Stress, Coping, and Resiliency Among Families of Individuals with Autism: a Systematic Review

Characterization of dyadic interaction features between fathers and mothers playing with their autistic children

BACKGROUND

Socio-communicative difficulties are a core symptom of autism that deeply impact interaction with others. Despite that, research on bidirectional caregiver-child interaction variables has been notably scant and predominantly focused on autistic children's interactive differences and the consequences on parenting behaviors.

AIM

The study aimed to assess parent-child interaction in the context of autism through observational validated instruments that consider qualitative and structural features in a complementary way to obtain a comprehensive characterization of the exchange within the dyad.

METHODS AND PROCEDURES

This study involved 56 paired parent-child dyads of 28 autistic children (mean age = 38.60 months, sd = 9.50) playing with their mothers and their fathers for 10 min. The video-recorded sessions were coded through the Emotional Availability Scales (EAS) and the Interpersonal Synchrony (IS) coding system.

OUTCOMES AND RESULTS

Fathers and mothers do not show significant differences in ISexcept for mother widenings, which are more frequent and successful, and in Emotional Availability. Further, dyads present moderate levels of Emotional Availability, indicating that parents may struggle with structuring, sensitivity, and interactive abilities with their autistic children, which in turn present low levels of responsiveness and involvement. Further, we explored an association between IS and EA characteristics.

CONCLUSION AND IMPLICATIONS

This study suggests the need for interventions to target interaction considering both caregivers, ultimately targeting both interaction structure and affect features. Research that includes fathers fosters strategies for individualization and treatment optimization.

Autism interventions designed or adapted for the Black/African American population: A systematic review

LAY ABSTRACT

Black/African American people in the United States who have a diagnosis of autism often experience service-related disparities, including not having the same access to high-quality autism and related care (e.g. behavioral interventions), and are less likely to have sustained treatment engagement across their lifespan. While interventions to support autistic people are typically designed to be universal, there is concern that these interventions not being tailored to the Black/African American population could reduce the overall impact due to a lack of responsiveness to the needs of the Black children or families who receive the intervention. The current systematic review summarized research on interventions developed for the Black autism community, including Black children with autism and their caregivers. After a comprehensive, systematic search, eight peer-reviewed publications were identified that met the study's inclusion criteria. The majority of the interventions were tailored to Black caregivers of children with autism. Autism researchers demonstrate different strategies for engaging Black caregivers in culturally responsive ways; however, more research into these interventions is needed in order to assess their effectiveness. In addition, there are still limited interventions adapted to be culturally responsive to Black/African American autistic people. The Cultural Adaptation Checklist framework is a novel approach with promise to become the standard for adapting interventions to meet the needs of culturally diverse groups. Cultural responsiveness is an important facet in the development of interventions that produce optimal outcomes for the range of diversity in the United States and is an important step to achieving equitable autism research practices.

The Association Between Coping Strategies and Psychological and Emotional Distress Among Health Care Providers Caring for Autistic Children in Jordan

BACKGROUND

Health care providers (HCPs) caring for autistic children report more perceived psychological and emotional distress related to their job. However, not much is known about what can be done to mitigate such distress, especially in countries with limited mental health resources, such as Jordan.

OBJECTIVE

This study aimed to examine the association between coping strategies (problem-focused, emotion-focused, and avoidant) and perceived emotional and psychological distress among HCPs of autistic children in Jordan.

METHODS

In this cross-sectional study, a convenience sample of 180 HCPs working with autistic children in Jordan were recruited through autism centers and social media using an online self-administered questionnaire.

RESULTS

The multiple linear regression analysis revealed that 31% of the variability in perceived emotional distress was explained by its significant association with problem-focused coping, emotion-focused coping, and avoidant coping. Likewise, 39% of the variability in perceived psychological distress was explained by its significant association with gender, having an immediate family, area of specialty, problem-focused coping, emotion-focused coping, and avoidant coping.

CONCLUSIONS

The study shows that problem-focused coping significantly decreases perceived emotional distress, whereas emotion-focused and avoidant coping significantly increase perceived emotional distress. Avoidant coping significantly increases perceived psychological distress. Understanding the association between coping strategies and perceived emotional and psychological distress among HCPs can assist mental health nurses in identifying at-risk providers and providing timely emotional and psychological support.

Changes in Caregiver Outcomes After Participation in the Engaged Eaters Program: A Caregiver-Mediated Feeding Intervention for Autistic Children and Their Families

IMPORTANCE

Caregivers are essential partners in caregiver-mediated interventions that build on family routines and practices. Research identifying how participation as an intervention partner influences caregivers' outcomes, including stress and self-efficacy, is scarce.

OBJECTIVE

To evaluate caregiver outcomes (stress, self-efficacy, and positive feeding responses and confidence) after participation in the Engaged Eaters Program.

DESIGN

Quasi-experimental pretest-posttest design.

SETTING

In-home via telehealth.

PARTICIPANTS

Fourteen primary caregivers of an autistic child (ages 2-7 yr) with feeding challenges.

INTERVENTION

The Engaged Eaters Program-Telehealth, a caregiver-mediated 6-mo in-home telehealth feeding intervention for autistic children ages 2 to 7 yr that included 24 intervention visits, eight caregiver training modules, and consultation with a dietician.

OUTCOMES AND MEASURES

Relationships between child feeding challenge severity and caregiver outcomes and individual differences in caregivers' intervention responses were evaluated. We assessed caregivers' stress (Parenting Stress Index, Fourth Edition Short Form), self-efficacy (Parent Sense of Competence Scale), Positive Feeding Responses and Confidence (PFRC; composite score of items from other assessments), and individual intervention response using pre- to postintervention change in scores.

RESULTS

Exploration of individual differences revealed that only caregivers with intake PFRC scores below the mean made significant improvements by the end of the intervention. No significant group-level changes were identified for stress, self-efficacy, or PFRC. Feeding challenge severity was not significantly related to caregiver outcomes.

CONCLUSIONS AND RELEVANCE

The results emphasize the importance of considering baseline practices, efficacy, and caregiver confidence when engaging caregivers in intervention. Future research should explore the nuanced relationship between caregiver outcomes and child characteristics. Plain-Language Summary: Caregivers are essential partners with feeding interventions that build on family routines and practices. When working with caregivers, occupational therapists should consider caregivers' readiness for and responses to an intervention because intervention practices may differentially affect caregivers' parenting practices, confidence, and self-efficacy. Caregivers' responses may also affect the overall effectiveness of a caregiver-mediated intervention. Positionality Statement: The term caregiver-mediated in used throughout this article in place of parent-mediated to be inclusive of all types of caregivers.

Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal

Mothers of children with autism spectrum disorder (ASD) face considerable psychological distress. Cognitive behavioral therapy (CBT) has shown promise in reducing caregiver burden, but evidence in the Arab world is lacking. Problem-solving appraisal training may optimize CBT's benefits. This study evaluated a tailored CBT program emphasizing the role of problem-solving appraisal in managing distress through the process of CBT. Sixty mothers were randomly allocated in a 1:1 ratio to either the CBT intervention group or the control group. The CBT group received 3-month sessions incorporating problem-solving appraisal training within a CBT curriculum from October 2022 to April 2023. Problem-solving techniques are focused on equipping individuals with the skills to identify, approach, and effectively resolve problems, leading to a reduction in stress levels and an improved capacity to cope with difficult situations. All mothers completed assessments of socio-demographics such as age, level of education, marital status, occupation, and adequacy of family income, the Depression Anxiety Stress Scale (DASS-21) and the Problem-Solving Inventory (PSI) before and after the program. The CBT group showed significant pre-to-post reductions in depression, anxiety, stress, and general psychological distress compared to controls (all p < 0.05). They also exhibited significant improvements in problem-solving confidence, approach-avoidance style and personal control (all p < 0.05). The customized CBT program markedly improved psychological well-being for mothers of children with ASD in Egypt. Incorporating problem-solving techniques may optimize CBT's benefits cross-culturally. These findings have implications for the implementation of evidence-based support programs for families impacted by ASD worldwide.

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

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

Occurrence and correlates of anxiety and depression in carers of autistic children across three nations

Purpose

Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that 'child' or 'carer' factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue.

Method

A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated.

Results

Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression.

Conclusion

The application of universal treatment models for carer anxiety and depression may be of differing value across nations.

Trends in Autism Spectrum-Related Motherhood Research: A Bibliometric Study

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in socialization. The amount of scientific research results on motherhood related to ASD has grown exponentially; however, there are no bibliometric studies in this field. Objective: This article aimed to analyze scientific research on motherhood related to the autism spectrum published in WoS. Articles on motherhood related to ASD were retrieved from the Web of Science (WoS). The advanced search interface used was "Title of the article, Abstract, Keywords". The analysis and visualization of the selected documents and their data were performed using a wide range of tools and software such as MS Excel (v16.0), VOS viewer (version 1.6.15), and R packages (Biblioshiny, version 2.0). A total of 1660 articles were included in this study. Most of the publications were original articles. The United States published the most significant number of articles among the countries identified. P.R. Hastings, M.M. Seltzer, and J. Van de Water were the main authors. The Journal of Autism and Developmental Disorders was the most productive and impactful journal. The main research topics were related to mental health and social support in the role of motherhood. This desk study provides researchers with a comprehensive understanding of ASD-related maternity research trends by evaluating relevant publications in recent decades. The results of this bibliometric analysis can serve as a basis and orientation for new studies.

Resilience among Parents and Children with Autism Spectrum Disorder

Resilience plays a pivotal role to offset stress among families of children with autism spectrum disorder (ASD). Although the majority of previous studies investigated resilience in parents, it is unclear what factors contribute to resilience in children. Thus, we aimed to explore resilience experienced by parents of children with ASD and how it affects children’s resilience. We invited 50 parents of a child with ASD, 13 years old or younger, across various Canadian provinces in an online survey. Parental resilience was positively associated with household income and negatively associated with parental stress. Resilience in children with ASD was positively associated with their social participation at home and community. Findings indicate a relationship between resilience in children with ASD and their participation, suggesting new ways to increase resilience in children with ASD by enhancing their participation.

Daily experiences and well-being of Chinese parents of children with autism

LAY ABSTRACT

The present study examined the influences of child-related stress, parental coping and social support on parental daily subjective well-being (i.e. positive and negative affect, life satisfactory) in Chinese families of children with autism spectrum disorder. For 14 days, a total of 76 parents (58 mothers) participated in the study and completed daily diaries. For mothers, child-related stress was related to lower life satisfaction; social support was related to higher life satisfaction that day. These daily relations were not found for fathers. Across all parents, avoidant coping was associated with higher negative affect and lower positive affect on the same day. Notably, daily positive coping was related to greater same-day positive affect as well as greater same-day and next-day life satisfaction. Interventions aimed at increasing positive coping and social support, and reducing child-related stress and avoidant coping are important to help parents maintain well-being, particularly for mothers of children with autism.

Resilience and Coping Strategies in Adults with Autism Spectrum Disorder

Individuals with Autism spectrum disorder (ASD) are prone to stress and anxiety affecting their mental health. Although developing coping and resilience are key to cope with stressors of life, limited research exists. We aimed to explore stakeholders' experiences related to the coping and resilience of adults with ASD. We interviewed 22 participants, including 13 adults with ASD, five parents, and four service provides of adults with ASD from various Canadian provinces. Using thematic analysis, three themes emerged including: (a) societal expectations and conformity, (b) adjusting daily routines, and (c) learning overtime. This study highlights the importance of coping and informs the development of services to help enhance resilience among adults with ASD.

"Music Therapy Was Never on the Table": Perspectives of Parents of Young Autistic Children

Parent coaching of music interventions is emerging as a viable model for families with young autistic children, yet recruitment difficulties have been apparent in previous studies. Understanding parent perspectives of early intervention services is critical to ensure that interventions are acceptable, feasible, and effective for all family members. In order to understand possible parental resistance to this type of parent education, we explored perspectives regarding music therapy, research, and parent coaching in parents of young autistic children. Fourteen parents attended virtual focus groups to discuss their experiences. We used a descriptive phenomenological approach to uncover the essence of their experience. Our findings indicate that, contrary to our preconceptions, participants did not show negative dispositions towards music therapy, research, or parent coaching. Instead, most participants had very little or no knowledge of music therapy services. They had limited experience with research in general, and only two participants had experienced music therapy directly. Several participants had varying amounts of experience with parent participation or parent coaching outside of music therapy and shared positive experiences with it. Parents seemed willing and eager to learn music strategies to support their children and saw value in the use of music for their child's development. First-contact providers (i.e., early interventionists and diagnosticians) and social media seem influential in parents' decision-making as they navigate early intervention services soon after diagnosis. Music therapy organizations are encouraged to design targeted efforts to make information on music therapy available through these sources.