The Longitudinal Effects of Network Characteristics on the Mental Health of Mothers of Children with ASD: The Mediating Role of Parent Cognitions

Living with the delusion of autism recovery: A grounded theory study on the experiences of mothers

PURPOSE

This study employs Charmaz's (2014) constructivist Grounded Theory (GT) approach to explore and construct a theory about the experiences of mothers raising children diagnosed with autism spectrum disorder (ASD).

METHODS

Data were collected over 1.5 years from online forum posts written by 10 mothers and in-depth qualitative interviews conducted with nine mothers. During the theoretical sampling phase, an additional four mothers were interviewed face-to-face. The analysis adhered to Charmaz's constructivist GT methodology, encompassing initial coding, focused coding, and theoretical coding.

RESULTS

The study introduces the grounded theory, "Living with the Delusion of Autism Recovery," which encapsulates mothers' oscillation between hope and despair as they navigate their children's developmental journeys. This longitudinal analysis traces mothers' experiences from the pre-diagnosis phase through special education, addressing a significant gap in the literature by examining the progression of experiences rather than isolated moments.

CONCLUSIONS

The findings underscore the urgent need for timely interventions and robust support systems. Delays in diagnosis, driven by healthcare professionals' reluctance to diagnose early and the lack of a formal early intervention system, exacerbate developmental challenges. This research provides a unique contribution to the literature by centering on the experiences of Turkish mothers, shedding light on cultural nuances and the dynamic nature of parenting a child with ASD in Türkiye. It is notable as the first study of its kind in Türkiye, offering invaluable insights into the evolving experiences of these mothers.

The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy

BACKGROUND

Chronic diseases are a global health challenge, and therefore, more attention should be paid to improving self-efficacy in people with chronic diseases. This study examined the relationship between family health and self-efficacy, and explored the mediating role of perceived social support and the moderating role of health literacy. The aim is to enhance the self-efficacy of chronic patients by improving family health, social support, and health literacy, thereby improving their physical and mental state.

METHODS

A cross-sectional study based on psychological and behavioural factors was conducted, namely, the 2022 China Residents Survey, which included 5150 Chinese patients with chronic diseases. The General Self-Efficacy Scale-Short Form was used to assess self-efficacy, the Health Literacy Questionnaire-short form was used to assess health literacy, the Perceived Social Support Scale-Short Form was used to evaluate perceived social support, and the Chinese version of the Family Health Scale-Short Form was used to assess family health status.

RESULTS

Family health of patients with chronic diseases had a significant positive effect on self-efficacy. Perceived social support was identified as a partial mediator between family health and self-efficacy, accounting for 59.39% of the total effect. Health literacy moderated the impact of family health on perceived social support and self-efficacy.

CONCLUSIONS

Chronic diseases have become a global health challenge, and more attention should be paid to improving the self-efficacy of the chronically ill population. Our results not only facilitate the understanding of the relationship mechanisms between family health and self-efficacy in chronic patients but can also serve as a guide for healthcare workers and policymakers who wish to provide better care for patients.

A Systematic Review of Parental Self-Efficacy in Parents of Autistic Children

Parental self-efficacy (PSE) assesses a parent's expectations and beliefs about their ability to effectively parent their child. PSE has implications for a parent's well-being, parenting practices, mental health, the parent-child relationship, and child adjustment. While PSE has been extensively examined within the broader parenting literature, the examination of PSE specifically for parents of autistic children has gained increasing attention in recent years. The following systematic review aimed to investigate the role of PSE for parents of autistic children by examining variables that predict PSE or are predicted by PSE in relation to how they align with the broader parenting literature and are unique to autism. Utilizing PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic children, (b) at least one quantitative outcome measure of PSE was utilized, and (c) the role of PSE was examined as an outcome, predictor, or variable in an explanatory model. A total of 53 studies were included in the review and the role of PSE was examined regarding family (e.g., parental characteristics, parent stress, well-being, and support) and child factors (e.g., autism symptomology, problem behaviors, interventions). Several themes emerged including a positive relationship between PSE and support, and a negative relationship between PSE and parenting stress, parent mental health outcomes (e.g., anxiety, depression), and autism symptomology. Findings were compared to the broader parenting and PSE literature to examine how increased considerations and challenges (e.g., child problem behaviors, social impairment, and caregiver strain) associated with raising an autistic child might impact PSE.

Revealing the Most Vulnerable Groups: Courtesy Stigma in Caregivers of Autistic Persons in Quebec

Introduction

Caregivers of autistic persons often face "courtesy stigma," a phenomenon by which caregivers experience stigma because of their association with a person whose disability may be stigmatized. Understanding the repercussions of this stigma is crucial not only for caregivers' mental health but also for the quality of care provided to their dependent. This study aimed to explore courtesy stigma among caregivers of autistic persons in Quebec, examining its prevalence and impact in order to identify groups that are particularly susceptible to negative outcomes.

Methods

This study used a cross-sectional online survey methodology employing quota sampling to collect responses from 194 participants. Data were collected using a computer-assisted web interview (CAWI) platform. The impact of courtesy stigma was measured in terms of care burden, mental health, and overall well-being of caregivers.

Results

The findings revealed that caregivers frequently experience rejection, isolation, and work-related challenges. Notably, caregivers' health was below average with the lowest reported health outcomes in Quebec. The caregivers who are the most vulnerable to negative outcomes included female caregivers, those aged 45 or older, financially strained households, caregivers of children requiring elevated levels of support, caregivers who isolated due to their autistic dependents, and those who experienced stigmatization directed at themselves or their children in the form of rejection.Interestingly, 60% of respondents reported that the caregiving burden was "not at all" to "somewhat" difficult, raising questions about factors that may mitigate caregiving challenges over time.

Conclusion

Negative outcomes from courtesy stigma vary depending on certain risk factors and individual characteristic. This study underscores the need for targeted public policies and interventions, particularly for those at a higher risk of experiencing the negative effects of courtesy stigma on the burden of care, overall health, and mental health. By tailoring resources and support for these priority groups, we can better address the challenges faced by families of autistic persons.

Parenting Self-Efficacy and Psychological Distress in Parents of Children with an Autism Spectrum Disorder

Research suggests that challenges associated with raising a child with an Autism Spectrum Disorder (ASD) can increase parents' risk for diminished parenting self-efficacy (PSE) and psychological wellbeing. The present study aimed to explore interrelationships between noteworthy predictors of PSE and parental psychological distress, including parental mastery beliefs and the co-parenting relationship amongst 122 Australian parents of children with autism. Results indicated that greater mastery beliefs and more favourable co-parenting relationships predicted greater PSE, and higher PSE predicted less psychological distress. PSE significantly mediated relationships between mastery beliefs and psychological distress, and between the co-parenting relationship and psychological distress. Findings have implications that can aid professionals to more effectively support parents raising children on the autism spectrum.

Social network size and mental health outcomes in youth with neuroinflammatory disorders

BACKGROUND

75 % of youth with MS report symptoms of fatigue, depression, and anxiety. Social network size (number of people in an individual's network) is known to have positive impacts on health and health behavior in pediatric populations and in individuals with multiple sclerosis.

OBJECTIVES

To estimate associations between social network size (SNS) and depression, anxiety, symptoms of post-traumatic stress disorder (PTSD), and quality of life among youth with recurrent neuroinflammatory disorders (RNI) in comparison to that of youth with monophasic acquired demyelinating syndrome (mono-ADS).

METHODS

Youth with RNI and mono-ADS were recruited from the Pediatric Neuroinflammatory Disorders Clinic at the Hospital for Sick Children between September 2020 and August 2022. After consent, participants completed the questionnaires on social network composition, depression, anxiety, PTSD, and quality of life. Descriptive and inferential analyses were conducted for differences between cohorts and correlations.

RESULTS

Youth with RNI (n = 37, Female= 22, Median age= 15, IQR= 3) and mono-ADS (n = 23, Female= 12, Median age= 14, IQR= 4.5) did not differ in: SNS, depression, anxiety, PTSD, and quality of life. Larger SNS was associated with lower anxiety (rs= -0.350, p<0.05) in youth with RNI and youth with RNI who presented anxiety disorder had significantly lower number of social contacts than those who did not (t = 2.23, p = 0.033, ES= 0.90) but not in mono-ADS. When analyzing the two cohorts grouped together, all youth who screened for anxiety had significantly smaller network size than those who did not (t = 2.06, p = 0.045, ES= 0.66). This was similar with those who screened for depression (t = 2.05, p = 0.046, ES= 0.58).

CONCLUSIONS

In youth with RNI, SNS was associated with anxiety. SNS is one important aspect of social networks that have the potential to shape mental health in youth with neuroinflammatory disorders. Future studies should focus on social network composition, strength of ties, and types of support in shaping health outcomes.

Influence of Social Support Network and Perceived Social Support on the Subjective Wellbeing of Mothers of Children With Autism Spectrum Disorder

This study explored the relations between the social support network of mothers of children with autism spectrum disorder (ASD), perceived social support, and their subjective wellbeing. The participants were mothers of children with ASD in Shanghai. Their social support network structure was explored via the nomination method. Perceived social support was measured using the Revised Social Provisions Scale for Autism (R-SPS-A), and the mothers’ subjective wellbeing was assessed using the Index of Wellbeing, Index of General Affect. A significant correlation was observed between the subjective wellbeing of mothers of children with ASD and perceived social support. Meanwhile, perceived social support was significantly correlated with the effectiveness of overall social support. Finally, perceived social support was also significantly correlated with the network size of social support. Moreover, the effectiveness of social support was significantly associated with the network size of social support and was highly significantly associated with the degree of intimacy of social support. Furthermore, the network size of instrumental support has a significant influence on all perceived social support subdimensions. Overall, social support effectiveness plays an important role in the social support network mechanism on perceived social support and subjective wellbeing in China.

Social network typology and health among parents of children with developmental disabilities: Results from a national study of midlife adults

OBJECTIVE

There is increasing interest in the role of contextual factors in promoting well-being among parents of children with developmental disabilities. This study aimed to examine whether social network types moderate the impacts of having a child with a developmental disability on parents' health.

METHODS

Using cross-sectional data from the Midlife in the United States survey (MIDUS 2 and Refresher cohorts), we analyzed a sample of 363 parents of children with developmental disabilities and 4,919 parents of children without developmental disabilities. K-means cluster analysis was implemented to identify a social network typology. Modified Poisson and negative binomial regression models estimated the effect of having a child with a developmental disability and the typology on parents' physical health (self-rated health, number of chronic conditions) and mental health (self-rated mental health, major depression).

RESULTS

The cluster analysis revealed two social network types. Parents of children with developmental disabilities were more likely to have "restricted/unsupported" networks, whereas parents in the comparison group were more likely to have "diverse/supported" networks. Social support was more important for differentiating the network types of parents of children with developmental disabilities, while social integration was more salient for the comparison group. Parents of children with developmental disabilities fared worse on all outcomes relative to parents of children without disabilities. However, the typology had a compensatory psychological effect; the diverse/supported network type conferred greater mental health benefits to parents of children with developmental disabilities than to those in the comparison group. The diverse/supported network type was also associated with better physical health, but the associations did not differ between the two parent groups.

CONCLUSIONS

The results of this study emphasize the importance of social determinants of well-being for those with exceptional parenting responsibilities. Strengthening social networks may have a particularly positive impact on such parents' mental health.

Comparing the Impact of Differing Preschool Autism Interventions on Parents in Two Canadian Provinces

Early Intensive Behavioural Intervention (EIBI) is effective for preschoolers with autism spectrum disorder (ASD). Parental measures are rarely included in EIBI effectiveness studies, yet parental distress and lower self-efficacy are associated with poorer child outcomes. Parents of preschoolers with ASD (N = 485) were surveyed at baseline (T1), one-year post-intervention (T2), and school entry (T3) about family distress/crisis, parental self-efficacy, and satisfaction with services in two Canadian provinces. Family distress/crisis decreased and parental self-efficacy increased from T1 to T2. Increases in self-efficacy were largely maintained at T3. Parents were highly satisfied with services. Greater satisfaction for those residing in the province utilizing a parent-coaching model suggests that parent involvement is associated with positive parent outcomes.

Understanding the Implications of Peer Support for Families of Children With Neurodevelopmental and Intellectual Disabilities: A Scoping Review

Background: Families are integrally involved in day-to-day caregiving of children with neurodevelopmental and intellectual disabilities (NDID). Given the widespread and increasing prevalence of children with NDID and the impact of family caregiving on psychological, social, and economic implications for both the child and family, understanding and supporting these families is an important public health concern. Objective: We conducted a scoping review on peer support networks to understand their implications on families. Considering increasing prevalence of NDID's, understanding the implications of existing networks is critical to improve and nurture future support networks that can complement and reduce the burden on existing formal support systems. Design: A comprehensive search of multiple databases was conducted. Articles were screened by two reviewers and any disagreements were resolved by a third reviewer. We explored existing research on parent-to-parent peer support networks, which included networks that developed informally as well as those that involved a formal facilitator for the group interpersonal processes. There were no limits on the study design, date and setting of the articles. We included all research studies in English that included an identifier for (i) "peer support networks," (ii) "children with neurodevelopmental and intellectual disabilities" and (iii) "family caregiver outcomes." Results: We identified 36 articles. Majority of the studies were conducted in North America, and were face to face networks. They included families of children with a wide range of NDIDs. Relevant information extracted from different studies highlighted peer support network characteristics and development process, needs of family caregivers attending these networks, factors affecting caregiver participation and the impact of peer support networks on family caregivers. These networks represent a way to strengthen family caregivers, developing resilience and social interactions. Family caregivers sharing similar experiences support one another and provide critical information to each other. Although results are encouraging, future studies incorporating improved study designs are needed to better evaluate the effectiveness of peer support networks. Furthermore, studies where peer support networks develop organically while the child is supported are warranted. Conclusion: Although results obtained are encouraging, our findings support the need for further research studies of peer support networks with better designs and more detailed description of the factors involved in the development.

What's eating you? Risk factors for poor health behaviors among family caregivers

OBJECTIVES

Overeating and obesity are major public health issues in the United States. Caregivers are at greater risk of engaging in poor health behaviors, such as emotional eating, to cope with the demands of caregiving. Using Heatherton and Baumeister (1991) Escape Theory, this study examines the associations between caregiver characteristics (i.e. age, gender, and BMI) and emotional eating, including the extent to which family strain mediates these associations.

METHOD

Data are from the MIDUS 3 dataset (N = 326) and include family caregivers of older adults and children with special health care needs (Mage = 62.88 years, SD = 10.28; 69.6% female).

RESULTS

Female caregivers were more likely than male caregivers to engage in emotional eating. Age was significantly associated with emotional eating, where increased age was associated with less emotional eating. ANCOVA results indicated that obese caregivers were the most likely to engage in emotional eating. Results also indicated that family strain significantly mediated the association between caregiver age and emotional eating. Linear regression analyses indicated that female gender predicted emotional eating, although family strain did not mediate the association between gender and emotional eating. Similarly, after controlling for family strain as a mediator, higher BMI was still significantly associated with emotional eating, suggesting that BMI is a strong predictor of emotional eating among family caregivers regardless of present family strain.

CONCLUSION

Interventions targeted at managing family strain, particularly for younger, female caregivers, could improve coping and decrease poor health behaviors.

Parental Self-Efficacy and Behavioral Problems in Children with Autism During COVID-19: A Moderated Mediation Model of Parenting Stress and Perceived Social Support

PURPOSE

COVID-19 pandemic has been verified as a public health emergency of international concern. During the special period, the health of vulnerable groups, such as children with autism, should be concerned. Some studies have been carried out to investigate the behavioral problems of children with autism during the COVID-19, but underlying mechanisms behind it is not clear. This study examines the role of parenting stress as a mediator in the relationship between parental self-efficacy and behavioral problems in Chinese children as well as the role of perceived social support as a moderator for this mediation effect.

METHODS

A total of 439 parents of children with autism (mean age=40.17, SD=5.26) were surveyed and completed five questionnaires (Conners Parent Symptom Questionnaire, Parental Self-Efficacy Questionnaire, Parenting Stress Index-Short Form 15, Perceived Social Support Questionnaire, and Neuroticism Extraversion Openness Five Factor Inventory). The statistical analyses were conducted by SPSS 26.0 and SPSS PROCESS macro.

RESULTS

Controlling for neuroticism, which is highly associated with psychological changes in parents, the study found that parental self-efficacy was significantly and negatively correlated with behavioral problems in children with autism. In addition, the relationship between parental self-efficacy and behavioral problems was mediated by parenting stress. Furthermore, parenting stress moderated the indirect relationship between parental self-efficacy and behavioral problems via perceived social support.

CONCLUSION

These results provide direct evidences for the inextricable relationship between family, social factors and behavioral problems of children with autism. It suggest that improving perceived social support to enhance parental self-efficacy is critical to buffering against parenting stress and stabilizing children with autism during the COVID-19 pandemic.

Buffering Effect of Spousal Support on Stress Levels in Mothers of Children with a Diagnosis of Autism Spectrum Disorder in Kerala, India

Objectives  Bringing up a child with the diagnosis of autism spectrum disorder (ASD) can be highly stressful. This study aimed to assess perceived stress, level of spousal support, emotion-focused coping styles, and other potentially associated factors among mothers accompanying children diagnosed with ASD for care from selected institutions in Kerala, India.

Materials and Methods  Consenting parents accompanying children to therapeutic programs in selected institutions were administered a semi structured interview schedule incorporating questions of the vernacular version of the Perceived Stress Scale (PSS-10), emotion-based coping strategies, spousal support in care of the child diagnosed with ASD, and possible-associated factors. Since internal consistency of stress and coping questionnaires were low, principal component analysis was used to extract composite variables with reasonable psychometric characteristics for stress and coping.

Statistical Analysis  Ordinal logistic regression was performed with a three-level stress category as the outcome variable.

Results  High stress was significantly associated with low spousal support (adjusted odds ratio or AOR: 2.80; 95% confidence intervals or CI 1.28–6.11), having a completely dependent child (AOR 4.24 [95% CI 1.92–9.38]), and low acceptance levels (AOR 2.60 [95% CI 1.14–5.89]). Unlike mothers with high spousal support, mothers with low spousal support were likely to have difficulty in interacting with others ( p = 0.02) and a low level of acceptance ( p = 0.05).

Conclusion  Spousal support is important to preserve psychological health in mothers of children diagnosed with ASD. Mothers with low spousal support may need interventions that help increase acceptance levels or decrease avoidant behavior.

Quality of Life Among Malaysian Parents with Autism Spectrum Disorder Child: The Double ABCX Model Approach

This paper reported the quality of life (QoL) of 260 Malaysian parents with autism spectrum disorder (ASD) and factors which influencing it. About half of these parents reported to having good QoL. The factors identified in the double ABCX model showed that perceived social support and sense of coherence (SOC) were mediated by coping strategies and had a positive direct and indirect effect on parents' QoL. These finding reiterate the importance of social support, coping skills, and strong SOC reflection skills in influencing the QoL of parents with ASD child. We therefore suggest parents to utilize the widely available social and organization supports to gain good QoL, which is also important for the wellbeing of their child.

'We're responsible for the diagnosis and for finding help'. The help-seeking trajectories of families of children on the autism spectrum

This article focuses on parents' process of seeking help for their child when a diagnosis of autism spectrum disorder is made or suspected. The study was conducted with 18 parents of children aged 4-10 years in Quebec (Canada). A trajectory-network approach was applied in order to carry out an in-depth analysis of family help-seeking trajectories based on the relationships mobilised (or neglected) over time and on life course events that may have precipitated (or hindered) help-seeking actions. Semi-directed interviews based on a name generator were conducted. A qualitative analysis of the content of family narratives was done and followed by the production of a schematic representation of each families' help-seeking trajectory. The results identified four constitutive phases during which relationships within the family, within associations, or with health and social services or education professionals helped or hindered the help-seeking process. The results show the relevance of the proposed approach for analysing the help-seeking process and better supporting families of children on the autism spectrum.

Examining the Links Between Received Network Support and Marital Quality Among Mothers of Children with ASD: A Longitudinal Mediation Analysis

Employing a cohort sequential design and multilevel modeling, the direct and indirect effects (via depressed mood, emotional wellbeing, and perceived support) of received network support on marital quality were assessed over a 7-year period (child age 7-14) on 96 married or cohabiting mothers of children with ASD. Findings indicated several significant direct and indirect effects affecting change within mothers over time, with effects varying by whether the support source was a spouse or partner, family members, or friends. In addition, one moderated mediation effect was noted, with the indirect effect of received spousal support on marital quality via perceived spousal support retaining significance only at low and moderate levels of child problem behavior severity. Study strengths, limitations, and clinical implications are discussed.

Profiles of Social and Coping Resources in Families of Children with Autism Spectrum Disorder: Relations to Parent and Child Outcomes

This study described empirically derived profiles of parents' personal and social coping resources in a sample of 207 families of children diagnosed with autism spectrum disorder. Latent Profile Analysis identified four family profiles based on socieoeconomic risk, coping strategy utilization, family functioning, available social supports, and perceptions of family-centered support. During the time of children's transition to school, parents in the most disadvantaged group experienced the highest levels of parenting stress and depression, and their children had significantly lower adaptive behaviour scores and more parent-reported behavior problems than children in the other three groups. Results highlight the need for systematic surveillance of family risk factors so that supports can be provided to enhance both parental well-being and children's developmental health.

Maternal ADHD Symptoms and Parenting Stress: The Roles of Parenting Self-Efficacy Beliefs and Neuroticism

OBJECTIVE

ADHD symptoms in adults are consistently related to stress in a variety of domains, although whether the link between ADHD symptoms and stress is direct, or accounted for or moderated by other variables, is little studied. We used a cross-sectional design to examine whether parenting self-efficacy accounts for the relation between maternal ADHD symptoms and parenting stress, and whether levels of maternal neuroticism moderate this relation.

METHOD

A nonclinical sample of mothers of 120, six- to 12-year-old children completed surveys online.

RESULTS

Maternal ADHD symptoms were associated with parenting stress, but this relation was accounted for by parenting self-efficacy beliefs. Neuroticism did not moderate the relations among these variables. Covariate analyses indicated that although parenting self-efficacy beliefs remain a robust predictor of parenting stress, the relation between maternal ADHD symptoms and parenting stress can be better accounted for by other variables.

CONCLUSION

The results highlight the importance of self-efficacy beliefs and demonstrate that ADHD symptoms are not sufficient to understand the experience of parenting.

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.

'The dots just don't join up': Understanding the support needs of families of children on the autism spectrum

Much research has documented the elevated levels of stress experienced by families of autistic children. Yet remarkably little research has examined the types of support that these families perceive to be beneficial to their lives. This study, co-produced by researchers and school-based professionals, sought to establish these families' support needs from their own perspectives. In total, 139 parents of autistic children with additional intellectual disabilities and limited spoken communication, all attending an inner-city London school, participated in an initial survey examining parental wellbeing, self-efficacy and the extent to which they felt supported. Semi-structured interviews were conducted with a subgroup of parents ( n = 17), some of whom reported in the survey that they felt unsupported, in order to gain their in-depth perspectives. The results from both the survey and the interviews suggested that existing support (particularly from formal support services) was not meeting parents' needs, which ultimately made them feel isolated and alienated. Parents who were interviewed called for service provision that adopted a relational, family-centred approach - one that understands the specific needs of the whole family, builds a close working relationship with them and ensures that they are supported at times when the parents and families feel they need it most.