The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning

Caregiver strain and sensory features in children with autism spectrum disorder and other developmental disabilities

Caring for children with disabilities contributes to increased levels of parent stress or caregiver strain. However, the potential relationship of sensory features to strain among caregivers of children with autism spectrum disorder (ASD) and other developmental disabilities (DD) is unknown. Sensory features include overreactions, underreactions, and unusual interests in sensations, which may negatively impact family functioning. This descriptive study confirmed three caregiver strain types (i.e., objective, subjective internalized, subjective externalized) and explored differences among ASD (n  =  71) and DD (n  =  36) groups, with the ASD group reporting higher levels. Furthermore, this study explored the contribution of sensory features to caregiver strain, finding differential contributions to strain in the ASD group and covariate contributions (i.e., child cognition, mother's education) in the DD group.

Respite care, marital quality, and stress in parents of children with autism spectrum disorders

Parents of children with autism spectrum disorders (ASD) are at risk for having higher stress and lower marital quality than other parents. Survey data regarding respite care, marital quality, and daily hassles and uplifts were obtained from 101 mother-father dyads who were together raising at least one child with ASD (total # of children = 118). Number of hours of respite care was positively related to improved marital quality for both husbands and wives, such that a 1-h increase in weekly respite care was associated with a one-half standard deviation increase in marital quality. This relationship was significantly mediated by perceived daily stresses and uplifts in both husbands and wives. More respite care was associated with increased uplifts and reduced stress; increased uplifts were associated with improved marital quality; and more stress was associated with reduced marital quality. The number of children in the family was associated with greater stress, and reduced relational quality and daily uplifts. Results suggest policymakers and practitioners should develop supports for providing respite for families raising children with ASD.

Predictors of health-related quality of life in Chinese caregivers of children with autism spectrum disorders: a cross-sectional study

The purpose of this study was to identify the predictors of health-related quality of life (HRQOL) among caregivers of children with autism spectrum disorders (ASD) in China. Two hundred and seventy-three caregivers were surveyed using questionnaires on HRQOL, family functioning, coping style, social support, and caregiver burden. Besides socio-demographic characteristics of children with ASD and their caregivers, results demonstrate that family functioning, coping style, social support, caregiver burden are predictors of HRQOL in caregivers of children with ASD, and these predictors correlated with each other. These results indicate that comprehensive intervention, which focuses on improving caregivers' coping strategies, social support (especially from family members and friends) and family functioning, and on releasing caregiver burden, should be provided to caregivers of children with ASD.

Family functioning in Asian families raising children with autism spectrum disorders: the role of capabilities and positive meanings

BACKGROUND

There has been increasing interest in exploring the factors contributing to successful adaptation and family functioning in ethnically and culturally diverse families who raise children with autism spectrum disorders (ASD), in order to inform more appropriate strength-based family support services. This pilot study used the Family Adjustment and Adaptation Response (FAAR) model as a theoretical framework to investigate the role of families' capabilities (coping strategies and resources of support) and positive meanings in raising a child with ASD in family functioning in an Asian context.

METHODS

Sixty-five Singaporean parents of 3- to 11-year-old children with ASD completed a series of questionnaires on demands, coping strategies, social support, positive meanings and family functioning.

RESULTS

Families reported a number of helpful coping strategies. Coping through family integration/optimism was most helpful, followed by understanding the condition and by developing esteem and psychological stability. Reported capabilities, but not positive meanings, mediated the relationship between demands and family functioning.

CONCLUSION

The findings are discussed in relation to existing literature, possible specific cultural issues, and the strengths and limitations of the study. Implications for supporting families of children with ASD in different social and cultural contexts are also discussed.

Developmental and mental health disorders: two sides of the same coin

Children with developmental disorders (DD) are at substantially greater risk of developing mental health problems compared to typically developing children. However, the mental health co-morbidity is often missed or hidden in the context of DD leading to reduced quality of life and increased burden of care. Mental health problems in the context of DD also result in less optimal school and post-school outcomes with reduced opportunities for employment and community participation. There is also considerable overlap in the risk factors for both conditions, and these follow a cumulative risk model. Although awareness among clinicians and the public is improving, there is paucity of theoretical models, early identification frameworks as well as care pathways for interventions. This paper presents a framework for evaluating developmental vulnerability that highlights common risk factors for developmental and mental health disorders.

Family adjustment across cultural groups in autistic spectrum disorders

This pilot ethnomethodological study examined perceptions of parents/caregivers of children diagnosed with autistic spectrum disorders concerning actions, norms, understandings, and assumptions related to adjustment to this chronic illness. The sample included 14 caregivers (75% Hispanic of various ethnic groups). Maximum variation sampling was used to compare participants on variables that were inductively derived via constant comparative methods of analysis. The following action categories emerged: "Seeking Diagnosis," "Engaging in Routines to Control behavior," "Finding Therapies (Types of Therapies)," "Finding School Accommodations," "Educating Others," "Rising to Challenges," and "Finding the Role of Spiritual and Religious Belief."

[Autism and social support in recently immigrated families : experience of parents from Maghreb]

This qualitative exploratory study examines the impact of an autism diagnosis on the social support networks of North African's parents recently immigrated to Quebec and having a child diagnosed with pervasive developmental disorder. Semi-structured interviews were conducted with ten parents and participant observation took place during support meetings for the mothers. Our results highlight how the autism diagnosis transforms the parents' family and community networks, creating tensions and losses while also generating new links, sources of support. Group meetings between mothers of the same community experiencing the same problem are perceived particularly beneficial. The analysis of the relationship between professional service providers and families underlines how the development of a therapeutic alliance is threatened by major problems caused by administrative obstacles and intercultural communication difficulties. A greater awareness by health and social professionals of the interaction between the migratory context and the social network challenges associated with autism diagnostic for immigrant families would help ease these parents' loneliness and suffering.

Parenting styles and parents' perspectives on how their own emotions affect the functioning of children with autism spectrum disorders

The grounded theory method was used to analyze the parenting styles used by caregivers to rear children with autism spectrum disorders (ASD) and to investigate parents' experiences regarding how to help their child overcome the symptoms. Thirty-two parents from 28 families of children with ASD in mainland China were interviewed. Analysis of interview transcripts revealed four patterns of parenting styles which varied in affiliation to the roles of caretaker and coach. Based on their experience, a sizable group of parents perceived that their own emotions influence the child's emotions and his/her symptoms. The results suggest the value of developing intervention programs on emotion regulation and positive parenting for the parents of children with ASD.

The association between child autism symptomatology, maternal quality of life, and risk for depression

Parents raising children with autism spectrum disorders (ASDs) have been shown to experience high levels of stress and report a lower quality of life. The current study examined the association between child autism symptomatology, mother's quality of life, and mother's risk for depression in a sample of 1,110 mothers recruited from a web-based registry of families with children with an ASD. Higher autism symptomatology and a greater number of co-occurring psychiatric disorders in the child were associated with an increased risk for current treatment of maternal depression and a lower maternal quality of life. The results highlight the importance of screening for depression, particularly in mothers of children with ASD and mental health and behavioral challenges.

Raising a child with disability and dealing with life events: a mother's journey

Intellectual disability services recognise people with intellectual disability as a family member and aim to provide effective support that facilitates family cohesion. However, the needs of families and individuals within the family should be addressed in a holistic manner to ensure a seamless service. This article outlines a mother's reflections on her experience of raising a child with autism spectrum disorder and its impact on her life. The article focuses on one mother's feelings, coping or lack of coping and growth during a time of sadness. This article written by a mother, nurse and academic through their shared interest in supporting families of children with a disability all came together to tell this story. It is hoped that this article will assist professionals understand a mother's perspective when raising a child with intellectual disability and support professionals to recognise the importance of listening, coordinated support and working in partnership.

Fatigue, stress and coping in mothers of children with an autism spectrum disorder

Raising a child with an autism spectrum disorder (ASD) can be exhausting, which has the potential to impact on parental health and wellbeing. The current study investigated the influence of maternal fatigue and coping on the relationship between children's problematic behaviours and maternal stress for 65 mothers of young children (aged 2-5 years) with ASDs. Results showed that maternal fatigue but not maladaptive coping mediated the relationship between problematic child behaviours and maternal stress. These findings suggest child behaviour difficulties may contribute to parental fatigue, which in turn may influence use of ineffective coping strategies and increased stress. The significance of fatigue on maternal wellbeing was highlighted as an important area for consideration in families of children with an ASD.

Family-focused autism spectrum disorder research: a review of the utility of family systems approaches

A family member with an autism spectrum disorder presents pervasive and bidirectional influences on the entire family system, suggesting a need for family-focused autism spectrum disorder research. While there has been increasing interest in this research area, family-focused autism spectrum disorder research can still be considered relatively recent, and there are limitations to the existing literature. The purpose of this article is to provide theoretical and methodological directions for future family-focused autism spectrum disorder research. In particular, this article proposes Family Systems approaches as a common theoretical framework for future family-focused autism spectrum disorder research by considering theoretical concepts such as Boundaries, Ambiguous Loss, Resilience and Traumatic Growth. We discuss reasons why these concepts are important to researching families living with autism spectrum disorder and provide recommendations for future research. The potential for research grounded in Family Systems approaches to influence clinical support services is also discussed.

TEACCH-based group social skills training for children with high-functioning autism: a pilot randomized controlled trial

BACKGROUND

Although social skills training programs for people with high-functioning autism (HFA) are widely practiced, the standardization of curricula, the examination of clinical effectiveness, and the evaluation of the feasibility of future trials have yet to be done in Asian countries. To compensate for this problem, a Japanese pilot randomized controlled trial (RCT) of the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)-based group social skills training for children with HFA and their mothers was conducted.

METHODS

Eleven children with HFA, aged 5-6 years, and their mothers were randomly assigned to the TEACCH program (n=5) or a waiting-list control group (n=6). The program involved comprehensive group intervention and featured weekly 2-hour sessions, totaling 20 sessions over six months. The adaptive behaviors and social reciprocity of the children, parenting stress, and parent-child interactions were assessed using the Strengths and Difficulties Questionnaire (SDQ), Parenting Stress Index (PSI), Beck depression inventory-II (BDI-II), and Interaction Rating Scale (IRS).

RESULTS

Through this pilot trial, the intervention and evaluation of the program has been shaped. There were no dropouts from the program and the mothers' satisfaction was high. The outcome measurements improved more in the program group than in the control group, with moderate effect sizes (SDQ, 0.71; PSI, 0.58; BDI-II, 0.40; and IRS, 0.69). This pilot trial also implied that this program is more beneficial for high IQ children and mothers with low stress than for those who are not.

CONCLUSION

We have standardized the TEACCH program, confirmed the feasibility of a future trial, and successfully estimated the positive effect size. These findings will contribute to a larger trial in the future and to forthcoming systematic reviews with meta-analyses.

TRIAL REGISTRATION

UMIN000004560.

A Stress Model for Couples Parenting Children With Autism Spectrum Disorders and the Introduction of a Mindfulness Intervention

Parents of children with autism spectrum disorders (ASD) are at an increased risk for acute and chronic stress compared to parents of children with other developmental disabilities and parents of children without disabilities. It is plausible that the stressors of having a child with ASD affect the couple relationship; however, few researchers have focused on this dynamic within these families. In this article, we seek to develop a model for how stress operates in families with children with ASD. In developing this new stress model, we describe the characteristics of ASD, discuss stressors that are pronounced in families of children with ASD as supported by the literature, and highlight the limitations of Perry's (2004) model in application to this population. Our expanded stress model includes the addition of parenting couple resources and parenting couple outcomes. Finally, we demonstrate how to apply the model using a mindfulness intervention to promote positive outcomes and strengthen the couple relationship.

The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder

Researchers commonly report that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities [e.g., Down syndrome (DS), cerebral palsy, intellectual disability]. The authors reexamined the research using comparison groups to investigate parenting stress and conducted a meta-analysis to pool results across studies. The experience of stress in families of children with ASD versus families of TD children resulted in a large effect size. Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.

Lack of father involvement in research on children with autism spectrum disorder: maternal parenting stress and family functioning

Autism spectrum disorder (ASD) has an estimated prevalence of greater than 1% of people in the U.S. Caring for children with ASD is stressful and challenging for parents. The purpose of the study is to understand the ramifications of the findings of a spouse/father's lack of participation for a study focused on stress and family functioning that attempted to recruit both parents of a child with ASD. The Kruskal-Wallis test compared medians of three groups of mothers of children with ASD in order to assess differences in parenting stress and family functioning discrepancy depending on their marital status and spouse survey participation. There were differences across the groups of mothers of children with ASD for the discrepancy in expectations for help, from the participants' spouse or relatives, with family tasks, meeting the demands of other work responsibilities, child care, challenging behaviors, and school absences. Mothers of children with ASD are at risk for isolation and stress from negotiating family functions with the fathers of the children. Health care providers can assess for stress and family functioning and may anticipate different needs based on marital status and by father's involvement in decision-making.

Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation

Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.

Relationship status among parents of children with autism spectrum disorders: a population-based study

Despite speculation about an 80% divorce rate among parents of children with an Autism Spectrum Disorder (ASD), very little empirical and no epidemiological research has addressed the issue of separation and divorce among this population. Data for this study was taken from the 2007 National Survey of Children's Health, a population-based, cross-sectional survey. A total of 77,911 parent interviews were completed on children aged 3-17 years, of which 913 reported an ASD diagnosis. After controlling for relevant covariates, results from multivariate analyses revealed no evidence to suggest that children with ASD are at an increased risk for living in a household not comprised of their two biological or adoptive parents compared to children without ASD in the United States.

The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder

Researchers commonly report that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities [e.g., Down syndrome (DS), cerebral palsy, intellectual disability]. The authors reexamined the research using comparison groups to investigate parenting stress and conducted a meta-analysis to pool results across studies. The experience of stress in families of children with ASD versus families of TD children resulted in a large effect size. Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.

Parental stress in families of children with a genetic disorder/disability and the resiliency model of family stress, adjustment, and adaptation

BACKGROUND

Research suggests that parents of children with disabilities endure increased amounts of stress but also experience positive outcomes.

PURPOSE

To further investigate findings from focus group interviews that explored parental stress in families of children with disabilities using a sequential mixed methods design.

METHOD

This study sought to model parental stress using the McCubbin and McCubbin (1993) Resiliency Model of Stress, Adjustment, and Adaptation using qualitative and quantitative data collected sequentially. Twenty-five parents of children with autism spectrum disorder, cerebral palsy, Down syndrome, and sickle cell disease participated in a 2-step study that encompassed qualitative followed by quantitative data ascertainment.

RESULTS

Parents who quantitatively experienced high stress or low stress used different behavioral themes to describe their experience qualitatively. Positive appraisals, resources, and ability to engage in problem solving and coping were associated with family resiliency.

Effects of a father-based in-home intervention on perceived stress and family dynamics in parents of children with autism

Parents of children with autism report high rates of stress. Parental differences in stress are inconsistent, with most research indicating that mothers report higher levels of stress than fathers. We explored parental differences before and after an in-home training program. Fathers were taught an intervention designed to improve their child's social reciprocity and communication; they then trained mothers. Stress was assessed with the Parenting Stress Index-Short Form, and family dynamics was assessed with the Family Adaptability and Cohesion Evaluation Scales II. Both mothers and fathers reported high preintervention levels of stress. After intervention, fathers' stress was reduced, but not significantly, possibly because of the variability in fathers' scores; mothers' stress scores were significantly reduced. Parenting styles were significantly different before and after intervention. Interdisciplinary teams, including occupational therapists, nurses, and special educators, can work.together to have a positive impact on the lives of families of children with autism.

The efficacy of a Social Skills Group Intervention for improving social behaviors in children with High Functioning Autism Spectrum disorders

This study tested the efficacy of a new social skills intervention, S ocial S kills GR oup IN tervention-High Functioning Autism (S.S.GRIN-HFA), designed to improve social behaviors in children with high functioning autism spectrum disorders. Fifty-five children were randomly assigned to S.S.GRIN-HFA treatment (n = 27) or control (i.e., traditional S.S.GRIN intervention; n = 28). Examination of the direction and magnitude of change in functioning revealed that children who participated in S.S.GRIN-HFA exhibited significantly greater mastery of social skill concepts compared to children in the control group. Parents of S.S.GRIN-HFA group participants reported an improved sense of social self-efficacy, whereas parents of control participants reported a decline. The advantages of a specialized intervention such as S.S.GRIN-HFA, designed specifically for children with high functioning autism spectrum disorders, are discussed.

Factor analysis of the Parenting Stress Index-Short Form with parents of young children with autism spectrum disorders

The primary purpose of this study was to examine the underlying factor structure of the Parenting Stress Index-Short Form (PSI-SF) in a large cohort of parents of young children with autism spectrum disorder (ASD). A secondary goal was to examine relationships between PSI-SF factors and autism severity, child behavior problems, and parental mental health variables that have been shown to be related to parental stress in previous research. A confirmatory factor analysis (CFA) was used to examine the three-factor structure described in the PSI-SF manual [Abidin, 1995]: parental distress, parent-child dysfunctional interaction, and difficult child. Results of the CFA indicated that the three-factor structure was unacceptable when applied to the study sample. Thus, an exploratory factor analysis was conducted and suggested a six-factor model as the best alternative for the PSI-SF index. Spearman's correlations revealed significant positive correlations with moderate to large effect sizes between the revised PSI-SF factors and autism severity, externalizing and internalizing child behaviors, and an index of parent mental health. The revised factors represent more narrowly defined aspects of the three original subscales of the PSI-SF and might prove to be advantageous in both research and clinical applications. Autism Res 2011,4:336-346. © 2011 International Society for Autism Research, Wiley Periodicals, Inc.

Parent-child DRD4 genotype as a potential biomarker for oppositional, anxiety, and repetitive behaviors in children with autism spectrum disorder

The primary objective of the present study was to examine whether a combination of parent-child DRD4 genotypes results in more informative biomarkers of oppositional, separation anxiety, and repetitive behaviors in children with autism spectrum disorder (ASD). Based on prior research indicating the 7-repeat allele as a potential risk variant, participants were sorted into one of four combinations of parent-child genotypes. Owing to the possibility of parent-of-origin effects, analyses were conducted separately for mother-child (MC) and father-child (FC) dyads. Mothers completed a validated DSM-IV-referenced rating scale. Partial eta-squared (ηp(2)) was used to determine the magnitude of group differences: 0.01-0.06=small, 0.06-0.14=moderate, and >0.14=large. Analyses indicated that children in MC dyads with matched genotypes had the least (7-/7-) and most (7+/7+) severe mother-rated oppositional-defiant (ηp(2)=0.11) and separation anxiety (ηp(2)=0.19) symptoms. Conversely, youths in FC dyads with matched genotypes had the least (7-/7-) and most (7+/7+) severe obsessive-compulsive behaviors (ηp(2)=0.19) and tics (ηp(2)=0.18). Youths whose parents were both noncarriers had less severe tics than peers with at least one parental carrier, and the effect size was large (ηp(2)=0.16). There was little evidence that noncarrier children were rated more severely by mothers who were carriers versus noncarriers. Transmission Disequilibrium Test analyses provided preliminary evidence for undertransmission of the 2-repeat allele in youths with more severe tics (p=0.02). Parent genotype may be helpful in constructing prognostic biomarkers for behavioral disturbances in ASD; however, findings are tentative pending replication with larger, independent samples.

The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: developmental considerations for parents

Anxiety symptoms are one of the most common mental health conditions in childhood. Children and adolescents with Autism Spectrum Disorders (ASD) are at risk for developing mental health symptoms and anxiety in particular, especially when compared with their peers - both in the general population as well as when compared to youth with other developmental disabilities. Cognitive behavior therapy (CBT) has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and an emerging body of literature indicates that modified CBT for youth with ASD can be effective in reducing anxiety symptoms. In a review of these modified treatment protocols, parent involvement is emphasized as an important component of interventions for youth with ASD and anxiety. However, the majority of these studies only briefly describe the parent's role, and little mention is made with regard to how the parent's role evolves over time as children age into adolescence. In this paper, the parent's role in the treatment of anxiety symptoms in children and adolescents with high-functioning ASD will be discussed with a particular emphasis on considerations for parents of teenagers. Specific recommendations for parent involvement will be provided.

Participation Patterns in Preschool Children with an Autism Spectrum Disorder

An understanding of participation patterns in preschool-aged children with an autism spectrum disorder will allow the occupation therapy practitioner to focus on goals relevant to the child and family. This study compares participation patterns and barriers to participation in children with an autism spectrum disorder with those of children with no diagnosis. Using the Preschool Activity Card Sort, parent interviews revealed children with an autism diagnosis participate in fewer preschool activities of self-care, community mobility, vigorous leisure, sedentary leisure, social interaction, chores, and education than children with no diagnosis. Reasons for non-participation generally focused on child behaviors; parents gave opportunities to participate, but the child, for a variety of reasons, could not capitalize on the opportunity. Practitioners can assist the family in managing the child's responses and behavior in a wide range of preschool activities.