Families of adolescents and adults with autism: Uncharted territory

Comparison of social isolation in autistic children and adolescents according to age, marital status and number of siblings

BACKGROUND

Children and adolescents with autism spectrum disorder (ASD) have difficulties that limit their opportunities to interact with peers and family members. These behaviors can lead to social exclusion, and consequently social isolation. The aim was to compare social isolation of children and adolescents with ASD according to age, marital status, and number of siblings.

MATERIALS AND METHODS

Cross-sectional descriptive study in 37 subjects with ASD. Social isolation was assessed using a 6-item scale (with five alternatives). The sociodemographic variables were age, sex, marital status of parents, and number of siblings. Two groups were formed according to age (children from 4 to 10 years old and adolescents from 11 to 20 years old).

RESULTS

For the total score of the social isolation scale, children showed a higher score (21.1 ± 4.7) than adolescents (17.7 ± 5.7). Children living with divorced parents had lower scores (16.2 ± 3.6), compared to married (22.2 ± 4.5) and cohabiting (22.8) children. For the number of siblings, with no siblings 17.2 ± 3.1 points, one sibling 22.2 ± 3.5 points, two siblings 22.1 ± 3.1 points, and three siblings 22.4 ± 3.2 points (P < 0.05). Age was related to social isolation (r = -0.30, P < 0.05).

CONCLUSION

Children who live with divorced parents and have no siblings presented a higher degree of isolation in relation to their counterparts who live with both parents and have at least one sibling. Age plays a relevant role, with children aged 4-10 years presenting a lower degree of isolation than the adolescent group. It is suggested that the preservation of a functional family and the presence of siblings could contribute to improving social isolation.

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.

Predicting the Outcomes of Parents of Transition-Age Youth or Young Adults with ASD

The transition outcomes for individuals with autism spectrum disorder (ASD) and their families are less than desirable. A survey of parent stressors, resources, coping/appraisals, and adaptation to transition was completed by 226 parents. The mediating mechanisms between stressors and parent outcomes were identified. At the indicator level, three stressors (i.e., autism severity, mental health crisis/challenging behaviors, and filial obligation), four resources (i.e., general social support, transition planning quality, parent-teacher alliance, and parenting efficacy), and three coping styles (i.e., problem-focused coping, avoidance-focused coping, and optimism) predicted parents' outcomes (i.e., burden, transition experience, subjective health, and quality of life). At the structural level, optimism, emotion-coping strategies, and resources mediated the relationships between stressors and parental outcomes. Research and practical applications are discussed.

Types of Family Caregiving and Daily Experiences in Midlife and Late Adulthood: The Moderating Influences of Marital Status and Age

Guided by the life-course perspective, this study contributes to the family caregiving, aging, and disability literature by examining the daily experiences of three types of family caregivers in midlife and late adulthood. A sample of 162 caregivers from the National Survey of Midlife in the United States study completed interviews, questionnaires, and a Daily Diary Study. Multilevel models showed the patterns of daily time use did not differ by caregiver types. Caregivers of sons/daughters with developmental disabilities (DD) experienced more daily stressors than caregivers of parents with health conditions (HC) and caregivers of spouses with HC. Unmarried caregivers of sons/daughters with DD reported spending more time on daily leisure activities and exhibited greater daily stressor exposure than other family caregivers. Age did not moderate the associations between caregiver types and daily experiences. Findings highlight the important consideration of the caregivers' characteristics to better determine the quality of their daily experiences in midlife and late adulthood.

Parents as a Team: Mother, Father, a Child with Autism Spectrum Disorder, and a Spinning Toy

This paper is a single case study involving a visit to a diagnostic clinic for autism spectrum disorder. A young boy finds a toy that he can hold with one hand and spin with another. In order to retrieve the toy and leave it in the clinic, the parents engage in a team effort. We describe this achievement in terms of two styles of practice or interactional routines with differing participation frameworks.We examine not only how the parents work as a team using these styles, but also how they improvise to extract the spinning toy from their son’s grasp with minimal protest on his part.

Parental beliefs about autism

This study investigated parental beliefs about the etiology, diagnosis, and treatment of autism spectrum disorders. Sixty-two families of affected children completed a questionnaire asking when the parent first noticed developmental or behavioral problems, when they were told the diagnosis, how confident they were about the ability of their child's physician to recognize autism, whether they believed anything specific might have caused their child's autism, and what medications and complementary or alternative therapies they had tried. Two-thirds of parents suspected a specific cause, and three-quarters questioned their physician's ability. Parents who perceived a greater delay in diagnosis or who had tried more different therapies both tended to have less confidence in their physician (p = 0.20 and p = 0.07, respectively). Physicians should inquire about parental beliefs concerning etiology, learn what treatments the children are receiving, perform screening at the 18 month visit, and make referrals for further evaluation as soon as a child begins to exhibit signs suggestive of autism.

Quality of Life and Depressive Symptomatology in Mothers of Individuals with Autism

Abstract This study aimed to investigate the Quality of Life (QOL) and the presence of the depressive symptoms in mothers of individuals with Autism Spectrum Disorder (ASD). Participants included 40 women, between 28 and 72 years old, married, with medium-low income and education levels, and with children between 10 and 40 years old. The instruments used were a social demographic and health characterization questionnaire, the World Health Organization Quality of Life (WHOQOL-Bref) questionnaire, the Beck Depression Inventory and Beck Hopelessness Scale (BDI-II and BHS), and the Baptista Depression Scale Adult Version (EBADEP A). The quality of life and the presence of depressive symptoms in mothers did not show significant correlation with the child's age. However, there was high and negative correlation between the quality of life and high levels of depressive symptoms and moderate correlation between environment and income. It concludes the necessity of preventive and therapeutic interventions for these mothers.

Maternal parenting behavior and child behavior problems in families of children and adolescents with autism spectrum disorder

Parents of a child with autism spectrum disorder (ASD) face specific challenges in parenting, but concrete parenting behavior has never been properly investigated in these families. This exploratory questionnaire study compared parenting behaviors among mothers of children and adolescents with ASD (n = 552) and without ASD (n = 437) and examined associations between child behavior problems and parenting behavior. Results showed that mothers of children with ASD reported significantly lower scores on Rules and Discipline and higher scores on Positive Parenting, Stimulating the Development, and Adapting the Environment. Age was differently related to parenting behavior in the ASD versus control group. Furthermore, distinctive correlation patterns between parenting behavior and externalizing or internalizing behavior problems were found for both groups.

Adults with autism in India: a mixed-method approach to make meaning of daily routines

Although individuals with Autism Spectrum Disorder (ASD) have been diagnosed in India for over fifty years, virtually nothing is known about the social circumstances of adults, their daily lives, and their families. Where are adults with autism? How do they spend their time? Who are they with, and what are they doing all day? A mixed-method approach was used to obtain information on daily routines of 54 adults with ASD living in New Delhi, India, and about parent levels of stress associated with these routines during a study collected from January through June, 2013. Whether or not they attended a structured setting during the day (59% did so), adults engaged in some 20 activities both inside and outside their home. Contrary to our expectations, most adults were not "hidden" and were out in public at least on occasion. Higher functioning adults were more likely to attend a structured setting, but parents described challenging behaviors, both adult and parent preference, and lack of options as reasons that adults stayed home. The amount of time adults spent outside their home was not associated with parent reported stress, but stress was significantly higher for mothers who were employed. Most families described adaptation to caring for their adult children. A partnership with an Indian nongovernmental organization provided mechanisms to amplify our research findings, making them meaningful to our participants and others.

Fragile X syndrome: an aging perspective

Cognitive and behavioral correlates of molecular variations related to the FMR1 gene have been studied rather extensively, but research about the long-term outcome in individuals with fragile X spectrum disorders remains sparse. In this review, we present an overview of aging research and recent findings in regard to cellular and clinical manifestations of aging in fragile X syndrome, and the FMR1 premutation.

Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress

BACKGROUND

Sensory over-responsivity (SOR) affects many individuals with autism spectrum disorders (ASD), often leading to stressful encounters during daily routines.

METHODS

This study describes the associations between early SOR symptoms and the longitudinal course of restrictions in family life activities and parenting stress across three time-points in families raising a child with ASD (n = 174). Covariates were child diagnostic severity, emotional problems, and maternal affective symptoms. At time 1 mean chronological age was 28.5 months. Children were administered the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL). Parents completed the Infant Toddler Sensory Profile (ITSP), Infant-Toddler Social Emotional Assessment (ITSEA), Beck Anxiety Index (BAI), and the Center for Epidemiologic Studies Depression Inventory (CES-D) at time 1; and the Parenting Stress Index (PSI) and Family Life Impairment Scale (FLIS) at the three annual time-points.

RESULTS

Latent Growth Curve Models indicated that higher SOR scores on the ITSP at time 1 were associated with higher initial levels of family life impairment and parenting stress and with a smaller magnitude of change over time. These associations were independent of severity of ADOS social-communication symptoms, MSEL composite score, ITSEA externalizing and anxiety symptoms, and maternal affective symptoms as measured by the BAI and CES-D. On average FLIS and PSI did not change over time, however, there was significant individual variability. Concurrently, SOR at time 1 explained 39-45% of the variance in family stress and impairment variables.

CONCLUSIONS

An evaluation of SOR should be integrated into the assessment of toddlers with ASD considering their role in family life impairment and stress.

Influences on maternal responsivity in mothers of children with fragile X syndrome

This study investigated the influence of maternal and child variables on the maternal responsivity of 55 mothers with young children with fragile X syndrome. Data included video observations of mother-child interactions in four different contexts, standardized assessments with the children, and standardized questionnaires for the mothers. The video observations were coded for child communication acts; maternal responsivity was coded at two levels: a more general measure and a behavior-by-behavior measure. Results indicated that child developmental level and language ability strongly influenced behavior-by-behavior responsivity, while maternal IQ was the strongest predictor of both general and behavior-by-behavior responsivity, after controlling for child developmental level.

Parental expectations regarding postschool social attainments of adolescents with autism spectrum disorders in Singapore

This study sought to understand the parental expectations of social attainments in the postschool years. The parents of 20 adolescents with autism spectrum disorders (ASD) attending special schools were interviewed. Most expected their children would be working in sheltered workshops or unemployed. All parents indicated that their children would live with them until they were unable to provide appropriate care, and nearly half expressed wishes for relatives to care for them thereafter. None expected any independent access to the community. Analysis of the interviews suggested that the adolescents' learning and behavior, parental concerns, availability of formal resources, and societal factors influenced parents' expectations. Implications for working with Asian populations and for service delivery in Singapore are discussed.

Stressful life events and daily stressors affect awakening cortisol level in midlife mothers of individuals with autism spectrum disorders

OBJECTIVES

The current study examines the awakening cortisol level in midlife mothers (M = 51.4 years old, SD = 8.4) of individuals (M = 22.1 years old, SD = 7.1) with autism spectrum disorders (ASD) under stressful conditions that are not specific to their son or daughter's ASD symptoms.

METHODS

In addition to completing a set of questionnaires and in-home interviews, 82 mothers from the Adolescents and Adults with Autism Study (AAA) participated in a Daily Diary Study.

RESULTS

Findings from the multilevel models indicated that mothers who previously were exposed to no negative life events in the previous period had an increased awakening cortisol level on days following a greater number and more severe stressors, a normative stress response. In contrast, we observed a flatter cortisol level of daily stressors in mothers who experienced a greater number of negative life events in the previous period.

CONCLUSION

These findings highlight the sustained toll that global and everyday stressors have on awakening cortisol level of midlife and aging mothers of individuals with ASD.

Changes in the mother-child relationship during the transition to adulthood for youth with autism spectrum disorders

We examined whether exiting high school was associated with changes in the mother-child relationship. Participants were 170 mothers of youth with ASD who were part of our larger longitudinal study and who exited high school during the study; data were collected four times over 7 years. Results indicated improvement in the mother-child relationship while in high school; however, improvement in all indices slowed or stopped after exit. Mothers of youth with ASD without an intellectual disability (ID) and who had more unmet service needs evidenced the least improvement after exit. Our findings provide further evidence that the years after high school exit are a time of increased risk, especially for those with ASD without ID and whose families are under-resourced.

Buried by autism: older parents’ perceptions of autism

In this study, we explored older parents’ perceptions of their adult sons and daughters with autism in order to gain insights into how parents’ beliefs about autism may influence their coping. Narrative analysis of in-depth interviews held with 16 parents aged 60 years and older of adults with autism revealed that these parents perceived that their son’s or daughter’s intelligence, sense of humour and social personality are blocked by autism. Adherence to these beliefs appeared to comprise important coping strategies that supported these parents in their caregiving roles by assisting them to maintain positive perceptions of their son or daughter with autism. Yet such beliefs also held costs for the parents, including reinforcing the belief that they need to regulate their own behaviour in order to realize the true son or daughter buried by autism.

Social needs in daily life in adults with Pervasive Developmental Disorders

Although social deficits remain a persistent component of the behavioural phenotype of Pervasive Developmental Disorders (PDD) in adulthood, it remains unclear whether these represent diminished social needs, as is seen in social anhedonia, or rather thwarted social needs, as is seen in social anxiety. This study used the Experience Sampling Method (ESM)--a structured diary technique--to examine social interaction in daily life of 8 adults with PDD, compared to 14 healthy controls. Multilevel linear regression analyses showed that PDD subjects a) did not spend more time alone, b) had no increased preference to be alone when in company, and c) spent more time with familiar people, compared to control subjects. Patients experienced more negative affect and anxiety when in the company of less familiar people compared to when they are alone, whereas no difference in affect could be found between being alone or being with familiar people. All these lines of evidence suggest that PDD subjects do have a desire to interact. However, this may be thwarted as is seen in social anxiety. Therapeutic interventions should aim at decreasing negative affect and anxiety in social interactions possibly by improving social skills to fulfil the existing social needs in adults with PDD.

Symptoms and behavior problems of adolescents and adults with autism: effects of mother-child relationship quality, warmth, and praise

Using a cross-lagged panel design, we investigated the impact of positive family processes on change in autism symptoms and behaviors. A sample of 149 co-residing mothers and their adolescent or adult child with autism was drawn from a large, longitudinal study. Maternal warmth and praise were measured using coded speech samples in which mothers talked about their son or daughter. A high level of relationship quality was associated with subsequent reductions in internalizing and externalizing problems as well as reductions in impairments in social reciprocity and repetitive behaviors. Maternal warmth and praise were also related to symptom abatement in the repetitive behaviors domain.

Living in a world of our own: the experience of parents who have a child with autism

In this article, we discuss findings of a hermeneutic phenomenological study that sought to describe the experiences of parents who have a child with autism. Qualitative interviews were conducted with parents from 16 families of children with autism residing in a western Canadian province. "Living in a world of our own" emerged as the essence of the parents' experiences. In "living in a world of our own," parents described a world of isolation. Three themes representing the essential challenging elements of the parents' experiences included vigilant parenting, sustaining the self and family, and fighting all the way. Although much is known about the fundamental importance of support to parents of children with chronic conditions and/or disabilities, findings from this study indicate that knowledge has not been adequately transferred to the care of children with autism.

Adolescents and Adults with Autism with and without Co-morbid Psychiatric Disorders: Differences in Maternal Well-Being

This study investigated the associations between the characteristics of adolescents and adults with autism spectrum disorders (ASD) and maternal well-being. Two groups were compared: mothers of adolescents and adults with ASD and co-morbid psychiatric disorders (n = 142) and mothers whose sons or daughters had a single diagnosis of ASD (n = 130). Individuals with co-morbid psychiatric disorders had higher levels of repetitive behaviors, asocial behavior, and unpredictability of behavior than their counterparts with ASD only. They also had poorer rated health as well as more frequent gastrointestinal problems and sleep problems. Mothers of sons and daughters with ASD and co-morbid psychiatric disorders reported higher levels of burden and a poorer quality parent-child relationship than mothers of sons and daughters with ASD only. Higher levels of asocial behavior, unpredictability of behavior, and poorer health in sons and daughters with ASD were predictive of greater burden in mothers and a poorer quality parent-child relationship.

Adults with autism living at home or in non-family settings: positive and negative aspects of residential status

BACKGROUND

Very little is known about the context of caregiving by parents of adults with autism or about the perceived impacts of continued patterns of co-residence vs. out-of-family living. In the present study, maternal assessments of residential status, involvement with adult children living in a non-family setting, and the impacts on mothers of their residential arrangements were examined.

METHODS

Mothers from 133 families of adults (aged 22 years and older) with autism spectrum disorder (ASD) completed questionnaires as part of a longitudinal study on family caregiving. Mothers completed open-ended questions regarding the positive and negative aspects of their child's residential arrangement. Mothers also completed scaled questions regarding their satisfaction with their child's residential arrangement, the different ways in which people's lives change after a relative moves from the home, and the frequency of contact with their son or daughter.

RESULTS

Mothers found co-residing with their adult child to be of greatest positive benefit to the family while those living apart found this residential arrangement of greatest benefit to the son or daughter with ASD. The greatest negative consequences for co-residing mothers were understood to fall on families, while mothers felt the majority of negative consequences for those that lived apart. There was a high level of contact and maternal involvement between the mother and adult child with ASD even after out-of-home placement.

CONCLUSIONS

Residential status, as appraised by mothers, has varying impacts on the individual with ASD, on the family, and on mothers as individuals and caregivers. The present analysis suggests the multifaceted and highly contingent maternal experience associated with where her child with ASD lives. Among families whose children live elsewhere, there is an impressive amount of continued contact between these families and their son/daughter.