot effortful control) than CWNS. CWS also performed more poorly in all aspects of adaptive functioning; however statistical significance was only reached for internalizing behaviors and general anxiety. The hierarchical linear regressions indicated that effortful control predicted the majority of the variance in five areas of adaptive functioning: peer competence, externalizing behaviors, internalizing behaviors, general anxiety, and depression. In the group of CWS, stuttering frequency predicted internalizing behaviors, general anxiety, and social anxiety. However, stuttering was the most important contributor to only one of the seven components of adaptive functioning, social anxiety. Conclusions: This study with school-aged CWS extends previous work indicating that preschool CWS exhibit lower effortful control than their normally fluent peers. The fact that emotional aspects of effortful control were a stronger predictor of social functioning, internalizing behaviors, and externalizing behaviors than either a stuttering diagnosis or the quantity of stuttering, may explain the adaptive functioning deficits often observed in CWS. Because effortful control is both a powerful contributor to adaptive functioning, and is reduced in CWS, clinical therapy approaches, which boost effortful control skills, have the potential to greatly lessen the impact of stuttering for CWS.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial stress and child cognitive and adaptive sequelae (Taylor et al., 1999). Research has demonstrated a relationship between familial stress and resources and child recovery of functioning following TBI (Taylor et al., 1999). We built on these findings by examining authoritarian parenting values and styles as a mediator of the relationship between parental stress and child adaptive outcomes 12-36 months following TBI or orthopedic injury (ORTHO). Participants were 21 children/adolescents with traumatic brain injuries and 23 with orthopedic injuries and one of their parents/guardians. Parents completed measures of demographics, parental stress, parenting values and styles, and child adaptive functioning. Child participants completed brief demographic questionnaires and intelligence screeners. Moderation was examined using hierarchical multiple regression. Mediation and moderated mediation were examined using bootstrapping tests of the indirect effect of parental stress on child adaptive functioning. After controlling for family insurance status, higher levels of parental stress were associated with reduced child adaptive functioning in the TBI group but not the ORTHO group. An examination of the mediational analyses revealed that higher levels of parental stress were associated with a greater reliance on authoritarian parenting styles, which was associated with reduced overall adaptive functioning and daily living skills across the two injury groups. Therefore, across groups, the relationship between parental stress and child overall adaptive functioning and daily living skills was found to be partially mediated by an authoritarian parenting style. Moderated mediation results revealed the presence of a significant interaction and 95% confidence interval on the socialization domain and indicated that the relationship between authoritarian parenting styles and child adaptive social skills differed significantly between the two groups. Our findings suggest a relationship between parental stress, authoritarian parenting styles, and child adaptive functioning in the 12-36 months following pediatric traumatic injury. Future research should explore the association among these, as well as other potentially mediating variables, both within and between the two groups with the goal of further elucidating the relationship between familial/environmental variables and child adaptive functioning following traumatic brain and orthopedic injury.

Epilepsy is one of the most common neurological disorders in children, with both seizures and their medical treatment associated with increased risk of neuropsychological impairments. Adaptive functioning in children with epilepsy is poorly understood. This study sought to identify the neuropsychological and medical predictors of optimal adaptive functioning in pediatric epilepsy. Forty-six children with epilepsy and 16 typically developing children and their parents participated in this study at two time points. Overall, adaptive functioning was found to be in the average to low average range in children with epilepsy. A composite measure assessing cumulative seizure history was able to significantly predict Adaptive Behavior Assessment System-II (ABAS-II) scores. Whether a child had experienced one or more seizures in the last year was the only individual seizure and treatment variable able to significantly predict adaptive functioning as measured by the ABAS-II. Verbal learning, executive functioning, and internalizing and externalizing behavior problems assessed at Time 1 predicted performance on the ABAS-II at Time 2. Verbal memory and attention, however, were not significant predictors of adaptive functioning. Consistent with what was hypothesized, executive functioning was found to mediate the relationship between seizure history and adaptive functioning when controlling for behavior problems at both Times 1 and 2. When behavior problems were the mediator and executive functioning was controlled for, mediation was not found. Executive functioning also mediated the relationship between group membership (monotherapy, polytherapy, and typically developing) and ABAS-II scores at Time 1, but not at Time 2 when a post-surgical group also was represented. Secondary analyses showed that the relationship between executive and adaptive functioning at Time 2 was moderated by whether or not a child had ever experienced seizures, such that children diagnosed with epilepsy evidenced greater correlations between these constructs than typically developing children. The results of this study suggest that a subset of children with epilepsy, those with active seizures and/or executive dysfunction, are at increased risk of adaptive deficits. These findings highlight the risk factors for suboptimal adaptive functioning in this population, and also suggest potential avenues for remediation.

Alzheimer’s disease (AD) is the most common form of dementia and is characterized by a gradual deterioration of the patients’ ability to independently perform day to day activities. Researchers have discovered significant changes in neuroanatomy, cognition and behavior that are related to the disease process of AD and researchers continue to uncover new variables, such as the presence of vascular risk factors, which may further increase our ability to understand and characterize the disease. The purpose of this study is to identify the neuroanatomical, cognitive and behavioral variables that best predict impairment of instrumental activities of daily living in individuals with probable AD. Reduced white matter integrity in the dorsolateral prefrontal cortex as well as the presence of vascular risk factors significantly predicted impairments in activities of daily living (ADLs). Executive functioning skills, typically described as frontal lobe system behaviors, were positively associated with ADLs. Further, executive functions fully mediated the relationship between frontal lobe white matter integrity and ADLs. A better understanding of the variables responsible for diminished ADLs in AD will allow researchers and clinicians to better target prevention and intervention strategies and ultimately help individuals with AD to maintain their independence for a longer duration.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial stress and child cognitive and adaptive sequelae (Taylor et al., 1999). Research has demonstrated a relationship between familial stress and resources and child recovery of functioning following TBI (Taylor et al., 1999). We built on these findings by examining authoritarian parenting values and styles as a mediator of the relationship between parental stress and child adaptive outcomes 12-36 months following TBI or orthopedic injury (ORTHO). Participants were 21 children/adolescents with traumatic brain injuries and 23 with orthopedic injuries and one of their parents/guardians. Parents completed measures of demographics, parental stress, parenting values and styles, and child adaptive functioning. Child participants completed brief demographic questionnaires and intelligence screeners. Moderation was examined using hierarchical multiple regression. Mediation and moderated mediation were examined using bootstrapping tests of the indirect effect of parental stress on child adaptive functioning. After controlling for family insurance status, higher levels of parental stress were associated with reduced child adaptive functioning in the TBI group but not the ORTHO group. An examination of the mediational analyses revealed that higher levels of parental stress were associated with a greater reliance on authoritarian parenting styles, which was associated with reduced overall adaptive functioning and daily living skills across the two injury groups. Therefore, across groups, the relationship between parental stress and child overall adaptive functioning and daily living skills was found to be partially mediated by an authoritarian parenting style. Moderated mediation results revealed the presence of a significant interaction and 95% confidence interval on the socialization domain and indicated that the relationship between authoritarian parenting styles and child adaptive social skills differed significantly between the two groups. Our findings suggest a relationship between parental stress, authoritarian parenting styles, and child adaptive functioning in the 12-36 months following pediatric traumatic injury. Future research should explore the association among these, as well as other potentially mediating variables, both within and between the two groups with the goal of further elucidating the relationship between familial/environmental variables and child adaptive functioning following traumatic brain and orthopedic injury.

Rationale: Autism is a neurodevelopmental disorder with onset prior to the age of three years characterized by qualitative impairments in social interaction and communication skill, along with a restricted repetitive and stereotyped pattern of behavior, interests, and activities. In addition to these core diagnostic features, aberrant sensory responding has also been widely reported in the literature describing children and adolescents with autism spectrum disorders (ASD). Aberrant sensory processing has, however, been infrequently studied compared to communication and cognition in autism and existing studies have had multiple methodological deficiencies, especially with sampling procedures. Purpose. The purpose of this study is to describe patterns of sensory processing found in children with an ASD to test the relationship(s) of these patterns to diagnostic and developmental variables. Method. Retrospective data collection was used to collect developmental and sensory processing variables of 400 children with an ASD. Sensory processing abilities were measured by the SSP. Results. The majority of the sample (80.5%) had a diagnosis of autism. The average age of the sample was 49.58 months. The adaptive, social, language, and motor developmental variables were consistent with diagnostic patterns in that the children with Asperger Disorder demonstrated higher developmental levels than the children with autism and PDD-NOS. Eighty-nine percent of the sample demonstrated some degree of sensory processing dysfunction on the SSP Total Score with the greatest difficulties reported on the Underresponsive/Seeks Sensation, Auditory Filtering, and Tactile Sensitivity sections. Exploratory factor analysis identified 6 parsimonious factors: Low Energy/Weak, Tactile and Movement Sensitivity, Taste/Smell Sensitivity, Auditory and Visual Sensitivity, Sensory Seeking/Distractibility, and Hypo-responsivity. These factor variables contributed to explaining the differences in five of six developmental variables of the sample that are associated with the diagnosis of autism. Receptive language, adaptive and expressive language performance were significantly correlated with sensory processing factor scores. Conclusions. Together, the sensory processing findings noted in this study describe a pattern of dysfunctional sensory modulation. These findings have significant implications for intervention programs involving individuals with an ASD, given the potential impact of these findings on a childs ability to maintain active engagement.

The current study examined anxiety and its observable correlates in children with Autism Spectrum Disorders (ASD) across a broad range of levels of cognitive functioning that in the past have not been accurately explored. I sought to challenge the assumption that there is a positive linear relationship between anxiety and level of cognitive functioning by including individuals across a broad range of cognitive functioning in my analyses, and by developing a measure (The Somatic Anxiety Scale) appropriate for assessing anxiety symptoms in children with little to no communicative functioning. Sixty-seven parents of children with ASD aged 5 to 12 completed a battery of measures in an online study assessing their child’s anxiety, repetitive behaviours, sensory processing issues, and adaptive functioning. The Somatic Anxiety Scale was significantly correlated with an existing measure of anxiety designed for verbal children (when only highly verbal children were assessed), suggesting that it may provide a foundation to develop a measure of anxiety symptoms in non-verbal individuals. No clear predictive relationship was observed between level of cognitive functioning and anxiety. Both lower and higher-order repetitive behaviours predicted anxiety, although higher-order behaviours were more predictive. Finally, a cluster analysis indicated three patterns of anxious behaviour divided across three categorizations of level of functioning. I suggest that previous assumptions about the relationship between level of cognitive functioning and anxiety may be underestimating the complexity of the relationship and suggest future research to study this relationship further. / Thesis (Master, Psychology) -- Queen's University, 2013-10-30 10:25:56.049

To date, the effect of planning ability on adaptive functioning has not been extensively examined in children treated for brain tumors. Findings indicate that individuals with brain tumors are more likely to experience poor planning ability (Boyd & Sautter, 1993) and that children with even mild neurological complications demonstrate impairments in adaptive functioning (Fletcher et al., 1990). The purpose of this study is to assess spatial planning and to examine its utility in predicting adaptive and cognitive functional impairment in children diagnosed and treated for brain tumors. Forty children diagnosed with a brain tumor (mean age at diagnosis 8.6 years) were administered the Rey-Osterrieth Complex Figure (ROCF) task, the Vineland Adaptive Behavior Scale (VABS), and the Stanford-Binet Intelligence Scale: Fourth Edition (SB:IV) at an average of one year post diagnosis (post acute) and again at two years post diagnosis (long term). The results of this investigation did not support the use of spatial planning skills as a predictor of adaptive functioning at one year or two years post diagnosis. However, spatial planning skill was an important predictor of cognitive functioning, accounting for a significant amount of variance at both one year and two years post diagnosis. These results were not expected and therefore further analyses were performed in order to better understand the data and results. Additional analyses suggest that it is spatial skill and not spatial planning that predicts adaptive functioning. Further research should continue to ask questions that will impact how we understand executive, adaptive, and cognitive functioning outcomes in children diagnosed with brain tumors.

Cognitive functioning has historically been used to predict adaptive outcomes of individuals with autism spectrum disorders; however, research shows that it does not adequately predict these outcomes. Therefore, the current study explored the role of emotion perception in the adaptive functioning of individuals with ASDs. Emotion perception was assessed using the DANVA-2, which has audio and static face stimuli, and the DAVE, dynamic, audio-visual emotion movies. Adaptive functioning was assessed using the Vineland-II Socialization, Communication, and Daily Living domains. Results indicated that individuals with ASDs demonstrated significant impairments in both adaptive functioning and emotion perception compared to typical individuals. Findings did not demonstrate a relationship between emotion perception and adaptive functioning, controlling for IQ. Future research should broaden the approach when investigating possible mechanisms of change for adaptive outcomes to include exploration of social perception more broadly, of which emotion perception is one component, and its relationship with adaptive outcomes.