Family influences on social and play outcomes among children with ASD during middle childhood

• Cross-sectional and longitudinal effects of marital quality and maternal EE on child social and play outcomes were examined.
• Controlling for child symptom severity, marital quality and maternal EE were significant cross-sectional predictors of several key dimensions of child social play.
• Marital quality also mediated the relationship between child symptom severity and several child play outcomes.
• Increased maternal EE over time was related to a substantive deterioration in child play competence (i.e., less connected group play).

Using data drawn from a longitudinal study of families of children with autism spectrum disorders (ASD), I examined the concurrent and prospective impact of two family factors, marital quality and maternal expressed emotion (EE) on five indicators of parent-reported child social functioning (number of peers in the child's play network, child participation in unstructured group play, and the extent to which group play was characterized by play interaction, disruption, and disconnection). Controlling for child autism symptom severity, regression analyses indicated martial quality and maternal EE to be significant cross-sectional predictors of number of playmates and group play participation. In addition, marital quality was found to mediate the relationship between symptom severity and both play outcomes. Despite these significant cross-sectional effects, initial analyses revealed no significant longitudinal family effects on play outcomes. Subsequent analyses focusing specifically on the prediction of substantial change in child social functioning over time, however, did find increased play disconnection to be significantly linked to heightened levels of maternal EE, suggesting that familial influences may play a role in hindering improvement in some aspects of social functioning among mid-aged children with ASD. Study implications and limitations are discussed.