Category: Autism Spectrum and Developmental Disorders

PS6- #B40 - Expressed Emotion as a Mediator Between Knowledge of Autism and Child Behavior Problems

Friday, Nov 17
2:45 PM – 3:45 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Autism Spectrum Disorders | Child Externalizing | Parenting

For caregivers of a child with autism spectrum disorder (ASD), expressed emotion (EE) can be conceptualized as a critical, hostile, and emotionally over-involved attitude toward their child (Brown & Rutter, 1966). Studies of families with a child with ASD have demonstrated a significant, positive relation between caregiver EE and child externalizing behaviors (e.g., Bader, Barry, & Hann, 2015; Greenberg, Seltzer, Hong, & Orsmond, 2006). More research is needed to examine what contributes to higher levels of EE. This study examined the indirect effect of knowledge of ASD on child externalizing behaviors through caregiver EE in a sample of families with a child with ASD. 


 Participants were 156 caregivers (116 females) and their 156 children (129 males). Caregivers were ages 24 to 53 years (M = 34.6; SD = 5.1) and most identified as biological parents (96.8%). Children were ages 4 to 11 years (M = 7.0; SD = 1.8), and the majority were identified as White (80.1%) and Bi/multiracial (7.1%). Caregivers self-reported that their children were diagnosed with ASD (89.1%), Asperger’s (8.3%), and PDD-NOS (2.6%).


 Participants completed several assessments, including: Behavior Assessment System for Children–3 (Reynolds & Kamphaus, 2015) to assess child behavior; Family Questionnaire (Wiedemann, Rayki, Feinstein, & Hahlweg, 2002) to assess caregiver EE (Criticism/Hostility and Emotional Overinvolvment [EOI] subscales were used); and A Survey of Knowledge of Autism Spectrum Disorder (Hansen, 2015) to assess ASD knowledge.


 A serial mediation model using PROCESS (Hayes, 2013) with bootstrapping analytical techniques with 10,000 samples with replacement was examined. Child ASD symptom severity was used as a covariate, child externalizing behavior was entered as the criterion variable, caregiver knowledge of ASD as the predictor, and Criticism/Hostility and EOI as parallel mediators. The total effect of ASD knowledge on child externalizing behaviors was significant, b = -.63, SE = .15, p < .001. ASD knowledge predicted a significant amount of variance in Criticism/Hostility, b = -.63, SE = .21, p = .003, and EOI, b = .67, SE = .16, p < .001. The path between Criticism/Hostility and child externalizing behaviors was significant, b = .30, SE = .06, p < .001, but the path between EOI and child externalizing behaviors was nonsignificant, b = .01, SE = .08, p = .87. There was a significant indirect effect of knowledge of ASD on child externalizing behavior through the two EE mediators, b = -.18, SE = .09 (95%CI -.37, -.005). Specifically, the indirect effect was significant for Criticism/Hostility, b = -.19, SE = .07 (95%CI -.35, -.08) but not EOI, b = .01, SE = .05 (95%CI -.09, .11). Finally, the direct effect of knowledge of ASD on child externalizing behavior (accounting for the indirect effect of EE) remained significant, b = -.45, SE = .16, p = .005. Results demonstrated that caregiver knowledge of ASD predicts child externalizing behavior directly and through Criticism/Hostility. Implications and recommendations based upon these findings are discussed.

Rebecca A. Lindsey

Washington State University

Laura K. Hansen

University of Southern Mississippi
Hattiesburg, Mississippi

Tammy D. Barry

Associate Professor and Director of Clinical Training
Washington State University