Change in Expressed Emotion As a Marker for Intervention Effectiveness in the Parents of Individuals with High Functioning Autism

Friday, May 15, 2015: 5:30 PM-7:00 PM
Imperial Ballroom (Grand America Hotel)
M. B. Steinfeld1, I. N. Leckliter2, D. J. Tancredi3, K. Singh4, I. Jalnapurkar5, A. Schneider6, J. Gunther7, D. Roa8 and M. Solomon9, (1)UC Davis Medical Center, Sacramento, CA, (2)Pediatrics, UC Davis School of Medicine MIND Institute, Sacramento, CA, (3)Pediatrics, University of California Davis, Sacramento, CA, (4)Private Practice, Sacramento, CA, (5)Psychiatry, University of Texas Health Sciences Center, Houston, TX, (6)Pediatrics, University of California at Davis, Sacramento, CA, (7)University of California Davis M.I.N.D. Institute, Sacramento, CA, (8)MIND Institute, UC Davis School of Medicine, Sacramento, CA, (9)Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, Sacramento, CA
Background:  Expressed emotion (EE) refers to the emotional climate between family members in their home environment.  High levels of EE have a detrimental impact on the functioning of family members with neurodevelopmental disorders including schizophrenia, ADHD, and autism (Hooley & Gotlib 2000, Dossetor et al 1994; Hastings et al 2006; Hastings & Lloyd 2007).

Objectives:  The aim of this pilot study was to examine whether the Five Minute Speech Sample (FMSS) measure of EE (Magana et al 1986)  would be sensitive to changes in EE after parent participation in a psycho-educational support group conducted as part of an evidence-based child social skills group training program (Solomon, Goodlin-Jones, & Anders, 2004). We hypothesized that participation in the parent group would be associated with a shift from high EE to low EE as measured by the FMSS.

Methods:  Parents of 39 verbal children ages 6-19 years (mean age 11.3 years) with a community diagnosis of autism spectrum disorder (ASD) completed the FMSS, which is a 5 minute semi-structured interview. Scoring reliability was established between coders by Magana, using her scoring system.  The interviews were audiotaped, transcribed and coded for the content and tone of the parent-child relationship. The transcripts were rated 0 “Low”, 1 “Borderline” or 2 “High” on levels of criticism (CRIT) and emotional over-involvement (EOI) displayed in the parents’ narratives about their children at the beginning and again at the end of the 25 week social skills intervention program and linked psycho-educational parent support group.

Results: EOI levels declined significantly over-time (mean difference = -0.15, 95% CI -0.84 to -0.19). Mean levels of CRIT and of high EE also changed in a clinically favorable direction, but were not statistically significant (mean difference in CRIT = -0.18, 95% CI: -0.51 to 0.15; difference in proportion EE = -0.18, 95% CI: -0.40, 0.04).

Conclusions: Parent participation in a psychoeducational group linked to their children’s social skills group resulted in improvement in one type of EE (i.e. EOI). The parents were able to complete the FMSS and many enjoyed doing so. Parental EE can be used as a means to better understand family functioning and provide a focus of intervention. Lower EE has the potential to improve family functioning and child outcomes. Based on these initial results, it appears that the FMSS is sensitive to functioning in families of children with ASD and, can be used longitudinally as a measure of intervention outcome for this population.