Parenting stress in Chinese mothers of children with autism spectrum disorders

Psychometric properties of the Arabic translation of the Dark Future Scale questionnaire in a non-clinical sample of Arabic-speaking young adults

BACKGROUND

Through the years, studying negative behaviors of the worldwide population seized the spotlight from many researchers who focused on building scales in order the measure the level of worries, fear and even depression of such stressed individuals. By definition, "Future anxiety" (FA) is fueled by negative thoughts leading to intense fear of unknown future events. The Dark Future scale (DFS) measures the level of anxiety experienced towards the future. Our aim was to examine the psychometric properties of a novel Arabic translation of the DFS.

METHODS

A sample of 684 Arabic-speaking young adults (65.6% women) filled the DFS, TEMPS-M (temperaments) and DASS-8 (psychological distress).

RESULTS

Confirmatory factor analyses (CFA) supported a unidimensional model of the DFS score, with all 5 items retained. This scale had good reliability. Moreover, concurrent validity demonstrated significant associations between DFS scores and psychological distress, depressive, cyclothymic, irritable and anxious temperament. Scores achieved scalar invariance across gender, with women having greater exposure to anxiety about the future.

CONCLUSION

Overall, these findings led to the conclusion that the Arabic DFS is a psychometrically valid tool for the assessment of FA. The DFS is a brief, reliable and easy to apply scale that would help researchers in psychology and psychiatry in assessing anxiety about future.

Does culture play a role? A pilot study on Western services for a Chinese-Canadian family with children with Autism spectrum disorder

PURPOSE

Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD.

MATERIALS AND METHODS

This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views.

RESULTS

Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy.

CONCLUSIONS

Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled.

Exploring Collaborative Efforts Toward Promoting Better Eating Habits among Autistic Children in the United Arab Emirates

According to the principle of duty of care, adults in the lives of children with disabilities such as autistic children are expected to promote their development. The Nutbeam's health literacy model was adopted to explore the efforts of special education teachers and parents toward promoting better eating habits among autistic children in the United Arab Emirates (UAE). Twenty-one participants, comprising fifteen special education teachers and six parents with autistic children, were examined in this study. The results indicated that some special education teachers' and parents' limited understanding of unhealthy food might impact the development of autistic children. Furthermore, the findings also highlight the lack of collaboration and communication between teachers regarding the nutrition and healthy living of autistic children. The findings have practical consequences, such as urging UAE health policymakers to provide professional development for special education instructors and parents of autistic children.

Coping resources and stress due to demands in parents to children with autism spectrum disorder

Introduction

Parents to children with autism spectrum disorder (ASD) are exposed to numerous demands in their daily lives and exhibit high levels of stress. The present study aims to find out which coping resources are mediators that help parents cope with these demands and which of those coping resources amplify or reduce stress arising from the demands. Studies often only focus on the connection between coping resources and stress without taking the demands into account at the same time.

Methods

For this reason, a mediation model was set up to answer the research question. Data from a German questionnaire survey with N = 266 parents who have children with ASD (two to 23 years old) were used. Subjectively perceived demands in everyday life (scale "Parental demands in everyday life"), parental stress ("Parental Stress Inventory", based on Abidin's parenting stress model) and the following coping resources were collected: parental self-efficacy beliefs ("Parents' sense of competence questionnaire"), available social support of parents (scale "Availability of social support") and parental coping strategies (German version of the Brief COPE).

Results

An exploratory factor analysis revealed four mediators: dysfunctional coping, functional coping, social support, and self-efficacy. The use of dysfunctional behavior and parental self-efficacy were found to be significant mediators that mediated between daily demands and parental stress. A direct effect of demands on parental stress was also found, implying partial mediation. The two factors of functional coping and support were not found to be significant mediators.

Discussion

Key findings indicate that parental stress resulting from the daily demands of parenting children with ASD can be reduced by high parental self-efficacy and increased by dysfunctional coping. For practice, it can be deduced that dysfunctional coping strategies of parents to children with ASD should be reduced and parental self-efficacy should be strengthened in order to reduce stress which arises from the multiple demands in everyday life.

Demands and stress before and during the COVID-19 pandemic of parents to children with autism spectrum disorder

Introduction

Parents to children with Autism Spectrum Disorder (ASD) face diverse daily demands that can lead to stress. The aim of this study was to examine to which extent stress in parents to children with ASD can be explained by daily demands before and during the COVID-19 pandemic (after lockdowns; first half of 2022), and whether there are differences between the two time periods in this regard.

Methods

Data from parents to children with ASD living in Germany from two independent questionnaire studies (before the pandemic: N = 168, during the pandemic: N = 105) were matched for comparability. Simple and multiple linear regression analyses were used to answer the research question.

Results

Parental stress as well as all demands examined showed higher levels during the COVID-19 pandemic than before. Significant predictors of parental stress before and during the COVID-19 pandemic were (1) the daily demands to deal with the child's problem behavior, (2) the restriction of one's personal way of life, and (3) the challenge to cooperate with the partner. During the COVID-19 pandemic, the child's problem behavior was particularly relevant. It was also found that the demand to deal with stigmatizing reactions did not explain parental stress during the COVID-19 pandemic whereas before the pandemic it had been a significant predictor.

Discussion

Although parental stress and the demands of daily life increased during the pandemic, most of the stress can be explained by the same demands. It is suggested that the increased levels may be due to an increase in the child's ASD symptomatology, which is why it is advisable to install therapeutic and care structures that prepare children with ASD for future crises.

A Moderated Mediation Model of Social Support on the Association between Coping Strategies and Psycho-Emotional Distress of Healthcare Professionals Caring for Children with Autism

Healthcare professionals caring for children with autism spectrum disorder are more likely to be emotionally and psychologically distressed because of the children's challenging behaviors. This study aimed to investigate whether social support mediates the association between coping strategies and perceived emotional and psychological distress among professionals working with children with autism spectrum disorder. Additionally, this study explored the moderating effect of autism severity on this mediation. The study's design is cross-sectional, correlational, and predictive. An online, self-administered questionnaire was used to recruit a convenience sample of 180 healthcare professionals working with children with autism spectrum disorder. The results revealed a significant mediation effect of family social support on the relationship between problem-focused coping and psychological distress for those dealing with moderate or severe autism. Likewise, there was also a significant mediation effect of family social support on the relationship between avoidant coping and psychological distress for those dealing with moderate autism. Familial social support can serve as a protective factor for healthcare professionals caring for children with autism against accumulated psychological distress. The direct effect of avoidant coping strategies on emotional distress changes depending on autism severity. The study's findings are informative to mental health nurses to create more effective coping strategies as problem-solving interventions or develop new coping strategies based on familial social support for those working with children with autism.

How do autistic severity and family functioning influence parental stress in caregivers of children with autism spectrum disorder in China? The important role of parental self-efficacy

Introduction

Parental stress among primary caregivers of children with autism spectrum disorder (ASD) is a significant concern. While previous research indicates that both family and child factors substantially influence parental stress, a few studies have comprehensively examined these factors from family, parent, and child perspectives. Moreover, the psychological mechanisms underlying parental stress remain underexplored.

Method

This study obtained a valid sample of 478 primary caregivers of children diagnosed with ASD in China and employed mediation and moderated mediation analyses to investigate the relationships between family adaptability and cohesion (FAC), ASD severity, parental self-efficacy, and parental stress.

Result

Results revealed that higher FAC was linked to reduced parental stress through increased parental self-efficacy. The indirect effect of parental self-efficacy was more substantial for caregivers of children with severe symptoms than those with mild symptoms.

Discussion

These findings offer insights into how FAC influences parental stress and underscore the importance of parental self-efficacy as a coping resource for mitigating parental stress. This study provides valuable theoretical and practical implications for understanding and addressing parental stress, particularly in families raising children with ASD.

Longitudinal Changes in the Parenting Stress of Mothers of Children with Cerebral Palsy and Their Relationship with Children's Gross Motor Function System Levels

Stress caused by children with disabilities harms the growth and development of children and their families. The present study aimed to investigate whether parenting stress of mothers of children with cerebral palsy changes and the relationship between children's gross motor function level and changes in parenting stress. Data were collected from 162 children with cerebral palsy and their mothers over a 2-year period at three time points. Gross motor function and parenting stress were assessed using the Gross Motor Function Classification System and the Korean version of the Parenting Stress Index-Short Form. Linear latent growth curve models of Wave 2 and Wave 3 variation in parenting stress were constructed. The relationship between Gross Motor Function Classification System level and parenting stress was evaluated via latent growth modeling. The results showed that the linear variation models reflected the time evolution of parenting stress. There were individual differences in parenting stress at the initial level and no individual differences in changes in parenting stress. The relationship between the initial level and the change rate of parenting stress was not significant. Higher initial values of the Gross Motor Function Classification System level were associated with higher initial values of parenting stress, but not related to a change in parenting stress. The results showed that parenting stress of mothers with children with cerebral palsy decreased over time and that Gross Motor Function Classification System level was related to parenting stress level. Based on these findings, directions for further research are put forth.

Stressful experiences and coping strategies of parents of young children with Down syndrome: A qualitative study

BACKGROUND

Previous studies have focused mostly on the negative experiences of parents of children with Down syndrome. We aimed to explore both the stressful experiences and coping strategies of parents from a non-Western country.

METHODS

Twenty-six parents of children aged 8-48 months with Down syndrome were included. Semi-structured interviews were conducted, and the data were analysed using thematic analysis.

RESULTS

The main themes of the stressful experiences were emotional burdens, caregiving burdens, struggle against stigma and discrimination, concerns about the future, challenges related to health, education, and financial issues. Parents used a variety of coping strategies to overcome the challenges by seeking support and help, searching for information, accepting and adapting, and adopting optimistic attitudes.

CONCLUSION

Although being a parent of a child with Down syndrome has many challenges, most parents effectively used coping strategies and adapted their lives to their new parental roles in their child's early years.

Social, Community, and Cultural Factors Associated with Parental Stress in Fathers and Mothers

Parenting stress is a key factor in predicting the quality of parent−child relationships and child development outcomes. Previous research tends to focus on examining individual factors contributing to parental stress, with minimal attention to other important contextual factors that may affect parenting. This study examines the issue from a broader ecological perspective by investigating social, cultural, and community factors associated with parental stress in a community sample of economically active fathers and mothers in Hong Kong. A secondary analysis was conducted using the data from the 2017 Family Survey, a territory-wide household survey conducted in Hong Kong. The data of the current study included a sub-sample of 736 working-class parents (48.4% males and 51.6% females). The mean age of fathers and mothers was 50.99 (SD = 11.2) and 48.68 (SD = 10.34) years, respectively. Mothers reported significantly higher levels of parental stress than fathers, t = −4.241, p < 0.001. Different social, cultural, and community factors were associated with parental stress for fathers and mothers. Strong endorsement of traditional family values (B = −0.23, p = 0.032) and frequent practice of filial piety (B = −0.005, p = 0.019) reduced parental stress in fathers. Additionally, fathers who perceived formal support as effective scored higher levels of parental stress, B = 0.20, p < 0.001. For mothers, informal social support from family members was the only social predictor for reduced parental stress (B = −0.14, p < 0.001) among all the other contextual variables. Community support to reduce parental stress in working parents should address the respective risk factors for fathers and mothers.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale

IMPORTANCE

The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities.

OBJECTIVE

To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction.

DESIGN

Cross-cultural validation.

SETTING

Community.

PARTICIPANTS

Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey.

OUTCOMES AND MEASURES

Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated.

RESULTS

The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74).

CONCLUSIONS AND RELEVANCE

The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

Stress and Anxiety Among Parents of Transition-Aged Children with Autism Spectrum Disorder: a Systematic Review of Interventions and Scales

The period between adolescence to young adulthood can be stressful for parents of transition-aged children (14 to 22 years old) with autism spectrum disorder. A systematic review was undertaken to examine if existing interventions address the unique parental stressors of this phase and if the scales used to measure parental stress and anxiety are suitable for this group. Of the 9813 studies screened, only 13 studies met the inclusion criteria. Findings indicated that interventions focused on mindfulness, social functioning, or multiple components, of which only two addressed the transition period and only three specifically targeted parents of this age group. Moreover, of the six scales which assessed stress or anxiety, none were designed for these parents. Findings highlight the urgent need for more suitable scales and targeted interventions.

How Do Fathers Help? A Moderation Analysis of the Association between Adverse Childhood Experiences and Child Behavioral Health in Fragile Families

Existing research has built concrete links between trauma exposure and lifelong behavioral health outcomes. However, the ways by which father engagement buffers the detrimental effects of trauma on early childhood behavioral health remains unexplored. Using the data of 3001 mothers from the Fragile Families and Child Well-being Study, we conducted a moderation analysis to examine the associations between adverse childhood experiences (ACEs), child behavioral health, father engagement, and maternal education. We found that ACEs at child age three were positively associated with child externalizing and internalizing behaviors at child age five. Father engagement at child age one buffered the harmful effects of ACEs on child externalizing behaviors, but this effect was only significant for children living with mothers with an education level lower than high school. Child psychiatrists should view father engagement as a critical factor in fostering child resilience, particularly for children living in families with limited resources.

The Mediating Effect of Parenting Stress on the Relationship Between Social Support and Quality of Life in Parents of Children With Autistic Spectrum Disorder: A Meta-Analytic Structural Equation Modeling

OBJECTIVE

The aim of the present study is to investigate whether parenting stress mediate the relationship between social support and quality of life in parents of children with Autistic Spectrum Disorder. In addition, we examined what other variables moderate the relationships in this mediation model.

METHODS

Using the two-stage meta-analytic structural equation modeling approach (MASEM), 44 correlation matrices were synthesized from 28 empirical studies (N = 13,270) and fitted to the hypothesized mediation model.

RESULTS

There is a significant partial mediation effect of parenting stress on the relationship between social support and quality of life. Subgroup analysis through the first stage analysis suggested that social support measurements, parental role, and child's age moderated the relationship between social support and parenting stress, and that the focus of quality of life moderated the relationship between social support and quality of life. Subgroup analysis through the second stage analysis indicated that parenting stress had a significantly stronger predictive effect on quality of life in Western culture, while the predictive effect of social support on quality of life was significantly stronger in Eastern culture.

CONCLUSION

Having more social support can reduce parents' stress and then improving their quality of life, which can help them cope more positively and effectively with their autistic children.

Stress, anxiety and depression in parents of children with autism spectrum disorders in Kazakhstan: prevalence and associated factors

INTRODUCTION

Studies worldwide reported increased levels of stress among parents of children with autism due to the unique caregiving challenges. While research has shown that parents' and autistic child's demographics and behavioral characteristics are associated with psychological distress among caregivers of children with autism, very few studies have investigated the impact of the caregiver's unmet needs on various aspects of the perceived family burden.

METHODS

This cross-sectional study examined the prevalence of stress, anxiety and depressive symptoms among a wide range of 146 parents with different sociodemographic characteristics, social support and unmet needs who care for children with autism spectrum disorder. These parents were recruited from autism non-governmental organizations and the National Children's Rehabilitation Center in Astana, Kazakhstan, a post-Soviet country in Central Asia. Multiple linear regression analyses were utilized to examine the relationship of parental psychological distress variables with social support, unmet needs and parental and child sociodemographic characteristics.

RESULTS

Significantly higher levels of stress and depression were reported among parents who perceived their needs as being unmet or extremely unmet as addressed by societal acceptance as compared to parents who reported adequate levels of needs met by social acceptance. Employed parents and parents with a higher level of perceived friends' support had less symptoms of stress, anxiety, and depression.

CONCLUSIONS

Increasing public awareness about autism and providing early detection and interventions for distressed caregivers of children with autism may be helpful in improving healthy functioning of parents and the entire family.

Are parental depressive symptoms related to the sleep quality and physical activity of their children with developmental disabilities?

BACKGROUND

Parenting young children with developmental disabilities presents unique opportunities and challenges. Parents can experience meaningful priority shifts in and appreciation for their lives, but they can also be at greater risk for diminished emotional health. Physiological child factors warrant further investigation as correlates for parent risk of or protection from depression.

AIM

This study examined the relations between parental depressive symptoms and the (1) sleep quality and (2) physical activity in their children with developmental disabilities adjusting for parent- and child-level factors.

METHODS AND PROCEDURES

Children and parents were recruited for participation in this study from a university-based neurodevelopmental clinic. Parents completed questionnaires about themselves including measures of depressive symptoms and about their children including measures of sleep quality and physical activity. Researchers administered developmental measures to the children and physicians completed children's diagnostic evaluations. Participants were 147 children (32 ± 4 months old) mostly with autism spectrum disorder (ASD) and their parents (mostly mothers). Factors associated with parent-reported depressive symptoms were analyzed with a generalized linear model.

OUTCOMES AND RESULTS

An R²_deviance value of 43 % confirmed that there was a substantial, moderate-to-large sized, improvement in the proportion of variance explained by the final model when compared with a null, or intercept-only, model. Depressive symptoms were approximately two times higher for parents of children with above average sleep disturbances and one and half times higher for parents whose children engaged in above average physical activity.

CONCLUSION AND IMPLICATIONS

Our study demonstrates the importance of considering children's sleep and physical activity in supporting children's developmental disabilities because they may offer pathways to enhanced family resilience and well-being.

Effect of Time Interval From Diagnosis to Treatment on Economic Burden in Families of Children With Autism Spectrum Disorder

The study aimed to investigate the economic costs in families of children with autism spectrum disorder (ASD) and explored how the time interval from diagnosis to treatment time interval from the date children first diagnosed with ASD to the date of first speech/behavior treatment influenced the economic costs. It was a cross-sectional study that recruited families with autistic children in Changsha, Hunan Province of China during March to November 2018. A self-designed questionnaire was applied to collect ASD-related economic costs in the two vital periods including the 12-month period after diagnosis and the most recent 12 months during the course of ASD. In total, 136 families with autistic children completed the interview. The results showed that 46.3% of children started intervention within 1 month. The median of total economic costs of these families in the 12-month period after diagnosis and the most recent 12 months was 26,502.26 RMB and 29,411.91 RMB, respectively. Compared with the time interval shorter than 1 month, time interval over 6 months was significantly associated with high direct economic costs (β SD = 0.308, 95% CI = 0.177, 1.254), inpatient/outpatient and drugs costs (β SD = 0.276, 95% CI = 0.104, 1.181), direct non-medical costs (β SD = 0.287, 95% CI = 0.140, 1.206), and total economic burden (β SD = 0.311, 95% CI = 0.186, 1.262); besides, time interval between 4 and 6 months was significantly related to large indirect costs (β SD = 0.230, 95% CI = 0.098, 1.363) in the 12-month period after diagnosis. Similarly, time interval between 1 and 3 months was significantly associated with high direct non-medical costs (β SD = 0.198, 95% CI = 0.004, 1.013) in the 12-month period after diagnosis. However, time interval from diagnosis to treatment was not correlated to economic costs in the recent 12 months. In the long term, shortening the time interval from diagnosis to treatment would reduce the economic burden on families, especially in the 12-month period after diagnosis.

An examination of parents' perceptions of developmental disability, social support, and health outcomes among Chinese American parents of children with developmental disabilities

Asian immigrant parents raising children with developmental disabilities experience frustration, stress, social isolation, and poor health outcomes. Based on data collected from 55 Chinese American parents of children with developmental disabilities, this study examined the relationships between individual characteristics, parents' perceptions of developmental disability, social support, severity of disability, and parents' self-reported physical health and depressive symptoms. The findings showed that Chinese American parents exhibited different pathways for better health outcomes. Overall social support, specific support from family and friends/co-workers, and community involvement were significant correlates of maternal self-reported physical health and depressive symptoms. Fear of stigmatization was significantly and positively associated with maternal depressive symptoms. Similarly, education and employment status correlated with paternal self-reported physical health and depressive symptoms. The ages of parents and their children were found to be negatively correlated with paternal depressive symptoms. The child's disability severity level was not associated with parents' self-reported physical health and depressive symptoms. The findings also confirmed that parents' self-reported physical health status was significantly and negatively associated with their own depressive symptoms. Chinese American mothers experienced poor physical health and greater depressive symptoms compared to Chinese American fathers. The study's clinical implications and limitations are discussed.

Autism severity aggregates with family psychiatric history in a community-based autism sample

The purpose of this study was to examine family psychiatric history in individuals with autism spectrum disorder (ASD) and its association with clinical presentation. Participants were 798 individuals with a clinical diagnosis of ASD, confirmed by the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), enrolled in Rhode Island Consortium for Autism Research and Treatment, a statewide research registry. Prior research suggests a specific behavioral phenotype in individuals with ASD who have family members with psychiatric diagnoses, including higher IQ and less severe language impairment. However, studies have not specifically investigated autism severity. We hypothesized that increased psychiatric family history would be associated with increased autism severity symptoms. Results show a strong association of increased burden of first-degree family psychiatric history with higher autism symptom severity as measured by Social Responsiveness Scale, Second Edition (SRS-2), but not with ADOS-2 severity scores, IQ, or adaptive functioning. These findings support the importance of investigating the contribution of psychiatric family history toward clinical ASD presentation. LAY SUMMARY: This study explored how family psychiatric history is related to clinical presentation of Autism Spectrum Disorder (ASD). Higher amounts of first-degree family psychiatric history was associated with higher autism symptom severity as measured by the Social Responsiveness Scale, Second Edition (SRS-2). The contribution of psychiatric family history requires ongoing investigation.

Being more than a mother: A qualitative study of Asian immigrant mothers in Australia who have children with disabilities

INTRODUCTION

Studies on mothers of children with disabilities commonly report on their poor quality of life, high stress and mental health symptoms. However, the impact of caring for a child with disability on mother's everyday activities is less understood. The aim of this study is to explore the everyday activities of north-east and south-east Asian (NESEA) migrant mothers of children with disabilities, living in Australia.

METHODS

Informed by a grounded theory approach, this qualitative study used purposive snow-ball sampling to recruit NESEA mothers who had immigrated to Australia for at least two years and had at least one child with disabilities. Eleven mothers were interviewed. Grounded theory analysis was used to derive themes.

RESULTS

The overarching theme is 'Transforming'. Five subthemes emerged: 1) Journeying into the unknown; 2) Being the carer; 3) Being an immigrant; 4) Pillars of support; and 5) Empowered for everyday activities.

CONCLUSION

This study revealed the everyday activities and roles of NESEA immigrant mothers who have children with disabilities, their enablers and barriers in engaging in their valued activities and their positive transformation. Findings underpin the importance of facilitating mothers' participation in activities and roles that promote their well-being. Service providers and policy makers can create opportunities for immigrant mothers to participate in health promoting activities.

Burden, impact, and needs of caregivers of children living with mental health or neurodevelopmental conditions in low-income and middle-income countries: a scoping review

This scoping review synthesises previous research on caregivers' experiences and perspectives of caring for a child with a mental health or neurodevelopmental condition while living in low-income and middle-income countries (LMICs). 35 studies done across 15 LMICs were included in this Series paper. Most studies were done in the Africa region. Child and adolescent mental health and neurodevelopmental conditions were perceived by caregivers to have both biomedical and traditional or spiritual causes and help-seeking was aligned to these explanatory beliefs. Caregivers commonly described reduced quality of life, which they attributed to their children's mental or neurodevelopmental condition, and additional reports of family disruption, caregiver psychological distress, and financial hardship. To strengthen mental health outcomes of young people, better mental health promotion information for caregivers is required along with improved engagement with communities and increased sensitivity to caregiver wellbeing and needs when developing interventions for children and adolescents.

Predictors of parenting stress in parents of children diagnosed with autism spectrum disorder: a scoping review

Introduction

Identifying the predictors of parenting stress in parents of children with autism spectrum disorder is crucial to provide the best health-care services.

Main text

The scoping review was conducted. Search engines (EBSCO, Springer, PubMed, Ovid, Google Scholar, and Science Direct) were used to collate published studies between the years 2009 and 2020. Keywords used were parenting stress, parental stress, predictors of parenting stress, Autism disorder, Autism, and scoping review. Primary screening of the titles and abstracts of 1039 articles was conducted. The secondary screening of 348 articles resulted in 27 articles included in this review. The reviewed articles revealed core symptoms of the disorder, namely, behavior problems, and socio-communication impairments strongly linked with the high level of parenting stress.

Conclusion

This scoping review is the initial step toward encouraging future efforts to provide supportive interventions for parents of children with autism spectrum disorder.

Interventions to Improve Outcomes for Parents of Children with Autism Spectrum Disorder: A Meta-Analysis

This meta-analysis examines the impact of parent interventions on outcomes for parents of children with ASD. A systematic review of the literature produced 37 studies that met inclusion criteria. Random-effects models revealed small but significant impacts of intervention on parental outcomes, primarily in parenting confidence and mental health. No improvements were observed in caregiving burden, family adjustment, physical health, or stress. Significant heterogeneity was observed; however, no moderation effects were detected for intervention or sample characteristics. These findings suggest parent interventions improve parenting confidence and, to a lesser degree, mental health. More work is needed to develop interventions that address a wider range of outcomes for parents of children with ASD. Limitations and implications for future research are discussed.

Direct, Indirect, and Buffering Effect of Social Support on Parental Involvement Among Chinese Parents of Children with Autism Spectrum Disorders

Parental involvement plays a pivotal role in promoting developmental and educational outcomes for children with autism spectrum disorder (ASD). This study aimed to examine the relationships between social support, parenting stress, and parental involvement by investigating a sample of 245 Chinese parents of children with ASD. Mediation analyses indicated that the relationships between support from family and friends and parental involvement were partially mediated by parenting stress, and support from significant others was directly, positively related to parental involvement. Additionally, support from family and friends moderated the influence of parenting stress on parental involvement in their children's education. The direct, indirect, and buffering effects of social support on parental involvement were discussed finally.

Savouring as an Intervention to Decrease Negative Affect in Anxious Mothers of Children with Autism and Neurotypical Children

Savouring is an emotion regulation strategy and intervention that focuses on the process of attending, intensifying and prolonging positive experiences and positive affect associated with these memories. Personal savouring involves a reflection on positive memories that are specific to the individual and do not involve others. In contrast, relational savouring entails reflecting on instances when people were responsive to the needs of their significant others. Such interventions hold potential benefits in enhancing positive affect (PA) and reducing negative affect (NA) for both parents of children with autism spectrum disorder (ASD) and parents of neurotypical children. Adults with greater symptoms of generalised anxiety have been found to have less PA and more NA. However, no study has investigated the effects of a mother’s anxiety symptoms on the efficacy of savouring in enhancing PA and reducing NA. Thus, this paper combined personal and relational savouring to investigate whether savouring may enhance PA and reduce NA of a pooled sample of mothers of neurotypical children and mothers of children with ASD. 52 mothers of neurotypical children and 26 mothers of children with ASD aged 3–7 years old were given a series of questionnaires and randomly assigned to either relational savouring or personal savouring conditions. In relational savouring, mothers were asked to reflect upon a shared positive experience with their child while in the personal savouring condition, a personal positive experience was recalled. Across mothers of children with ASD and neurotypical children, findings suggest that savouring leads to a decrease in NA (p < 0.01) but not increases in PA. Similarly, mothers with higher levels of anxiety experience a greater decrease in NA (p < 0.001) compared to mothers with lower levels of anxiety post-savouring. This study proposes that a brief savouring intervention may be effective among mothers of preschoolers. As lower levels of negative affect is linked to healthier psychological well-being, mothers might be able to engage in more effective and warm parenting after savouring exercises, which would cultivate positive mother-child relationships that benefit their children in the long-term.

Posttraumatic Growth Among Parents of Children with Autism Spectrum Disorder in China and Its Relationship to Family Function and Mental Resilience: A Cross-Sectional Study

OBJECTIVE

This study was conducted to examine the posttraumatic growth (PTG) of parents of children with autism spectrum disorder (ASD) and the association among family function, mental resilience and PTG.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted with 205 parents of children with ASD in the clinical department of a university-affiliated hospital in Guangzhou from January to October 2019. The Posttraumatic Growth Inventory, Family Assessment Device, and Connor-Davidson Resilience Scale were employed for data collection.

RESULTS

The mean PTG score of parents was 59.56±18.46; and 24.63%, 43.84%, and 32.51% of parents exhibited a high level, moderate level and low level, respectively, of PTG. The problem-solving dimension of family function (p = 0.005) and the strength dimension of mental resilience (p ≤0.001) were positively related to PTG.

CONCLUSIONS

Parents of children with ASD experienced moderate PTG overall. The problem-solving dimension of family function and the strength dimension of mental resilience were significant predictors of PTG.

PRACTICAL IMPLICATIONS

Interventions to improve family function and the mental resilience of parents with ASD children could contribute to improving the PTG of parents.

The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study

BACKGROUND

During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated.

OBJECTIVE

The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic.

METHODS

This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2).

RESULTS

In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks.

CONCLUSIONS

The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165.

Brief Report: Mindfulness Training for Chinese Adolescents with Autism Spectrum Disorder and Their Parents in Hong Kong

This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness program (MYmind) on Chinese adolescents with autism spectrum disorder and their parents in Hong Kong, China using a randomized controlled trial with a waitlist control group. Results showed the study had 80% compliance rate, 0% dropout rate, and 89% response rate. Between-group comparisons showed mindfulness had trend effects on parent’s rumination (g = 1.16), mindful parenting (d = 0.6), parenting style (d = 0.59), and parenting stress (d = 0.5). The study demonstrated the feasibility of the MYmind program in the Chinese context. A larger trial with longer follow-up period is suggested to better examine the effect of mindfulness on adolescents with ASD and their parents.

Urine Nitric Oxide Is Lower in Parents of Autistic Children

Parents raising children with autism spectrum disorder (ASD) usually carry on their daily life under tremendous stress, but limited empirical research has been devoted to this population. It is known that parents' health status directly impacts therapeutic outcome of ASD children. As an important regulator in cardiovascular, nervous and immune systems, nitric oxide (NO) levels haven't been reported in parents of ASD children yet. In this study, we measured urine nitrite and nitrate from 43 ASD parents (ASD-P), and 43 healthy adults in the same range of age (Control) who didn't have any ASD descendants. Comparison between the ASD-P and Control groups showed that NO 2 - , NO 3 - , and NO 2 - / NO 3 - were all significantly lower in the ASD-P group. Analysis on the interaction effect of sex and group indicated that urine NO 3 - of mothers in ASD-P was lower than that in females of the Control group, but no significant difference was observed between males in both groups. It is for the first time that urine nitric oxide metabolites (nitrite, nitrate) levels were precisely reported to differentiate parents of autistic children from other adults without ASD descendants. This phenomenon suggests that parents (especially mothers) of autistic children might have experienced more mental and physical stressors, which led to decreased NO levels during metabolism. Further investigations are necessary to uncover the etiology of low urine NO among parents of autistic children.

Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China

Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China.A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model.About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression.Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.

Cohort protocol: Guangzhou High-Risk Infant Cohort study

INTRODUCTION

Despite the increase in the survival rate of high-risk infants (HRIs) worldwide, the prevalence of motor and neurodevelopmental sequelae in such newborns has not shown concomitant improvement. Meanwhile, there are few cohorts that explore factors related to the development of HRIs in China. Therefore, the Guangzhou High-Risk Infant Cohort (GHRIC) has been designed to examine the complex relationships among a myriad of factors influencing growth and development in such children.

METHODS AND ANALYSIS

The GHRIC study is a prospective cohort study that by the year 2023 will enrol an estimated total of 3000 HRIs from Guangzhou Women and Children's Medical Center (GWCMC) in Guangzhou, China. This study is designed to assess the growth and cognitive characteristics of HRIs and the risk factors affecting their development and prognoses. Data on risk factors, neurodevelopmental and cognitive-function evaluations, laboratory results, and specimens will be collected and analysed. Information on perinatal and clinical interventions for these infants will also be recorded during regular follow-up visits until age 6.

ETHICS AND DISSEMINATION

The protocol for this study has been approved by the Research Ethics Committee of GWCMC, which accepted responsibility for supervising all of the aspects of the study (No. 2017102712). Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the Internet and social media.

TRIAL REGISTRATION NUMBER

ChiCTR-EOC-17013236.

Predicting Mental Health and Psychological Wellbeing in Mothers of Children with Autism Spectrum Disorder: Roles of Intolerance of Uncertainty and Coping

Research has consistently shown that parents of children with autism spectrum disorder (ASD) are more likely to report chronic stress and symptoms of psychopathology when compared to parents of typically developing children and children with other psychological or physical conditions. Certain individual characteristics might either put parents at risk or allow them to cope more effectively under the strenuous conditions of raising children with neurodevelopmental conditions. Previous research has suggested that higher levels of intolerance of uncertainty and certain coping styles are associated with higher parental levels of anxiety and depression. The aim of this study is to characterize the way in which intolerance of uncertainty and coping (avoidant and problem-focused coping) predict mental health and psychological wellbeing in parents of children with ASD. Only mothers participated in this study. Fifty mothers (M_age = 44.28 years, SD_age = 6.58) of children with ASD completed questionnaires assessing anxiety and depression, psychological wellbeing, intolerance of uncertainty, and avoidant and problem-focused coping. The results from this study provide preliminary evidence that higher use of problem-focused coping but not avoidant coping and intolerance of uncertainty predicts psychological wellbeing. Furthermore, our observation of greater intolerance of uncertainty and higher use of avoidant coping predicting anxiety and depression supports previous research. The findings from this study have implications for the development of intervention programs to help improve the mental health and psychological wellbeing of parents. LAY SUMMARY: This research studied the factors that impact the mental health of parents of children on the autism spectrum. We found that mothers, who are not comfortable with uncertainty, use more avoidant coping, and less problem-focused coping have poorer mental health. Identifying these factors is a crucial first step in developing intervention programs to help improve the mental health of parents. Autism Res 2020, 13: 1797-1801. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

The Impact of Child Autistic Symptoms on Parental Marital Relationship: Parenting and Coparenting Processes as Mediating Mechanisms

Research shows that parenting a child with autism spectrum disorder (ASD) is associated with increased marital conflicts and reduced marital love. Less is known, however, about the potential mechanism underlying these associations. The present study tested a family process model linking child autism to parental marriage. We hypothesized that child autistic symptoms would be associated with increased marital conflicts and reduced marital love among parents of children with ASD, and that these associations would be mediated by parenting stress and coparenting conflicts. A total of 382 parents of children with ASD from Hong Kong, China completed questionnaire measures of child autistic symptoms, parenting stress, coparenting conflicts, marital conflicts, and marital love. Structural equation modeling (SEM) and Bootstrap analyses were conducted to analyze the relations among the variables. SEM showed that child autistic symptoms were related to higher levels of parenting stress and coparenting conflicts, which were, in turn, related to increased marital conflicts and reduced marital love among parents of children with ASD. Bootstrap analyses further demonstrated that child autistic symptoms had significant indirect effects on marital conflicts and marital love via parenting stress and coparenting conflicts. Theoretically, this study revealed the potential pathways through which child autism symptomatology may adversely impact the family processes and compromise the marital relationships of parents of children with ASD. Practically, this study pointed to the utility of helping parents of children with ASD to manage child autistic symptoms, alleviate parenting stress, and reduce coparenting conflicts in improving their marital qualities. LAY SUMMARY: This study showed that child autistic symptoms were related to higher levels of parenting stress and coparenting conflicts, which were, in turn, related to increased marital conflicts and reduced marital love among parents of children with autism spectrum disorder (ASD). These findings pointed to the importance of helping parents of children with ASD to manage child autistic symptoms, alleviate parenting stress, and reduce coparenting conflicts in improving their marital qualities. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2020, 13: 1516-1526. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

A systematic review of screening tools for the detection of autism spectrum disorder in mainland China and surrounding regions

Screening for autism spectrum disorder is the first step toward early detection and diagnosis, thereby impacting the likelihood of children accessing early intervention and, importantly, improving long-term outcomes. This systematic review aimed to (a) establish a clear baseline of autism spectrum disorder screening tools currently used throughout mainland China and surrounding regions, (b) identify the strengths and limitations of these instruments, and (c) develop specific recommendations regarding screening for autism spectrum disorder throughout Chinese-speaking countries. Databases were searched for recent (2015-2018) articles published in Chinese or English languages. Twenty-two studies (13 Chinese, 9 English) met inclusion criteria; two from Taiwan and the remainder from mainland China. Studies varied greatly in the extent of psychometric analyses and reported autism spectrum disorder prevalence. The majority of diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. (DSM-IV) or 5th ed. (DSM-5)) criteria, although a small number of studies utilized gold-standard diagnostic assessment instruments. It is recommended that a systematic, multi-tiered, screening network be established to improve the identification of autism spectrum disorder in China and surrounding regions. Assessment and diagnosis need to be culturally appropriate, and amenable to low-resource settings. In addition, increased public awareness programs to reduce stigma will be important in improving outcomes for children with autism spectrum disorder.

Coping strategies of parents of children with autism spectrum disorder: a systematic review

To deal with stress, parents of children with ASD use coping strategies that help to tackle the challenging situations of raising their child. This systematic review examines parental coping strategy's questionnaires, factors which influence these coping strategies, interactions between these strategies and perceived stress and their impact on parental quality of life. According to PRISMA guidelines, an electronic search was conducted on Medline, PsycInfo and Eric: 156 articles were identified and 11 studies were selected. Many types of self-reported questionnaires were used to assess parental coping strategies. Studies highlighted that parents of a child with ASD used more avoidance strategies and less social support-seeking strategies than those of typical children. Furthermore, problem-focused coping protects parental stress and quality of life, that on the contrary, emotion-focused coping is a risk factor for alteration. Our systematic review illustrates the need to adapt psychoeducational interventions for parents of children with ASD.

Refining the Parenting Stress Index-Short Form (PSI-SF) in Chinese Parents

The Parenting Stress Index-Short Form (PSI-SF) is a popular brief assessment of parenting stress. However, its latent structure and psychometric properties have not been extensively addressed, in particular in non-Western cultures. The present study is the first to examine the factor structure and psychometric properties of the PSI-SF in parents from Mainland China (683 mother-father dyads; mean age of mothers = 37.10 years, SD = 3.68; mean age of fathers = 39.81 years, SD = 4.13). Initial analyses revealed that previously proposed factor structure of the PSI-SF did not fit the data well. Exploratory and confirmatory factor analyses were then conducted to develop a psychometrically sound and efficient abbreviated version of the PSI-SF. In this new version of 15 items (PSI-SF-15), there are three factors (i.e., parental distress, parent-child dysfunctional interaction, and difficult child). This abbreviated scale showed strict measurement invariance across sex of parent and satisfactory internal consistency. The convergent validity of the PSI-SF-15 were supported by its expected relations with the original PSF-SF measures, the multitrait-multimethod procedure, and its expected relations with scores on parenting behavior, parental depressiveness, and children's conduct problems. In conclusion, these results suggest that the PSI-SF-15 is a valid measure of parenting stress in Chinese parents, and that it holds promise as an informative and reliable alternative to the original PSI-SF when administration time is limited.

Neuropsychiatric Symptoms, Parenting Stress and Social Support in Chinese Mothers of Children with Autism Spectrum Disorder

Although little is known about the current situation regarding autism spectrum disorder (ASD) in mainland China, psychiatric disorders are common among Chinese mothers of preschool children with ASD. Previous studies showed ASD child's behavioral symptoms, maternal anxiety, and maternal depressive symptoms were associated with overall parenting stress in northern China. In the present study, we retrospectively analyzed medical records at the hospital related to neuropsychiatric symptoms, parenting stress and social support in mothers of children with ASD from southern China. A total of 80 mothers of children with ASD were screened. Among them, 34 mothers were in low-functioning ASD group (L-ASD group) and 46 mothers were in high-functioning ASD group (H-ASD group). Identification of the ASD cases was confirmed with a Revised Autism Diagnostic Inventory. Neuropsychiatric symptoms, parenting stress and social support were measured by neuropsychiatric inventory (NPI), parenting stress index short form (PSI-SF), and multi-dimensional scale of perceived social support (MSPSS). Total mean score of the NPI in the L-ASD group was significantly higher than that in the H-ASD group (P<0.01). The subscale scores of NPI, including depression, anxiety, apathy, irritability, agitation, night time behavior disturbances and change in appetite were significantly higher in the L-ASD group than those in the H-ASD group (P<0.01 or P<0.05). Meanwhile, the total PSI-SF scores and the scores of parental distress (PD), parental-child dysfunctional interaction (PCDI) and difficult child (DC) in the L-ASD group were significantly higher than those in the H-ASD group (P<0.01 or P<0.05). The total score of MSPSS was also higher in the L-ASD group than in the H-ASD group (P<0.01). This study goes further to show the neuropsychiatric symptoms and parenting stress are significantly higher in mothers of children with ASD, and more social supports are needed for mothers of children with ASD from southern China, especially for mothers of children with low-functioning ASD.

Effect of parenting stress in Korean mothers of children with disabilities on life satisfaction: Moderating effect of intrinsic religious orientation

BACKGROUND

With growing interest in parenting stress among mothers of children with disabilities, the current study examined the multidimensional aspects of parenting stress and their impact on life satisfaction among Korean mothers of children with disabilities. Based on the suggestions of prior findings concerning the potential role of intrapersonal resources on moderating parenting stress, the study focused on intrinsic religious orientation as one of the intrapersonal resources.

METHOD

Participants completed measures of three types of parenting stress (parental distress, parent-child dysfunctional interaction and difficult child), life satisfaction and religious orientation.

RESULTS

Two subscales of parenting stress (i.e., parental distress and difficult child) had negative associations with life satisfaction. Intrinsic religious orientation weakened the relationship between parental distress and life satisfaction, especially among individuals who held moderate and high levels of intrinsic religious orientation.

CONCLUSION

These findings indicate the existence of differential associations between parenting stress type and life satisfaction in Korean mothers of children with disabilities. The current findings also identified the interrelationships between the religious resources and maternal parenting stress of children with disabilities. Intrapersonal religious resources have the potential to counterbalance the negative impact of maternal distress.

Social impairment of children with autism spectrum disorder affects parental quality of life in different ways

This study evaluated the life quality of Chinese parents of preschool children with autism spectrum disorder (ASD) and their association with child social impairment and childcare burden. The participants included 406 families of children with ASD and 513 families with typically developing (TD) children. The findings indicated that parents in the ASD group had a lower quality of life than parents in the TD group, whereas only mother of children with ASD experienced a greater childcare burden than mother with TD children. Lower parental quality of life were associated with higher social impairment of children. To further clarify the correlativity of child social impairment, parental quality of life and childcare burden, the mediation analyses were conducted. The results showed that childcare burden mediated the influence of child social impairment on maternal quality of life, while it has no mediating effect on fathers. It implies that social impairment of children affects parental quality of life in different ways.

From child autistic symptoms to parental affective symptoms: A family process model

BACKGROUND

Depression and anxiety are prevalent among parents of children with autism spectrum disorder (ASD), but limited research has investigated why parenting a child with ASD is associated with elevated distress and increased risks of mental health problems. We responded to this gap in the literature by examining the associations between child autistic symptoms and parental affective symptoms, as well as the potential underlying mechanisms. Guided by a family process theory, we hypothesized that child autistic symptoms would be positively associated with parental depressive and anxiety symptoms, and that these associations would be mediated by parents' concerns about their children's characteristics (future-related worry), parental roles (parenting stress), marital relationships (marital conflicts), and family conditions (family economic pressure).

METHODS

Cross-sectional questionnaire data were collected from 375 parents of children with ASD residing in Hong Kong, China. The hypotheses were tested using structural equation modeling.

RESULTS

Child autistic symptoms were positively associated with parental depressive and anxiety symptoms. These associations were mediated by future-related worry, parenting stress, marital conflicts, and family economic pressure.

CONCLUSIONS

Our findings revealed the potential pathways through which child autism symptomatology may adversely affect parental mental health. Our findings also highlighted the importance of designing multipronged intervention programs for families raising children with ASD in order to improve relevant family processes and reduce parental affective symptoms.

Coping strategies of Taiwanese children with autism spectrum disorders

AIMS AND OBJECTIVES

To explore and describe the coping experiences of children with autism spectrum disorders in Taiwan.

BACKGROUND

Children with autism spectrum disorders are faced with daily social and living challenges, which can cause stress. Chinese culture emphasises discipline and obedience, which may influence coping strategies of children with autism spectrum disorders in Taiwan.

DESIGN

This qualitative study employed an exploratory descriptive design.

METHOD

Data were collected from in-depth, face-to-face structured interviews. Interviews explored coping strategies of Taiwanese school-aged children (aged 6-19) with autism spectrum disorders. Children (N = 17) and their caregivers were recruited by purposive sampling. Transcribed interview data were thematically analysed using the procedure of Miles and Huberman.

RESULT

Five themes emerged from the analysis of the data, which described the coping strategies of the children: (1) problem-solving, (2) acting-out, (3) avoidance, (4) seeking help and (5) self-regulation. These themes included multiple coping strategies, which employed the concepts of engagement and disengagement.

CONCLUSIONS

The children with autism spectrum disorder used many strategies to cope with the stresses resulting from behaviours and symptoms associated with the disorder. Most of the Taiwanese children use both problem-solving and emotional-focused coping strategies.

RELEVANCE TO CLINICAL PRACTICE

Understanding coping strategies of children with autism spectrum disorder could help caregivers (parents, teachers) and medical professionals develop interventions to reduce these challenges, which could alleviate stress and improve social functioning for these children.

Parenting stress in South Korean mothers of adolescent children with autism spectrum disorder

Objectives: This study investigated parenting stress in South Korean mothers of adolescent children with autism spectrum disorder (ASD) and the variables associated with their parenting stress. Methods: A total of 138 South Korean mothers participated in this study. Descriptive statistics, independent sample t-tests, ANOVA tests, and a stepwise multiple regression analysis were used in this study. Results: The majority of South Korean mothers of adolescent children with ASD in this study showed higher than normal parenting stress. Child's maladaptive behavior, receipt of early childhood special education, age, and autism severity as well as mother's receipt of services from mental health professionals were the factors significantly associated with parenting stress. Conclusion: Considering the factors significantly associated with mother's stress level, interventions focusing on child's maladaptive behavior and mother's mental health are important. The interventions aiming to address parenting stress in mothers of adolescent children with ASD may find the findings of this study useful.

Parenting children with intellectual disabilities in Malawi: the impact that reaches beyond coping?

BACKGROUND

Rates of disability are high in resource poor settings with 85% of children with disabilities living in these settings. Long-term caregiving for disabled children is associated with fatigue, financial difficulties, parenting distress and other psychological issues. While such parents of children have repeatedly highlighted their feelings of discrimination, stigma and exclusion, leading to mental health issues, there is little research from the developing world addressing these issues.

RESEARCH OBJECTIVES

This study aims to explore psychological experiences of parents caring for children with intellectual disabilities; understand their mechanisms of coping and their psychosocial needs in Malawi.

METHODOLOGY

This study used a qualitative phenomenological design. We purposively sampled parents who had children diagnosed with intellectual disability from two clinics in two cities in Malawi. Between January 2015 and March 2015, we conducted 10 focus group discussions and four in-depth interviews. All ethical study procedures were carefully followed. All interviews were tape-recorded, transcribed and translated from vernacular to English. Thematic approach of data analysis was adopted to understand the data.

FINDINGS

Caring for intellectually disabled children comes with a number of challenges. Parents have limited access to services for their children let alone for their own psychological issues; they experience stigma and discrimination, have mental health issues resulting from the caring role, have suicidal ideas and in some cases have even been coerced by neighbours to kill their disabled child. To manage these issues, most parents cope through their spirituality.

DISCUSSION AND RECOMMENDATION

Apart from suicide and filicide, the findings of this study are similar to those performed in other countries. It is recommended that parents' psychological issues be managed concurrently when providing services for their children. There is also a need to develop psychosocial training interventions to address the needs of the parents of these children.

Anxiety, depression, and quality of life in Iranian mothers of children with autism spectrum disorder

Autism spectrum disorder (ASD) is being more recognized and diagnosed in developing as well as developed countries. We aimed to investigate the frequency of anxiety, depression, and quality of life in mothers of children with ASD in Iranian families. We conducted a descriptive cross-sectional study on demographic data and mental health characteristics of 127 mothers of children with ASD. Mothers of children with ASD had high levels of anxiety (72.4%), depression (49.6%), and low scores of health-related quality of life (HRQOL). There was strong association between the child's age and the severity of mother's depression and QOL. Duration since diagnosis of ASD positively correlated with maternal depression. Anxiety, depression, and low HRQOL are more common in Iranian mothers with autistic children in our study. Our findings have implications for further investigation in mental health status of mothers of children with ASD, and providing educational support and interventional strategies may improve the mental health status of the entire family.

Investigating Parenting Stress across Pediatric Health Conditions - A Systematic Review

The stress parenting responsibilities place on parents increases in situations involving pediatric illness, and therefore can potentially interfere with the normal family life. The present review examines sources of parenting stress across a wide spectrum of illnesses, using three illness groups as exemplars: Congenital heart disease, pediatric cancer, and Autism Spectrum Disorder. A systematic review of the literature using PubMed, CINAHL, Scopus, and PsycINFO databases yielded 66 observational studies investigating sources of parenting stress in parents of young children with congenital heart defects, cancer, and Autism Spectrum Disorder. Quality assessment, using the STROBE and COREQ quality indexes, was further conducted for the included studies. Stressors were categorized, and then analyzed in light of the diagnostic characteristics of the populations in focus. Findings indicate that parents across all illness groups experience increased levels of parenting stress. Several categories were identified in accordance to the parenting stress model as follows: illness-related factors, parental factors, child characteristics, familial factors, and social factors. Further analysis has revealed distinct parental concerns within the groups deriving from the diagnostics, care demands, or social responses specific to each group. Theoretical and practical implications for Family-Systems Nursing Practice were further discussed. Future research and assessment of parenting stress should account for the illness course and address family needs within the specific context of the illness.

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND

The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES

To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS

The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS

The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS

This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK

Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012002223.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Employment and financial burden of families with preschool children diagnosed with autism spectrum disorders in urban China: results from a descriptive study

BACKGROUND

Autism spectrum disorder (ASD) affects many aspects of family life, such as social and economic burden. Little investigation of this phenomenon has been carried out in China. We designed this study to evaluate the employment and financial burdens of families with ASD-diagnosed preschoolers.

METHODS

Four hundred and fifty-nine nuclear families of children with ASD, 418 with some other disability (OD) and 424 with typically developing (TD) children were recruited for this study. Employment and financial burdens of families were evaluated using a structured questionnaire; logistic regression was used to examine differences in job change measures by group, and ordinal logistic regression was used to investigate the association between household income and group.

RESULTS

Fifty-eight percent of families with ASD children and 19% of families with OD children reported that childcare problems had greatly affected their employment decisions, compared with 9% of families with TD children (p < 0.001). Age of child, parental education and parental age notwithstanding, having a child with ASD and having a child with OD were both associated with increased odds of reporting that childcare greatly interfered with employment (ASD, OR: 15.936; OD, OR: 2.502; all p < 0.001) and decreased the odds of living in a higher-income household (ASD, estimate = -1.271; OD, estimate = -0.569; all p < 0.001). The average loss of annual income associated with having a child with ASD was Chinese RenMinBi (RMB) 44,077 ($7,226), compared with RMB 20,788 ($3,408) for families of OD children.

CONCLUSIONS

ASD is associated with severe employment and financial burdens, much more than for OD, in families with preschool children.