Mediating Effects of Social Support on Quality of Life for Parents of Adults with Autism

A Longitudinal Mixed-Methods Characterization of Family Support from Adolescence to Young Adulthood in Autism and Other Developmental Disabilities

Although caregiving responsibilities and need for support persist and evolve across the life course in families with autistic youth or youth with other developmental disabilities (DDs), little is known about support during their child's adulthood years. Therefore, the present study used a mixed-methods approach to examine change and stability in formal and informal family support across the transition to adulthood. Caregivers of 126 individuals with autism or DDs completed a modified version of the Family Support Scale, including open-ended questions, at five time points from adolescence (age 16) into young adulthood (age 22). Caregivers reported that informal support from family members was the most frequently used, helpful, and valued source of support with relative stability across time. In contrast, the reported helpfulness, use, and value of formal support (e.g., professionals, schools) for caregivers declined over time. Qualitative content analyses revealed characteristics of highly valued support included support type (e.g., instrumental or emotional) and features of the support source (e.g., their understanding). There was a shift to valuing emotional support more than instrumental support over time, especially for caregivers of less able adults. Partnership and dependability emerged as highly valued features of the support source. These findings fit within a social convoy perspective and likely reflect the "service cliff" experienced by autistic individuals or people with DDs and their families. As social networks shrink over time and formal services are less readily available in adulthood, remaining sources of support, particularly from family members, become increasingly important.

What is in a Day? Investigating the Relationship Between Sleep Quality and Quality of Life Among Caregivers of Children With Autism

OBJECTIVE

The purpose of this study was to investigate the relationship between sleep quality and quality of life (QOL), or overall level of well-being, in caregivers of children with autism spectrum disorder (ASD) on the daily level.

METHOD

This study utilizes mobile ecological momentary assessment (mEMA) to capture daily experiences of caregivers of children with ASD over a period of 14 days. Utilizing mEMA, this study examines relations between sleep quality and QOL and the role of mood and physical health as mediators on the daily level, specifically for caregivers of children with ASD (n = 51). The data were analyzed using multilevel modeling by MLMed macro.

RESULTS

The results suggest that there is a significant positive relation between sleep quality and QOL across individuals. Surprisingly, there was a negative relation between sleep quality and QOL within individuals. The positive relationship between sleep quality and QOL across participants was explained through positive mood across individuals. Furthermore, this relationship also occurred through better physical health across and within individuals.

CONCLUSION

For caregivers of children with ASD, daily positive mood and better physical health explain the relationship between daily sleep quality and QOL. Understanding daily experiences of caregivers of children with ASD may inform interventions and practices aimed at improving sleep and its associated outcomes to ultimately improve caregiver well-being.

Brief Report: Investigating Temporal Factors in the Context of Parenting an Autistic Child

The current study was a secondary analysis of cross-sectional data collected in New Zealand. Parents (n = 291) of an autistic child completed an online survey that included temporal/demographic questions relating to the parent and child, and parent ratings of the child's core ASD symptoms, their parenting stress, and psychological well-being. Child and parent ages were related to ASD core symptoms, parenting stress, and psychological well-being, the parent-child age gap was not. Diagnostic delay was only positively associated with parent depression and negatively associated with child communication impairment. Findings indicated that temporal variables can be predictive of parent well-being and child autism symptoms. The findings suggest that focusing interventions on communication abilities may have positive impacts parental mental health.

The relationship between perceived social support and rumination among parents of children with autism: moderating effect of the degree of intervention received by children

Objective

As the number of children diagnosed with autism rises year by year, the issue of nurturing this particular group becomes increasingly salient. Parents of autistic children, as the nearest and most reliable caregivers for their children, shoulder immense psychological strain and accountability. They are compelled to confront an array of daily life challenges presented by their children, as well as endure multiple pressures such as societal scrutiny and financial burdens. Consequently, the mental health status of the parents is of utmost significance.

Methods

In this study, questionnaire survey combined with literature analysis were applied. The rumination thinking scale and the social support scale were used to investigate the relationship between social support perceived by parents of autistic children and rumination. Meanwhile, the moderating effects of intervention on children with autism were also explored. It hopes that our research would provide a basis for alleviating psychological stress and improving the mental health levels of the parents. A total of 303 parents of children with autism were collected (including 160 females and 143 males). Corresponding data analyses were conducted using SPSS 26.0.

Results

Parents of autistic children generally exhibited high levels of rumination, with significant gender differences. At the same time, the perceived social support by the parents significantly influenced their level of rumination. It showed that the higher the social support received by parents, the lower the level of rumination. More importantly, the extent of intervention received by the children had a regulating effect on rumination of their parents.

Conclusion

The personalized psychological support programs should be developed based on the actual situation of parents, to better manage the challenges presented by raising a child with autism. Our findings would provide important theoretical underpinnings and practical guidance for psychological intervention efforts aimed at families of autistic children. Moreover, these findings offer novel insights for future research, with the potential to advance the field of mental health studies concerning parents of children with autism.

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.

Fatigue among Greek Parents of Children with Autistic Spectrum Disorder: The Roles of Spirituality and Social Support

The high demands of caring for and raising a child with autism spectrum disorder on a daily basis may lead parents to physical and mental fatigue. This study aimed to assess the effect of social support and spirituality on the fatigue of parents with children with autistic spectrum disorder. A cross-sectional study with a convenience sample was conducted in Schools of Special Education in Attica (Greece). The sample consisted of 123 parents who completed The Fatigue Assessment Scale (FAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale (FACIT Sp-12) to measure the levels of fatigue, social support, and spirituality, respectively. The Pearson correlation coefficient was used to investigate the relationship between the quantitative variables. To study the effect of social support and spirituality on fatigue, multivariable linear regression was applied. The mean age was 47.3 years old, 81.3% were women, and 38.9% stated "Close/Very close faith toward God". Higher levels of total MSPSS and FACIT Sp-12 were associated with lower total FAS (r = -0.50, p < 0.001 and r = -0.49, p < 0.001, respectively). Social support and spirituality were significant predictors of fatigue.

Initial Psychometric Properties of the Catalight Family Wellbeing Scale

PURPOSE

Wellbeing refers to a person's overall happiness and satisfaction with life. Wellbeing for people with Intellectual and Developmental Disabilities (I/DD) and their families is historically significantly lower compared to the general population. It is important in the context of behavioral health treatment to not only measure the individual who is receiving treatment's overall wellbeing, but also the wellbeing of the family. The purpose of this study was to understand the initial psychometric properties of the Catalight Family Wellbeing Scale.

METHODS

The Catalight Family Wellbeing Scale was developed for families who have a child with I/DD. Caregivers of 3106 families who have a child with a diagnosed I/DD, including autism spectrum disorder, completed the scale as part of their onboarding for behavioral health treatment along with three other questionnaires. The psychometric properties including internal reliability and factor structure were completed as well as initial convergent and divergent validity.

RESULTS

Results of the analyses revealed very strong internal reliability and a three-factor structure. Validity analyses revealed a moderate positive relationship with parental self-efficacy and a moderate negative relationship with parental stress. Additionally, the sample population represents an ethnically diverse group with multiple co-occurring diagnosis in addition to I/DD.

CONCLUSIONS

The initial psychometric properties of the Catalight Family Wellbeing Scale are positive and support the use of the scale for families who have a child with I/DD across a diverse sample.

Parent perspectives on treatment: A mixed methods analysis of PEERS® for Preschoolers

LAY ABSTRACT

Autistic children have social communication differences that can contribute to difficulties making and keeping friends, as well as poor mental health (e.g. anxiety, depression). Social skills training programs for preschoolers on the spectrum have been shown to increase social functioning and improve outcomes. Parent involvement in these programs is essential, as parents are able to use the intervention strategies outside of sessions. Teaching parents skills to help their children is also thought to reduce parenting stress through empowerment, knowledge, and social support. However, we still do not know much about how parents experience social skills treatments and whether there are specific parts that are especially helpful to them. This study examined parent perspectives on the University of California, Los Angeles Program for the Education and Enrichment of Relational Skills (PEERS®) for Preschoolers, an evidence-based, group social skills intervention for autistic young children who are struggling socially. Twenty-four parents reported on their child's progress through questionnaires and participated in semi-structured interviews that asked about their experiences and perspectives 1-5 years after completing (PEERS®) for Preschoolers. Parents reported that their children displayed increased social skills and confidence after (PEERS®) for Preschoolers, while parents described feeling more positive, supported, and having greater understanding of their child and their development. Those parents who continued to use strategies taught in (PEERS®) for Preschoolers, particularly priming and preparing their child for social activities, showed greater improvements in long-term child outcomes and parenting stress. Overall, findings show that parents had a positive experience during and after PEERS® for Preschoolers, finding the program helpful in multiple ways to both their child and to themselves as a parent.

Quality of Life in Hungarian Parents of Autistic Individuals

PURPOSE

Parents of autistic individuals have been known to have a lower overall quality of life (QQL) than those of typically developing children. We present the first Hungarian large-sample study whose objective was to explore the differences in QOL between parents of autistic individuals (AS) and those of neurotypical (NT) persons.

METHODS

Based on the ABCX model we developed a questionnaire comprising standardized scales to characterize the life of parents involved. Our data came from parents of 842 individuals (ASD = 521, NT = 321) between 0 and 49 years. Battery deployed standardized instruments to examine quality of life (WHO-QQL BREF and Quality of Life in Autism questionnaire, QOLA). We assessed the families' socio-economic/demographic characteristics, parents' psychological well-being, the autistic/neurotypical individuals' characteristics, and the interventions.

RESULTS

Our data showed significantly lower QOL in parents of autistic individuals in all domains of questionnaires. We analyzed 20 relevant factors to uncover the predictors of parental QOL. We confirmed the existence of most but not all predictors present in earlier literature and identified intervention-related predictors.

CONCLUSION

Our study confirms the importance of supporting parents in their role, and of providing health and social supports that focus on quality of life, in addition to child care.

Health-related quality of life in family caregivers of autistic adults

Introduction

Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL.

Methods

N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL.

Results

Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05).

Discussion

Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.

Formal social support and quality of life of caregivers with autistic children: a large-scale nationwide survey in China

Introduction

Caregivers of children with autism spectrum disorder (ASD) were reported poor quality of life (QOL). Formal social support might improve the QOL of caregivers, however, limited research to date has focused on this association in China and formal social support for this group is conspicuously lacking. The study was aim to understand the QOL in male and female caregivers with ASD children in China and to explore the relationship between QOL and formal social support for caregivers with children with ASD through a large-scale nationwide survey.

Methods

An online questionnaire was used to conduct a cross-sectional study with a sample of 6,120 caregivers of children with ASD. Relationship between Quality of Life and several potential predictors is measured and analyzed. Quality of life were measured by Medical Study Short-Form Health Survey version 2 (Chinese version). Multivariate logistic regression analysis was used to analyze the factors affecting caregivers' QOL.

Results

The results revealed that the QOL of caregivers of autistic children in China was poor especially male caregivers. Social support was a positive predictor. More importantly, formal social support from rehabilitation institutions can improve caregivers' physical QOL. Caregivers' satisfaction with the rehabilitation institutions affecting their physical and mental QOL.

Conclusion

The formal social support provided by rehabilitation institutions plays a positive role in improving the quality of life of caregivers.

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

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

Who cares? A scoping review about the experiences of parental caregivers of autistic adults

BACKGROUND

The autistic population is growing and ageing and this also applies to the parents. Despite this, research about parental experiences is still relatively scarce. Even though studies show, compared with adults with other disabilities, parents of autistic adolescents and adults report a decrease in well-being and that caregiving is often a lifelong commitment.

METHOD

This scoping review maps, synthesises and identifies gaps in previous research as regards the experiences of parental caregivers of adult autistic children. The review was based on Arksey and Malley's framework and six databases were searched.

RESULTS

The results show how the research has focused on the well-being and consequences of daily caregiving for an American middle-class mother who co-resides with an adult son.

CONCLUSION

To enhance knowledge about formal services and service needs, more research is necessary on different welfare regimes and social contexts.

Parental Perceptions on the Importance of Nutrients for Children with Autism Spectrum Disorder (ASD) and the Coping Strategies: A Qualitative Study

Autism Spectrum Disorder (ASD) is a developmental disorder that comes with co-occurring eating behavior such as limited food varieties, selective food intake, and repetitive eating patterns, contributing to significant challenges for their parents. Many parents find mealtimes difficult and develop anxiety or stress about their child’s nutrition, health, and overall well-being. Hence, parents must equip themselves with the correct awareness and nutrition knowledge. An online open-ended semi-structured interview was conducted among fifteen parents from the community-rehabilitation program center to explore their understanding of nutrition’s importance and the possible coping strategies when facing challenges. The interview sessions were recorded, followed by three researchers’ coding processes. Data were then subjected to thematic analysis. The interview sessions suggested that the parents were aware of the autism trait eating behavior and had a general knowledge about nutrition. However, it was quite challenging when it came to preparation. Nevertheless, the parents are able to manage the challenges with unique kinds of coping strategies. In addition, a complete educational dietary intervention program including psychosocial aspects for parents is recommended for better effectiveness.

Social Network Diversity and Mental Health Among Mothers of Individuals With Autism

The present study examined the associations between networks of social relationships and psychological well-being among mothers of adolescents and adults with autism (n = 352) over a 12-year period of time. A structural equation modeling approach was used to delineate the relative impacts of network size and relationship diversity on maternal mental health, and to assess whether such effects are bidirectional. Mothers with more diverse relationships experienced reductions in depression and anxiety symptoms over time, and the psychological benefits of diversity remained after adjusting for network size. Results also suggest bidirectional links between network size, diversity, and maternal mental health. Research and clinical implications are discussed.

Perceived social support and family members of patients with mental disorders: A mixed method study

Introduction

Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders.

Materials and methods

Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis.

Findings

The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas.

Conclusion

The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members.

Short report: Social support access among single caregivers with children on the autism spectrum

BACKGROUND

Caregivers of children with autism are more likely to experience parenting stress than parents of neurotypical children. Research on parenting stress focuses on partnered caregivers and little is known about the comparative social support experienced by single caregivers.

AIM

To explore differences in perceived social support between single versus partnered caregivers of adolescent and adult children on the autism spectrum.

METHODS AND PROCEDURES

A cross-sectional, quantitative study using the ENRICHD Social Support Instrument (ESSI) as a measure of perceived social support. Univariate and multivariable analyses were conducted to examine the association between caregiver relationship status and perceived social support.

OUTCOMES AND RESULTS

There were statistically significant associations between relationship status and perceived social support, with single caregivers perceiving less social support than partnered caregivers (p < .001).

CONCLUSIONS AND IMPLICATIONS

Single caregivers of adolescent and adult children on the autism spectrum perceive less social support than partnered caregivers. Service providers should routinely evaluate the support access of this single caregivers and target support services to address the distinct needs of this population.

Burden of care and quality of life in caregivers of children and adolescents with autism spectrum disorder

BACKGROUND

Autism spectrum disorder is a neurodevelopmental disorder which is increasing across the globe. The disorder in children not only creates burden of care in caregivers but also leads to impaired quality of life of families.

OBJECTIVE

To study the burden of care and quality of life in caregivers of children and adolescents with ASD.

METHODOLOGY

Cross sectional study conducted in Child and Adolescent psychiatry outpatient services at a government centre in north India between September 2014 to August 2015. The sample consisted of 40 caregivers of children with Autism. Mean age of the caregiver's were 34.72 ± 6.32 years. Burden of care and quality of life were measured by Burden Assessment Schedule (BAS) and World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire respectively.

RESULTS

Mean burden of care on BAS was 71.73 ± 8.62 indicating quite a high degree of burden on the caregivers of ASD. Significantly higher burden was reported by caregivers belonging to low income families and caregivers of children in age group 6-12 years. A positive correlation was observed between severity of autism and burden of care in caregivers. The study also found that as the severity of symptom increases the QoL in caregiver worsens.

CONCLUSION

Caregivers of children with ASD suffer from high burden of care and impaired QoL.

Parental self-efficacy and family quality of life in parents of children with autism spectrum disorder in China: The possible mediating role of social support

OBJECTIVE

This study explored the related factors of FQOL in parents of children with ASD and examined whether social support mediates the relationship between parental self-efficacy and FQOL in parents of children with ASD.

DESIGN AND METHODS

Using a cross-sectional design, a total of 260 parents of children with ASD were recruited from September 2019 to November 2020. They completed the Beach Center Family Quality of Life Scale, the Parenting Sense of Competence Scale, and the Social Support Rating Scale.

RESULTS

Parental self-efficacy and social support explained approximately 49.5% of the variance in FQOL. After controlling for the confounding influence of parents' education level, parental self-efficacy had a direct effect on FQOL (β = 0.292, SE = 0.108, P < 0.01) and an indirect effect on FQOL (β = 0.165, SE = 0.069, P < 0.01). Effects were mediated through social support, with partial mediating effects accounting for 36.11% of the total effect.

CONCLUSIONS

Both parental self-efficacy and social support are critical to promoting FQOL, and a partial mediating effect of social support was established.

PRACTICAL IMPLICATIONS

Interventions for families with children with ASD should focus on enhancing parental self-efficacy, followed by a perceived social support and FQOL prompt.

Parenting Children with Autism Spectrum Disorder during Crises: Differential Responses between the Financial and the COVID-19 Pandemic Crisis

Parenting a child with autism can be particularly stressful and challenging, especially during periods of crises. This study focuses on parenting children with autism during the COVID-19 pandemic in comparison to the economic crisis, six years ago. We administered the same set of questionnaires (CES-D, F-COPES, PSI-SF, and WHOQoL-BREF), along with a demographic characteristic and a COVID-19-related questionnaire to the same group of parents of children with autism as we did six years ago. Results indicated that during the COVID-19 crisis, the level of parenting stress and the distress due to personal factors related to demands of parenting, were significantly lower compared to the economic crisis, while the environment facet of quality of life was significantly higher. The depressive symptomatology was elevated during both periods. Finally, when addressing the pandemic crisis, parents were more likely to passively accept problematic issues, less able to obtain social support, and less able to acquire and accept help from others. In our sample, findings differentiate the genre of crises through the parents’ responses regarding the sense of competence in their parental role, their quality of life, and the coping strategies they implemented. The study implies that each crisis must be confronted with particular responses to particular needs.

'We can't do it alone': Perceived social support in parents of children with a significant cognitive and motor developmental delay

BACKGROUND

It is generally acknowledged that parent social support is an important target for intervention. To explore the specific needs of parents of young children with a significant cognitive and motor developmental delay (SDD), we aim to chart the sources and perceived sufficiency of the social support they receive.

METHOD

Within the context of a broader project, 42 parents of a young child with SDD filled out a questionnaire on contextual factors, including information on social support.

RESULTS

The majority of parents reported to receive (more than) sufficient support. Insufficiency is primarily reported with regard to practical support. Apart from the partner, grandparents of the child were the most common source of support.

CONCLUSIONS

This study confirms the importance of professional support and work-life balance within this specific target group. Specific attention for practical support needs seems warranted considering the high basic care needs of these children.

Feelings of Loneliness and Social Dissatisfaction in Siblings of Children with Autism Spectrum Disorders: The Role of Birth Order and Perceived Social Support

Loneliness has been associated with several adverse psychosocial outcomes in childhood and adolescence. The present study aimed to investigate feelings of loneliness and social dissatisfaction in school-aged typically-developing (TD) siblings of children with an autism spectrum disorder (ASD). For this purpose, 118 siblings of children with ASD and 115 siblings of TD children and one of their parents participated in this study. Siblings of ASD-children reported higher levels of loneliness and social dissatisfaction than the controls. The hierarchical multiple regressions performed revealed that those feelings were inversely associated with being the first-born and with specific aspects of social support as perceived by the parent. The younger siblings of ASD-children seem to be in need of certain interventions beyond social support.

The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder

PURPOSE

The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality.

DESIGN AND METHODS

We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated.

RESULTS

A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%.

CONCLUSIONS

Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

Stress in Egyptian parents of children with developmental disabilities. The moderating effect of social support

BACKGROUND

Research shows that parents of children with developmental disabilities (DDs) are at increased risk for elevated stress. Child adaptive functioning as well as social supports are key factors influencing stress in parents. However, few studies have examined the interaction between these variables and their contribution to perceived stress especially in Egyptian parents.

AIMS

The present study investigated the relationship between parenting stress, child adaptive functioning, and social supports. It also examined the moderating role of social support in the relationship between child adaptive functioning and stress in Egyptian parents of children with DDs.

METHOD

Sixty-four Egyptian parents of children with DDs completed assessment measures of parenting stress, child adaptive functioning, and social supports.

RESULTS

Parenting stress was negatively associated with child adaptive functioning and informal social supports. However, there was no association between parenting stress and formal social supports. In addition, level of informal social support had a moderating effect on the relationship between child adaptive functioning and level of parenting stress.

CONCLUSIONS

The findings highlight the importance of interventions that reduce child-related stressors, particularly low adaptive functioning. Programs that address parenting stress and promote effective informal and formal social supports are crucial to help parents cope with stress.

Experiences of Parents of Specialist Peer Mentored Autistic University Students

ABSTRCTBackground: Parents continue to support to autistic university students, and consequently, experience considerable stress.Aim: To explore the experiences of parents of specialist peer mentored university students and to examine these using the ICF as a theoretical framework.Method: Thirteen semi-structured interviews were completed and analyzed using thematic analysis. Directive content analysis linked the data to the ICF core set for autism spectrum disorders (ASD).Results: Five interrelated themes emerged: The mentoring relationship is a facilitator, Developing skills for university, Mentoring changes lives, Mentoring is not a substitute for other supports, and University is an emotional rollercoaster. Specialist peer mentoring was linked to Activity and Participation (44%) and Environmental factors (32%) of the ICF core set for ASD.Conclusion: These results add to the specialist peer mentoring evidence-base, and indicate perceived benefits for autistic university students and their parents. An unintended consequence was that parents broadened their participation in activities.

Quality of Life in Caregivers of Children and Adolescents with Autistic Spectrum Disorder: Development and Validation of the Questionnaire

Studies have shown that children and adolescents with autism and their relatives present a high level of stress and more family problems, impacting parents' and caregivers' quality of life (QoL). Despite studies on this subject, there is no specific questionnaire to evaluate QoL in parents or caregivers of children and adolescents with an autistic spectrum disorder (ASD) in Brazil. Therefore, this study's primary purpose was to develop and validate a specific questionnaire to evaluate QoL in these individuals. The study was performed using the following steps: development of the ASD Parent/caregiver QoL questionnaire (autistic spectrum disorder parent/caregiver quality of life-ASDPC-QoL), subjective evaluation, validation of the questionnaire by the Delphi method, assessment of internal consistency, responsiveness, and reliability of the ASLPC-QoL, and administration of the questionnaire to 881 Brazilian ASD caregivers or parents. ASDPC-QoL comprises 28 questions divided into four domains (social, concerns, physical and mental health) with good psychometric properties (reproducibility, reliability, internal consistency, responsiveness, and validity). Our data showed that worries and physical health were the domains with the lowest scores in ASDPCA-QoL. ASDPCA-QoL did not differ among gender and age of child considering the total and all domains. Older participants (≥41 y/o) presented the best scores for social and worries domains but did not differ in other domains and the total. Parents or caregivers of ASD children diagnosed for more than three years have better mental and physical health domains than those recently diagnosed (up to 1 year) but did not differ in the total and other domains. Individuals with a partner and with the highest educational level present the best score for the social domain. Employed individuals showed better scores than unemployed ones for all domains and the total, except for worries, which did not differ. It also occurred comparing the individuals that do not use antidepressants and the ones that use them. Assessing and better understanding the QoL of caregivers is highly relevant. By understanding the social, worries, physical, and emotional health domains of caregivers, it is possible to track harmful aspects, prevent and treat pathologies, in addition to assisting in the implementation of effective public policies.

Predictors of the Quality of Life of Informal Carers of Adults on the Autism Spectrum

Carers of adults on the autism spectrum often experience high levels of stress, worry, and caregiver burden. There are few studies identifying the predictors of carer mental well-being and none have been conducted in Australia. Data from the Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Autism in Adulthood was used to test the conceptual model by Sonido et al. (Rev J Autism Dev Disord, 2019, https://doi.org/10.1007/s40489-019-00177-8 ) by (a) identifying the predictors of mental well-being for carers of adults on the spectrum, (b) using model selection to determine which predictors contribute to the model of best fit, and (c) testing for mediating relationships between the predictors. Several predictors were directly associated with carer psychological quality of life, including carer age, care recipient intellectual disability, and carer intolerance of uncertainty. Model selection strongly supported the inclusion of most clusters from the conceptual model. Some mediating relationships were found, such as care recipient depressive behaviours mediating the relationships between caregiver burden and psychological quality of life. Future studies of the conceptual model will improve understanding of the predictors of carer mental well-being and enable tailored interventions to improve the psychological health of carers of adults on the autism spectrum.

Predictors of the Quality of Life of Informal Carers of Adults on the Autism Spectrum

Carers of adults on the autism spectrum often experience high levels of stress, worry, and caregiver burden. There are few studies identifying the predictors of carer mental well-being and none have been conducted in Australia. Data from the Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Autism in Adulthood was used to test the conceptual model by Sonido et al. (Rev J Autism Dev Disord, 2019, https://doi.org/10.1007/s40489-019-00177-8 ) by (a) identifying the predictors of mental well-being for carers of adults on the spectrum, (b) using model selection to determine which predictors contribute to the model of best fit, and (c) testing for mediating relationships between the predictors. Several predictors were directly associated with carer psychological quality of life, including carer age, care recipient intellectual disability, and carer intolerance of uncertainty. Model selection strongly supported the inclusion of most clusters from the conceptual model. Some mediating relationships were found, such as care recipient depressive behaviours mediating the relationships between caregiver burden and psychological quality of life. Future studies of the conceptual model will improve understanding of the predictors of carer mental well-being and enable tailored interventions to improve the psychological health of carers of adults on the autism spectrum.

Mental Health and Resilient Coping in Caregivers of Autistic Individuals during the COVID-19 Pandemic: Findings from the Families Facing COVID Study

Many caregivers of autistic people experience mental health issues, and the impact of disruptions due to COVID-19 may present additional challenges for these individuals. This study characterized caregiver stress, anxiety, and resilient coping during COVID-19 and investigated the impact of COVID-19 disruptions, demographic variables, and resilient coping on mental health. The majority of caregivers reported some degree of disruption associated with COVID-19, and more than half reported moderate levels of stress and high anxiety. Resilient coping did not emerge as a moderator between COVID-19 disruptions and caregiver mental health, but instead had a direct effect on outcomes. Future research is needed to understand additional factors impacting the mental health of caregivers of autistic people during the COVID-19 pandemic.

Inclusion, Exclusion and Isolation of Autistic People: Community Attitudes and Autistic People's Experiences

There is limited research examining the inclusion of autistic people in their local communities. This paper reports on two Australian studies which explored this gap, focusing on both autistic people's experiences and non-autistic people's attitudes towards autistic individuals. Study One was conducted with primarily non-autistic people (n = 2,383), and Study Two with primarily parents and carers of autistic people (n = 1,297 people). The majority of non-autistic adults perceived discrimination against autistic people in the community; consistent with the experiences of autistic people and their carers. Of particular concern was more negative attitudes towards, and experiences of, autistic adults. There is an urgent need to improve society's acceptance and inclusion of autistic people of all ages.

Stress and distress in New Zealand parents caring for a child with autism spectrum disorder

The aim of this cross-sectional study was to identify predictors of the mental health of parents of a child with autism spectrum disorder (ASD). A convenience sample of 658 parents residing in New Zealand completed an online questionnaire. Participants responded to questions probing parent and child characteristics, child ASD severity (the Autism Impact Measure: AIM), parenting stress (the Autism Parenting Stress Index: APSI), and parent mental health (the General Health Questionnaire: GHQ-28). The results indicated that the majority of the parents in our sample have reached clinical levels of psychiatric distress, in particular anxiety. Parent and child characteristics were poor predictors of parental mental health problems. Parenting stress, however, was found to be a significant predictor, also acting as a mediator variable between child ASD symptom severity and parental mental health problems. Our findings are interpreted in relation to their significance to clinical practice.

Empirical evaluation of the association between daily living skills of adults with autism and parental caregiver burden

BACKGROUND

Despite the joy of parenting, the burden of daily caregiving for children with autism spectrum disorders (ASD) can be overwhelming and constant. Parents can expect to provide enduring care for their children with ASD. Given that the majority of individuals with autism spectrum disorders (ASD) remain in their family homes well into adulthood, often the need for assistance with activities of daily living (ADLs) is placed on parents. Providing ongoing support to adult children who have difficulty with completing ADLs can increase parental caregiving demands. Therefore, the purpose of this study was to examine the relationship between the ability of adults with ASD to perform ADLs with parental perceptions of caregiver burden.

METHODS

Quantitative analysis of cross-sectional multi-state data gathered electronically using Qualtrics from 320 aging parents of adults with ASD was conducted. Regression models were fit to examine the association of ADL challenges with total caregiver burden and its four domains (emotional, financial, time dependence, and developmental).

RESULTS

Parental perceptions of caregiver burden decreased, particularly time dependence and developmental burden, when adult children were less dependent in ADLs, even after adjusting for parental health and behavioral challenges.

CONCLUSIONS

Findings support the need for family-centered interventions to improve the capacity of adults with ASD to perform ADLs independently.

The Types and Functions of Social Supports Used by Parents Caring for a Child With Autism Spectrum Disorder

The challenges faced by parents caring for a child with Autism Spectrum Disorder (ASD) can amplify parenting stress, though the impacts of these challenges can be alleviated by social supports. A sample of 674 parent volunteers completed a survey probing the types of social supports currently being used, what function (i.e., tangible, emotional, financial, informational) they judged them to perform, and how each of the utilised supports reduced parenting stress and was considered helpful. Results indicated that informal social supports and social media were perceived as more helpful than formal supports, which were typically perceived in a neutral manner by parents. Overall, the study indicates that addressing the support needs of parents of a child with ASD remains a priority.

A Snapshot of Social Support Networks Among Parental Caregivers of Adults with Autism

This study provided a description of types and dimensions of informal and formal social support among aging parental caregivers of adult children diagnosed with autism spectrum disorder (ASD). Parents participated in a web-based survey regarding use of and satisfaction with social support services for parents or their adult children. Results indicated that many parents participated in autism support groups (27.5%), with psychiatric services (48.8%), counseling (40.6%), and financial assistance (39.7%) the most commonly used formal social supports. Emotional support (88.8%) and informational support (67.5%) were the most common informal social supports used. Professionals who are working with parental caregivers and their adult children diagnosed with ASD should be aware of available social support services to help them find needed services.

Social support and family quality of life in Chinese families of children with autism spectrum disorder: the mediating role of family cohesion and adaptability

BACKGROUND

The current study examined the interrelations among social support, family quality of life (FQOL), and family cohesion and adaptability in Chinese families of children with autism spectrum disorder (ASD).

METHODS

A sample of 163 caregivers of children with ASD in China were surveyed with the Social Support Rating Scale, Beach Center Family Quality of Life Scale, and Chinese version of Family Adaptability and Cohesion Scale II, respectively. We used structural equation modeling to examine the mediating role of family cohesion and adaptability on the relationship between social support and FQOL.

RESULTS

The results indicated that social support had a positive impact on FQOL and that family cohesion and adaptability completely mediated the relationship between social support and caregivers' satisfaction on FQOL.

CONCLUSIONS

Facilitating family cohesion and adaptability by providing social support may be beneficial to help families of children with ASD improve their FQOL. The findings identified the need for developing targeted interventions for this population.

In-the-moment experiences of mothers of children with autism spectrum disorder: a comparison by household status and region of residence

Purpose: This study compared the in-the-moment experiences among mothers of children with Autism Spectrum Disorders (ASD) by their household status (i.e., single versus coupled) and region of residence (i.e., regional versus major city area).Methods: An experience sampling method was employed to collect data, and a total of 40 mothers used an iOS device to record activity types and in-the-moment experiences for one week during school term. Mann-Whitney U test and multilevel analysis were conducted to compare the experiences of these mothers.Results: The analyses found the following results: 1) mothers spent most time in childcare and least time in self-care activities; 2) coupled mothers were more likely to feel supported; 3) coupled mothers were less likely to feel supported in domestic tasks; 4) mothers from major city were more likely to feel challenged in self-care activities; and 5) mothers from major city were more likely to feel supported in productivity tasks.Conclusion: Limited but significant differences between single and coupled mothers, as well as mothers from regional and major city areas, were found. Future research direction and service provisions were suggested.Implications for rehabilitationThis study shows that all mothers spent the most time on childcare and the least amount of time on self-care activities.In-the-moment experiences between single and coupled mothers, as well as mothers from major cities and mothers from regional areas, differ somewhat; however, this study builds evidence to support that these mothers' experiences are similar.The result of the study indicates that single mothers require extra support as they carry similar levels of responsibilities as coupled mothers, but without the support of a partner.Promoting a sense of control may assist all mothers to fully engage in parenting activities.

Informal Support, Health, and Burden Among Parents of Adult Children With Autism

BACKGROUND AND OBJECTIVES

Many adults with autism spectrum disorders require lifelong reliance on caregiver support. As these caregivers age and experience health challenges, social support can be critical. This study seeks to understand if caregiver health moderates the relationship between informal social support and caregiver burden.

RESEARCH DESIGN AND METHODS

A total of 320 parents (age 50+ years) of adult children diagnosed with ASD were recruited from autism organizations and support groups and completed a web-based survey. Separate moderation analyses were used to determine if caregiver health was moderating the relationship between informal social support and composite caregiver burden, as well as the separate domains of developmental, time dependence, emotional burden, and impact of caregiving on finances. For each analysis, perceptions of available informal social support were the independent variable, composite and domains of caregiver burden were dependent variables, and parents' self-reported general health was the moderating variable.

RESULTS

Caregiver health had a statistically significant moderating effect when predicting the relationships between informal social support and composite caregiver burden, as well as time dependence burden and impact of caregiving on finances.

DISCUSSION AND IMPLICATIONS

Increased attention should be focused on supporting the current and future needs of both aging caregivers and their adult children with ASD. Future research on the dynamics of social support, health, and burden is also urgently needed to address the growing number of aging caregivers of adults diagnosed with ASD.

The Cold Shoulder or a Shoulder to Cry on? Mechanisms of Formal and Informal Social Support in the ASD Parenting Context

The underlying mechanisms by which social support exerts its (typically) positive effects on parental wellbeing are still being investigated in the autism spectrum disorder (ASD) context. Parents (n = 674) of a child with ASD responded to questions probing parenting stress, parent psychological health, their child's ASD symptoms, and the types of social supports they were currently utilising. Hierarchical multiple linear regression analyses examined whether social support moderated or mediated (or neither) the relationships between: (a) parent-rated child ASD symptoms and parenting stress, and (b) parenting stress and parent psychological health. The main findings were that none of the mediating models reached statistical significance, while 7/20 moderation analyses were significant, though significance was dependent upon how social support was operationalised.

Childhood Caregiving Roles, Perceptions of Benefits, and Future Caregiving Intentions Among Typically Developing Adult Siblings of Individuals with Autism Spectrum Disorder

Typically developing siblings (TDS) of individuals with Autism Spectrum Disorder (ASD) frequently serve as caregivers during childhood, known as parentification, and primary caregivers for siblings in adulthood. In order to evaluate mechanisms linking these roles, we surveyed emerging-adult TDS (N = 108) about childhood parentification roles caring for parents and siblings, current perceptions of benefits associated with ASD and with engaging in parentification, and intention to provide future caregiving. We hypothesized that parent-focused parentification would negatively impact caregiving intention via perception of decreased benefits whereas sibling-focused parentification would positively impact intention via perception of increased benefits. Results indicate that parent-focused parentification is common and associated with fewer perceived benefits of caregiving and less intention to provide future caregiving. Prevention implications are discussed.

Correlates of quality of life in mothers of children with diagnosed epilepsy

Contrary to a plethora of studies on the quality of life (QoL) of parents caring for children with chronic conditions, information regarding parents of children with epilepsy remains limited. The main purpose of the current study was to explore associations between children's biomedical characteristics, mothers' sociodemographic characteristics, mothers' situational factors, and QoL among mothers of children with epilepsy. One hundred and fifty mothers of children with epilepsy completed valid and reliable measures. The study was conducted at a large outpatient clinic for children with epilepsy in a central hospital in southern Israel. Sense of mastery and optimism emerged as significant predictors of all four domains of QoL; self-rated health (SRH) and mothers' socioeconomic status were significant predictors of three QoL domains; mothers' sleeping disturbances and children's behavioral problems predicted one QoL component. These results highlight the pivotal role that mastery and optimism play in securing the QoL of mothers caring for children with epilepsy. Moreover, mother's socioeconomic status and SRH should also be screened to deal with possible socioeconomic deprivation. In addition, health professionals should screen mothers and children for sleeping disturbances, and provide information about sleep hygiene. Psychosocial interventions need to be developed and offered to parents, in an attempt to address the social and behavior problems of children with epilepsy.

Needs, strain, coping, and mental health among caregivers of individuals with autism spectrum disorder: A moderated mediation analysis

This study investigated the relationships among caregiving strain, coping, and mental health among caregivers of individuals with autism spectrum disorder (ASD) and the mediational moderation of caregiver needs. One hundred and ninety-three caregivers of individuals with ASD completed an online survey. Results showed that maladaptive coping behaviors were significant in mediating the relationship between strain and mental health. Professional service and emotional caregiving needs moderated the relationship between maladaptive coping and mental health at times of high caregiving strain, but not involvement, health information, and instrumental support needs. Results highlighted the negative effect of maladaptive coping, as well as professional service and emotional support needs were salient in moderating coping and mental health in times of high caregiving strain.

Impact of Caregiver Burden on Quality of Life for Parents of Adult Children With Autism Spectrum Disorder

This study sought to examine the impact of time, developmental, emotional, and financial burdens on the quality of life (QOL) for parents (aged 50+) of an adult child with autism spectrum disorder (ASD). Participants ( N = 320) completed a web-based survey and could indicate interest in participating in one-on-one follow up interviews. Multiple linear regression analysis indicated that two variables, developmental burden and impact of caregiving on finances, were statistically significant predictors of parents' QOL. Developmental burden was the strongest predictor of parental QOL, demonstrating an inverse relationship. Qualitatively, reported findings indicated that many parents were experiencing all four burdens. Findings highlighted the need to provide services and supports to alleviate burden among aging parents of adult children with ASD.

Cross-Cultural Revision and Psychometric Properties of the Chinese Version of the Autism Spectrum Rating Scale (2-5 Years)

Background: No sufficient biomarkers are available for early identification of autism in the general population. Currently, the diagnosis of ASD depends on behavioral assessments. A useful screening tool can help to detect early autistic symptoms and provide children an early opportunity for ASD-related interventions. This research aimed to assess cross-cultural adaptation and psychometric properties of the autism spectrum rating scale (ASRS) under the Chinese cultural environment.

Methods: Participants were recruited from 17 kindergartens and 5 special education schools across five cities (Shanghai, Guangzhou, Changsha, Chengdu, and Harbin) in China. A total of 2,181 kindergarten children and 207 ASD cases participated in this study. Mplus 7.03 was utilized to conduct exploratory factor analysis, followed by adaptive modifications to construct the revised Chinese version of the ASRS (RC_ASRS).

Results: The result showed that 62 items comprised a two-factor structure; Factor 1 (social communication, SC) included 21 items, and Factor 2 (unusual behavior, UB) included 41 items. Cronbach's alpha ranged from 0.87 to 0.91 within the RC_ASRS. The total score and the SC and UB scores were significantly higher in ASD cases than in kindergarten samples (Cohen's d ranged from 0.82 to 2.72). The total RC_ASRS score showed an area under the curve (AUC) of 0.95 (95% CI: 0.93–0.97). With a total score cut-off ≥ 60, the RC_ASRS is an excellent tool to identify ASD cases from Chinese kindergarten children (sensitivity = 88.6%, specificity = 84.5%).

Conclusions: The RC_ASRS has excellent psychometric properties and is a reliable, useful tool for early ASD screening among Chinese children.

Aging in Place in Every Community: Social Exclusion Experiences of Parents of Adult children With Autism Spectrum Disorder

This article offers an examination of aging processes of lifelong caregivers and the possibilities for social exclusion place experienced by parents of adult children with autism spectrum disorder (ASD). This study of parental caregivers ( n = 51) sheds light on how enduring caregiving roles can lead to social exclusion in three ways: misunderstanding of ASD and stigma, the complexity of the caregiving roles, and impact on daily routines including challenges with long-term planning for both the adult children and the parental caregivers. Implications for practice to address social exclusion include education and building greater communication ties among family member for family members and advocacy for more and higher quality services including respite care. This article concludes with discussion of the impact of this aging, yet caregiving population and the need for knowledge about aging processes and anticipating aging for these caregivers.