Associations between Caregiver Stress and Depression and Language in Infants with Autistic and Non-autistic Siblings

• In Event: The Role of SES, Stress, and Language Input on Cognitive Development in at-risk Children

Abstract

Introduction: Caregivers of autistic children present with higher stress levels and depressive symptoms, which are known to negatively impact language of autistic children (Bonis, 2016; Wensu et al., 2019). However, we do not know how elevated caregiver stress and depression may impact later language abilities in younger siblings of children on the autism spectrum (Sibs-autism), who are at increased (approximately twenty-fold) likelihood of receiving a future diagnosis of autism and/or language impairment themselves (Ozonoff et al., 2011; Wan et al., 2012). The present study explored the mechanisms by which caregiver stress and depressive symptoms influence later language outcomes of infant siblings at high and low likelihood for later autism diagnosis. We hypothesized that caregivers with increased stress and depressive symptoms might speak less to their children, resulting in reduced language abilities later in life.

Method: Participants were 50 infants, 28 Sibs-autism (Mage = 13.71 months; SD =1.84 months) and 22 infants with non-autistic, otherwise typically-developing older sibling/s (Sibs-NA; Mage = 14.05 months; SD =2.13 months) who were followed longitudinally. All families spoke English as their primary language. During the first visit (12-18 months), caregiver stress was reported by the Parenting Stress Index Short Form (PSI-4 SF) and caregiver depression was reported by The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R). Additionally, adult word count (AWC; a proxy for caregiver linguistic input) was obtained from Language ENvironment Analysis recorders. Nine months later (21-27 months), language outcomes were assessed using aggregate receptive and expressive language scores derived from the Vineland Adaptive Behavior Scales, the Mullen Scales of Early Learning, and the MacArthur Bates Communicative Development Inventory: Words and Sentences. A series of mediation and moderation models were carried out to determine the degree to which the association between caregiver stress and depression and later expressive and receptive language was mediated by AWC and to test whether these associations varied by sibling group.

Results: Mediation models indicated that the relation between caregiver stress and child language was significantly mediated by AWC (receptive language 95% CI = [–0.0161, –0.0009]; expressive language 95% CI = [–0.0128, –0.0004]) when controlling for caregiver education (see Figure 1). Moderated mediation models indicated that sibling-status was not a significant moderator of any of the relations relevant to the aforementioned indirect effect. Caregiver depression was not a significant predictor of language input or later language outcomes.

Discussion: These findings provide empirical support for the theory that caregiver stress levels influence later language outcomes in infants at both heightened and population-level likelihood for being diagnosed with autism. Results show that this relation is mediated by the adult language input that an infant receives in their home environment. Additionally, findings suggest that caregiver stress is more strongly associated with caregiver language input and child language outcomes than caregiver depression. Caregiver stress may be a particularly important aspect of caregiver mental health to consider when assessing the impacts of the home language environment on language outcomes for all infants, regardless of likelihood for autism.

Authors

• Jennifer E Markfeld, Vanderbilt University
  Presenting Author

• Jacob Feldman

• Samantha Bordman

• Claire Daly

• Pooja Santapuram

• Bahar Keceli Kaysili, Vanderbilt University

• Tiffany G. Woynaroski