Dunlop, Andrew; (2024) Exploring the relationships between externalising behaviours and peer relationship problems in autistic youth. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

BACKGROUND: Externalising behaviours (e.g. aggression, hyperactivity and conduct problems) are common in autistic youth. Environmental risk factors (existing outside of the individual) are thought to play a role in the development of externalising symptoms. However, it is currently unclear what form they may take and whether they help or hinder. The focus of this systematic review is the identification of such risk factors which may potentially be amenable to modification. The identification of which measures of externalising are being used to identify such behaviours in autistic youth is also an important consideration. METHOD: Five databases were searched for studies investigating environmental risk factors associated with externalising behaviours displayed by autistic youth: ASSIA, EMBASE, MEDLINE, PsycINFO and Web of Science. Studies were grouped by theme of risk factor via narrative synthesis. Themes with sufficient studies also underwent meta-analysis. The review was pre-registered with PROSPERO (CRD42023453415). RESULTS: 7599 studies were identified with 123 selected for full-text review. 50 were eligible for narrative synthesis with 24 studies featuring in 6 meta-analyses. In total, there were 10 themes: parental mental health or stress, victimisation, parenting style, socioeconomic status, parental relationship characteristics, parental expressed emotion, parental education, child educational context, family significant life events, and family functioning. Meta-analyses were conducted for four environmental risk factors: parental mental health or stress (mean effect size Z = 0.36, 95% CI:[0.30,0.42]), parenting style (mean effect size Z = 0.07, 95% CI:[-0.03,0.18]), socioeconomic status (mean effect size Z = 0.07, 95% CI:[-0.02,0.15]), parental expressed emotion (mean effect size Z = 0.26, 95% CI:[0.04,0.49]). The three most used measures of externalising were The Child Behaviour Checklist (CBCL; Achenbach & Rescorla, 2001), The Strengths and Difficulties Questionnaire (SDQ; Goodman, 1999) and the Scales of Independent Behavior Revised (SIB-R; Bruininks et al., 1996). INTERPRETATION: Eight of the identified themes displayed some meaningful relationship with autistic young person externalising symptoms: Parental mental health or stress, victimisation, parenting style, SES (narrative synthesis but not meta-analysis), parental relationship characteristics, parental expressed emotion, family significant life events and family functioning. The studies included within the themes of Parental education and child educational context did not find evidence of a significant relationship with externalising. Clinical and academic implications of these relationships are discussed.

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