Exposure to family stressful life events in autistic children: Longitudinal associations with mental health and the moderating role of cognitive flexibility.

The main longitudinal pathway from family stressful events to mental health symptoms was not significant in the full sample, and the subgroup finding did not differ significantly from the typical shifting group. The subgroup effect was small; the authors note that family stressful events explained about 4% of the variance in internalizing symptoms. Family stressful events were measured as parent-reported family events in the previous 12 months, not child-specific events, event severity, or timing. Internalizing symptoms were measured by teacher report, and teachers may be less aware of a child's internal experiences than parents. Attrition was substantial: 103 families withdrew before the earlier assessment, and only 95 participants had complete data across the four later waves. Children who completed all waves had higher IQ than those who dropped out, so the analysed sample may not represent children with lower cognitive ability. The study cannot establish causality because unmeasured factors, such as genetic influences or family circumstances, could explain both stress exposure and symptoms.

The authors declared no potential conflicts of interest. The study was funded by the Canadian Institutes for Health Research, Kids Brain Health Network, Autism Speaks, the Government of British Columbia, Alberta Innovates Health Solutions and the Sinneave Family Foundation. Additional funding sources are named for individual authors.

Do not read the subgroup finding as proof that family stress causes internalizing symptoms or that cognitive flexibility moderates risk. The full-sample pathway was not significant, the group difference test was not significant, and the study did not test an intervention.