Stability and Change of Insightfulness Among Mothers of Children with Autism Spectrum Disorder

Background: A recent clinical trial of a parent-mediated intervention targeting responsive parental communication (Siller et al., 2013) revealed a conditional treatment effect, suggesting that baseline measures of maternal insightfulness moderate the intervention’s efficacy.  Mothers who were better able to discuss their child’s thoughts and emotions in a complex, nuanced, and accepting way showed larger treatment-related gains in responsive parental behaviors than mothers who were less insightful at baseline. 

Objectives: To investigate stability and change across two repeated measures of maternal insightfulness among mothers in the control group of a clinical trial.

Methods: The sample included 34 mothers of children with ASD (chronological age: M = 56 months, SD = 12; expressive language age: M = 15 months, SD = 8) enrolled in the control group of a clinical trial (Siller et al., 2013).  Participants completed a series of baseline assessments to evaluate child characteristics (e.g., Mullen Scales of Early Learning, ADOS).  Measures of maternal insightfulness were administered twice over a period of 5 months (M = 141 days, SD = 43 days).  Maternal insightfulness was evaluated using the Insightfulness Assessment (IA, Oppenheim & Koren-Karie, 2002), a semi-structured interview that asks parents to discuss their child’s thoughts and feelings during a previously recorded video vignette. Interviews are coded on ten 9-point rating scales, including insight into the child’s motives, flexibility of thought, and complexity in description of the child.  Profiles of scores on the ten scales indicate one of three primary classifications: Positively Insightful (PI), One-Sided (OS), or Disengaged (DE). A composite score was calculated by averaging six highly correlated subscales (r > 0.6).  Inter-rater agreement between two coders was established on the composites (ICC = 0.77) and classifications (kappa = 0.82) on 12 transcripts. 

Results: At time 1, the mean composite scores of mothers classified as PI (n = 11), OS (n = 13), and DE (n = 9) were 6.0 (SD = 0.7), 3.5 (SD = 0.7) and 2.7 (SD = .5), respectively.  At time 2, the composite scores of mothers classified as PI (n = 6), OS (n = 12); and DE (n = 12) were 5.3 (SD = 1.6), 3.3 (SD = .7), and 3.1 (SD = 1.5), respectively. To evaluate the stability of individual differences in the insightfulness composite scores, we computed an Intraclass Correlation Coefficient (ICC = 0.72, p < 0.01).  Although the percentage of mothers classified as PI decreased over time (33% and 20% at time 1 and 2), a chi-square test revealed that this change was not statistically significant, x²(1) = 3.54, ns.  Similarly, paired sample t-tests revealed no significant difference in composite scores between time 1 and 2, t (25) = .79, ns. 

Conclusions: Individual differences in maternal insightfulness appear to be relatively stable, with 72% of the variance in insightfulness composite scores at time 2 being predicted by baseline measures of insightfulness.  We found no evidence to support that maternal insightfulness increases over time.  There is a need to investigate the potential for responsiveness-based interventions to nurture maternal insightfulness.