Date Presented 04/06/19
Flourishing, an indicator of positive mental health, is important for children’s development and well-being. Behavioral contributors to flourishing, independent of environment, were examined in a large data set of children from age 6 to 17 years. Children with ASD had significantly lower odds of flourishing and demonstrating the behavioral tendencies compared to controls, confirming the early need to address positive emotions and positive affect for these individuals.
Primary Author and Speaker: Claudia Hilton
Additional Authors and Speakers: Karen Ratcliff, Diane Collins, Joanne Flanagan, Ickpyo Hong
PURPOSE: Flourishing is an indicator of positive mental health and is important for children’s development and well-being (Kandasamy et al., 2018). It is a measure of positive behavior and contributes to the development of independence that is critical for all youth for successful transition into adulthood (Hume et al., 2014). The National Survey of Children’s Health 2016 (NSCH) identified three behavioral tendencies that are independent of environmental contributors to flourishing among children. These behavioral tendencies include curiosity, finishes, and self-control and result from positive emotions which, when present, contribute to positive affect and build personal resources (Frederickson, 2001). These personal resources help an individual to broaden his/her mindset and manage threats, and contribute to personal development and well-being. Few studies have examined the construct of flourishing among school-aged children and none among children with autism spectrum disorders (ASD).
RESEARCH QUESTION: How do parents’ perceptions of flourishing compare between children with and without ASD in a large dataset?
DESIGN: We used a cross-sectional design to examine data from the NSCH. Data consisted of parent/caregiver responses, was representative of the entire United States population (all 50 states) of non-institutionalized children ages 0-17 years, and was collected from June 2016 to February 2017.
METHODS: The total sample between age 6 and 17 years was 35,280 children. Flourishing (1=yes, 0=no) was defined by the NSCH survey as a combination of 1) curiosity (interest or curiosity about learning), 2) finishes (ability to complete tasks or follow through with plans), and 3) self-control (stays calm when challenged). Comparison between the two groups was not a pair comparison since the two groups are generically different in various demographic, clinical, social, and environmental factors which would result in selection bias (Rosenbaum and Rubin, 1983). Therefore, we examined how differently the two groups (ASD and controls) demonstrated flourishing behavioral tendencies using various covariate adjustment methods. Traditional multivariate logistic regression models and propensity score matching with inverse probability weighting for covariate adjustment (PS-IPWT) method (Rosenbaum and Rubin, 1983) were used to balance 12 demographic, clinical, social, and environmental factors when estimating the odds ratio of achieving the three individual flourishing tasks between children with and without ASD.
RESULTS: Among the study sample, 2.33% children (n=823) had ASD. Demographic, clinical, social, and environmental factor differences between the two comparison groups were balanced (all p>0.05) after applying the PS-IPWT method. The traditional logistic regression model and PS-IPTW method revealed that children with ASD had significantly lower odds of flourishing and demonstrating the three flourishing behavioral tendencies compared to the control group: curiosity (odds ratios [ORs]=0.281∼0.244, p < 0.001), finishes (ORs=0.314∼0.279, p < 0.001), and self-control (ORs=0.106-0.092, p < 0.001).
CONCLUSIONS: With both covariate adjustment methods, children with ASD had lower odds of demonstrating flourishing and the three behavioral tendencies. The PS-IPTW method demonstrated the same directions of regression coefficients and lower odds ratios compared to the traditional logistic regression model, indicating robust study results.
IMPACT STATEMENT: Children with ASD demonstrate lower odds of flourishing so are at greater risk for decreased psychological, social, and physical well-being, which impacts adult independence. This finding confirms the need to address positive emotions and positive affect for individuals with ASD at a young age.
References
Frederickson, B. L. (2001). The role of positive emotions in positive psychology. American Psychologist, 56 (3), 218-226. DOI: 10.1037//0003-066X.56.3.218
Hume, K. Boyd, B. A., Hamm, J.V. & Kucharczyk, S. (2014). Supporting independence in adolescents on the autism spectrum. Remedial and Special Education, 35(2), 102–113. DOI: 10.1177/0741932513514617
Kandasamy, V., Hirai, A. H., Ghandour, R. M. & Kogan, M. D. (2018). Parental Perception of Flourishing in School-Aged Children: 2011–2012 National Survey of Children’s Health. Journal of Developmental and Behavioral Pediatrics, 0, 1–11. DOI: 10.1097/DBP.0000000000000559
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrica, 70(1), 41-55. DOI:10.1093/biomet/70.1.41
