Parenting stress, salivary biomarkers, and ambulatory blood pressure: a comparison between mothers and fathers of children with autism spectrum disorders

Caring by default: experiences of caregivers of children with developmental disabilities in Ghana mirrored in the context of the stress process model

BACKGROUND

Caring for a child with developmental disabilities (DD) is associated with significant stress and burden. Caregivers' experiences are influenced by factors such as poverty, stigma, and the lack of accessibility to services, equipment, and assistive devices. These factors are prevalent in a low-resource setting like Ghana which ultimately influences the experiences of caregivers. The aim of the study was to explore the experiences of caregivers of children with DD in the context of the Stress Process Model.

METHODS

The study employed a descriptive phenomenological design Caregivers of children with DD attending the Neurodevelopmental Clinic of a Teaching Hospital were purposively sampled. Data collection involved semi-structured interviews, reaching saturation with 14 participants. The interviews were audio-recorded transcribed verbatim and analysed using thematic analysis.

RESULTS

Four main themes emerged: perception of caregiving, stressors faced by caregivers, negative health outcomes and coping strategies. Perception of caregiving had two sub-themes as stressful nature of caregiving and time-consuming. Six sub-themes were linked to stressors faced by caregivers: the child's ADL needs, communication barrier, managing challenging behaviour, child's health needs, unmet educational needs, and economic burden. Negative health outcomes had three sub-themes: decline in physical, mental and social well-being. While some caregivers used maladaptive coping strategies like blaming, others employed adaptive coping strategies like religious coping through prayer, self-encouragement and support from other family members.

CONCLUSION

The study highlights the complex interaction between caregivers' perception of their caregiving situation, the stressors they experience, their coping resources,  and the negative health outcomes associated with caregiving. These findings underscore the need for context-specific caregiver programmes to mitigate the negative impacts of caregiving.

Gender differences in predictors of quality of life for parents of children with Autism Spectrum disorder in Saudi Arabia

PURPOSE

Few researchers have examined gender differences in the quality of life (QoL) of parents of children with autism spectrum disorder (ASD) in diverse cultural contexts. The purpose of this study was to identify how ASD severity, affiliate stigma, perceived social support, family functioning, and coping strategies differentially predict the QoL of mothers and fathers of children with ASD in Saudi Arabia.

DESIGN AND METHODS

Based on a cross-sectional research design, data were gathered between April and July 2023 from a convenience sample of 376 parents (220 mothers and 156 fathers) of children with ASD in Saudi Arabia. Welch's t-test and regression were used to achieve the study purpose.

RESULTS

Mothers of children with ASD reported lower QoL, perceived social support, and family functioning than fathers. Mothers relied on emotion-focused coping strategies, whereas fathers used problem-focused coping strategies. Furthermore, affiliate stigma, perceived social support, and family functioning significantly predicted the QoL of mothers and fathers of children with ASD. However, the severity of ASD affected only the QoL of the mothers. Problem-focused coping significantly predicted fathers' QoL but not mothers' QoL.

CONCLUSIONS

The results highlight gender differences in the factors that predict the QoL of parents of children with ASD in Saudi Arabia.

PRACTICE IMPLICATIONS

Healthcare professionals should consider parents' gender when providing support and interventions to improve parental QoL.

Experiences of Parental Caregivers of Adults with Autism in Navigating the World of Employment

PURPOSE

Caregiving often presents challenges for parents, particularly for parents of loved ones with disabilities or health challenges, who need and/or want to be employed. This study describes the employment experiences of aging parents as they continue to balance engagement in the paid workforce with the ongoing provision of care for their adult children with autism spectrum disorder (ASD). The purpose of this study was to examine the lived experiences of parents of adult children with ASD in the context of balancing career and caregiving responsibilities.

METHODS

The current study uses a qualitative phenomenological research approach to describe the lived experiences of 51 parents who were caring for an adult child with ASD. The parents participated in telephone interviews to obtain information about their career experiences while providing care and support to their adult children with ASD.

RESULTS

Three caregiving themes emerged including: (a) difficulty balancing caregiving with work responsibilities, (b) reasons for working, not working, or working intermittently, and (c) work as an escape or wanting to work more.

CONCLUSION

As more individuals with ASD reach adulthood, often relying to varying extents on their families for daily support, parental employment will continue to be impacted as they juggle their career with caregiving responsibilities. Economically, one or more family members typically need to work to sustain the family's needs and employment support should be considered. As a society, families often need to make choices even with an adult child with ASD of who will work, how, and when.

Differences in Interpersonal Resources and Risk Factors Among Mothers and Fathers of Children on the Autism Spectrum: A Serial Mediation Model

Mothers and fathers of children on the autism spectrum may differ in their perception of their interpersonal resources and risk factors. Fathers (114) and mothers (507) of children on the autism spectrum participated in the study. Fathers (vs. mothers) reported lower interpersonal resources (interpersonal emotion regulation and perceived support from friends and formal sources, but not family) and higher levels of interpersonal risk factors (social, not emotional, loneliness). A serial mediation model indicated that parents' gender predicted interpersonal emotion regulation which in turn related to parents' social loneliness directly and indirectly through perceived social support. Fathers of children on the autism spectrum may differ from mothers in perceptions of interpersonal resources and risk factors related to parents' social belonging needs.

High Depressive Symptoms, Low Family Functioning, and Low Self-Efficacy in Mothers of Children With Autism Spectrum Disorder Compared to Two Control Groups

BACKGROUND

Parents of children with autism spectrum disorder (ASD) face unique challenges in raising their children, and they are at higher risk for depression compared to parents of children with typical development (TD) and other disabilities.

AIMS

(1) To compare prevalence of depressive symptoms among mothers of children with ASD (n = 101), Down syndrome (DS, n = 101), and TD (n = 43) and (2) to describe the relationships among depression, self-efficacy, and family functioning, and describe the mediating role of maternal child care self-efficacy between depressive symptoms and child behavior.

METHODS

In this cross-sectional study, mothers completed the Social Communication Questionnaire, Aberrant Behavior Checklist, Patient Health Questionnaire-9 (PHQ-9), Family Assessment Device General Functioning Scale, and Maternal Self-Efficacy Scale.

RESULTS

Mothers of children with ASD had significantly higher mean PHQ-9 scores (p < .001), higher proportion of positive depression screening (p < .001), and lower family functioning (p < .001). Better family functioning is associated with less depression, better self-efficacy, and less severe ASD symptoms and behaviors. Self-efficacy mediated the relationship between depression and child ASD symptoms, and problematic behavior.

CONCLUSIONS

The rates of reported history of depression and low family functioning in mothers of children with ASD are twice the rate in mothers of children with DS and TD. Maternal child care self-efficacy is protective against maternal depression, even in the presence of severe child problematic behaviors and ASD symptoms. Interventions that increase child care self-efficacy and family functioning may be helpful in addressing depression in mothers of children with ASD.

Positive and challenging themes in parents' perceptions of their relationships with their child with autism: Comparison between mothers and fathers

LAY ABSTRACT

Most studies of how parents of children with autism see the parent-child relationship used questionnaires completed by the parents and focused on challenges. This study broadened the lens by interviewing parents using open-ended questions that provide an opportunity to raise challenging but also positive experiences. Seventy-five mother-father dyads were interviewed individually about their own and their spouses' relationships with their preschooler, and we found nine relationship themes. In descending order, the themes mentioned most frequently by mothers were "Security and Closeness," "Love," and "Tenderness and Sensitivity," and by fathers were "Pleasure in Joint Activities," "Security and Closeness," and "Guidance." Positive themes were more common than challenging themes. Finally, more mothers mentioned the themes "Love," "Tenderness and Sensitivity," "High Involvement and Care," and "Difficulties" than did fathers, whereas more fathers mentioned the themes "Guidance" and "Pleasure in Joint Activities" than did mothers. The findings portray a nuanced view of the parenting experience of mothers and fathers of preschoolers with autism.

Factors Predicting Poor Mental and Physical Health in Parents of Children with Autism Spectrum Disorder: Results from 2016 to 2019 National Survey of Children's Health

Although poor health has been reported in parents of children with autism spectrum disorder (ASD), most studies excluded fathers and focused on mental health. We combined 2016-2019 data from the National Surveys of Children's Health to determine child and parent characteristics that predict poor mental and physical health in fathers (n = 818) and mothers (n = 2111) of children with ASD. For fathers of children with ASD, higher parenting stress was significantly associated with greater odds of poor physical health, whereas racial and ethnic minorities and living at 400% above the federal poverty were significantly associated with lower odds of poor mental health. For mothers of children with ASD, greater child sleep problems were significantly associated with greater odds of poor physical health, and two-parent household living 400% above the poverty line was significantly associated with reported lower odds of poor mental health. Continued efforts to reduce parenting stress and improve child sleep problems, along with expanding existing services and coverages of ASD services, especially for low-income families, may help reduce the burden on these families, preventing adverse future health outcomes in this population.

Experimental Evidence Shows That Housing Vouchers Provided Measurable Benefits, Including Parent Stress Reduction

This article presents early findings on the causal effects of a housing voucher on family stress, which plays an important role in children's healthy development. Using the Housing and Children's Healthy Development study, which is the only randomized controlled trial of housing vouchers (conducted in the Cleveland, Ohio, and Dallas, Texas, metropolitan areas), we found measurable health and related benefits accruing to families who received vouchers even though half of those who leased housing with vouchers only lived in that dwelling for roughly one year or less. Vouchers also substantially improved cost burdens, sufficiency of space, adequacy of heat, and daytime neighborhood safety. Our analysis shows that the affordability secured by the voucher (reduction of cost burden) played the most important role in reducing parent stress. One policy implication of the affordability findings is the need to keep families' housing cost burden affordable.

Profiles of the parenting experience in families of autistic children

LAY ABSTRACT

Research shows that parents of autistic children, on average, are stressed; however, there is likely an array of factors that characterize the parenting experience in the context of autism other than stress. Understanding the diversity in the parenting experiences of both mothers and fathers of autistic children is important in the development of family-based intervention. A total of 188 co-habiting couples with an autistic child described their parenting experiences using a series of questionnaires examining their feelings of stress, parenting competence, and parenting attitudes and behaviors. We then sorted responses into profiles-three for mothers and four for fathers. We found that children of parents who reported the least amount of stress, highest feeling of competence, and use of responsive and directive parenting strategies (the Adaptive profile) had children with the least severe behavioral problems and autism symptoms. It was not necessary for both parents to be in the Adaptive category for child emotional and behavioral problems to less severe. We found that children did just as well when one parent was Adaptive compared with when both parents fell into this category.

Relationship Between Gastrointestinal Symptoms in Autism Spectrum Disorder and Parent Stress, Anxiety, Depression, Quality of Life and Social Support

Gastrointestinal (GI) symptoms are a common comorbidity in children and adolescents with autism spectrum disorder (ASD). Little is known about the impact that GI symptoms have on parental well-being. Parents of 409 children and adolescents with ASD completed the GI Symptoms Inventory, Parenting Stress Index-Short Form, World Health Organization Quality of Life Abbreviated Version, Hospital Anxiety and Depression Scale, and the Multidimensional Scale of Perceived Social Support. High levels of stress were demonstrated by parents with 40.1% receiving clinically significant scores. A relationship was found between parental stress and GI symptoms. Parental anxiety and depression were found at high levels but were not more common in parents of individuals with GI symptoms than those without. Lower levels of quality of life were found in parents of individuals with GI symptoms compared to parents of individuals without GI symptoms. Parents of children with GI symptoms were less satisfied with their personal and social relationships with others. Parents of children with GI symptoms had lower scores on a measure of perceived social support than parents of children and adolescents without GI symptoms. GI symptoms are stressful for parents and future research is needed to determine how to alleviate this stress and to improve the quality of life of parents of individuals with ASD.

Are all parental experiences equal?: Cluster analysis of salivary cortisol and perception of parental stress in mothers of children with autism spectrum disorder

Many parents of children with autism spectrum disorder (ASD) report high stress levels related to their parenting role. The experience of stress is reflected in physical symptoms and well-being, as observed by abnormal patterns of cortisol regulation. However, it may be a mistake to conceive parenthood as unilaterally stressful as diverse experiences are possible. Mothers of children with ASD provided salivary cortisol samples and self-rated parental stress. The area under the curve with respect to ground was calculated in regard to three daily collection time points. As a group, mothers reported average levels of parenting stress and flat daily cortisol output. The current age of the child and age at the time of diagnosis moderately predicted overall daily cortisol. Hierarchical clusters analysis identified four distinct profiles of stress regulation based on daily cortisol regulation and perception of parental stress. Groups did not differ based on the severity of symptoms related to autism or demographic information. We suggest that other variables, such as stress mediators and secondary stressors, may explain variability in stress regulation. Future research and intervention should perceive the parental experience as heterogeneous and focus on individualizing the support offered in light of diverse experiences.

The mediating role of perceived social support: alexithymia and parental burnout in parents of children with autism spectrum disorder

Background

Parental burnout is a concept that reflects the emotional exhaustion and emotional distance of parents from children due to their inability to cope with the pressure of parenting. It has been confirmed that parents of autistic children are at higher risk for parental burnout. Additional research has suggested a relationship between parental burnout and parents' personality traits. However, the relationship between alexithymia, an independent personality factor, with parental burnout is little to none.

Objective

To look into the connection between parental burnout and alexithymia among parents of autistic children.

Method

Three hundred and one parents were approached for recruitment and data were collected from 203 parents through a cross-sectional survey assessing parental burnout, alexithymia status, and perceived social support. Because the data is not normally distributed, Spearman's rank correlation coefficient rho(p) was used to assess the correlation between the variables; and then using AMOS to analyze the mediating effects of perceived social support and the moderating effect of gender.

Result

The result showed that (1) There is a negative association between alexithymia with parental burnout (β = 0.6, p < 0.01), while perceive social support was the negative predictor of alexithymia (β = -0.45, p < 0.01) and parental burnout (β = -0.26, p < 0.01); (2) perceive social support partially mediated the relationship between alexithymia and parental burnout of parents of autistic children, which can explain 16.3% of the total effect; (3) Gender plays a moderating role in the first half of the indirect effect of alexithymia on parental burnout, as evidenced by the significant difference in path coefficients between the male and female models (male: β = -0.10, p < 0.05; female: β = -0.60, p < 0.05).

Conclusion

Health professionals and policymakers should be aware of parental burnout among parents of autistic children in China and take early intervention steps. Furthermore, they should recognize the negative impact of alexithymia and the positive impact of social support when developing plans to alleviate parental burnout in children with autism, with a particular focus on mothers with alexithymia, who are more likely to experience low social support and burnout than fathers with alexithymia.

Examining indicators of psychosocial risk and resilience in parents of autistic children

Background

Parents of autistic children experience increased levels of caregiver strain and adverse mental health outcomes, even in comparison to parents of children with other neurodevelopmental disabilities. Previous studies have largely attributed these increased levels of mental health concerns to their child behavioral concerns and autism symptomatology, but less attention has been given to other potential child factors, such as child adaptive functioning. Additionally, little is known about potential protective factors, such as parents' emotion regulation (ER) abilities, that may ameliorate the experience of caregiver strain, anxiety, and depression.

Objective

The current study examined the impact of child characteristics (restricted and repetitive behaviors, adaptive functioning and behavioral concerns) on parent mental health outcomes (caregiver strain, anxiety, depression and wellbeing). Additionally, we explore parents' ER abilities as a moderator of the impact of child characteristic on parents' mental health outcomes.

Results

Results of linear mixed effect models indicated a significant relationship between parents' ER abilities and all four parent outcomes. Additionally, children's adaptive functioning abilities and repetitive behaviors (RRBs) were significant predictors of caregiving strain. Parents' ER abilities were a significant moderator of the effect of children's repetitive behaviors and adaptive functioning challenges on caregiver strain, such that better ER abilities mitigated the impact of child clinical factors on caregiver strain. Finally, a significant difference was detected for mothers' and fathers' mental health, with mothers reporting higher caregiver strain, and more symptoms of anxiety and depression than did fathers.

Conclusion

This study leveraged a large sample of autistic children and their biological parents to examine the relationship between children's clinical characteristics and parents' psychological wellbeing. Results indicate that, although parents of autistic children do experience high rates of internalizing mental health concerns that relate to child adaptive functioning and RRBs, parent ER abilities act as a protective factor against parents' adverse mental health outcomes. Further, mothers in our sample reported significantly higher rates of depression, anxiety, and caregiver strain, as compared with fathers.

The impact of caregiving for children with chronic conditions on the HPA axis: A scoping review

Caregiving has been robustly linked to caregiver health through the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in the context of caregiving for an adult with a chronic illness. However, little research examines the physiological impact of caregiving for a child with a chronic illness despite high burden and unique stressors. In this review, we explore the links of caregiving for a child with a congenital, chromosomal, or genetic disorder to the regulation or dysregulation of the HPA axis. A search was conducted in PubMed, Embase, and the Web of Science and 15 studies met inclusion criteria. Overall, there were inconsistent links of caregiving to HPA axis functioning, perhaps due to the heterogeneity across disease contexts, study designs, and biomarker measurement. Future research should standardize measurement and study designs, increase participant diversity, and examine moderators of the links of caregiving to the HPA axis.

Adaptation of Parents Raising a Child with ASD: The Role of Positive Perceptions, Coping, Self-efficacy, and Social Support

This study explored the adaptation of parents raising a child with an Autism Spectrum Disorder (ASD) specifically the contributory role of positive perceptions, coping, self-efficacy, and social support. One hundred and thirty-six parents of children with a diagnosis of ASD completed a battery of self-report questionnaires via an online survey. Using multiple regression analyses positive perceptions, adaptive coping, self-efficacy, and social support were each a significant contributor to one or more positive adaptation outcomes. Multiple moderated regression analysis found no evidence that these factors were significant moderators between behavioural problems and parental adaptation. The implications of these findings in supporting parents raising a child with ASD are outlined.

Brief Report: Above and Beyond Safety: Psychosocial and Biobehavioral Impact of Autism-Assistance Dogs on Autistic Children and their Families

Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child by preventing elopement and mitigating 'meltdowns'. Although anecdotal accounts and case-studies have indicated that AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiological measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.

Uplifts, Respite, Stress, and Marital Quality for Parents Raising Children With Down Syndrome or Autism

Direct, indirect, and partner effects estimated among uplifts, respite care, stress, and marital quality across mothers and fathers of children with autism spectrum disorder (n = 102) and Down syndrome (n = 111) were examined in this cross-sectional study. Parents of children with ASD who reported more uplifts and less stress individually reported better marital quality; these wives reported better marital quality as their husbands reported more uplifts and less stress. Wives with children with DS who reported more uplifts, individually along with their husbands reported less stress and better marital quality. Respite was directly associated with marital quality for parents of children with ASD and indirectly associated with marital quality for parents of children with DS with reduced individual stress. Implications are discussed.

The Unexpected Comfort of Feeling It All: A Support Group for Mothers of Autistic Adolescents Using the Lens of Ambiguous Loss

Many parents experience grief and loss in response to their child receiving an autism diagnosis in early childhood. However, there is a dearth of research that considers if grief and loss are experienced by parents throughout their child's adolescence and young adulthood. Further, there is a small but growing body of evidence suggesting that parents of autistic children may be living with ambiguous loss in particular, that is, a loss for which there is no closure or resolution. This case study introduces a peer group intervention utilizing an ambiguous loss framework that school social workers and other clinicians can adopt to support mothers of autistic adolescents who are struggling with ambiguous loss. Through the group process, the mothers developed deeper understanding, self-compassion, and effective coping strategies, resulting in a more resilient approach to the transition process and an enhanced capacity to plan for a meaningful adult life with their autistic child.

Maternal and child factors associated with the health-promoting behaviours of mothers of children with a developmental disability

BACKGROUND/AIM

Mothers caring for their child or adult with a developmental disability can experience mental health disparity. Protective factors such as healthy behaviours are under-researched. This study investigated relationships between mental health, healthy behaviours, and disability factors.

METHODS

The cross-sectional online survey included: Depression Anxiety Stress Scales (DASS); Family Empowerment Scale (FES); Health Promoting Activities Scale (HPAS); and a measure of childhood quality of life (QoL).

RESULTS

All mothers were raising offspring (aged 3-36 years) with a developmental disability. Fifty-two percent of mothers (N = 81) had a mental health diagnosis. DASS scores were elevated for depression (58 %), anxiety (52 %) and stress (68 %). Mothers participated in health promoting activities infrequently and reported low satisfaction with community health-supporting facilities. Depressive symptoms, maternal empowerment and two indicators of child-related QoL explained 29.7 % of the variance in healthy behaviours. Depressive symptoms were the most important predictor of lack of health promoting behaviours.

CONCLUSIONS

Better mental health predicted more frequent participation in health promoting behaviour. Future research might explore the extent to which health promoting behaviours protect mental health. Service changes including family health focused services, and custom designed health promotion or coaching programs may improve the health behaviours of mothers with high care responsibilities.

The Route of Stress in Parents of Young Children with and without Autism: A Path-Analysis Study

We provide a conceptual model on the complex interaction between stress, psychological predisposition, and personality traits, accounting for gender, in parents of children with and without autism. We performed a path analysis using a structural equation modeling approach in a sample of parents including 60 ASD and 53 TD couples. In parents of typically developing children (TD), depression level and age are the main direct predictors of stress through the mediating effect of anxiety. Otherwise, in the ASD parent group, the personality trait ‘openness’ directly predicts the defensive response and stress levels without the mediating effect of anxiety. Our data suggest a route of action in promoting new behavioral strategies to prevent parenting stress, making families run smoothly.

Resilience and social support as predictors of post-traumatic growth in mothers of children with autism spectrum disorder in Saudi Arabia

BACKGROUND

There are few studies about the role of resilience and social support in post-traumatic growth (PTG) in parents of children with autism spectrum disorder (ASD).

AIM

This study examined the relationship between social support, resilience, and PTG and the predictive role of resilience and social support related to PTG in Saudi Arabian mothers.

METHODS AND PROCEDURES

A survey-based quantitative study was conducted in 88 mothers aged 18-46 years (M = 33.5; SD = 8.02) who had a child with ASD. They were sampled from nine day care centers in Riyadh and the Central-Eastern-Southern region.

OUTCOMES AND RESULTS

The findings showed a significant positive correlation between perceived social support, resilience, and PTG, and revealed that Resilience-competence was the only significant predictor of PTG-personal strength, appreciation of life, spiritual change new possibilities, and total PTG, while positive acceptance of change was a significant predictor of PTG-relating to others. Moreover, social support from friends and significant others were significant predictors of PTG-total.

CONCLUSIONS AND IMPLICATIONS

We found that, for mothers of a child with ASD in Saudi Arabia, the biggest factors predicting post-traumatic growth were a notion of personal competence and social support from friends. Intervention is suggested to lower the risk of trauma.

Comparing Fathers' and Mothers' Perspectives About Their Child's Autism Spectrum Disorder

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.

Expressed Emotion in Families of Children With and Without Autism Spectrum Disorder, Cerebral Palsy and Down Syndrome: Relations with Parenting Stress and Parenting Behaviors

This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.

The relationship between 2019-nCoV and psychological distress among parents of children with autism spectrum disorder

OBJECTIVES

The psychological distress caused by COVID-19 may be pronounced among the parents of children with autism spectrum disorder (ASD). This study aimed to investigate psychological distress among parents of children with ASD during the COVID-19 pandemic.

METHODS

A total of 1764 parents of children with ASD and 4962 parents of typically developing (TD) children were recruited. The participants completed an online survey which contained demographic information, the impact due to COVID-19 crisis, resilience, coping styles, anxiety and depression. Hierarchical linear regression was used to assess the contributions of these variables to anxiety and depression.

RESULTS

After adjusting for demographic variables, the following factors were associated with parents' anxiety and depression symptoms: (i) Whether or not the participants had a child with ASD; (ii) resilience; (iii) coping strategies, and; (iv) the impact due to COVID-19. Among these, the psychological stress caused by COVID-19 played the most important role in parental anxiety (β = 0.353) and depression (β = 0.242) symptoms. Parents of children with ASD had lower levels of resilience and positive coping, and used more negative coping strategies than parents of TD children. Among all participants, 8.0 and 24.2% of parents had symptoms of anxiety and depression, respectively. Compared to parents of TD children, more parents of children with ASD exhibited symptoms of anxiety and depression (12.2% vs. 6.6%; 31.0% vs. 21.7%, respectively).

CONCLUSIONS

During the COVID-19 pandemic, parents experienced varying levels of anxiety and depression, particularly, parents of children with ASD. More specific attention should be paid to parental mental health and long-term effective intervention programs, that are targeted towards parents of children with ASD, and such programs should be promoted around China in the wake of the COVID-19 crisis.

Influence of transition readiness from paediatric to adult health care on quality of life in child-parent dyads with long-term conditions

AIM

To delineate the impact of perspective of children's transition readiness from paediatric to adult health care on quality of life in child-parent dyads with long-term conditions. We used Actor-Partner Interdependence Model to identify actor effects (effect of one's own transition readiness on one's own quality of life) and partner effects (effect of one's own transition readiness on the partner's quality of life).

DESIGN

A multi-centre cross-sectional survey.

METHODS

The study was conducted in two paediatric hospitals in China from October 2018-August 2019. We used a researcher-designed questionnaire to collect demographic and clinical characteristics. Furthermore, we used four questionnaires assessing transition readiness and quality of life in child and parent respectively to collect data from 370 child-parent dyads. Structural equation modelling was applied to estimate the effect of actor-partner interdependence models.

RESULTS

The total score of transition readiness had two actor effects on total child and parent quality of life controlling for age (β_children  = 3.335, p = .032 and β_parents  = 8.952, p < .001), while only one actor effect controlling for gender (β_parents  = 8.891, p < .001). Specific transition readiness dimensions had different partner effects on different domains of children and parents' quality of life. Moreover, younger children and fathers had a better quality of life.

CONCLUSION

Our study verified inherently interpersonal relationship that transition readiness appeared to influence quality of life in child-parent dyads with long-term conditions.

IMPACT

This study was the first to verify mutual influence of transition readiness and quality of life in child-parent dyad using actor-partner interdependence model. Nurses who design the transition promoting programs should consider the effective communication between healthcare provider and child-parent dyads and support parents' involvement to improve shared understanding about managing child's condition, especially for older children and mothers.

Parental stress, involvement, and family quality of life in mothers and fathers of children with autism spectrum disorder in mainland China: A dyadic analysis

BACKGROUND

Research shows that parents of children with autism spectrum disorder (ASD) are burdened with childcare responsibilities and at increased risk for elevated stress and poor family quality of life (FQOL). Little is known, however, about the dynamic interactions between mothers' and fathers' perceived parenting stress in relating to parental involvement and FQOL, especially in the Chinese cultural context.

AIMS

This study examined the intrapersonal and interpersonal effects of parenting stress on parental involvement and FQOL for families of children with ASD in mainland China.

METHOD

A total of 210 Chinese couples (total N = 420) completed measures of caregiving involvement, perceived parenting stress, and FQOL. The Actor-Partner Interdependence Mediation Model (APIMeM) was employed to examine the dyadic relationships among the variables.

RESULTS

Both parents' parenting stress was negatively associated with their own involvement and FQOL. Moreover, fathers' parenting stress was indirectly related to mothers' perceptions of FQOL through their involvement in the care of their child with ASD.

CONCLUSIONS

The findings highlight the important roles of fathers' parenting stress and involvement in affecting their own and their partners' satisfaction with FQOL within Chinese families raising a child with ASD.

A Virtual Resiliency Intervention for Parents of Children with Autism: A Randomized Pilot Trial

Parents of children with Autism experience high levels of stress. Resiliency is the ability to cope and adapt when faced with stressful events. This randomized, waitlist controlled pilot trial examines the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind-body group intervention for parents of children with ASD. The intervention was feasible and acceptable. The immediate treatment group showed no difference in distress and greater improvement in resiliency and stress reactivity/coping relative to the delayed treatment group, (M difference 5.78; p = .038 and M difference 7.78; p = .001 respectively). Findings showed promising feasibility, acceptability, and preliminary efficacy for parents of children with ASD.

An Exploration into Mothers' Experiences of Feeding Children with Autism Spectrum Disorder in South Africa

OBJECTIVES

To explore the experiences of mothers feeding their children with autism spectrum disorder (ASD) in South Africa as well as to better understand the impact of context and culture on feeding disorders.

PARTICIPANTS AND METHODS

A qualitative research design was employed. Seven mothers of 8 children (1 mother had twins), aged 4-9 years, who were diagnosed with ASD and who had associated feeding difficulties participated in the study. Semi-structured interviews were conducted, and data were transcribed and analysed using inductive thematic analysis.

RESULTS

Findings indicated that children with ASD and feeding difficulties increase parental stress and anxiety. Novel findings pertaining to context and culture showed the negative impact feeding difficulties have on the siblings, the role taken on by the mother as the caregiver and the provider, and an additional financial burden associated with feeding a child with ASD.

CONCLUSIONS

Findings add to the field of speech therapy by providing awareness of the challenges experienced by these mothers as well as those that are unique to the South African context. In addition, the current study provides insight into the experiences of mothers from different contexts and cultural backgrounds to those reported in previous literature.

Biological Consequences of Psychological Distress in Caregivers of Children with Autism Spectrum Disorder and its Potential Relevance to Other Chronic Diseases Including Cancer

Purpose of Review

Caregivers of children with a chronic illness are a neglected group in medical research and patient care, and are frequently confronted with chronic psychological distress. The biological consequences of this chronic distress are unclear but highly relevant, as these caregivers have a lifelong task in caring for their child. In this review, the authors specifically describe caregiver distress related to autism spectrum disorder (ASD), but the review may be relevant to other chronic diseases, including cancer.

Recent Findings

Epidemiological evidence illustrates the increased mortality risk in caregivers of children with ASD although some individual factors appear to diminish these risks. Biological studies demonstrate that caregiver distress can lead to dysregulation of the hypothalamic-pituitary-adrenal-axis, a pro-inflammatory state of the immune and central nervous system, and gut microbiome imbalance.

Summary

Caregivers of children with a chronic illness like ASD deserve more health-related attention with respect to their psychological and physical well-being. Such attention would benefit individual caregivers, as well as their children, as both are highly interconnected. Structural psychological and physical screening of caregivers can be considered.

Awakening cortisol indicators, advanced glycation end products, stress perception, depression and anxiety in parents of children with chronic conditions

This cross-sectional study aims to investigate awakening cortisol indicators and to explore their association with stress perception, advanced glycation end products (AGEs), depression and anxiety in parents of children with chronic conditions. We included five parental groups according to children's diagnoses: Down syndrome (DS; N = 31), autistic spectrum disorder (ASD; N = 29), cerebral palsy (CP; N = 15), diabetes mellitus type 1 (DMT1; N = 38), and a control group of heathy children (CG; N = 33). Salivary cortisol and AGEs were measured, alongside with psychological indices. Partial correlation and multiple linear regression were used in the analysis to identify parental characteristics associated with total awakening cortisol output (area under the curve with respect to the ground, AUC_G), cortisol awakening response (area under the curve with respect to the increase, AUC_I), perceived stress, and health outcomes (AGEs, depression and anxiety). There was no difference between groups for AUC_G, while DS and DMT1 groups showed reduced AUC_I (β = -0.241, p = 0.040; β = -0.249, p = 0.028, respectively), and ASD parents had a borderline insignificant result (β = -0.205, p = 0.081). Non-smokers had higher AUC_G, and parental sedentary activity and sleep duration were associated with AUC_I. AUC_G was positively associated with AGEs (β = 0.218, p = 0.013), anxiety (β = 0.207, p = 0.004), and with depression (β = 0.156, p = 0.034), unlike the AUC_I. DS parental group showed lower general stress perception (β = -0.260, p = 0.005). Parents of children with DMT1 had more pronounced depressive symptoms (β = 0.183, p = 0.039), while CP parents had a borderline insignificant result for depression (β = 0.143, p = 0.058). Based on these results, parents of children with chronic conditions have altered awaking cortisol response and are under increased risk of adverse health consequences.

Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT

BACKGROUND AND OBJECTIVES

Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up.

METHODS

Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time.

RESULTS

Both groups improved during active treatment in all subdomains of parent stress (β = -1.42, -1.25, -0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = -0.62 and -0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = -1.91 and -1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems.

CONCLUSIONS

Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.

Mental health outcomes among parents of a child who has a developmental disability: Comparing different types of developmental disability

BACKGROUND

There is very little information on the effects of different types of developmental disability on the mental health of parents of children who have a DD.

OBJECTIVE

This paper compared the mental health of parents of children with Autism Spectrum Disorder (ASD), Down syndrome, Fetal Alcohol Syndrome (FAS) and other types of DD.

METHODS

A cross-sectional design was used to examine population-level administrative health data for mental health outcomes in cohorts of fathers and mothers of children with four different types of a DD. As well as type of DD, additional variables were examined, these included: sex of the parent, age of the parent at birth of the child with the DD, income, sex of the child with the DD, number of children in the family and place of residence.

RESULTS

For both fathers and mothers odds of a diagnosis of depression or another mental health problem were associated with type of DD. Parents of children with FAS experienced the greatest odds of a depression or other mental health diagnosis. Odds of a diagnosis for fathers were associated with low income. Odds of a diagnosis for mothers were associated with the sex of the child with the DD.

CONCLUSIONS

These findings are important for understanding families which include a child with a DD, as a guide for future research, and for developing effective programs and services for these parents.

Mental health of parents of children with a developmental disability in British Columbia, Canada

Background

There is evidence in the literature that parents of children who have a developmental disability experience an increased risk of mental health problems.

Methods

This study used population-level administrative data from the Ministry of Health, British Columbia, Canada, to assess the mental health of parents of children who have a developmental disability compared with the mental health of parents of children who do not have a developmental disability. Population-level and individual explanatory variables available in the data were included in the models.

Results

At a population level, the study found strong evidence that parents of children who have a developmental disability experience higher odds of depression or other mental health diagnoses compared with parents of children who do not have a developmental disability. Age of the parent at birth of the child, income and location of healthcare services were all associated with outcomes.

Conclusion

Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.

Ethnic Differences in Home-Related Maternal Stress: Muslim and Jewish Mothers

Parental stresses are normal responses to raising children. They are affected by stresses parents and children accumulate and bring to their interrelations. Background factors like economic difficulties or the relations between the parents may affect parental stresses as well as demographic and environmental factors like noise and access to urban parks. Most studies on parental stress are based on a verified psychological questionnaire. We suggest using frequency domain heart rate variability index (HRV) to measure parental stress enabling, by thus, the measurement of physiological aspects of stress and risk to health. Parental stress is measured as the difference between HRV accumulated at home while staying with the children and without the husband and HRV measured in the neighborhood while staying without the children and the husband. We use the index to compare differences among Muslim and Jewish mothers in exposure to maternal stress at their homes and to expose the factors that predict differences in maternal stress. We found that Muslim mothers suffer from home-related maternal stress while Jewish mother do not. Number of children and ethnically related environmental aspects predict differences in maternal stress between Muslim and Jewish mothers. Muslims' lower access to parks stems from lack of home garden and parks in their neighborhoods in the Arab towns but mainly by restrictions on Muslim mothers' freedom of movement to parks. Despite differences in levels of noise at home and in the status of the mother in the household, these factors did not predict differences in maternal stress. Instead, the study highlights the crucial role of greenery and freedom of movement to parks in moderating home-related maternal stress.

Family Emotional Climate and Children with Autism Spectrum Disorder

Little research has examined family emotional climate in the context of having a child with autism spectrum disorder (ASD). The goal of the current study was to determine how the emotional quality of family subsystems (parent-child and parent couple relationships, for both mothers and fathers) combine to create various classes of family emotional climate and to identify predictors of class membership in 148 families of children with ASD. The emotional quality of family subsystems was assessed using Five Minute Speech Samples from mothers and fathers. In total, 148 families of children with ASD (86% male) aged 6-13 years were included in analyses. About one-third of parents did not have a college degree and more than two-thirds were of non-Hispanic White origin. Latent class analysis revealed that 43% of the sample was characterized by high levels of warmth and low levels of criticism in both the parent-child and parent couple relationships; 12% of the sample was characterized by low warmth and high criticism in both sets of relationships; and the rest of the sample was divided among three additional classes of emotional climate characterized by different configurations of warmth and criticism across both sets of relationships. Parent level of broader autism phenotype and child emotional and behavioral problems were associated with emotional climate class membership. Implications for interventions are discussed.

Family Emotional Climate and Children with Autism Spectrum Disorder

Little research has examined family emotional climate in the context of having a child with autism spectrum disorder (ASD). The goal of the current study was to determine how the emotional quality of family subsystems (parent-child and parent couple relationships, for both mothers and fathers) combine to create various classes of family emotional climate and to identify predictors of class membership in 148 families of children with ASD. The emotional quality of family subsystems was assessed using Five Minute Speech Samples from mothers and fathers. In total, 148 families of children with ASD (86% male) aged 6-13 years were included in analyses. About one-third of parents did not have a college degree and more than two-thirds were of non-Hispanic White origin. Latent class analysis revealed that 43% of the sample was characterized by high levels of warmth and low levels of criticism in both the parent-child and parent couple relationships; 12% of the sample was characterized by low warmth and high criticism in both sets of relationships; and the rest of the sample was divided among three additional classes of emotional climate characterized by different configurations of warmth and criticism across both sets of relationships. Parent level of broader autism phenotype and child emotional and behavioral problems were associated with emotional climate class membership. Implications for interventions are discussed.

Health Care Transition for Adolescent and Young Adults with Intellectual Disability: Views from the Parents

PURPOSE

This study explored the health care transition (HCT) experiences of parents of adolescents and young adults (AYAs) with intellectual disability (ID), 18-33 years of age, including barriers and facilitators to the AYA's transition to adulthood within and between the medical, educational, community, and vocational systems.

DESIGN AND METHODS

A qualitative descriptive design with semi-structured individual interviews with 16 parent participants was used. Purposive sampling of parents was utilized with variation on race/ethnicity and AYA age, stage in transition, and condition. This study was conducted through a major medical center in the southeast United States. Content analysis was utilized.

RESULTS

Three overarching themes represented the factors and essence of supporting AYAs with ID transition to adulthood. Inefficient and siloed systems illuminated barriers families are commonly experiencing within and between the medical, educational, community, and vocational systems. 'Left out here floundering' in adulthood, described the continued inadequacy of resources within each of these systems and parent's having to find available resources themselves. Hope despite uncertainty, included the perceived costs and benefits of their AYA's disability and the value of parent peer support in providing key knowledge of resources, strategies, and perspectives.

CONCLUSIONS

Our findings illuminate the need for improved infrastructure to provide effective HCT and partnerships to help integrate HCT support within other life course systems. Results support the rationale for non-categorical HCT-focused approach.

PRACTICE IMPLICATIONS

A parent peer coach-facilitated intervention offers promise for bridging the gap between systems and meeting family needs.

Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence

Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.

Child Autism Spectrum Disorder Traits and Parenting Stress: The Utility of Using a Physiological Measure of Parental Stress

Caregivers of children with autism spectrum disorder (ASD) report greater stress due to unique parenting demands (e.g.; Estes et al. in Brain Dev 35(2):133-138, 2013). Stress is often studied through self-report and has not been extensively studied using physiological measures. This study compared parenting stress in mothers of children with and without ASD traits. Twenty-seven mother-child dyads participated in an interaction task while measuring mother's heart rate variability (HRV) and mothers self-reported stress levels. Results demonstrated that while self-report and physiological stress measures were not correlated, ASD symptomology did account for HRV change score (i.e., more severe ASD symptoms were positively related to HRV change). This may reflect an atypical coping response. Implications for using physiological indicators for studying parenting stress are explored.

Psychophysiological measures of stress in caregivers of individuals with autism spectrum disorder: a systematic review

PURPOSE

Parents of children with autism spectrum disorder (ASD) often self-report heightened levels of stress and physical health problems. This paper reviewed studies assessing physiological measures of stress among parents of children with ASD.

METHODS

Systematic database searches identified 15 studies meeting inclusion criteria. Studies were reviewed to determine: (a) control group characteristics; (b) caregiver and care recipient characteristics; (c) setting; (d) physiological measures employed; (e) physiological outcomes; and (f) stressor type. A measure of methodological quality was also applied.

RESULTS

Salivary cortisol was the most common physiological measure employed. A pattern of blunted physiological activity emerged within the reviewed studies, though some studies reported normal or even higher physiological activity among this population.

CONCLUSIONS

Findings suggested dysfunction of the hypothalamic-pituitary-adrenal-axis and autonomic nervous system for some, but not all, parents of children with ASD. Further research is warranted.

Prenatal Risk for ASD: Fetal Cortisol Exposure Predicts Child Autism-Spectrum Disorder Symptoms

The etiology of autism spectrum disorder (ASD) is multifactorial and complex and likely involves interactions among genetic, epigenetic and environmental factors. With respect to environmental influences, a growing literature implicates intrauterine experiences in the origin of this pervasive developmental disorder. In this prospective longitudinal design, we examine the hypothesis that fetal exposure to maternal cortisol may confer ASD risk. In addition, because ASD is four times more prevalent in males than females and because sexually dimorphic responses to intrauterine experiences are commonly observed, we examine whether or not any associations differ by fetal sex. Maternal plasma cortisol was measured at 15, 19, 25, 31, and 37 weeks' gestation in a sample of 84 pregnant women. ASD symptoms were assessed in their 5-year old children with the Social Communication Questionnaire (SCQ). Fetal exposure to lower levels of maternal cortisol was associated with higher levels of ASD symptoms among boys only. The observed hypocortisolemic profile exhibited by these mothers may indicate a risk factor that precedes the stress of caregiving for a child with ASD and may not be solely a consequence of the stress of caregiving as previously thought. Further, these findings confirm the value of examining prenatal hormone exposures as predictors of ASD risk and support the premise that altered prenatal steroid exposures may play a role in the etiology of ASD.

Salivary Biomarkers of Parenting Stress in Mothers Under Community Criminal Justice Supervision

BACKGROUND

Community criminal justice supervised mothers are an underserved population who experience high rates of psychological distress and unique parenting challenges, but little is known about physiological stress system function in this population.

OBJECTIVE

We tested the salivary biomarkers of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis function as predictors of subjective maternal stress.

METHOD

We recruited 23 mothers (age: M = 35.6 years, SD = 9.3 years; 35% Hispanic, 22% Black, 22% White, 22% multiracial) who were court mandated to a residential treatment center. We measured salivary alpha-amylase (AA) and cortisol, which index SNS and HPA activity, respectively, before and after a naturalistic reminder of a stressful parenting experience. We assessed self-reported parenting stress using the Parenting Stress Index-Short Form (PSI-SF) subscales Parental Distress, Parent-Child Dysfunctional Interactions, and Difficult Child. We used regression to test AA and cortisol mean levels and reactivity as predictors of subscale scores.

RESULTS

Mean, but not reactive, salivary stress biomarker levels were associated with parenting stress domains. Mean cortisol levels predicted scores on the Parent-Child Dysfunctional Interaction subscale (adj. R = .48), whereas mean AA predicted Difficult Child subscale scores (adj. R = .28).

DISCUSSION

Our results demonstrate the potential predictive utility of AA and cortisol as salivary biomarkers of maternal stress in community-supervised mothers. Given that maternal stress is associated with criminal recidivism and child behavioral health in this population, these biomarkers could potentially inform interventions to improve dyadic health and social outcomes.

The Association Between Emotional and Behavioral Problems in Children with Autism Spectrum Disorder and Psychological Distress in Their Parents: A Systematic Review and Meta-analysis

This review (Prospero Registration Number: CRD42017057915) aimed to systematically identify and summarize existing research on the relationship between additional emotional and behavioral problems (EBP) in children with autism, and parenting stress (PS) and mental health problems (MHP) in their parents. Sixty-seven studies met criteria for inclusion in the review, 61 of which were included in the meta-analysis. Pooled correlation coefficients were in the low to moderate range ([Formula: see text]). Some evidence for moderation by measurement characteristics was found. Narrative review of concurrent adjusted associations showed some evidence for shared relationships with other factors, most notably ASD severity and parent perception of own parenting. Longitudinal studies showed mixed evidence for bidirectional predictive relationships between child EBP and parent psychological distress variables.

Aspects of the parent-child relationship and parent metabolic outcomes

Much is known about the effect of parent-child relationships on child health; less is known about how parent-child relationships influence parent health. To assess the association between aspects of the parent-child relationship and parent metabolic outcomes, and whether these associations are moderated by parent gender. Five metabolic outcomes (systolic and diastolic blood pressure, heart rate, total cholesterol and glycated hemoglobin) were assessed among 261 parents (45.83 ± 5.50 years) of an adolescent child (14.57 ± 1.072 years). Parents completed questionnaires assessing their child's hassles and the quality of their days with their child. Parents' perceptions of their child's hassles were associated with parent heart rate (B = 2.954, SE = 1.267, p = 0.021) and cholesterol (B = 0.028, SE = 0.011, p = 0.010), such that greater perceived child hassles were associated with higher heart rate and cholesterol levels, on average. These associations were not moderated by parent gender (all ps > 0.30). Parent report of their day with their child was not associated with parent metabolic outcomes (all ps > 0.20). Parent gender moderated the association between parent report of their day with their child and parent systolic blood pressure (B = 13.861, SE = 6.200, p = 0.026), such that less positive reports were associated with higher blood pressure readings among fathers, but not mothers. This study suggests that parent metabolic health may in part be influenced by aspects of the parent-child relationship.

Parental Burden and its Correlates in Families of Children with Autism Spectrum Disorder: A Multicentre Study with Two Comparison Groups

BACKGROUND

The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions.

OBJECTIVE

This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child's characteristics, and parents' coping resources and strategies.

METHODS

The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child's clinical characteristics and parents' caregiving burden, psychological distress, coping resources and strategies were assessed.

RESULTS

The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies.

CONCLUSION

This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.

The impact of child and family stressors on the self-rated health of mothers of children with autism spectrum disorder: Associations with depressed mood over a 12-year period

Employing a cohort sequential design and multilevel modeling, the effects of child and family stressors and maternal depressed mood on the self-rated health of 110 mothers of children with autism spectrum disorder were assessed over a 12-year period when children in the study were 7–19 years old. Findings indicate a significant decline in self-rated health over time. In addition, child and family stressors, as well as maternal depressed mood, exerted significant between-persons effects on self-rated health such that mothers who reported more stressors and depressed mood across the study period were less likely to rate themselves in better health across that period. In addition, a significant within-person relationship between maternal depressed mood and self-rated health was found, indicating that at times when mothers reported higher levels of depressed mood than usual (their personal average across the study), they were significantly less likely to report better self-rated health. Finally, maternal depressed mood partially mediated the between-persons effects of child and family stressors on self-rated health such that increased stressors led to increased maternal depressed mood which, in turn, led to poorer maternal self-rated health. Findings suggest that chronic stressors erode maternal health over time and that depression may be an important mechanism linking stressors to decreased maternal health.