1
|
Hejl JL, Hulgaard DR, Rasmussen ASD, Larsen LEN, Rask CU. Linking heart and mind - lived experiences of parents to children with congenital heart disease and mental health issues. Clin Child Psychol Psychiatry 2024:13591045241267129. [PMID: 39041634 DOI: 10.1177/13591045241267129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Children with congenital heart disease are more likely to receive special educational services in schools and have an increased risk of mental health issues. We explored the lived experiences of parents caring for a child with heart disease and concurrent mental health issues in Denmark. Semi-structured interviews with ten parents (age 39-57 years) to these children (age 5-17 years) were analysed using interpretative phenomenological analysis. Three Group Experiential Themes (GETs) were generated from the analysis: The first GET, Parental roles and caring behaviours, described parental struggles of fulfilling their parenting role ideals and experiences with stigmatization of MHI. GET two, Parental reflections on their illness explanations, portrayed how parents utilize different illness explanations to make sense of their child's MHI. GET three, Differences in access to help and support, captured how the CHD affected overall access to mental health support. The results may inform various topics of importance for health professionals to address in their clinical encounters with these families.
Collapse
Affiliation(s)
- Julie L Hejl
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ditte R Hulgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Anne Sofie D Rasmussen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Lærke Emilie N Larsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Milea-Milea AC, Fernández-Pérez D, Toledano-González A. The psychological impact of the COVID-19 pandemic on children/adolescents with ASD and their family environment: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:203-228. [PMID: 36757483 PMCID: PMC9909131 DOI: 10.1007/s00787-023-02151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
The main objective of the review is to analyze the impact of the pandemic in children/teenagers with Autism spectrum disorder (ASD) and in their family environment. An electronic search was carried out in different databases (PsycInfo, Web of Science and Scopus) in order to find publications associated with the aim of this project. The search terms used were derived from the combination of the following search string: "((Pandemic OR Epidemic OR Outbreak OR COVID-19 OR Coronavirus) AND (Children OR Adolescents OR Youth OR Child OR Teenager) AND (Autism OR ASD OR Autism Spectrum Disorder))''. In total, 21 articles were included in this review. The findings of the different investigations included in this review show that the pandemic has produced a negative psychological impact in children/teenagers with ASD. Therefore, long-term follow-up studies should be carried out with the objective of creating effective interventions to treat this problematical.
Collapse
Affiliation(s)
| | - Dolores Fernández-Pérez
- Department of Psychology, Faculty of Medicine, University of Castilla-La Mancha, Albacete, Spain.
- Neurological Disabilities Research Institute, Albacete, Spain.
| | - Abel Toledano-González
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Neurological Disabilities Research Institute, Albacete, Spain
| |
Collapse
|
3
|
Wang L, Xie Z, Zhao D. Spring is not yet here: raising a child with ASD in rural southwest China. Disabil Rehabil 2024; 46:322-333. [PMID: 36573417 DOI: 10.1080/09638288.2022.2161642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aims to reveal the parenting experiences of parents of children with autism spectrum disorder (ASD) in rural southwest China under the framework of ecological systems theory. MATERIALS AND METHODS Semi-structured interviews were conducted with 21 parents of children with ASD from rural southwest China and the interview data were analyzed using the three coding steps of the grounded theory method, namely open, axial, and selective coding. RESULTS The results showed four themes: challenges from within the family; relationships between parents, the school, and the community; scarcity and low accessibility of available resources and services; the culture of discriminating against people with disabilities and the loss of eligibility for welfare. The mismatch between the needs of families of children with ASD and the resources available in social-environmental systems is the major issue faced by parents. CONCLUSIONS Raising a child with ASD in rural southwest China is affected by the interactions between the families and the internal structures in different environmental systems. The culture of discriminating against people with disabilities formed in the macrosystem could be the essential factor that affects the smoothness of the parenting process of children with ASD.
Collapse
Affiliation(s)
- Linlin Wang
- Department of Special Education, Yunnan Normal University, Kunming, People's Republic of China
| | - Zhengli Xie
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dehu Zhao
- Department of Special Education, Yunnan Normal University, Kunming, People's Republic of China
| |
Collapse
|
4
|
Nord D, Hamre K, Andresen J. The Effects of Health Insurance Coverage on Workforce Engagement of Family Caregivers of Children With Intellectual Disability and Autism. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:10-25. [PMID: 38147890 DOI: 10.1352/1944-7558-129.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/28/2023] [Indexed: 12/28/2023]
Abstract
For many families of children with intellectual disability and autism (ID/ASD), private health insurance and public programs, such as Medicaid and the Children's Health Insurance Program (CHIP), are critical sources of support. The purpose of this study was to examine the impact of health insurance coverage on workforce engagement of parents of children with ID/ASD. The study utilized 2014-2018 pooled National Health Interview Survey data to construct national estimates and test the effects of health insurance status on parent workforce outcomes. Primary findings indicate significantly higher odds of workforce absence (OR = 2.83, p < .0038) and unemployment (OR = 8.91, p < .0038) among parents with children with ID/ASD using public health insurance, compared to the reference group. Additionally, parents of children with ID/ASD who were uninsured were found to experience significantly higher unemployment (OR = 4.86, p < .0038) than the reference group. Findings have policy and research implications related to workforce engagement for parents, including issues impacting health insurance coverage, specifically related to Medicaid and CHIP.
Collapse
Affiliation(s)
- Derek Nord
- Derek Nord, Indiana University, Indiana Institute on Disability and Community
| | - Kristin Hamre
- Kristin Hamre, Indiana University, School of Social Work
| | - John Andresen
- John Andresen, Indiana University, Indiana Institute on Disability and Community
| |
Collapse
|
5
|
Chan KKS, Fung WTW, Leung DCK. Self-compassion mitigates the cognitive, affective, and social impact of courtesy stigma on parents of autistic children. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1649-1660. [PMID: 36566467 DOI: 10.1007/s00127-022-02413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/12/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Due to the courtesy stigma of autism spectrum disorder, many parents of autistic children are devaluated and discriminated against by the public. Despite the high prevalence of this courtesy stigma, very few studies have examined its negative effects on parents of autistic children and explored the factors that may protect the parents from these negative effects. The present study utilized a 2-year, two-wave prospective longitudinal design to examine the associations of courtesy stigma with adverse cognitive (self-stigma), affective (depressive and anxiety symptoms), and social (parent-child and inter-parental conflicts) consequences for parents of autistic children and to test whether these associations would be moderated and mitigated by self-compassion. METHODS A total of 381 parents of autistic children completed questionnaires about courtesy stigma, self-compassion, self-stigma, depressive and anxiety symptoms, and parent-child and inter-parental conflicts at time 1 (T1) and time 2 (T2). RESULTS Courtesy stigma interacted with self-compassion at T1 in predicting self-stigma, depressive and anxiety symptoms, and parent-child and inter-parental conflicts at T2. Specifically, the associations of courtesy stigma with the adverse psychological consequences were weaker for parents with high self-compassion than for those with low self-compassion. CONCLUSION Our results demonstrate the prospective associations of courtesy stigma with adverse cognitive, affective, and social consequences for parents of autistic children, as well as the protective effects of self-compassion against such associations. These results highlight the importance of increasing parents' self-compassion to help them cope with courtesy stigma and improve their psychological well-being.
Collapse
Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China.
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, China.
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Donald Chi Kin Leung
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| |
Collapse
|
6
|
Li M, Lan R, Ma P, Gong H. The effect of positive parenting on adolescent life satisfaction: the mediating role of parent-adolescent attachment. Front Psychol 2023; 14:1183546. [PMID: 37465493 PMCID: PMC10351537 DOI: 10.3389/fpsyg.2023.1183546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
This study explores the impact of positive parenting on adolescents' life satisfaction and the mediating role of parent-adolescent attachment, based on the family systems theory and attachment theory. The sample included 5,047 adolescents (2,353 males, 2,694 females) with a mean age of 16.65 (SD = 1.21) from Henan Province, China. This study used the Positive Parenting Scale, the Inventory of Parent and Peer Attachment and the Satisfaction with Life Scale to survey 5,047 adolescents. The results showed that: (1) father's positive parenting positively predicted adolescent life satisfaction, while mother's positive parenting did not significantly predict adolescent life satisfaction; (2) Father-adolescent attachment and mother-adolescent attachment play a mediating role in the relationship between fathers' positive parenting, mothers' positive parenting, and adolescent life satisfaction, respectively; (3) Differences in the mechanisms of father's positive parenting and mother's positive parenting on adolescent life satisfaction. Among them, mothers' positive parenting positively predicts mother-adolescent attachment, which in turn affects adolescent life satisfaction. On the other hand, fathers' positive parenting can influence adolescent life satisfaction through two pathways: by positively predicting father-adolescent attachment and by positively predicting mother-adolescent attachment. The research findings indicate that father's and mother's positive parenting have different direct effects on adolescent's life satisfaction, and both can indirectly influence adolescent life satisfaction through the mediating variables of father-adolescent and mother-adolescent attachment. These findings have important theoretical and practical implications for promoting family education and adolescent psychological well-being.
Collapse
Affiliation(s)
- Mengge Li
- School of Psychology, South China Normal University, Guangzhou, Guangdong, China
| | - Ruiming Lan
- School of Psychology, Fujian Normal University, Fuzhou, Fujian, China
| | - Peng Ma
- School of Psychology, South China Normal University, Guangzhou, Guangdong, China
| | - Huoliang Gong
- School of Psychology, Henan University, Kaifeng, Henan, China
| |
Collapse
|
7
|
Ağırkan M, Koç M, Avcı ÖH. How effective are group-based psychoeducation programs for parents of children with ASD in Turkey? A systematic review and meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104554. [PMID: 37301054 DOI: 10.1016/j.ridd.2023.104554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
Recent research shows that group-based psychoeducation programs designed for parents of children with ASD have grown in popularity over time. The international evidence for the effectiveness of psychoeducation programs designed for parents of children with ASD in developed societies emphasizes the importance of providing a synthesis of the effectiveness of programs in developing societies. This study's primary aim is to assess the efficacy of group-based psychoeducation programs in Turkey for parents of children with ASD. The second aim is to investigate how the programs are influenced by the potential moderators (type of involvement, research design, number of sessions, duration of sessions, and number of participants). For these purposes, a database search was conducted that included group-based psychoeducation programs for parents of children with ASD implemented in Turkey. Twelve group-based psychoeducation programs that met the inclusion criteria were included in the study. The results showed that group-based psychoeducation programs for parents of children with ASD had "medium" effects on psychological symptoms [ES(SE) = 0.65 (.08), 95%CI (0.48-0.81)], "low" effects on social skills [ES(SE) = 0.32 (.16), 95%CI (0.02-0.62)], and "high" effects on well-being [ES(SE) = 1.05 (.19), 95%CI (0.66-1.43)]. According to moderator analyses, the type of involvement and the number of sessions were statistically significant moderators of psychological symptoms, but not the research design, duration of sessions, or number of participants.
Collapse
Affiliation(s)
- Murat Ağırkan
- Department of Psychological Counseling and Guidance, Faculty of Education, Erzincan Binali Yıldırım University, 23200 Erzincan, Turkey.
| | - Muharrem Koç
- Department of Psychological Counseling and Guidance, Hacettepe University, 06530 Beytepe, Ankara, Turkey.
| | - Özlem Haskan Avcı
- Department of Psychological Counseling and Guidance, Hacettepe University, 06530 Beytepe, Ankara, Turkey.
| |
Collapse
|
8
|
Rattaz C, Loubersac J, Michelon C, Picot MC, Baghdadli A. Changes in mothers' and fathers' stress level, mental health and coping strategies during the 3 years following ASD diagnosis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 137:104497. [PMID: 37004353 DOI: 10.1016/j.ridd.2023.104497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/17/2023] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND ASD in a child affects parental mental health, with elevated levels of stress, anxiety and depression reported in parents. METHOD In this study, we examined mothers' and fathers' stress, anxiety and depression, as well as their coping strategies in a sample of 103 children and adolescents enrolled in the ELENA cohort study in France at diagnosis and three years after diagnosis. RESULTS Results showed that mothers had higher levels of stress and anxiety / depression than fathers and used more social support coping strategies at diagnosis, which might be explained by increased levels of parental involvement. Mothers' stress level significantly decreased during the three years following ASD diagnosis but no such decrease was observed in fathers' stress level. A significant decrease in anxiety and depression was observed for both parents, suggesting that parental distress is particularly elevated during the critical diagnosis period. Results finally yielded a significant decrease in emotion-focused coping strategy in mothers over the three-year period, an ineffective strategy that takes places at the time of diagnosis but then decreases during the period following ASD diagnosis, in relation to the acceptance process. CONCLUSIONS Implications in terms of addressing the unmet mental health needs of parents and their coping strategies are discussed.
Collapse
Affiliation(s)
- Cécile Rattaz
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Clinical Research Unit, Department of Medical Information, CHU Montpellier, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Faculté de Médecine, Université de Montpellier, France.
| |
Collapse
|
9
|
Roubinov D, Don B, Blades R, Epel E. Is it me or my child? The association between maternal depression and children's behavior problems in mothers and their children with or without autism. FAMILY PROCESS 2023; 62:737-753. [PMID: 36017571 DOI: 10.1111/famp.12810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 06/08/2023]
Abstract
Bidirectional associations between maternal depression and child behavior problems have been reported in prior research, however, few studies examine these relations across varied family contexts. This study examined parenting stress and child diagnosis of autism spectrum disorder (ASD) as moderators of bidirectional associations between maternal depression and child behavior problems over time. Our sample included 86 mother-child dyads who reported maternal depressive symptoms, child behavior problems, and parenting stress at three time points over more than 1 year. Approximately half were mothers of children with ASD (n = 41) and half were mothers of neurotypical children (n = 45). We tested the bidirectional associations between maternal depressive symptoms and children's behavior problems and the potential moderating role of parental stress or child ASD diagnosis on these bidirectional associations using aggregated, lagged, and linear mixed models. Even after controlling for lagged maternal depressive symptoms, child behavior problems were associated with greater subsequent maternal depression at the between-person level, but not at the within-person level. The converse relation of prior maternal depressive symptoms on subsequent child behavior problems was not significant. Neither parenting stress nor child ASD diagnosis moderated bidirectional associations between maternal depressive symptoms and children's behavior problems. Child behavior predicted maternal depression, but the converse was not true, regardless of parenting stress levels or child's ASD diagnosis. For mothers experiencing elevated parenting stress and those with children with ASD, this may help alleviate elevated feelings of guilt related to their children's behavior problems.
Collapse
Affiliation(s)
- Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Brian Don
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Robin Blades
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| |
Collapse
|
10
|
Boulton KA, Hodge MA, Jewell A, Ong N, Silove N, Guastella AJ. Diagnostic delay in children with neurodevelopmental conditions attending a publicly funded developmental assessment service: findings from the Sydney Child Neurodevelopment Research Registry. BMJ Open 2023; 13:e069500. [PMID: 36725093 PMCID: PMC9896183 DOI: 10.1136/bmjopen-2022-069500] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Early developmental assessment is crucial for effective support and intervention. This study examined factors that contribute to (a) older child age when caregivers first became concerned about their child's development and (b) older child age at the point of entry into developmental and diagnostic assessment. We also quantified how factors contributed to risk of children not receiving an assessment by 5 years and considered the acceptability of electronic data capture for families. DESIGN This cross-sectional study collected information about caregiver developmental concerns, family history and child characteristics. SETTING Children and families entered a large, publicly funded hospital-based paediatric developmental assessment service. PARTICIPANTS Consecutively enrolled children (N=916) aged 6 months to 17 years with neurodevelopmental concerns and their caregivers. MAIN OUTCOMES AND MEASURES A developmental history questionnaire completed by caregivers. RESULTS The average age that caregivers identified developmental concerns was 3.0 years of age but the average age of a receiving a developmental assessment was 6.6 years. Only 46.4% of children received a diagnostic assessment by 5 years of age, even though 88.0% of caregivers were concerned about their child's development by that age. Parental age, relationship status, education level, prior use of support services and being from a culturally and linguistically diverse background contributed to age at identification of concern, age at diagnostic assessment and the likelihood of receiving a diagnostic assessment by 5 years. Electronic data capture had high acceptability, with 88.2% of caregivers reporting a preference for electronic completion of questionnaires. CONCLUSIONS The study shows a substantial delay in diagnostic assessments that leaves most vulnerable children without an assessment by school age and highlights contributors to delays. These delays highlight the complexity of delivering early intervention and support policies that rely on swift and appropriate developmental assessment to vulnerable families.
Collapse
Affiliation(s)
- Kelsie A Boulton
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Antoinette Hodge
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Ailsa Jewell
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Ong
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Natalie Silove
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Chan KKS, Leung DCK, Fung WTW. Longitudinal impact of parents' discrimination experiences on children's internalizing and externalizing symptoms: A 2-year study of families of autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:296-308. [PMID: 35585707 DOI: 10.1177/13623613221093110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Although many parents of autistic children are routinely discriminated against, the potential impact of this discrimination on their parenting processes and child-rearing outcomes has seldom been investigated. The present study addressed this gap in the literature by examining the longitudinal associations of parents' discrimination experiences with children's internalizing and externalizing symptoms among families of autistic children and testing whether these associations would be mediated by parental depression, harsh parenting, and coparenting conflict. On three occasions across 2 years (i.e. T1, T2, and T3), 441 parents of autistic children from Hong Kong, China, provided questionnaire data. Path analyses showed that parents' discrimination experiences at T1 had significant direct effects on parental depression, harsh parenting, and coparenting conflict at T2, which, in turn, had significant direct effects on children's internalizing and externalizing symptoms at T3. Bootstrap analyses further demonstrated that parents' discrimination experiences at T1 had significant indirect effects on children's internalizing and externalizing symptoms at T3 via parental depression, harsh parenting, and coparenting conflict at T2. Our findings have important theoretical contributions and significant practical implications. Theoretically, our findings elucidate how parents' discrimination experiences may longitudinally heighten children's internalizing and externalizing symptoms by adversely affecting parental well-being and parent-child and inter-parental relationships. Practically, our findings highlight the importance of designing and implementing community-based stigma reduction programs and family-based stigma coping interventions to reduce parents' discrimination experiences and associated adverse outcomes on well-being, parenting, marriage, and child development.
Collapse
|
12
|
Son C, Yoo HJ, Kim JH, Oh M. Mood and Emotional Changes After PEERS ® Program in Parents of Young Adults With Autism Spectrum Disorder. Soa Chongsonyon Chongsin Uihak 2023; 34:30-36. [PMID: 36636495 PMCID: PMC9815999 DOI: 10.5765/jkacap.220023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 01/05/2023] Open
Abstract
Objectives This study examined the changes in anxiety and depressive symptoms in the parents of Korean adults with autism spectrum disorder (ASD) after participating in the Korean version of the Program for the Education and Enrichment of Relational Skills for Young Adults (PEERS®-YA-K). Methods Forty-six parents were enrolled (mean age 54.7 years; 22 fathers and 24 mothers), of whom 27 participated in the PEERS®- YA-K as social coaches. Participants completed self-report scales, including the Test of Young Adult Social Skills Knowledge (TYASSK), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Symptom Check-List-90-R (SCL-90-R). The scales were administered three times: before and after the 16-week program and 4 months after the program ended. Differences between participant variables at pretreatment, post-treatment, and follow-up were analyzed using paired-sample t-tests. Results Participants showed a significant improvement in their social skills knowledge (TYASSK) (p<0.01). There was a significant improvement in the BAI and BDI scores of parents with severe depressive and anxiety symptoms at the baseline (p<0.05). Paternal paranoia and maternal hostility results also significantly improved on the SCL-90-R. Conclusion This study suggests that PEERS®-YA-K can reduce parental anxiety and depressive symptoms. To the best of our knowledge, this is the first to compare the degree of depression and anxiety after PEERS®-YA-K in parents of adults with ASD.
Collapse
Affiliation(s)
- Chansoo Son
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea,Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea,Address for correspondence: Miae Oh, Department of Psychiatry, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8551, Fax: +82-2-957-1997, E-mail:
| |
Collapse
|
13
|
Marital Satisfaction and Perceived Family Support in Families of Children with Autistic Spectrum Disorder: Dyadic Analysis. Healthcare (Basel) 2022; 10:healthcare10071227. [PMID: 35885754 PMCID: PMC9322168 DOI: 10.3390/healthcare10071227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Raising children with autism spectrum disorder (ASD) causes tremendous stress for parents that may lead to marital conflict and relationship dissatisfaction. Many factors are associated with parent relationships including severity of autistic behaviors and social support. This study aimed to investigate whether severity of autistic behaviors, perceived family support, and complementarity of interpersonal styles between husbands and wives predicted couple satisfaction among the parents of children with ASD. Method: Seven hundred ninety-seven parent dyads of children aged 7–14 years old with ASD participated in the study. Measurements used included couple satisfaction index, perceived family support using the Multidimensional Scale of Perceived Social Support, inter-personal style using the inventory of interpersonal problems, the ABC autism checklists as well as sociodemographic and related factors. The Actor Partner Interdependence Model estimated by multilevel modeling was used for analysis. Results: Perceived family support was relevant in married couples regarding their marital relationship, but the effects on husbands and wives differed. Husbands’ relationship satisfaction was predicted by how they perceived being supported by family. The severity of autistic behaviors predicted relationship satisfaction but only actor effect. Negative prediction of interpersonal complementarity on couple satisfaction was observed. In addition, time spent on raising children had a negative impact on the quality of the relationship. Partner effect of time spent was observed among women. Conclusion: Dyadic analysis using an actor–partner independence model confirmed perception of family support predicts relationship satisfaction among parents of children with ASD in addition to the severity of autistic behaviors and time spent caring for children. Complementarity of individual interpersonal style had no effect on couple satisfaction. This research suggests implications for interventions regarding building skills that elicit support from family members.
Collapse
|
14
|
Chan KKS, Yip CCH, Leung DCK. Longitudinal impact of self-stigma content and process on parental warmth and hostility among parents of children with autism spectrum disorder. J Autism Dev Disord 2022:10.1007/s10803-022-05529-8. [PMID: 35441921 DOI: 10.1007/s10803-022-05529-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 02/08/2023]
Abstract
This study examined whether self-stigma content and process would prospectively influence parental warmth and hostility through increasing parenting stress among parents of children with autism spectrum disorder (ASD). On three occasions across two years, 441 Hong Kong parents of children with ASD provided questionnaire data. Path analyses showed that self-stigma content and process were associated with greater parenting stress, which was, in turn, associated with reduced parental warmth and increased parental hostility. Our findings reveal the longitudinal influences of self-stigma on parenting practices and demonstrate how these influences can be explained by parenting stress. Our findings also suggest the importance of supporting parents of children with ASD to mitigate self-stigma and associated parenting stress in improving their parenting practices.
Collapse
Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong. .,Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong.
| | | | - Donald Chi Kin Leung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
| |
Collapse
|
15
|
Fallahchai R, Fallahi M. Parental stress and dyadic adjustment among parents of children with ASD: Moderating effects of dyadic coping and perceived social support. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 123:104192. [PMID: 35149330 DOI: 10.1016/j.ridd.2022.104192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Previous studies examining the association between child behavior problems and parental stress have reported mixed results. AIM This study aimed to explore the associations between child behavior problems and parental stress as well as parental stress and dyadic adjustment, and the moderating roles of stress communication, perceived partner supportive dyadic coping, and perceived social support in the relationship between parental stress and dyadic adjustment. METHODS AND PROCEDURES Data were derived from 233 parents with at least one child with ASD from Iran. OUTCOMES AND RESULTS The results demonstrated that child behavior problems were positively associated with parental stress whereas parental stress was negatively associated with dyadic adjustment. Furthermore, stress communication, perceived partner supportive dyadic coping, and perceived social support moderated the relationship between parental stress and dyadic adjustment. CONCLUSIONS The current findings may attract the attention of clinicians and professionals who work with parents of children with ASD on the effect of stress and how to manage stress on these parents' dyadic adjustment.
Collapse
Affiliation(s)
- Reza Fallahchai
- Department of Psychology, University of Hormozgan, P.O. Box 3995, Bandar Abbas, Iran.
| | - Maryam Fallahi
- Department of Psychology, University of Hormozgan, P.O. Box 3995, Bandar Abbas, Iran.
| |
Collapse
|
16
|
Kalb LG, Holingue C, Pfeiffer D, Reetzke R, Dillon E, Azad G, Freedman B, Landa R. Parental relationship status and age at autism spectrum disorder diagnosis of their child. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2189-2198. [PMID: 34010065 PMCID: PMC8446293 DOI: 10.1177/13623613211013683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autism spectrum disorder (ASD) can be diagnosed as early as 18 months of age. However, the average age at diagnosis in the United States is over 2 years later. A lot has been written about the many barriers families face when seeking a diagnosis for their child. One area of research that has received no attention is whether separation between a child's biological parents affects the age at which a child is diagnosed with ASD. This study was conducted among 561 children who were receiving an ASD diagnosis for the first time. On average, these children were 5 years of age. The study took place in an urban, outpatient specialty autism clinic in the United States. Biological parents self-reported their relationship status during the evaluation. This was categorized as either "together" (married or living together but not married) or "not together" (separated, divorced, or never married). At the time of diagnosis, most children's biological parents were together (69%). We found children of parents who were together were diagnosed 1.4 years earlier than those who were not together. These findings have important implications for providing support to families that separate early in a child's life, with the goal of reducing the age at ASD evaluation among single parents and those who have been separated from their child's other biological parent. Providing support to these families is important since earlier age at diagnosis leads to earlier intervention, which can improve long-term outcomes for the child, family, and community as a whole.
Collapse
Affiliation(s)
- Luther G Kalb
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Calliope Holingue
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Danika Pfeiffer
- Kennedy Krieger Institute, USA
- Johns Hopkins University School of Medicine, USA
| | - Rachel Reetzke
- Kennedy Krieger Institute, USA
- Johns Hopkins University School of Medicine, USA
| | | | - Gazi Azad
- New York State Psychiatric Institute, USA
- Columbia University Vagelos College of Physicians and Surgeons, USA
- New York Presbyterian Hospital, USA
| | - Brian Freedman
- University of Delaware Center for Disabilities Studies, USA
| | - Rebecca Landa
- Kennedy Krieger Institute, USA
- Johns Hopkins University School of Medicine, USA
| |
Collapse
|
17
|
Chen SD, Yu Y, Li XK, Chen SQ, Ren J. Parental Self-Efficacy and Behavioral Problems in Children with Autism During COVID-19: A Moderated Mediation Model of Parenting Stress and Perceived Social Support. Psychol Res Behav Manag 2021; 14:1291-1301. [PMID: 34429669 PMCID: PMC8374842 DOI: 10.2147/prbm.s327377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE COVID-19 pandemic has been verified as a public health emergency of international concern. During the special period, the health of vulnerable groups, such as children with autism, should be concerned. Some studies have been carried out to investigate the behavioral problems of children with autism during the COVID-19, but underlying mechanisms behind it is not clear. This study examines the role of parenting stress as a mediator in the relationship between parental self-efficacy and behavioral problems in Chinese children as well as the role of perceived social support as a moderator for this mediation effect. METHODS A total of 439 parents of children with autism (mean age=40.17, SD=5.26) were surveyed and completed five questionnaires (Conners Parent Symptom Questionnaire, Parental Self-Efficacy Questionnaire, Parenting Stress Index-Short Form 15, Perceived Social Support Questionnaire, and Neuroticism Extraversion Openness Five Factor Inventory). The statistical analyses were conducted by SPSS 26.0 and SPSS PROCESS macro. RESULTS Controlling for neuroticism, which is highly associated with psychological changes in parents, the study found that parental self-efficacy was significantly and negatively correlated with behavioral problems in children with autism. In addition, the relationship between parental self-efficacy and behavioral problems was mediated by parenting stress. Furthermore, parenting stress moderated the indirect relationship between parental self-efficacy and behavioral problems via perceived social support. CONCLUSION These results provide direct evidences for the inextricable relationship between family, social factors and behavioral problems of children with autism. It suggest that improving perceived social support to enhance parental self-efficacy is critical to buffering against parenting stress and stabilizing children with autism during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Shu Dan Chen
- School of Education, Guangzhou University, Guangzhou, People’s Republic of China
| | - Yun Yu
- Guangzhou Haizhu Foreign Language School, Guangzhou, People’s Republic of China
| | - Xing Kai Li
- School of Education, Guangzhou University, Guangzhou, People’s Republic of China
| | - Sui Qing Chen
- School of Education, Guangzhou University, Guangzhou, People’s Republic of China
| | - Jie Ren
- School of Education, Guangzhou University, Guangzhou, People’s Republic of China
| |
Collapse
|
18
|
Grebe SC, Mire SS, Kim H, Keller-Margulis MA. Comparing Fathers' and Mothers' Perspectives About Their Child's Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:1841-1854. [PMID: 34027629 DOI: 10.1007/s10803-021-05077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Mothers are often the primary parent participants in autism spectrum disorder (ASD) research. As a result, little is known about fathers' perceptions regarding their children's ASD and whether these perceptions differ from mothers'. Given the limited information available regarding fathers' perceptions about their children's ASD, this study aimed to investigate father variables (stress, coping, support, and perception of disability) and how they compare to mothers'. Participants were 361 biological parents (294 mothers and 67 fathers) of children on the autism spectrum who participated in a larger study. Results revealed significant differences between mothers' and fathers' self-reported stress and coping. Understanding differences between parents' perspectives has both research and clinical implications for working with families raising children on the autism spectrum.
Collapse
Affiliation(s)
- Stacey C Grebe
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA. .,Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Boulevard, Room 491, Houston, TX, USA.
| | - Sarah S Mire
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Hanjoe Kim
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Milena A Keller-Margulis
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| |
Collapse
|
19
|
Linking Child Autism to Parental Depression and Anxiety: The Mediating Roles of Enacted and Felt Stigma. J Autism Dev Disord 2021; 51:527-537. [PMID: 32519191 DOI: 10.1007/s10803-020-04557-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study examined whether child autistic symptoms would heighten parental affective symptoms through evoking enacted stigma from the community (i.e., public and courtesy stigma) and felt stigma within the parents (i.e., vicarious and self-stigma). Cross-sectional questionnaire data were collected from 441 parents of children with autism spectrum disorder. Path analyses showed that social communication and interaction deficits and restricted and repetitive behaviors in child autism were positively associated with public and courtesy stigma. While public stigma was positively associated with parental vicarious stigma, courtesy stigma was positively associated with parental self-stigma. Both vicarious and self-stigma were positively associated with depressive and anxiety symptoms among parents. Findings revealed how child autism could compromise parental well-being through exacerbating the family's stigmatizing experiences.
Collapse
|
20
|
Alshahrani MS, Algashmari H. The moderating effect of financial stress and autism severity on development of depression among parents and caregivers of Autistic children in Taif, Saudi Arabia. J Family Med Prim Care 2021; 10:1227-1233. [PMID: 34041156 PMCID: PMC8140263 DOI: 10.4103/jfmpc.jfmpc_2203_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Autistic spectrum disorder (ASD) is a common problem in the Kingdom of Saudi Arabia. However, little research explored the extent of anxiety and depressive disorders in parents of children with ASD. METHOD Descriptive questionnaire-based cross-sectional survey of a sample of parents of children with ASD who attended Prince Mohammed Bin Salman Autistic Centre, Ministry of defense, Taif city. RESULTS The study included (n = 50) parents. The prevalence of mild depression was 30%, whereas the prevalence of moderately severe depression was 68%. Increased ASD severity level was associated with a significant impact on the PHQ-9 total score (level II was 1.293 times level I to have an increased PHQ-9 score, and level III was 1.530 times level I to have an increased PHQ-9 score). Economic status did not significantly alter depressive symptoms. DISCUSSION AND CONCLUSION ASD diagnosis in Saudi children is associated with high parental depressive prevalence. However, this result could be bidirectional. Stigma, future-related worry, and stress could mediate parental depressive symptoms. Our findings in Saudi parents of children with ASD corroborate the established association between parental depressive symptoms and ASD severity. Our results corroborated previous findings that neither parental gender nor child gender exert any substantial effect on predictability of depressive symptoms among parents of children with ASD. Comprehensive therapeutic packages for children with ASD should include treatment of emotional problems arising out of carer burden among their parents. Screening for parental emotional problems should be routine in autism treatment facilities.
Collapse
Affiliation(s)
| | - Hasaan Algashmari
- Department of Family Medicine, Al-Hada Armed Forces Hospital, Taif City, Saudi Arabia
| |
Collapse
|
21
|
Kütük MÖ, Tufan AE, Kılıçaslan F, Güler G, Çelik F, Altıntaş E, Gökçen C, Karadağ M, Yektaş Ç, Mutluer T, Kandemir H, Büber A, Topal Z, Acikbas U, Giray A, Kütük Ö. High Depression Symptoms and Burnout Levels Among Parents of Children with Autism Spectrum Disorders: A Multi-Center, Cross-Sectional, Case-Control Study. J Autism Dev Disord 2021; 51:4086-4099. [PMID: 33459915 DOI: 10.1007/s10803-021-04874-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
The diagnosis of autism spectrum disorder (ASD) in a child affects family processes, increases parenting stress and marital conflicts, and may lead to parental psychopathology. It may also affect the prognosis for their children. The aim of this study is to determine depression and burnout levels as well as their predictors among parents of children with ASD compared with those of healthy children. We also sought to evaluate rate of complementary and alternative medicine (CAM) interventions among parents and explore the associations of this phenomenon in an exploratory fashion. 145 children with ASD and 127 control children were enrolled along with their mothers and fathers. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate parents' depression symptoms and burnout levels. Symptoms of children with ASDs were evaluated according to the Childhood Autism Rating Scale by the clinicians. Family, child and CAM variables were screened by means of a sociodemographic data form. Descriptive, bivariate and correlation analyses were used in statistical evaluations. Predictors of burnout were evaluated with multiple regression analysis. Burnout and depression levels among parents of children with ASD were significantly elevated compared to controls. Burnout levels of mothers were significantly elevated compared to fathers while depression scores of fathers were significantly elevated compared to mothers. Maternal burnout was significantly predicted by presence of functional speech in child while paternal burnout was significantly predicted by paternal vocation. Maternal depression was associated with paternal depression, lack of speech in child and attendance of child to special education services. Paternal depression was associated with autistic symptom severity and maternal depression. More than half the parents sought CAM interventions. Education level did not affect search for CAM interventions while both maternal and paternal psychopathology and presence of epilepsy among children increased use of CAM methods. Psychological support should be provided to both mothers and fathers of a child receiving a diagnosis of ASD. Addressing parents' burnout and stress levels and facilitating their negotiation of knowledge on etiology and treatments for ASD may be beneficial for the family unit as a whole.
Collapse
Affiliation(s)
- Meryem Özlem Kütük
- Department of Child and Adolescent Psychiatry, Baskent University, Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Bolu Abant İzzet Baysal University Medical Faculty, Bolu, Turkey.
| | - Fethiye Kılıçaslan
- Department of Child and Adolescent Psychiatry, Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, Turkey
| | - Gülen Güler
- Department of Child and Adolescent Psychiatry, Mersin University, Mersin, Turkey
| | - Fatma Çelik
- Department of Child and Adolescent Psychiatry, Malatya State Hospital, Malatya, Turkey
| | - Ebru Altıntaş
- Department of Psychiatry, Başkent University, Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| | - Cem Gökçen
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Karadağ
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Çiğdem Yektaş
- Uskudar University Medical Faculty, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Tuba Mutluer
- Department of Child and Adolescent Psychiatry, Koç University, İstanbul, Turkey
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Celal Bayar University, Manisa, Turkey
| | - Ahmet Büber
- Department of Child and Adolescent Psychiatry, Pamukkale University, Denizli, Turkey
| | - Zehra Topal
- Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - Ufuk Acikbas
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Aslı Giray
- Department of Genetics and Bioengineering, Alaaddin Keykubat University, Antalya, Turkey
| | - Özgür Kütük
- Department of Medical Genetics, Başkent University, Adana Dr. Turgut Noyan Medical and Research Center, Adana, Turkey
| |
Collapse
|