Subjective Burden and Depression in Mothers of Children with Autism Spectrum Disorder in India: Moderating Effect of Social Support

The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study

PURPOSE

To investigate the factors linked to the caregiving burden among family caregivers of pediatric patients with fractures.

METHODS

This descriptive cross-sectional research used non-probabilistic sampling involving 200 pediatric patients (0-14 years) with fractures and their family caregivers. Data was collected between November 2019 and June 2020. The Chinese version of the Zarit Burden Interview (ZBI) and Simplified Coping Style Questionnaire (SCSQ) assessed caregiving burden and coping styles. We examined clinical data of patients and caregivers, identifying factors influencing caregiving burden by integrating findings from parallel studies, and conducted statistical analyses on these factors.

RESULTS

Most family caregivers in this study were women (80.5%), with mothers comprising 56% of the total. The average ZBI score was 40.65 ± 17.27, and 81.5% of caregivers had moderate or severe burden. Factors associated with caregiving burden included caregiver gender, co-caregivers, positive and negative coping scores, and monthly income. The significant factors that were identified accounted for approximately 42.4% of the variability in the caregiving burden.

CONCLUSIONS

This study concluded that family caregivers of pediatric patients with fractures often experience moderate to severe burdens, especially female caregivers, those without co-caregivers, using negative coping strategies, and from low-income families. Thus, it is essential to provide these families with professional information, policy support, and affordable, effective care services.

IMPLICATIONS TO PRACTICE

Healthcare professionals should prioritize addressing the caregiving burden of family caregivers of pediatric patients with fractures. Nurses can actively improve the health of these pediatric patients and ease parental burden by providing information about social support systems.

A capacity-building intervention for parents of children with disabilities in rural South India

BACKGROUND

A disability service organization piloted a parent capacity-building intervention for parents of children with developmental disabilities in rural South India.

AIMS

To examine the impact of this parent capacity-building group intervention on parent empowerment, peer support, social inclusion, advocacy skills, and the factors influencing these outcomes.

METHODS AND PROCEDURES

A qualitative study recruited 37 participants from 17 parent groups through convenience sampling. Six focus groups occurred six months post the start of this intervention and explored these parents' experiences with the groups and their perceived impacts.

OUTCOMES AND RESULTS

Qualitative analysis yielded four main themes and corresponding sub-themes: peer support (feeling peaceful and supported, building self-efficacy), social inclusion (space to share, acceptance and identity), knowledge sharing (increasing awareness, accepting advice), and advocacy (building confidence, making requests). Participation in parent groups provided participants with opportunities to find peer support, utilize knowledge sharing, feel socially included, and build advocacy skills.

CONCLUSIONS AND IMPLICATIONS

This study provides a greater understanding of the impact and benefits of parent capacity-building interventions in low-resource settings. Results will improve this intervention and guide other organizations in creating similar programs.

WHAT THIS PAPER ADDS

This paper adds perspectives of parents who are caregivers of children with developmental disabilities in rural South India. More specifically, this paper highlights the impact of a parent-focused intervention in group settings in both rural and urban areas. Parent support group interventions are not common in India and low- and middle-income countries and there is a paucity of literature describing these interventions and their impact. In this study, parents described a need for multifaceted interventions to support their child in the community. These parent groups provided space for caregivers of children with developmental disabilities to make connections, feel validated, and grow confidence to utilize new knowledge or advice shared by other parents to further enhance their lives. Further, parent-group settings provide opportunities to build advocacy skills through timely discussions. Parents reported an increase in feelings of acceptance within the group itself but not within the wider community. This highlights the need for involving the wider community in interventions to promote integration for families with children with disabilities.

Factors predicting depressive symptoms in parents of children with autism spectrum disorder in eastern China

BACKGROUND

Parents of children with autism spectrum disorder (ASD) are at a higher risk of depression than parents of typically developing children and those of children with other developmental disorders. Depression affects the well-being and quality of life of parents of children with ASD and has serious consequences for the long-term health outcomes of children with ASD. Therefore, this study explored the current status of depressive symptoms in parents of children with ASD in eastern China and further analyzed multiple aspects of the predictors of depressive symptoms.

METHODS

A multicenter cross-sectional survey was conducted among parents of children with ASD in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China. A structured questionnaire that focused on child-related factors, parent-related factors, depressive symptoms, courtesy stigma, and social support was used to obtain data. Binary logistic regression was used to identify the independent predictors of depressive symptoms in parents of children with ASD.

RESULTS

A total of 409 parents of children with ASD were recruited, of whom 18.8% had depressive symptoms. Parents of children with ASD who raised a child who spoke few to no words (odds ratio [OR]: 2.747, 95% confidence interval [CI]: 1.026-7.357), claimed a high economic burden (OR: 3.215, 95% CI: 1.234-8.379), reported no change or increased severity of ASD in their children (OR: 2.518, 95% CI: 1.108-5.720), and those with a higher courtesy stigma score (OR: 1.189, 95% CI: 1.093-1.294) were more likely to have depressive symptoms. Conversely, parents of children with ASD who were employed (OR: 0.427, 95% CI: 0.201-0.907), satisfied with their current marital status (OR: 0.429, 95% CI: 0.221-0.834), and those with a higher social support score (OR: 0.973, 95% CI: 0.950-0.996) were less likely to have depressive symptoms.

CONCLUSIONS

Depressive symptoms are common in parents of children with ASD in eastern China. Therefore, screening and intervention for depressive symptoms in parents of children with ASD is necessary, especially for those with high-risk factors.

Spring is not yet here: raising a child with ASD in rural southwest China

PURPOSE

This study aims to reveal the parenting experiences of parents of children with autism spectrum disorder (ASD) in rural southwest China under the framework of ecological systems theory.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 21 parents of children with ASD from rural southwest China and the interview data were analyzed using the three coding steps of the grounded theory method, namely open, axial, and selective coding.

RESULTS

The results showed four themes: challenges from within the family; relationships between parents, the school, and the community; scarcity and low accessibility of available resources and services; the culture of discriminating against people with disabilities and the loss of eligibility for welfare. The mismatch between the needs of families of children with ASD and the resources available in social-environmental systems is the major issue faced by parents.

CONCLUSIONS

Raising a child with ASD in rural southwest China is affected by the interactions between the families and the internal structures in different environmental systems. The culture of discriminating against people with disabilities formed in the macrosystem could be the essential factor that affects the smoothness of the parenting process of children with ASD.

Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco

LAY ABSTRACT

It is very important to understand the needs of caregivers to be able to empower caregivers and to develop or improve services around the world. Therefore, research in different regions is needed to understand differences in caregivers needs between countries, but also between areas within countries. This study investigated differences in needs and service use between caregivers of autistic children in Morocco, living in urban and rural areas. A total of 131 Moroccan caregivers of autistic children took part in the study and responded to an interview survey. The results showed both similarities and differences between urban and rural living caregivers' challenges and needs. Autistic children from urban communities were much more likely to receive intervention and attend school than children from rural communities, even though age and verbal skills of the two groups of children were comparable. Caregivers expressed similar needs for improved care and education, but different challenges in caring. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to respond to regional needs, resources, and practices. In addition, the results showed the importance of addressing challenges as experienced by caregivers such as costs related to care, barriers in access to information, or stigma. Addressing these issues may help reduce both global and within-country differences in autism care.

Vulnerabilities Prompting Use of Technology and Screen by Mothers of Autistic Children in India: Lived Experiences and Comparison to Scientific Literature

Technology and screen media has its place in every home, yet the influences of the same are less known. This research aims to explore the vulnerabilities that prompt the mothers to use screen media for their children, prior to a diagnosis of autism for their child. It also aims to explore literature the influence of screen media on speech and language development in children. This study combined semi-structured interviews with 16 mothers of autistic children in Southern India and a scoping literature review that resulted in 24 articles. The literature refers to a positive influence when co-viewing with the child, and it predominantly highlights improvements in speech and not in language. The interviews revealed that screens were used as a means of support, a language and learning development tool, or as a calming technique. Thus, the study shows that the mothers resorted to screen use for their children more out of helplessness, and not as an informed choice. Mothers of autistic children clearly express their vulnerabilities and indicate feelings of being lost without advice, with regard to use of screen-time. This suggests a need for more research into how they can be supported.

Courtesy stigma among primary caregivers of children with autism spectrum disorder in eastern China

Introduction

The experience and perception of stigma is a common problem among primary caregivers of children with autism spectrum disorder (ASD), and has a profound adverse impact on primary caregivers and children with ASD; however, few studies have explored courtesy stigma among primary caregivers of children with ASD in the Chinese context. The aim of this study was to explore the status of courtesy stigma among primary caregivers of children with ASD in Lianyungang, Jiangsu Province, Eastern China, and to conduct in-depth analysis of its predictors from multiple perspectives.

Methods

An institution-based multi-center cross-sectional survey was conducted in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China, from October 2022 to February 2023. A structured questionnaire to assess child-related factors, primary caregiver-related factors, courtesy stigma, general self-efficacy, and social support, was used to collect data. Predictors of courtesy stigma among primary caregivers of children with ASD were identified by linear regression.

Results

A total of 428 primary caregivers of children with ASD were recruited. The mean ± standard deviation (SD) score for courtesy stigma was 7.49 ± 4.13. Multiple linear regression analysis revealed that primary caregivers of children with ASD who were not too satisfied with their current marital status (β = 1.21, 95% CI: 0.34-2.08, p < 0.05) were more likely to have a high courtesy stigma; however, significantly lower courtesy stigma was observed in primary caregivers of children with ASD who were not picky eaters (β = -1.33, 95% CI: -2.08 - -0.58, p < 0.05), and who reported low level challenge in caring for children with ASD (β = -1.16, 95% CI: -2.20 - -0.12, p < 0.05), good general self-efficacy (β = -0.16, 95% CI: -0.25 - -0.06, p < 0.05), and good social support (β = -0.04, 95% CI: -0.08 - -0.01, p < 0.05).

Conclusion

There is a high level of courtesy stigma among primary caregivers of children with ASD in eastern China, and it is affected by numerous factors. More resources should be directed to groups that are more likely to experience stigma.

A study of attitudes and experiences relating to alcohol use in a community of family farmers from Southern India

Problematic drinking is found to be common among Indian farmers. This study aims to improve our understanding of the causes, consequences, and culture surrounding drinking in Indian farming communities. 36 semi-structured interviews with male and female farmers were thematically analyzed. Problematic drinking in male farmers was found to significantly impact farmer's relationships, work, finances, and health, and to be related to spousal abuse and neglect. Drinking to cope with mental and physical pain was common, and stigma around drinking appears to be a barrier to social support. Implications for future research and treatment efforts for Indian farmers are discussed.

Qualitative analysis of social support for caregivers of children with neurodevelopmental disorders in South India

BACKGROUND

Despite its importance, limited formal social supports are available for caregivers of children with neurodevelopmental disorders (NDDs) navigating rehabilitation and caregiving in low-resource contexts. The current study investigates the social support sources and coping processes of caregivers of children with NDD at a rural rehabilitation center in South India. An emphasis is placed on interactions between the study participants and families of other children with NDD receiving services at the center.

METHODS AND PROCEDURE

A constructivist grounded theory methodology was adopted. Data analysis was based on data obtained from twenty-two parents obtaining rehabilitation services in the center over two phases.

OUTCOMES AND RESULTS

Constant comparative analysis of caregivers' perceptions and experiences generated a theoretical framework of the long-term emergence of social support and coping, comprising three subcategories: accessing service, gaining acceptance and experiencing support at a grassroots level, and coping at a grassroots level.

CONCLUSIONS AND IMPLICATIONS

Findings illustrate the need for and benefit of supporting caregivers of children with NDD to find informal social support. Critical considerations for rehabilitation providers, researchers, and policymakers to facilitate caregivers' formal and informal social support and coping skills are discussed.

Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review

OBJECTIVES

To identify caregiver and children factors associated with caregiver burden on primary caregivers of children with cerebral palsy (CP).

DESIGN

Systematic review DATA SOURCES: Seven electronic databases, including PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, CINAHL and Embase, were systematically searched up to 1 February 2023.

ELIGIBILITY CRITERIA

Original observational studies reporting caregiver burden and related factors among caregivers of children with CP.

DATA ABSTRACTION AND SYNTHESIS

Two reviewers independently screened results and assessed the quality of studies. Title, abstract, full-text screening and data abstraction were done independently by two reviewers. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The quality of evidence for factors was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

16 articles were included in the review. All studies were cross-sectional and examined caregiver-reported burden measures. The Zarit Burden Interview was the most commonly used questionnaire. Depression of caregiver and severity of illness in children with CP were moderate quality of evidence for factors contributing to caregiver burden.

CONCLUSIONS

Higher caregiver burden is associated with more depressive feelings and worse life quality of the caregiver, and with more severe physical disability of the children. Future studies should focus on high-quality longitudinal research and appropriate assistance to reduce caregiver burden and improve the quality of caregiving for children with CP.

PROSPERO REGISTRATION NUMBER

CRD42021268284.

Posttraumatic growth and rumination among parents of children with autism spectrum disorder: The mediating role of social support

Although rumination and social support are regarded as essential predictors of posttraumatic growth (PTG), few studies have explored the associations among PTG, rumination, and social support in parents of children with autism spectrum disorder (ASD). This study examined whether social support mediates the relationship between rumination and PTG. Cross-sectional questionnaire data were collected from 385 parents of children with ASD from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Event Related Rumination Inventory, and Social Support Rating Scale. Path analyses showed that subjective support partially mediates the relationship between deliberate rumination and PTG (β = 0.073, P &lt; 0.001), and indirect effects account for 15.30% of the total effects. In addition, a negative direct path was found between intrusive and PTG because of the suppression effect of subjective support (β = -0.110, P &lt; 0.01), and indirect effects accounted for 80% of the direct effects. For future studies, it underscores the essential role of subjective support and rumination in promoting PTG in parents of children with ASD.

Correlates of Caregiving Burden among Bedouin-Muslim Mothers of Children Diagnosed with Epilepsy

A paucity of research exists on caregiving burden (CB) and the factors associated with it among minority groups, such as Bedouin mothers of children diagnosed with epilepsy (CDE). The aim of this study was to explore associations between CB and care-recipients' characteristics, contextual factors, and caregivers' characteristics among those mothers.

METHODS

A total of 50 mothers completed self-report questionnaires while visiting pediatric neurology outpatient clinic centers, using valid and reliable measures.

RESULTS

Bivariate associations were found between social support, number of medications, and CB. General self-efficacy and place of residence emerged as significant predictors of caregiver burden.

CONCLUSIONS

These findings provide health professionals with a better understanding of the factors that should be assessed in order to address caregiver burden among Bedouin mothers of CDE. Understanding the unique characteristics and culture of the Bedouin community can help professionals in targeting caregivers with a lower sense of self-efficacy, and those that reside in Bedouin cities, in order to reduce their caregiving burden.

Emotional and behavioral problems in children with autism spectrum disorder and psychological distress in their parents in Saudi Arabia: The moderating effect of marital relationship satisfaction

BACKGROUND

There is a well-established association between emotional and behavioral problems in children with Autism Spectrum Disorder (ASD), unmet family support needs, and psychological distress in their parents. However, no studies hypothesized a buffering effect of marital relationship satisfaction.

AIM

The aim of this research was to investigate the moderating effect of marital relationship satisfaction in the associations among emotional and behavioral problems in children with ASD, unmet family support needs, and anxiety and depression of their parents in the context of Saudi Arabia.

DESIGN AND METHODS

This cross-sectional study recruited parents from five rehabilitation centers for children with ASD in Saudi Arabia. Data were collected with surveys completed online. A sample of 93 parents (84% female, 4.3% were 24 or younger, 36.2% between 25 and 34 years old, 40.5% between 35 and 44, and 14.7% between 45 and 54) of children with ASD was obtained. Two models of multiple regression analysis were performed to determine the relationships.

RESULTS

About 56% of the parents had anxiety symptoms and 60% had depressive symptoms. Emotional and behavioral problems of children and higher levels of unmet family support needs were associated with higher levels of anxiety in parents, and adaptive behavior of children was associated with reduced levels of depression in parents. Relationship satisfaction moderated the impact of children's emotional and behavioral problems on parental anxiety.

CONCLUSION AND IMPLICATIONS

The study highlighted the importance of marital relationship satisfaction in buffering the negative effects of ASD-related factors of children on the psychological well-being of their parents.

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.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Repercussion of the implementation of the Picture Exchange Communication System - PECS in the overload index of mothers of children with Autism Spectrum Disorder

PURPOSE

The aim of this study was to analyze the repercussion of the implementation of PECS on the burden index of mothers of children with Autism Spectrum Disorder (ASD).

METHODS

This was a longitudinal study (CEP 0403/2017). The sample consisted of 20 mother and child with ASD. The mothers were on average 41 years and 5 months and the children were 7 years and 2 months old. Fifteen children were male and five were female. The brazilian version of the Burden Interview scale was applied to verify the level of caregiver burden. The Autism Behavior Checklist (ABC) was applied to the analysis of non-adaptive behaviors and to analyze the lexical repertoire: Auditory and Expressive Vocabulary Tests. The PECS Implementation Program was composed of 24 sessions of individual speech therapy with the active presence of mothers. At the end all children and mothers were reevaluated with part of the instruments.

RESULTS

There was a tendency to reduce maternal overload indexes after the implementation of the PECS. There was a significant decrease in non-adaptive behaviors and an increase in the expressive and auditory vocabulary indexes of the children at the final moment of the study. We did not observe a significant correlation between the degrees of overload with age, schooling and intellectual quotient of children, nor schooling and maternal socioeconomic status.

CONCLUSION

It was possible to analyze the repercussion of the implementation of the PECS on the burden of mothers of children with ASD assisted by the Program.

Feasibility of a school-based mental health program implementation to improve the status of depression and quality of life of mothers of children with autism spectrum disorders in urban Bangladesh: MENTHOL study

BACKGROUND

We assessed the feasibility of implementing psychological counseling services (PCS) for mothers of children with autism spectrum disorders (ASD) integrated within special education settings in urban Bangladesh.

METHOD

In two special education schools for ASD in Dhaka City, trained female psychologists screened mothers using the Patient Health Questionnaire (PHQ-9). PCS was administered to all the mothers irrespective of a diagnosis of depression. Mothers with a PHQ-9 score >4 who met criteria for a major depressive episode (MDE) based on the DSM-IV Structured Interview Axis I Disorders (SCID-I) were also administered skill-building training through monthly home visits to support ASD care. The level of depression was assessed by the Depression Measurement Scale (DMS), and quality of life (QoL) was measured by Visual Analogue Scale (VAS) of EQ5D5L scale before and after PCS.

RESULT

Among 188 mothers enrolled in the study, 81 (43%) received PCS, and 27.1% (22) had MDE. In the first month, 73 sessions were scheduled and 60 completed (85%). In the last month, 53 sessions were scheduled and 52 completed (98%). The mean DMS score decreased from 79.5 ± 23 to 60 ± 20 (p = 0.004), and DMS scores were significantly higher among mothers with MDE (97.8 ± 12.1 v. 69.9 ± 22.1; p < 0.001) compared to those without MDE (72.7 ± 22.6 v. 56.1 ± 18.1; p = 0.003). The mean VAS score improved from 70.3 ± 14.1 to 80.2 ± 13.3 (p = 0.001) between the first and the last session. Changes in DMS were negatively correlated with changes in VAS scores (β: -0.213, 95% CI 0.370 to -0.056).

CONCLUSION

Within special education schools for ASD in urban Bangladesh, it was feasible to administer an integrated program of PCS for mothers of children with ASD by trained psychologists who were able to screen and intervene to reduce their level of depression and improve their quality of life.

Caregiver Burden in Schizophrenia and Autism Spectrum Disorders: A Comparative Study

OBJECTIVE

There is no study comparing schizophrenia and autism spectrum disorders (ASD) in terms of caregiver burden. This study aims to compare the caregiver burden among family members of the patients with schizophrenia and ASD and investigate the predictive factors.

METHODS

A cross-sectional study with the family members living with and/or providing care to their patients was carried out. A sociodemographic form, the Beck Depression Inventory, the Self-Stigma Inventory for Families, and the Zarit Caregiver Burden Scale were utilized. Regression analyses were conducted to determine the predictive factors for higher burden.

RESULTS

Caregiver burden in ASD was significantly higher than in schizophrenia. Regression analysis showed that the predictors of high caregiver burden were the need for self-care (OR=3.6), self-destructive behaviors (OR=3.4), self-stigma (OR=1.1), depression (OR=1.1), and level of income (OR=1.0) for all family members. When the diagnosis was removed from the equation, the factors determining the high burden did not change.

CONCLUSION

This study suggests that characteristics of the illness are stronger predictors than family members' characteristics in explaining high caregiver burden for both illnesses. Psychological, social, and economic supports should be provided for families to help alleviate their caregiving burden.

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

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

Social Support and Family Functioning in Chinese Families of Children with Autism Spectrum Disorder

Families caring for children with autism spectrum disorder (ASD) have reported poorer family functioning. Social support might strengthen family functioning, but limited research to date has focused on this association in China. This study conducted a cross-sectional survey of Chinese families that have children with ASD to examine the relationship between social support and family functioning. Caregivers of children with ASD from Sichuan province in China (N = 167) were surveyed concerning their perceived social support and family functioning. The Social Support Rating Scale was used to investigate caregivers' perceived social support from three dimensions: subjective support, objective support, and the utilization of support. A Chinese version of the Family Adaptability and Cohesion Scale was used to investigate their perceptions of family cohesion and adaptability. The Pearson correlation coefficient and stepwise multiple regression were used for analyses. The results suggested that social support was positively related to family cohesion and adaptability. Of the three sub-domains of social support, both subjective support and the utilization of support were positively associated with family cohesion and adaptability. The study's findings evidenced the importance of different types of social support and could be used to develop a targeted support service for families that have children with ASD to improve their family functioning and sustain the family unit.

Autism spectrum disorder in India: a scoping review

Autism is a grand challenge in global mental health to be dealt with on a priority basis. Phenotypic knowledge, biological understanding, and evidence-based intervention studies are all from western countries. We know very little about autism in the low- and middle-income countries (LMIC). Lack of infrastructure and difficulties in operationalizing research has widened the knowledge gap. We performed a comprehensive scoping review of research in Autism Spectrum Disorder in India to have an overall impression, identify gaps, and formulate evidence-based recommendations for further study. We searched PubMed, SCOPUS, and Cochrane Library to identify relevant Indian studies. A hundred and fifty-nine publications met the inclusion criteria. Most of the research contribution in autism is from few tertiary care medical centres, technological institutes, and not-for-profit organizations. We identified various themes of research like clinical profile, interventions, biomarkers, psychological, social, epidemiological, and risk factors. Evidence-based intervention studies, translation and adaptation of standard diagnostic instruments, and qualitative research on the experience of autism appeared to be state of the art. However, epidemiological studies, biomarkers identification, risk assessment studies were of low quality. There is a need for nationwide studies with representative sampling on epidemiology, biomarkers, and risk factors for a complete evaluation of the actual burden and biology of autism in India. Also, there is a need to design implementation research to evaluate the effectiveness of evidence-based interventions in routine healthcare settings. We recommend that future research should fill these gaps in understanding autism and improving its outcome in India.

Impact of a family-centred early intervention programme in South India on caregivers of children with developmental delays

BACKGROUND

This study evaluated the impact on caregiver strain and family empowerment among caregivers of children with disabilities who received training and education as part of a family-centred community-based early intervention programme in South India.

METHODS

This prospective open cohort longitudinal study compared change from baseline to two years post-intervention among caregivers of the first cohort of children who were enrolled in the programme. Paired t-tests determined effect on the Modified Caregiver Strain Index (MCSI) and Family Empowerment Scale (FES), and p-values were adjusted for multiple comparisons using the False Discovery Rate approach.

RESULTS

Of the 308 caregivers (91% women), 44% provided care to children with cerebral palsy and 56% to children with other developmental delays. The mean age of the children at baseline was 3.3 (±1.5 years). The overall mean change from baseline in the FES was 4.1 (95% CI: 3.3, 4.9; p < 0.001) representing improved empowerment. The mean change for the MCSI score was -3.7 (95% CI: -4.5, -2.9; p < 0.001) representing reduced caregiver strain.

CONCLUSIONS

A family-centred early intervention programme that provides training and education to caregivers of children with developmental delays demonstrated positive change in caregiver strain and family empowerment.Implications for RehabilitationThe well-being of a child is influenced by the well-being of their caregiver.Improving caregiver well-being can help improve care and support for children with developmental delays.A family-centred early intervention therapy programme that includes training and education to caregivers can reduce strain and improve family empowerment.

Why Do People Browse and Post on WeChat Moments? Relationships among Fear of Missing Out, Strategic Self-Presentation, and Online Social Anxiety

This study examined the mediating and moderating roles of positive and honest self-presentations in the relationship between fear of missing out (FoMO) and online social anxiety (OSA). A total of 796 social media users were recruited online. These participants completed a questionnaire package, which included a section on demographic information, the Positive Self-Presentation and Honest Self-Presentation Scales, the FoMO Scale, and the Social Anxiety Scale for Social Media Users. Both positive and honest self-presentations partially mediated the relationship between FoMO and OSA, with the former acting as an accelerative mediating factor. Honest self-presentation had a buffering moderating role between FoMO and OSA. Positive self-presentation showed marginal gender differences on the moderating effect. Positive and honest self-presentations clarified the "double-edged sword" effects on the relationship between FoMO and OSA. Honest self-presentation, rather than positive self-presentation, buffered OSA. Results can be used as reference to develop interventions on self-presentation strategies to relieve OSA.

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.

The Protective Role of Social Support Sources and Types Against Depression in Caregivers: A Meta-Analysis

The protective effects of social support for caregiver mental health are well documented, however the differential impact of support providers (partner, child, family, siblings, friends, professionals) and types (perceived, received) remain unclear. Observational data from 21 independent studies, involving a pooled sample of 2273 parents, stepparents and grandparents of children (aged ≤ 19) with autism spectrum disorder (ASD) were examined. Pearson's r, publication bias and heterogeneity were calculated using random effects modelling. Significant associations were noted between lowered depressive symptoms and positive sources of support, regardless of support type. Parental mental health can be enhanced by strengthening close personal relationships alongside connections with formal support services. Longitudinal research is needed to explore support need and perceived helpfulness over time.

[Social support as a protective factor for the mothers of children with Congenital Zika Syndrome]

Mothers of children with CZS face exceptional challenges caring for their offspring. Due to this reality, the availability of social support can function as an important protective factor. In this respect, this study aimed to evaluate the role of informal and formal social support in mental health, parental self-efficacy and satisfaction in the life of mothers of children with CZS. A total of 69 mothers of children with CZS (M = 26.4 years; SD = 6.23) living in the state of Ceará, Brazil participated in this study. They filled out the Social Support Satisfaction Scale, General Health Questionnaire, Parental Self-efficacy Scale and Satisfaction with Life Scale. The results show that the greater perception of informal social support significantly enables better mental health and satisfaction with life levels. In addition, access to formal social support significantly enables enhanced perception of parental self-efficacy. The results observed with the mothers of children with CZS are consistent with those reported in other studies with mothers of children with chronic conditions, pointing out that formal and informal social support have different effects on mental health, parental self-efficacy, and satisfaction with life, even controlling the effect of sociodemographic variables.

Caregiving burden among informal caregivers of people with disability

OBJECTIVE

Chinese informal caregivers experience burden due to their caregiving responsibilities that violate their belief of reciprocal parent-child relationship, but little is known about this burden and coping processes among Chinese. It is believed that internal coping (i.e., self-reliance) and external coping (i.e., seeking help from others) better captured cultural characteristics of coping styles observed among Chinese. Thus, the aim of this study was to estimate the prevalence of mental ill health, identify correlates, investigate the impact of caregiving burden on mental health, and explore the potentially moderating role of two coping strategies.

DESIGN

A purposive sample of 234 informal caregivers of family with intellectual or mental disability in Macao (SAR), China, from August to September 2018 was investigated.

METHODS

DASS-21, Caregiving Burden Inventory (CBI), Perceived Difficulty Scale (PD), and a modified Chinese Coping Scale were used. Multiple regression analyses were conducted.

RESULTS

CBI and PD were associated with depression, anxiety, and stress. Whereas internal coping buffered the effect of PD on depression and anxiety, external coping exacerbated the effect of PD on anxiety and the effect of CBI on depression and anxiety.

CONCLUSION

Poor mental health among caregivers is associated with greater caregiving challenges and burdens. Internal coping helped to buffer but external coping worsened the effect of burdens on mental health outcomes. Interventions that improve internal coping and mental health might be helpful for ageing informal caregivers.

Research and development of autism diagnosis information system based on deep convolution neural network and facial expression data

Purpose

Facial expression provides abundant information for social interaction, and the analysis and utilization of facial expression data are playing a huge driving role in all areas of society. Facial expression data can reflect people's mental state. In health care, the analysis and processing of facial expression data can promote the improvement of people's health. This paper introduces several important public facial expression databases and describes the process of facial expression recognition. The standard facial expression database FER2013 and CK+ were used as the main training samples. At the same time, the facial expression image data of 16 Chinese children were collected as supplementary samples. With the help of VGG19 and Resnet18 algorithm models of deep convolution neural network, this paper studies and develops an information system for the diagnosis of autism by facial expression data.

Design/methodology/approach

The facial expression data of the training samples are based on the standard expression database FER2013 and CK+. FER2013 and CK+ databases are a common facial expression data set, which is suitable for the research of facial expression recognition. On the basis of FER2013 and CK+ facial expression database, this paper uses the machine learning model support vector machine (SVM) and deep convolution neural network model CNN, VGG19 and Resnet18 to complete the facial expression recognition.

Findings

In this study, ten normal children and ten autistic patients were recruited to test the accuracy of the information system and the diagnostic effect of autism. After testing, the accuracy rate of facial expression recognition is 81.4 percent. This information system can easily identify autistic children. The feasibility of recognizing autism through facial expression is verified.

Research limitations/implications

The CK+ facial expression database contains some adult facial expression images. In order to improve the accuracy of facial expression recognition for children, more facial expression data of children will be collected as training samples. Therefore, the recognition rate of the information system will be further improved.

Originality/value

This research uses facial expression data and the latest artificial intelligence technology, which is advanced in technology. The diagnostic accuracy of autism is higher than that of traditional systems, so this study is innovative. Research topics come from the actual needs of doctors, and the contents and methods of research have been discussed with doctors many times. The system can diagnose autism as early as possible, promote the early treatment and rehabilitation of patients, and then reduce the economic and mental burden of patients. Therefore, this information system has good social benefits and application value.

South Korean mothers' childhood abuse experience and their abuse of their children with intellectual and developmental disabilities: Moderating effect of parenting self-efficacy

BACKGROUND

A history of childhood abuse has been found to adversely affect the transition to motherhood. Compared to other children, children with intellectual and developmental disabilities are at higher risk of being maltreated at home. However, maternal parenting self-efficacy has been found to improve mothers' positive interactions with their children.

OBJECTIVE

Given that, this study examined the moderating effect of maternal parenting self-efficacy on the relationship between mothers' childhood abuse experience and their abuse of their children with IDDs.

PARTICIPANTS AND SETTING

Participants include 134 South Korean mothers with children between 2 and 8 years of age with intellectual and developmental disabilities.

METHOD

Mothers' childhood abuse experience was assessed using the Childhood Trauma Questionnaire, which measures the extent of mothers' exposure to parental abuse in their childhood. Parenting self-efficacy was measured using the Echelle Globle du Sentiment de Competence Parentale (EGSCP). The Abusive Parenting scale was used to assess mothers' abusive parenting; it measured the degree to which mothers had ever either physically or emotionally abused their children.

RESULTS

The moderating effects of parenting self-efficacy on the relationships between childhood emotional abuse and abusive parenting (B = -.06, t(126) = -2.33, p = .022, 95 % CI[-.1142, -.0092]) and between childhood physical abuse and abusive parenting (B = -.07, t(126) = -2.64, p = .009, 95 % CI[-.1283, -.0184]) were significant.

CONCLUSIONS

These findings emphasize the importance of helping mothers with a history of abuse alleviate parental stress arising from raising children with IDDs by enhancing their parenting self-efficacy.

Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study

BACKGROUND

Affiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored.

METHODS

A correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress.

RESULTS

The relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others.

CONCLUSIONS

These findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research.

Parental experiences with an adolescent female and male with Autism Spectrum Disorder (ASD) in India

Purpose

The purpose of this paper is to compare experiences of two parents of adolescents with Autism Spectrum Disorder (ASD) differing in gender, including their daily routines at school and at home, challenging behaviour, social support and future plans for their children.

Design/methodology/approach

The parents of the two adolescents with ASD were interviewed with open-ended questions related to their children as well as their personal experiences, along with getting their individual responses for the established Satisfaction with Life Scale (SWLS).

Findings

There were similarities and differences in the parents’ experiences with their adolescent children with ASD. Similarities included a limited social support outside their families, hopes for the future of their children, where in they emphasised the need for some “normality” for their child, and a lack of plan in terms of legal guardianship and written wills after their own time. Some of the differences were also noted in the parents’ description of symptoms of their children, with the father of the female adolescent reporting more negative experiences both with his child, as well as with his spouse, a lack of social support and, subsequently, more “dissatisfaction” on the SWLS than the mother of the male adolescent.

Research limitations/implications

One of the major limitations of this study is the absence of feedback from the other parent besides the one being interviewed, due to which only one parental perspective was provided here.

Social implications

There are vital social implications of this study. Both parents reported a limited social support due to which they expressed the need for increasing awareness for ASD in the general society. These findings illustrate the need for a focus on designing interventions for improving outcomes for both parent and child in similar situations.

Originality/value

This study compared the experiences of two parents of adolescents with ASD, differing in gender and symptomology, but similar in other respects, including the family demographic characteristics and cultural context.