Characteristics of change triggered temper outbursts in children with PWS and ASD and how these may impact on the efficacy of behavioural intervention strategies.

Background
Temper outbursts are prevalent in individuals with PWS and are often triggered by unexpected changes to routines or plans. However, such outbursts are also common in individuals with several other neurodevelopmental disorders, including those with a diagnosis of autism spectrum disorder (ASD). We compared the profile of temper outbursts in children with PWS to that in children with ASD. We examined whether differences in the temper outburst profile predicted differences in the outcomes of two caregiver led intervention strategies aiming to reduce change triggered outbursts.
Methods and results
Thirteen 7-15 year olds with PWS – taking part in a larger study involving 60 children evidencing temper outbursts following changes – were individually matched for age to children with ASD (mean ages: 10.70; 10.76 yrs). Caregivers participated in a structured/semi-structured interview on children's outbursts; completed a web-based outburst diary over a 6 month baseline; and are currently using either a change signalling intervention to reliably warn children of forthcoming changes; or a planning ahead intervention to reduce children's exposure to unexpected changes.
As reported at interview, on average, children with PWS showed more frequent temper outbursts than those with ASD (closer to daily vs. weekly). For seven children with PWS and six with ASD, 60% or more of their temper outbursts were reported to be triggered by changes. Whilst outbursts had similar durations when triggered by changes or by other events in children with PWS; change triggered outbursts in children with ASD were generally shorter. The most commonly reported outburst components in children with PWS included indicators of heightened emotional arousal but this was not the case for children with ASD. Data on behavioural change associated with each of the intervention strategies will be discussed.
Conclusions
Change triggered temper outbursts can be a problem for children PWS and ASD, however subtle differences appear to exist in the profile of these outbursts. Some of these differences may be relevant for the expected efficacy of different behavioural intervention strategies that target outbursts.
Summary
Temper outbursts (tantrums) were compared in children with PWS or autism spectrum disorder before and during use of one of two helping strategies. Helping strategies were led by caregivers and aimed to reduce outbursts that follow changes to routines or plans by making such changes more predictable, or by reducing the quantity of changes. Characteristics of outbursts may be important to help us predict which helping strategies may be most effective.

Implications of coping strategies and community cohesion for mental health in Colombia

In the face of mass human rights violations and constant threats to security, there is growing recognition of the resilience of people and communities. This paper builds on such work by investigating the effects of individual coping strategies, perceived community cohesion, and their interaction on mental health symptoms in Colombia. The study was conducted five years after the mass demobilisation of the former paramilitaries and takes an exploratory quantitative approach to identify two distinct forms of coping approaches among participants living in the Caribbean coast of Colombia. A constructive coping approach included active engagement, planning behaviours, emotional support, acceptance and positive reframing of daily stressors. A destructive coping approach in this study entailed denial of problems, substance use and behavioural disengagement from day-to-day stress. In addition, the strength of perceived community cohesion, or how close-knit and effective the individuals feel about the community in which they live, was examined. Structural equation modelling revealed that a constructive coping approach was significantly related to lower depression, while a destructive coping approach predicted more symptoms of depression. Although there was not a significant direct effect of perceived community cohesion on mental health outcomes, it did enhance the effect of constructive coping strategies at the trend level. That is, individuals who used constructive coping strategies and perceived their communities to be more cohesive, reported fewer depression symptoms than those who lived in less cohesive settings. Implications for promoting constructive coping strategies, as well as fostering cohesion in the community, are discussed.