Brief Report: Impact of Child Problem Behaviors and Parental Broad Autism Phenotype Traits on Substance Use Among Parents of Children with ASD

Psychological, behavioural, and physical aspects of caregiver strain in autism-caregivers: a cohort study

Background

People who give care to autistic individuals (autism-caregivers) experience higher levels of caregiver strain than people who provide care for individuals with other chronic conditions (non-autism-caregivers). This places them at higher risk for psychological, behavioural and physical health concerns. The aim of this study is to delineate psychological, behavioural, and physical aspects of caregiver strain in autism-caregivers compared to non-autism-caregivers.

Methods

We included 3354 adult caregivers from the general population in the Netherlands participating in the second assessment (January, 1, 2014-December, 31, 2017) of the Lifelines Cohort. In this cohort study, using multivariable regression adjusted for age, sex, and socioeconomic status, we analysed psychological (anxiety and depression based on a Mini International Neuropsychiatric Interview, and self-reported stress and perceived health), behavioural (questionnaire-assessed physical activity, alcohol use, and smoking), and physical aspects (body mass index, waist circumference, and leukocyte-counts) of caregiver strain in autism-caregivers (n = 722) compared with non-autism-caregivers (n = 2632).

Findings

Autism-caregivers reported more stress (OR 3.61, 95% CI 2.60-4.99). Both anxiety (OR 1.85, 95% CI 1.37-2.49) and depressive disorders (OR 1.83, 95% CI 1.17-2.86) were more common in autism-caregivers than in non-autism-caregivers. Perceived health, physical activity, alcohol use, and smoking were not different between autism- and non-autism-caregivers. In autism-caregivers, lymphocyte- and monocyte-counts were lower than in non-autism-caregivers.

Interpretation

In this large cohort, autism-caregivers had worse psychological health than non-autism-caregivers. Moreover, autism-caregiving might be associated with an altered immune balance. These findings underline the higher caregiver strain in autism-caregivers compared to other caregivers. This calls for increased support to autism-caregivers.

Funding

Lifelines has been funded by the Dutch government.

What are Replicable Aspects of the Broader Autism Phenotype among College Students?

Are people with heightened autistic traits less likely to help other people? Recent research suggests that heightened autistic traits are associated with reduced self-reported prosocial behavior among college students. However, the growing literature examining sub-clinical traits associated with autism, or the Broader Autism Phenotype (BAP), among college students has invested insufficient attention in replication of findings, potential interrelationships between constructs, or the degree to which social desirability bias may contribute to findings. To identify replicable aspects of the BAP, we administered a battery of measures to 391 undergraduate students. Replicating prior work, findings suggested that self-reported difficulties understanding the self and others (but not less feeling for others) and sensory atypicalities are core aspects of the BAP. Reduced social desirability bias was also associated with the BAP. Prior associations between reduced prosocial tendencies and the BAP were not replicated. Findings highlight the importance of assessing multiple potential aspects of the BAP, particularly reduced susceptibility to the social desirability bias, when using self-report measures.

Mothers' and Fathers' Prescription Drug Misuse in Family Contexts: Implications for the Adjustment of Parents of Children With and Without Autism

Although prescription drug misuse is an identified risk factor for individuals' outcomes, less is known about its occurrence in and implications for families. To address this limitation, we examined whether mothers' and fathers' prescription drug misuse is associated with the adjustment of parents, including those with a child with autism spectrum disorder (ASD) and those without. Mothers and fathers from families with a child with ASD (n = 178) and comparison families without a child with ASD (n = 174) completed surveys of past-year prescription drug misuse and their personal and relationship adjustment. In total, 7.7% (N = 27) of mothers and 8.2% (N = 29) of fathers reported recent prescription drug misuse. There was significant interdependence between mothers' and fathers' recent prescription drug misuse in families with a child with ASD but not in comparison families. Actor-partner interdependence modeling was used to examine associations between parents' prescription drug misuse and their own and their partner's adjustment, controlling for medical use of prescription drugs and demographic covariates. Across family diagnosis statuses, mothers' prescription drug misuse predicted higher levels of their own alcohol problems, whereas fathers' prescription drug misuse related only to mothers' poorer sleep quality. Moreover, mothers' prescription drug misuse was associated with higher levels of their own depression symptoms in ASD-status (but not in comparison) families. Understanding parents' prescription drug misuse and its effects on family members is critical for informing future research and prevention and treatment strategies.