Frazier Thomas W, Crowley Ethan, Shih Andy, Vasudevan Vijay, Karpur Arun, Uljarevic Mirko, Cai Ru Ying
Department of Psychology, John Carroll University, University Heights, OH, United States.
Science and Public Health Department, Autism Speaks, New York, NY, United States.
Front Psychol. 2022 Oct 20;13:1022700. doi: 10.3389/fpsyg.2022.1022700. eCollection 2022.
The present study sought to clarify the impact of executive and social functioning on challenging behavior and the downstream influence of challenging behavior on quality of life and functioning in a large transdiagnostic sample. Understanding these relationships is crucial for developing and designing tailored intervention strategies. In a cross-sectional study, parent informants of 2,004 children completed measures of executive and social functioning, challenging behavior, child and family quality of life, and reported on functional impacts of challenging behavior. Using structural (path) modeling, analyses evaluated the associations between executive and social functioning, including emotion regulation and risk avoidance, with overall and specific types of challenging behavior. Structural models also examined the influence of challenging behavior on child and family quality of life, including measures of the immediate and extended environment, and functional impacts on the parent/child as well as interactions with the medical/legal systems. Finally, mediational models explored the direct and indirect effects of executive and social functioning on quality of life and impact measures challenging behavior. Results indicated that executive functioning accounts for substantial variance ( = 0.47) in challenging behavior. In turn, challenging behavior accounts for substantial variance in child and family quality of life ( = 0.36) and parent/child impacts ( = 0.31). Exploratory mediational models identified direct effects from executive and social functioning measures on quality of life and functional impacts and indirect effects for executive functioning challenging behavior. These findings support the development of new intervention strategies and suggest the need to measure executive functioning when assessing and tailoring the treatment of challenging behavior in clinical practice.
本研究旨在阐明执行功能和社交功能对挑战性行为的影响，以及挑战性行为对大量跨诊断样本的生活质量和功能的下游影响。了解这些关系对于制定和设计量身定制的干预策略至关重要。在一项横断面研究中，2004名儿童的家长完成了执行功能和社交功能、挑战性行为、儿童和家庭生活质量的测量，并报告了挑战性行为的功能影响。使用结构（路径）模型，分析评估了执行功能和社交功能（包括情绪调节和风险规避）与总体及特定类型挑战性行为之间的关联。结构模型还研究了挑战性行为对儿童和家庭生活质量的影响，包括对直接和扩展环境的测量，以及对父母/子女的功能影响以及与医疗/法律系统的互动。最后，中介模型探讨了执行功能和社交功能对生活质量的直接和间接影响以及挑战性行为的影响测量。结果表明，执行功能在挑战性行为中占很大比例的方差（=0.47）。反过来，挑战性行为在儿童和家庭生活质量（=0.36）和父母/子女影响（=0.31）中占很大比例的方差。探索性中介模型确定了执行功能和社交功能测量对生活质量和功能影响的直接效应，以及执行功能通过挑战性行为产生的间接效应。这些发现支持新干预策略的开发，并表明在临床实践中评估和调整挑战性行为的治疗时需要测量执行功能。
