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Santiago CFG, Lelis DF, Ferreira GFS, Pinto AL, Caldeira IP, Ribeiro NG, Forechi L, Baldo TDOF, Baldo MP. Mental health in mothers of children with autism spectrum disorder: a cross-sectional study. Women Health 2024; 64:636-647. [PMID: 39155146 DOI: 10.1080/03630242.2024.2392137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 07/11/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
The increased prevalence of autism spectrum disorder (ASD) has placed a significant emotional and psychological burden on mothers. We explored the association between the severity of ASD symptoms in children and the mental health of their mothers during the COVID-19 pandemic. Our study included 1,924 mothers of children with ASD, enrolled in a web-based cross-sectional survey over 85 consecutive days to gather clinical and sociodemographic data. The severity of ASD symptoms was obtained according to the children's age. Using the Depression, Anxiety, and Stress Scales (DASS-21) scale, we found that 35.8 percent of mothers experienced both anxiety and depression. A high education level and a high family income reduced the chance of concurrent anxiety and depression. Conversely, unemployment, a child using psychiatric medication, and higher severity of ASD symptoms increased the chance. Notably, the severity of the ASD symptom was the sole predictor of maternal co-occurring anxiety and depression across all age groups (<3 years aOR = 2.04, 95%CI 1.07-3.89; 3-5 years aOR = 2.76, 95%CI 1.67-4.56; ≥ 6 years aOR = 1.61, 95%CI 1.04-2.50). Recognizing the challenges associated with ASD leads to greater acceptance and tailored interventions, ultimately improving the overall well-being of both individuals with ASD and their mothers.
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Affiliation(s)
- César F G Santiago
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | - Deborah F Lelis
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | | | - Andressa L Pinto
- Department of Medicine, Centro Universitário UNIFIPMoc-Afya, Montes Claros, Brazil
| | - Isabella P Caldeira
- Department of Medicine, Centro Universitário UNIFIPMoc-Afya, Montes Claros, Brazil
| | - Natália G Ribeiro
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | - Ludimila Forechi
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Thais de O Faria Baldo
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
- Department of Medicine, Centro Universitário UNIFIPMoc-Afya, Montes Claros, Brazil
| | - Marcelo P Baldo
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
- Department of Medicine, Centro Universitário UNIFIPMoc-Afya, Montes Claros, Brazil
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Valderrama A, Nikièma B, Forgeot d’Arc B, Guerrero L, Giroux M. Revealing the Most Vulnerable Groups: Courtesy Stigma in Caregivers of Autistic Persons in Quebec. Front Psychol 2024; 15:1320816. [PMID: 39144608 PMCID: PMC11323393 DOI: 10.3389/fpsyg.2024.1320816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/11/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Caregivers of autistic persons often face "courtesy stigma," a phenomenon by which caregivers experience stigma because of their association with a person whose disability may be stigmatized. Understanding the repercussions of this stigma is crucial not only for caregivers' mental health but also for the quality of care provided to their dependent. This study aimed to explore courtesy stigma among caregivers of autistic persons in Quebec, examining its prevalence and impact in order to identify groups that are particularly susceptible to negative outcomes. Methods This study used a cross-sectional online survey methodology employing quota sampling to collect responses from 194 participants. Data were collected using a computer-assisted web interview (CAWI) platform. The impact of courtesy stigma was measured in terms of care burden, mental health, and overall well-being of caregivers. Results The findings revealed that caregivers frequently experience rejection, isolation, and work-related challenges. Notably, caregivers' health was below average with the lowest reported health outcomes in Quebec. The caregivers who are the most vulnerable to negative outcomes included female caregivers, those aged 45 or older, financially strained households, caregivers of children requiring elevated levels of support, caregivers who isolated due to their autistic dependents, and those who experienced stigmatization directed at themselves or their children in the form of rejection.Interestingly, 60% of respondents reported that the caregiving burden was "not at all" to "somewhat" difficult, raising questions about factors that may mitigate caregiving challenges over time. Conclusion Negative outcomes from courtesy stigma vary depending on certain risk factors and individual characteristic. This study underscores the need for targeted public policies and interventions, particularly for those at a higher risk of experiencing the negative effects of courtesy stigma on the burden of care, overall health, and mental health. By tailoring resources and support for these priority groups, we can better address the challenges faced by families of autistic persons.
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Affiliation(s)
- Alena Valderrama
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Sainte-Justine University Hospital and Research Centre of Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Béatrice Nikièma
- Sainte-Justine University Hospital and Research Centre of Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
| | - Baudouin Forgeot d’Arc
- Sainte-Justine University Hospital and Research Centre of Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- Psychiatry Department, Faculty of Medicine, University of Montreal, Montréal, QC, Canada
| | - Lucila Guerrero
- Sainte-Justine University Hospital and Research Centre of Sainte-Justine Mother and Child University Hospital Center, Montreal, QC, Canada
- The Office of Patient-Family-Caregiver Partnership, Sainte-Justine Mother and Child University Hospital Center, Montréal, QC, Canada
| | - Mathieu Giroux
- The Office of Patient-Family-Caregiver Partnership, Sainte-Justine Mother and Child University Hospital Center, Montréal, QC, Canada
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Aslan Genç H, Doenyas C, Aksu Y, Musaoğlu MN, Uzunay S, Mutluer T. Long-term Behavioral Consequences of the COVID-19 Pandemic for Autistic Individuals and Their Mothers. J Autism Dev Disord 2024; 54:2578-2590. [PMID: 37140744 PMCID: PMC10157142 DOI: 10.1007/s10803-023-05933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 05/05/2023]
Abstract
Long-term effects of the COVID-19 pandemic on autistic individuals and their families are recently emerging. This study investigated these effects in 40 mother-child dyads by measuring the behavioral problems of autistic individuals (via Aberrant Behavior Checklist) and their mothers' anxiety levels (via Beck Anxiety Inventory) during the pre-pandemic period, one month after, and one year after its onset. One year into the pandemic, aberrant behaviors of autistic individuals worsened only for those whose mothers had high anxiety levels. The continued negative impact of the COVID-19 pandemic on the behavior of autistic individuals is related to their mother's anxiety level, highlighting the need to support maternal mental health in families with individuals with autism.
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Affiliation(s)
- Herdem Aslan Genç
- Department of Psychiatry, Koç University School of Medicine, Istanbul, Türkiye.
- Research Center for Translational Medicine, Koç University, Istanbul, Türkiye.
| | - Ceymi Doenyas
- Department of Psychological Counseling and Guidance, Yıldız Technical University, Istanbul, Türkiye
| | - Yasemin Aksu
- School of Medicine, Koç University, Istanbul, Türkiye
| | | | - Sena Uzunay
- School of Medicine, Koç University, Istanbul, Türkiye
| | - Tuba Mutluer
- Department of Psychiatry, Koç University School of Medicine, Istanbul, Türkiye
- Research Center for Translational Medicine, Koç University, Istanbul, Türkiye
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Hamama L. Perceived Social Support, Normalization, and Subjective Well-Being Among Family Members of a Child with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1468-1481. [PMID: 36637591 DOI: 10.1007/s10803-022-05857-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
The experience of family members of children with autism spectrum disorder (ASD) is not uniform. This study focused on mothers of a child with ASD (Study 1) and typically developing siblings (TDSs) during their emerging adulthood (Study 2). Similarities and differences were explored regarding a proposed model examining the paths of perceived social support (PSS) and normalization (a coping strategy) with subjective well-being: satisfaction with life (SWL) and positive affect (PA). Similarities were found in the paths between PSS, normalization, and SWL, in mothers and TDSs, but differences emerged regarding PA. These findings highlight the importance of PSS as a resource that contributes to normalization and SWL. Professional awareness of family members' PSS and their engagement in normalization is needed.
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Affiliation(s)
- Liat Hamama
- The Bob Shapell School of Social Work, Tel Aviv University, 69978, Ramat Aviv, Israel.
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Bradley RS, Staples GL, Quetsch LB, Aloia LS, Brown CE, Kanne SM. Associations Between Parenting Stress and Quality Time in Families of Youth with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:829-840. [PMID: 36626008 PMCID: PMC9830131 DOI: 10.1007/s10803-022-05852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/11/2023]
Abstract
Increased stress among parents of youth with ASD has been well-documented. However, research on aspects of the parent-child relationship and subsequent links to parenting stress is limited. We assessed parents (N = 511) of youth with ASD to examine relations between parenting stress and parent-child quality time (amount of quality time, shared enjoyment, synchronicity). Elevated parenting stress was associated with less time spent engaging with youth in shared activities and decreased parent and child enjoyment during shared interactions. Parents with elevated stress reported engaging in shared activities and experiencing synchronicity with their child less often than parents below the clinical threshold. Future research should emphasize longitudinal efforts examining the directionality of this relationship to better inform family-focused intervention.
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Affiliation(s)
- Rebecca S Bradley
- University of Arkansas, 316B Memorial Hall, 72701, Fayetteville, AR, USA.
| | - Grace L Staples
- University of Arkansas, 316B Memorial Hall, 72701, Fayetteville, AR, USA
| | - Lauren B Quetsch
- University of Arkansas, 316B Memorial Hall, 72701, Fayetteville, AR, USA
| | - Lindsey S Aloia
- University of Arkansas, 316B Memorial Hall, 72701, Fayetteville, AR, USA
| | - Cynthia E Brown
- Pacific University, College Way, 97116, Forest Grove, OR, USA
| | - Stephen M Kanne
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York, USA
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Volgyesi-Molnar M, Gyori M, Eapen V, Borsos Z, Havasi A, Jakab Z, Janoch L, Nemeth V, Oszi T, Szekeres A, Stefanik K. Quality of Life in Hungarian Parents of Autistic Individuals. J Autism Dev Disord 2024:10.1007/s10803-024-06243-3. [PMID: 38280137 DOI: 10.1007/s10803-024-06243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Parents of autistic individuals have been known to have a lower overall quality of life (QQL) than those of typically developing children. We present the first Hungarian large-sample study whose objective was to explore the differences in QOL between parents of autistic individuals (AS) and those of neurotypical (NT) persons. METHODS Based on the ABCX model we developed a questionnaire comprising standardized scales to characterize the life of parents involved. Our data came from parents of 842 individuals (ASD = 521, NT = 321) between 0 and 49 years. Battery deployed standardized instruments to examine quality of life (WHO-QQL BREF and Quality of Life in Autism questionnaire, QOLA). We assessed the families' socio-economic/demographic characteristics, parents' psychological well-being, the autistic/neurotypical individuals' characteristics, and the interventions. RESULTS Our data showed significantly lower QOL in parents of autistic individuals in all domains of questionnaires. We analyzed 20 relevant factors to uncover the predictors of parental QOL. We confirmed the existence of most but not all predictors present in earlier literature and identified intervention-related predictors. CONCLUSION Our study confirms the importance of supporting parents in their role, and of providing health and social supports that focus on quality of life, in addition to child care.
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Affiliation(s)
- Marta Volgyesi-Molnar
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary.
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary.
| | - Miklos Gyori
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District & Ingham Institute, Liverpool, Australia
| | - Zsofia Borsos
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Agnes Havasi
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Zoltan Jakab
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Laszlone Janoch
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Vivien Nemeth
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
- Faculty of Education and Psychology, Doctoral School of Education, ELTE University, Budapest, Hungary
| | - Tamasne Oszi
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
| | - Agota Szekeres
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
- Hungarian University of Agriculture and Life Sciences, Institute of Education, Kaposvar, Hungary
| | - Krisztina Stefanik
- Hungarian Academy of Sciences - ELTE University 'Autism in Education' Research Group, Budapest, Hungary
- Faculty of Special Education, Institute of Special Needs Education for People with Atypical Behaviour and Cognition, ELTE University, Budapest, Hungary
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Chen X, Tong J, Zhang W, Wang X, Ma S, Shi D, Yan D, Liu Y. Factors predicting depressive symptoms in parents of children with autism spectrum disorder in eastern China. BMC Public Health 2024; 24:226. [PMID: 38238720 PMCID: PMC10797873 DOI: 10.1186/s12889-024-17731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
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.
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Affiliation(s)
- Xu Chen
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Jiao Tong
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Weijing Zhang
- National Health Commission Contraceptives Adverse Reaction Surveillance Center, NO.277 Fenghuang west Street, Gulou District, 210036, Nanjing, Jiangsu, China
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
| | - Xin Wang
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Shan Ma
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Dongdong Shi
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Dongmei Yan
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China.
| | - Yan Liu
- National Health Commission Contraceptives Adverse Reaction Surveillance Center, NO.277 Fenghuang west Street, Gulou District, 210036, Nanjing, Jiangsu, China.
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China.
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China.
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Dückert S, Bart S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Health-related quality of life in family caregivers of autistic adults. Front Psychiatry 2023; 14:1290407. [PMID: 38193135 PMCID: PMC10773769 DOI: 10.3389/fpsyt.2023.1290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. Methods N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Results Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Discussion Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.
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Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bart
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Faculty Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brinkman AH, Barry TD, Lindsey RA. The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-developing Sibling Internalizing Behavior in Families with a Child with ASD. J Autism Dev Disord 2023; 53:4591-4603. [PMID: 36180666 DOI: 10.1007/s10803-022-05760-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.
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Affiliation(s)
- Aurora H Brinkman
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA
| | - Tammy D Barry
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA.
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Larson E, Jeglum N, Shmays C. Mixed-method evaluation of fidelity of motivational interviewing-based coaching in 5Minutes4Myself Wellness Program for caregivers of children with autism. PEC INNOVATION 2023; 2:100149. [PMID: 37214523 PMCID: PMC10194175 DOI: 10.1016/j.pecinn.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Objective This mixed method analysis examined fidelity of the motivational interviewing (MI) delivered during the 5Minutes4Myself wellness program for caregivers of children with Autism Spectrum Disorders. Methods Coaches used a manualized MI-approach to collaboratively design participants' individualized wellness programs, and then used it in monthly coaching sessions to support goal pursuit. Audio-recorded consultations and post-participation focus groups were transcribed verbatim. Consultation transcripts were rated for MI adherence using Motivational Interviewing Treatment Integrity Code. Focus group data was coded by the team to identify conceptual categories. Results Eighty-seven percent of consultations achieved a beginning (competent) level expert-derived MI standard. Caregivers noted that coaches' MI approach evoked deep emotions and understandings about their lives related to wellness goals, allowed for a permissive flexibility in goal pursuit, and fostered supportive accountability. Conclusion MI was used with high levels of fidelity. Participants described the MI approach as more productive, precise, and useful in addressing their needs compared to other available interventions.
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Affiliation(s)
- Elizabeth Larson
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Chloe Shmays
- Providence Child Development Institute, Portland, OR, USA
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11
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Ljungberg M, Schön UK. Who cares? A scoping review about the experiences of parental caregivers of autistic adults. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:929-939. [PMID: 37264729 DOI: 10.1111/jar.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The autistic population is growing and ageing and this also applies to the parents. Despite this, research about parental experiences is still relatively scarce. Even though studies show, compared with adults with other disabilities, parents of autistic adolescents and adults report a decrease in well-being and that caregiving is often a lifelong commitment. METHOD This scoping review maps, synthesises and identifies gaps in previous research as regards the experiences of parental caregivers of adult autistic children. The review was based on Arksey and Malley's framework and six databases were searched. RESULTS The results show how the research has focused on the well-being and consequences of daily caregiving for an American middle-class mother who co-resides with an adult son. CONCLUSION To enhance knowledge about formal services and service needs, more research is necessary on different welfare regimes and social contexts.
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Affiliation(s)
- Malin Ljungberg
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Rattaz C, Loubersac J, Michelon C, Picot MC, Baghdadli A. Changes in mothers' and fathers' stress level, mental health and coping strategies during the 3 years following ASD diagnosis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 137:104497. [PMID: 37004353 DOI: 10.1016/j.ridd.2023.104497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/17/2023] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND ASD in a child affects parental mental health, with elevated levels of stress, anxiety and depression reported in parents. METHOD In this study, we examined mothers' and fathers' stress, anxiety and depression, as well as their coping strategies in a sample of 103 children and adolescents enrolled in the ELENA cohort study in France at diagnosis and three years after diagnosis. RESULTS Results showed that mothers had higher levels of stress and anxiety / depression than fathers and used more social support coping strategies at diagnosis, which might be explained by increased levels of parental involvement. Mothers' stress level significantly decreased during the three years following ASD diagnosis but no such decrease was observed in fathers' stress level. A significant decrease in anxiety and depression was observed for both parents, suggesting that parental distress is particularly elevated during the critical diagnosis period. Results finally yielded a significant decrease in emotion-focused coping strategy in mothers over the three-year period, an ineffective strategy that takes places at the time of diagnosis but then decreases during the period following ASD diagnosis, in relation to the acceptance process. CONCLUSIONS Implications in terms of addressing the unmet mental health needs of parents and their coping strategies are discussed.
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Affiliation(s)
- Cécile Rattaz
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Clinical Research Unit, Department of Medical Information, CHU Montpellier, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'excellence sur l'autisme et les troubles neuro-développementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France; Faculté de Médecine, Université de Montpellier, France.
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13
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Rieder AD, Viljoen M, Seris N, Shabalala N, Ndlovu M, Turner EL, Simmons R, de Vries PJ, Franz L. Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa. Child Adolesc Psychiatry Ment Health 2023; 17:64. [PMID: 37210513 PMCID: PMC10199438 DOI: 10.1186/s13034-023-00611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI-whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. METHODS We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. RESULTS Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication-9/10 improved, Foundations of Learning-10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication-9/10 improved, Socialization-6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. CONCLUSIONS This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
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Affiliation(s)
- Amber D Rieder
- Division of Child and Family Mental Health & Community Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa.
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Minkateko Ndlovu
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Ryan Simmons
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Lauren Franz
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
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14
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Moorthy SD, Carlstedt AB, Fischl C. Mothers' participation in family gatherings and social events with their children with autism spectrum disorder: A scoping review. Aust Occup Ther J 2023. [PMID: 37139858 DOI: 10.1111/1440-1630.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/09/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Participating in family gatherings can provide enjoyment and quality time together as a family. However, being the primary carers, mothers of children with autism spectrum disorder may experience this phenomenon differently. The purpose of this study is to explore how available literature describes mothers' experiences of participation in family gatherings and social events with their children with autism spectrum disorder. METHODS A scoping review was used to explore available literature and identify studies describing mothers' experiences of family gatherings and social events with their children. A thematic synthesis was performed to analyse and synthesise the findings. RESULTS A total of 8 articles were included for review. The analysis of the included studies resulted in one central theme-Negative experiences despite strategies-and four analytical themes: Feeling fear, stress, and anxiety; Avoiding family gatherings; Enjoying less and becoming less confident; and Using strategies. CONCLUSION These findings indicate that mothers of children with autism spectrum disorder experience difficulties during gatherings even when using strategies, hence limiting their participation.
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Affiliation(s)
| | - Anita Björklund Carlstedt
- School of Health and Welfare, A.D.U.L.T. Research Group, Jönköping University, Jönköping, Sweden
- School of Health and Welfare, Department of Rehabilitation, Jönköping University, Jönköping, Sweden
| | - Caroline Fischl
- School of Health and Welfare, Department of Rehabilitation, Jönköping University, Jönköping, Sweden
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15
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Bispo-Torres AC, Lucena R, Tavares-Rodrigues IC, Barouh JL, Lins-Silva DH, Dorea-Bandeira I, Souza LS, Faria-Guimarães D, Tolentino A, Miranda-Scippa Â, Hermens DF, Sampaio AS, Quarantini LC, Glozier N, Hickie IB, Bandeira ID. Psychopathological symptoms in parents and siblings of people on the autism spectrum: A systematic review and meta-analysis. Psychiatry Res 2023; 323:115145. [PMID: 36921507 DOI: 10.1016/j.psychres.2023.115145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
Parents and siblings of children on the autism spectrum experience significant distress, and for this reason, it is essential to understand the most prevalent psychopathological symptoms among this population. This work aims to establish the prevalence of psychopathological symptoms in parents and siblings of individuals on the autism spectrum, following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) criteria. Searches were carried out using the PubMed/Medline, Embase, PsycINFO, SciELO, and Biblioteca Virtual em Saúde (BVS) databases. Twenty-three articles were included in this review. Depressive symptoms were the most frequently reported conditions, with a higher prevalence in mothers of children on the autism spectrum. In the meta-analysis, mothers of children on the autism spectrum scored higher by 0.42 standard deviations on the symptom scales (SMD 0.42; CI 0.25-0.59), with low statistical heterogeneity (I2 0%, p = 0.5) when compared with mothers of children with atypical development. The psychopathological symptoms of relatives should be investigated as part of the follow-up procedures for the child on the autism spectrum to facilitate their treatment.
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Affiliation(s)
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | | | - Judah L Barouh
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Daniel H Lins-Silva
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Ingrid Dorea-Bandeira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Lucca S Souza
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Daniela Faria-Guimarães
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Arthur Tolentino
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil
| | - Ângela Miranda-Scippa
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Daniel F Hermens
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Sunshine Coast 4575, Australia
| | - Aline S Sampaio
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40110060, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Lucas C Quarantini
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40025010, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40110060, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110060, Brazil
| | - Nick Glozier
- Brain and Mind Centre, The University of Sydney, Sydney 2050, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney 2050, Australia
| | - Igor D Bandeira
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto 94305, United States.
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16
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Rieder AD, Viljoen M, Seris N, Shabalala N, Ndlovu M, Turner EL, Simmons R, Vries PJ, Franz L. Improving access to early intervention for autism - findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa. RESEARCH SQUARE 2023:rs.3.rs-2624968. [PMID: 36909555 PMCID: PMC10002833 DOI: 10.21203/rs.3.rs-2624968/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI - whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. Methods We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. Results Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication - 9/10 improved, Foundations of Learning - 10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication - 9/10 improved, Socialization - 6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. Conclusions This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
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Affiliation(s)
- Amber D Rieder
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Marisa Viljoen
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Noleen Seris
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Minkateko Ndlovu
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | | | - Ryan Simmons
- Department of Biostatistics and Bioinformatics, Duke University
| | - Petrus J Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University
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Dembo RS, Mailick MR, Rudolph AE, Huntington N, DaWalt LS, Mitra M. Social Network Diversity and Mental Health Among Mothers of Individuals With Autism. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:101-118. [PMID: 36807480 PMCID: PMC10506165 DOI: 10.1352/1944-7558-128.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/05/2022] [Indexed: 06/18/2023]
Abstract
The present study examined the associations between networks of social relationships and psychological well-being among mothers of adolescents and adults with autism (n = 352) over a 12-year period of time. A structural equation modeling approach was used to delineate the relative impacts of network size and relationship diversity on maternal mental health, and to assess whether such effects are bidirectional. Mothers with more diverse relationships experienced reductions in depression and anxiety symptoms over time, and the psychological benefits of diversity remained after adjusting for network size. Results also suggest bidirectional links between network size, diversity, and maternal mental health. Research and clinical implications are discussed.
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Affiliation(s)
- Robert S Dembo
- Robert S. Dembo and Marsha R. Mailick, University of Wisconsin-Madison
| | - Marsha R Mailick
- Robert S. Dembo and Marsha R. Mailick, University of Wisconsin-Madison
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Maltman N, DaWalt LS, Hong J, Baker MW, Berry-Kravis EM, Brilliant MH, Mailick M. FMR1 CGG Repeats and Stress Influence Self-Reported Cognitive Functioning in Mothers. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:1-20. [PMID: 36548377 PMCID: PMC10445796 DOI: 10.1352/1944-7558-128.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/25/2022] [Indexed: 06/17/2023]
Abstract
Variation in the FMR1 gene may affect aspects of cognition, such as executive function and memory. Environmental factors, such as stress, may also negatively impact cognitive functioning. Participants included 1,053 mothers of children with and without developmental disabilities. Participants completed self-report measures of executive function, memory, and stress (i.e., life events, parenting status), and provided DNA to determine CGG repeat length (ranging from 7 to 192 CGGs). Stress exposure significantly predicted greater self-reported difficulties in executive function and the likelihood of memory problems. Cubic CGG effects independently predicted executive function and memory difficulties, suggesting effects of both genetic variation and environmental stress exposure on cognitive functioning.
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Affiliation(s)
- Nell Maltman
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | - Leann Smith DaWalt
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | - Jinkuk Hong
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | | | | | | | - Marsha Mailick
- Murray H. Brilliant and Marsha Mailick, University of Wisconsin-Madison
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Agarwal R, Wuyke G, Sharma U, Burke SL, Howard M, Li T, Sanchez M, Bastida E. Stress and Anxiety Among Parents of Transition-Aged Children with Autism Spectrum Disorder: a Systematic Review of Interventions and Scales. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-23. [PMID: 36065251 PMCID: PMC9434067 DOI: 10.1007/s40489-022-00340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
The period between adolescence to young adulthood can be stressful for parents of transition-aged children (14 to 22 years old) with autism spectrum disorder. A systematic review was undertaken to examine if existing interventions address the unique parental stressors of this phase and if the scales used to measure parental stress and anxiety are suitable for this group. Of the 9813 studies screened, only 13 studies met the inclusion criteria. Findings indicated that interventions focused on mindfulness, social functioning, or multiple components, of which only two addressed the transition period and only three specifically targeted parents of this age group. Moreover, of the six scales which assessed stress or anxiety, none were designed for these parents. Findings highlight the urgent need for more suitable scales and targeted interventions.
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Affiliation(s)
- Rumi Agarwal
- FIU Embrace, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Gabriella Wuyke
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Utsav Sharma
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32611 USA
| | - Shanna L. Burke
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Melissa Howard
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Elena Bastida
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
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20
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Leung CNW, Tsang B, Huang DH, Chan RWS. Building Self-Efficacy in Parenting Adult Children With Autistic Spectrum Disorder: An Initial Investigation of a Two-Pronged Approach in Role Competence. Front Psychol 2022; 13:841264. [PMID: 35941955 PMCID: PMC9355802 DOI: 10.3389/fpsyg.2022.841264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/01/2022] [Indexed: 12/05/2022] Open
Abstract
Previous studies on parenting adult children with ASD were scarce, and their intervention protocols mainly were derived from established work with children. Development of an applicable adult-oriented protocol and demonstration of its effectiveness is warranted. The present study outlined the development and evaluation of Core Autism Parenting Skills (CAPS), which targets to enhance parenting self-efficacy (PSE) intervention for adult children with ASD by addressing two intervention goals in parallel: acquisition of parenting skills and cultivating positive attributes. In CAPS, PSE is operationalised into four parent roles: to observe, reinforce, empathise, and accompany, each with requisite attributes, skills, and prescribed training. Twenty-seven parents with adult children with ASD (aged 16-37) were recruited. They completed measures assessing their PSE, competence in the four parent roles, and emotional well-being at pre-training, post-training and 2-month follow-up. The intervention was well-received by the participants and reported significant improvements in PSE, parent role competence at post-training and 2-month follow-up. The applicability of PSE and parent role competence in constructing effective parenting intervention for adult children with ASD was supported.
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21
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Uzodinma UE, Ede MO, Dike IC, Onah NG, Obiweluozo PE, Onwurah CN, Onuorah AR, Ejiofor JN, Ugwu CI, Amoke CV, Onah SO, Diara BC, Okwor CO, Aneke OA, Ngwoke AN, Ezema LC, Ifelunni CO, Nwachukwu UC, Oforka TO, Ilechukwu LC. Improving quality of family life among Christian parents of children with low vision in Nsukka catholic diocese using rational emotive family health therapy. Medicine (Baltimore) 2022; 101:e27340. [PMID: 35758344 PMCID: PMC9276117 DOI: 10.1097/md.0000000000027340] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 09/09/2021] [Accepted: 04/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Most Christian parents living with children with low vision have reported to be experiencing psychological disturbances that are affecting the family health. As a result, the quality of family life is being impaired. The experience of parents catering for children with low vision is mainly influenced by psychosocial factors that could determine the quality of family life of such parents. This present study is to investigate the efficacy of rational emotive family health therapy in reducing poor quality of family life among Christian parents of children with low vision in Nsukka Catholic Dioceses. METHOD This is a randomized pretest and posttest control trial. Participants were 88 parents of children living with low vision in Nsukka Catholic Dioceses, Nigeria. The power of the sample size was determined using Gpower statistical software. The participants in rational emotive family health therapy programme-group were exposed to a 12-session treatment programme whereas their counterparts in waitlisted control group did not receive anything. A family quality of life scale was utilized in assessing the participants. Data analyses were performed using repeated measures ANOVA. RESULTS It was found that rational emotive family health therapy had a significant positive effect on increasing quality of family life among the study participants compared to those in the waitlisted control group. CONCLUSION This study contributed and validated the efficacy of rational emotive family health therapy in improving quality of family life among parents of children with low vision.
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Affiliation(s)
| | | | | | - Nkechi G. Onah
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria
| | | | - Chimezie N. Onwurah
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | - Adaorah R. Onuorah
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | | | - Collins Ikenna Ugwu
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria
| | - Chijioke V. Amoke
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | - Sebastian O. Onah
- Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nigeria
| | - Benjamin C. Diara
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria
| | - Christopher O. Okwor
- Department of Religion and Cultural Studies, University of Nigeria, Nsukka, Nigeria
| | | | - Anthonia N. Ngwoke
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | - Luke Chizoba Ezema
- Department of Social Science Education, University of Nigeria, Nsukka, Nigeria
| | | | - Ugwunna C. Nwachukwu
- Department of Community Medicine, Faculty of Medical Sciences, University of Nigeria Ituku-Ozalla Campus, Nsukka, Nigeria
| | - Theresa O. Oforka
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
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22
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Marsack-Topolewski CN, Wang F. Dimensions of Caregiver Burden between Compound and Noncompound Caregivers of Adults with Autism. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:402-420. [PMID: 34427543 DOI: 10.1080/01634372.2021.1969609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
The expanding population of adults with autism spectrum disorder (ASD) will increase the number of aging parents who often assume the role of primary caregivers. Among aging caregivers of adults with ASD, compound caregiving (caring for additional family members) has become an increasingly common scenario. However, limited research has examined the burden of compound caregivers and little is known about the specific dimensions of burden among this population. The present study aims to compare differences between compound 1, compound 2, and noncompound caregivers on specific dimensions of caregiver burden associated with adult children with ASD. Using a cross-sectional design, data were collected from 320 caregivers aged 50 and older through a web-based survey. Four dimensions of burden (time dependence, developmental, emotional, and financial) were compared using MANOVA. Compound 1 and noncompound caregivers experienced lower levels of time dependence burden than compound 2 caregivers. In terms of developmental burden, the social life of compound 2 caregivers was more affected by caregiving compared to noncompound caregivers. The findings have practice implications for identifying caregivers' multiple responsibilities and the multi-faceted impact of caregiving, and prioritizing interventions for compound caregivers and its subpopulations to reduce their time and developmental burden.
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Affiliation(s)
- Christina N Marsack-Topolewski
- School of Social Work Michigan Developmental Disabilities Institute, Affiliated Research Associate, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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23
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Miniarikova E, Vernhet C, Peries M, Loubersac J, Picot MC, Munir K, Baghdadli A. Anxiety and depression in parents of children with autism spectrum disorder during the first COVID-19 lockdown: Report from the ELENA cohort. J Psychiatr Res 2022; 149:344-351. [PMID: 34776249 PMCID: PMC9750171 DOI: 10.1016/j.jpsychires.2021.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/26/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Covid-19 pandemic had a strong impact on mental health in the general population. This study conducted during the first lockdown in France considered parents of children with Autism Spectrum Disorder (ASD) prospectively followed in the ELENA Cohort. OBJECTIVES We aimed to (1) compare the Anxiety and Depression (AaD) levels during the lockdown between mothers and fathers, (2) compare the parent's AaD between the lockdown and the last ELENA follow-up visit, and (3) identify risk factors for parental AaD during lockdown among socio-demographic and children's clinical characteristics. METHODS The Hospital Anxiety and Depression Scale (HADS) was used to assess AaD in 134 parent's pairs. Parents also completed the Questionnaire about their living conditions during COVID-19, their child's interventions and perceived changes about their child's behaviors and sleep. Child's ASD severity, intellectual and socio-adaptive skills and parent's socio-demographic characteristics were collected from ELENA follow-up. RESULTS The parents' AaD levels were lower during the lockdown compared to the last ELENA visit that coincided in 96% with the child's ASD diagnosis. The AaD levels were more pronounced in mothers and significantly associated with the child's challenging behaviors, parents' teleworking and perceived knowledge about COVID-19. The perception of an insufficient knowledge was the only risk factor for mothers' AaD. CONCLUSION Our findings highlighted the pertinence for an assessment of the mental health of main caregivers of children with ASD, consideration of their gender characteristics, and the importance of providing relevant information during pandemic. Future studies examining the pandemic long-term effects are needed. TRIAL REGISTRATION NUMBER NCT02625116.
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Affiliation(s)
- Ela Miniarikova
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, Montpellier, France
| | - Christelle Vernhet
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, Montpellier, France
| | - Marianne Peries
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, Montpellier, France
| | - Julie Loubersac
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Marie-Christine Picot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France; Clinical Research Unit, Department of Medical Information, CHU Montpellier, Montpellier, France
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amaria Baghdadli
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, Montpellier, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France; Faculté de Médecine, Université de Montpellier, France.
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24
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Papanikolaou K, Ntre V, Gertsou IM, Tagkouli E, Tzavara C, Pehlivanidis A, Kolaitis G. Parenting Children with Autism Spectrum Disorder during Crises: Differential Responses between the Financial and the COVID-19 Pandemic Crisis. J Clin Med 2022; 11:jcm11051264. [PMID: 35268354 PMCID: PMC8911193 DOI: 10.3390/jcm11051264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Parenting a child with autism can be particularly stressful and challenging, especially during periods of crises. This study focuses on parenting children with autism during the COVID-19 pandemic in comparison to the economic crisis, six years ago. We administered the same set of questionnaires (CES-D, F-COPES, PSI-SF, and WHOQoL-BREF), along with a demographic characteristic and a COVID-19-related questionnaire to the same group of parents of children with autism as we did six years ago. Results indicated that during the COVID-19 crisis, the level of parenting stress and the distress due to personal factors related to demands of parenting, were significantly lower compared to the economic crisis, while the environment facet of quality of life was significantly higher. The depressive symptomatology was elevated during both periods. Finally, when addressing the pandemic crisis, parents were more likely to passively accept problematic issues, less able to obtain social support, and less able to acquire and accept help from others. In our sample, findings differentiate the genre of crises through the parents’ responses regarding the sense of competence in their parental role, their quality of life, and the coping strategies they implemented. The study implies that each crisis must be confronted with particular responses to particular needs.
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Affiliation(s)
- Katerina Papanikolaou
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
- Correspondence:
| | - Vassiliki Ntre
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
| | - Ioanna-Maria Gertsou
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
| | - Evdokia Tagkouli
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
| | - Chara Tzavara
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
| | - Artemios Pehlivanidis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (V.N.); (I.-M.G.); (E.T.); (C.T.); (G.K.)
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25
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van den Heuvel RM, Wensing M, Geurts HM, Teunisse JP. The Social Support Network of Adults with an Autism Spectrum Condition: An Exploration Using the Network in Action-Questionnaire. J Autism Dev Disord 2022; 53:1974-1988. [PMID: 35182260 PMCID: PMC10123042 DOI: 10.1007/s10803-022-05467-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
Actively involving the network during treatment, as recommended in Autism Spectrum Condition (ASC) guidelines, can be facilitated with the Network in Action-Questionnaire (NiA-Q), which identifies the current and potential sources of social support. The aims of this study were to (1) examine the factor structure of the NiA-Q and (2) to explore the self- and proxy-report on the social network. Before the start of treatment in a mental health institution, 193 adults with an ASC diagnosis and 84 proxies completed the NiA-Q. Factor analysis showed two factors: positive social support and interpersonal distress. Self- and proxy-report on the NiA-Q did not differ for most variables, except for social network wishes. The NiA-Q provides a basis for network involvement and strengthening.
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Affiliation(s)
- Rinske M van den Heuvel
- Leo Kannerhuis, Youz (Parnassia Group), Stationsweg 49, 6861 EE, Oosterbeek, The Netherlands. .,HAN University of Applied Sciences, Nijmegen, The Netherlands. .,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Michel Wensing
- General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Hilde M Geurts
- Leo Kannerhuis, Youz (Parnassia Group), Stationsweg 49, 6861 EE, Oosterbeek, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Pieter Teunisse
- Leo Kannerhuis, Youz (Parnassia Group), Stationsweg 49, 6861 EE, Oosterbeek, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
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26
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Wang Z, Wang L, Chang S, Wang H. 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. Front Psychiatry 2022; 13:713620. [PMID: 35250654 PMCID: PMC8891381 DOI: 10.3389/fpsyt.2022.713620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Zhidan Wang
- School of Education Science, Jiangsu Normal University, Xuzhou, China
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27
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Smith DaWalt L, Hickey E, Hudock R, Esler A, Mailick M. Impact of Working Together for adults with autism spectrum disorder: a multifamily group intervention. J Neurodev Disord 2021; 13:44. [PMID: 34625016 PMCID: PMC8499454 DOI: 10.1186/s11689-021-09395-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adults with autism spectrum disorder (ASD) have lower engagement in their communities, higher rates of unemployment/underemployment, and continued difficulties with challenging behavior compared to their neurotypical peers. Multi-family psychoeducation emphasizes education and problem-solving with the goal of improving these outcomes for the individual with the disability. METHODS Using a randomized waitlist control design, the present study evaluated a multi-family group psychoeducation intervention, Working Together, for adults on the autism spectrum without intellectual disability (n = 40). Five waves of data were collected at 3-month intervals. In this design, families in the intervention condition participated in intervention during the 6 months between baseline and time 3 data collection; the waitlist control condition received the intervention immediately after the time 3 data collection. We compared these two conditions, intervention group (n = 20) vs waitlist control group (n = 20), on key outcomes for the adults with ASD: engagement in work-related activities, engagement in meaningful activities, and behavior problems. RESULTS Results indicated medium to large effect sizes associated with the Working Together intervention across key outcomes, including adults on the spectrum experiencing significant increases in meaningful activities and decreases in internalizing problems. Although increases in work-related activities were not statistically significant, an observed one-half of a standard deviation difference from before to after the intervention indicated clinically significant change. We also found maintenance of the treatment effect through 6 months post-treatment for the intervention group and replication of the treatment effect within the control group after they received the intervention. CONCLUSION Working Together is a promising multi-family group psychoeducation intervention designed to improve functioning during adulthood. These findings highlight the need for more intervention services research during adulthood and specifically the need for family-centered supports.
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Affiliation(s)
- Leann Smith DaWalt
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI USA
| | - Emily Hickey
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI USA
| | - Rebekah Hudock
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
| | - Amy Esler
- Department of Pediatrics, University of Minnesota, Minneapolis, USA
| | - Marsha Mailick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI USA
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28
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Hong J, Kapoor A, DaWalt LS, Maltman N, Kim B, Berry- Kravis EM, Almeida D, Coe C, Mailick M. Stress and genetics influence hair cortisol in FMR1 premutation carrier mothers of children with fragile X syndrome. Psychoneuroendocrinology 2021; 129:105266. [PMID: 34020265 PMCID: PMC8217368 DOI: 10.1016/j.psyneuen.2021.105266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 01/20/2023]
Abstract
To investigate genetic and environmental influences on cortisol levels, mothers of children with fragile X syndrome (FXS) were studied four times over a 7.5-year period. All participants (n = 84) were carriers of the FMR1 "premutation", a genetic condition associated with impaired HPA axis functioning. Genetic variation was indicated by expansions in the number of CGG (cytosine-guanine-guanine) repeats in the FMR1 gene (67-138 repeats in the present sample). The environmental factor was cumulative exposure to adverse life events during the study period. Cortisol was measured at the beginning of the study via saliva samples and at the end of the study via hair samples; hormone values from these two specimen types were significantly correlated. The interactions between CGG repeat number and adverse life events significantly predicted hair cortisol concentration, including after accounting for the initial salivary cortisol level. For those with fewer CGG repeats, stress exposure was associated with elevated cortisol, the expected response to stress, although women with a higher number of CGGs had a reduced cortisol response to adverse events, which might be related to HPA dysfunction. These results indicate that both exogenous and endogenous factors affect HPA functioning in this population of women.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, United States.
| | - Amita Kapoor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison
| | | | | | - Bryan Kim
- Waisman Center, University of Wisconsin-Madison
| | | | - David Almeida
- Department of Human Development and Family Studies, Pennsylvania State University
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29
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Corbett BA, Muscatello RA, Klemencic ME, Schwartzman JM. The impact of COVID-19 on stress, anxiety, and coping in youth with and without autism and their parents. Autism Res 2021; 14:1496-1511. [PMID: 33913261 PMCID: PMC8237027 DOI: 10.1002/aur.2521] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
In the wake of COVID-19, the world has become a more uncertain environment-a breeding ground for stress and anxiety, especially for individuals with autism spectrum disorder (ASD). The study examined stress, anxiety, and coping in a data-driven, real-time assessment of 122 youth with and without ASD and their parents at the height of the COVID-19 shutdown and three-months later. Standardized measures were administered to ascertain stress and coping explicitly related to the pandemic (RSQ COVID-19-Child [self-report], Adult [self-report from the guardian of youth], Parent [report about child]) and anxiety (STAI-C, STAI-A). Multivariate, univariate analyses of variance and hierarchical regression were used. ASD youth endorsed more Trait anxiety and response to specific stressors (e.g., virus). Caregivers of youth with ASD (Adults) self-reported higher anxiety, yet scores were elevated for both groups. Adults of youth with ASD reported more stress, especially related to the virus, access to healthcare, and concern for the future. In the TD group, youth and adults used more Primary and Secondary Control Coping whereas ASD youth and adults used more Disengagement Coping. Adult stress was the primary predictor of parent perception of child stress as well as Child self-reported stress. While the ASD group was consistently high compared to the TD group, there were no significant changes over time for stress or anxiety. Results reveal striking differences in youth with ASD and their parents regarding stress, anxiety, and coping. Findings highlight the need for essential support, access to services, and strategies to enhance psychological and emotional well-being. LAY SUMMARY: This study examined stress, anxiety, and coping related to the COVID-19 pandemic in 61 youth with autism spectrum disorder (ASD) and 61 youth with typical development (TD) and their parents. Results showed that ASD youth reported more anxiety and stress. Adults of youth with ASD indicated higher self-reported anxiety and stress than adults of TD youth. TD youth and their parents reported using more adaptive coping strategies. Findings highlight the need for strategies to enhance psychological and emotional well-being.
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Affiliation(s)
- Blythe A. Corbett
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt University Medical Center, Vanderbilt Kennedy CenterNashvilleTennesseeUSA
- Department of PsychologyVanderbilt UniversityNashvilleTennesseeUSA
| | - Rachael A. Muscatello
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mark E. Klemencic
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jessica M. Schwartzman
- Department of Psychiatry and Behavioral SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
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30
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Weiss JA, Robinson S, Riddell RP, Flora D. Understanding Stability and Change in Perceived Social Support in Parents of Autistic Children and Adolescents. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:679974. [PMID: 36188809 PMCID: PMC9397722 DOI: 10.3389/fresc.2021.679974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/30/2021] [Indexed: 12/28/2022]
Abstract
Parents of children with autism often have their own support needs. Informal social support can be an important component of managing parenting-related stressors. We know very little about the factors that lead to higher levels of perceived social support or the potential reciprocal relationship social support has with other factors in parents of children with autism. The current longitudinal study examined the reciprocal relations of perceived social support and parent stress and child behavior problems across a 1-year period, using three time points. There was remarkable stability in variables over time. Baseline perceived social support significantly predicted changes in child behavior and parent stress at the 6-month time point, but neither of those variables significantly predicted social support. This study adds to our understanding of social support and clarifies how perceived social support relates to other factors longitudinally.
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Affiliation(s)
- Jonathan A. Weiss
- Developmental Disabilities and Mental Health Laboratory, Department of Psychology, York University, Toronto, ON, Canada
- *Correspondence: Jonathan A. Weiss
| | - Suzanne Robinson
- Developmental Disabilities and Mental Health Laboratory, Department of Psychology, York University, Toronto, ON, Canada
- Roncesvalles Psychology Clinic, Toronto, ON, Canada
| | - Rebecca Pillai Riddell
- Opportunities to Understanding Childhood Hurt Laboratory, Department of Psychology, York University, Toronto, ON, Canada
| | - David Flora
- Quantitative Methods, Department of Psychology, York University, Toronto, ON, Canada
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31
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Mahoney WJ, Blaskowitz MG, Johnson KR. Occupational Therapy-Related Assessments for Adults With Intellectual Disability: A Scoping Review. Am J Occup Ther 2021; 75:12498. [PMID: 34781342 DOI: 10.5014/ajot.2021.046342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. OBJECTIVE To identify occupational therapy-related tools in the peer-reviewed literature for use in practice with adults with ID. DATA SOURCES Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy-related assessment with adults 18 yr or older who had primary or co-occurring ID. FINDINGS Fifty-eight articles identified 73 occupational therapy-related assessment tools. CONCLUSIONS AND RELEVANCE This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners. What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy-related assessment tools for adults with ID and an assessment reference guide.
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Affiliation(s)
- Wanda J Mahoney
- Wanda J. Mahoney, PhD, OTR/L, is Associate Professor of Occupational Therapy and Medicine, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
| | - Meghan G Blaskowitz
- Meghan G. Blaskowitz, DrPH, MOTR/L, is Assistant Professor, Department of Occupational Therapy, Duquesne University, Pittsburgh, PA
| | - Khalilah R Johnson
- Khalilah R. Johnson, PhD, MS, OTR/L, is Assistant Professor, Division of Occupational Science and Occupational Therapy, University of North Carolina School of Medicine, Chapel Hill
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32
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Marsack-Topolewski CN, Samuel PS, Tarraf W. Empirical evaluation of the association between daily living skills of adults with autism and parental caregiver burden. PLoS One 2021; 16:e0244844. [PMID: 33400706 PMCID: PMC7785247 DOI: 10.1371/journal.pone.0244844] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the joy of parenting, the burden of daily caregiving for children with autism spectrum disorders (ASD) can be overwhelming and constant. Parents can expect to provide enduring care for their children with ASD. Given that the majority of individuals with autism spectrum disorders (ASD) remain in their family homes well into adulthood, often the need for assistance with activities of daily living (ADLs) is placed on parents. Providing ongoing support to adult children who have difficulty with completing ADLs can increase parental caregiving demands. Therefore, the purpose of this study was to examine the relationship between the ability of adults with ASD to perform ADLs with parental perceptions of caregiver burden. METHODS Quantitative analysis of cross-sectional multi-state data gathered electronically using Qualtrics from 320 aging parents of adults with ASD was conducted. Regression models were fit to examine the association of ADL challenges with total caregiver burden and its four domains (emotional, financial, time dependence, and developmental). RESULTS Parental perceptions of caregiver burden decreased, particularly time dependence and developmental burden, when adult children were less dependent in ADLs, even after adjusting for parental health and behavioral challenges. CONCLUSIONS Findings support the need for family-centered interventions to improve the capacity of adults with ASD to perform ADLs independently.
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Affiliation(s)
| | - Preethy Sarah Samuel
- Occupational Therapy Program, Department of Health Care Sciences, Wayne State University, Detroit, Michigan, United States of America
| | - Wassim Tarraf
- Occupational Therapy Program, Department of Health Care Sciences, Wayne State University, Detroit, Michigan, United States of America
- Institute of Gerontology, Wayne State University, Detroit, Michigan, United States of America
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33
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Alhuzimi T. Stress and emotional wellbeing of parents due to change in routine for children with Autism Spectrum Disorder (ASD) at home during COVID-19 pandemic in Saudi Arabia. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103822. [PMID: 33271447 DOI: 10.1016/j.ridd.2020.103822] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/08/2020] [Accepted: 11/22/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Parents of children with Autism Spectrum Disorder (ASD) experience considerable amounts of stress and impaired emotional well-being. Consequently, it is likely that these have been adversely impacted by COVID-19 outbreak due to disruptions to the schedules of children with ASD. AIM This study investigated the stress and emotional well-being of parents of children with ASD in Saudi Arabia during the COVID-19 pandemic. METHOD The study obtained quantitative data from 150 parents of children with ASD from different regions in Saudi Arabia using an online survey. The data collected included demographic data of the parents, ASD status of the family, ASD support during COVID-19 pandemic, severity of ASD behaviours in comparison to the pre- COVID-19 status eating behaviour of the child with ASD, Parental Stress, and emotional well-being. The PSI-short form (PSI-SF) (Abidin, 1995) scale was utilised to obtain data related to parental stress and the General Health Questionnaire (GHQ-12) (Goldberg, 1992) scale was utilised to obtain data related to parents' emotional well-being. RESULTS The study found that family ASD status (in particular, age and gender of child with ASD, and severity of his/her symptoms) had a significant impact on parental stress and emotional well-being. Moreover, parental stress and emotional well-being were negatively impacted by the frequency and usefulness of ASD support received during COVID-19 pandemic. These were also adversely impacted by the change in severity of ASD behaviours of the children with ASD. Finally, parental stress was found to have a negative impact on the emotional well-being of parents. Overall, the study found that the parental stress and emotional well-being of parents of children with ASD in Saudi Arabia had been unfavourably impacted by COVID-19 pandemic. CONCLUSIONS Overall, the study found that the parental stress and emotional well-being of parents with ASD in Saudi Arabia had been unfavourably impacted by COVID-19 pandemic. This study recommends the involvement of the Saudi Ministry of Health to establish and extend support services to support parents of children with ASD. Moreover, the provision of training programs to help parents deal with the characteristic behaviour of their children with ASD such as, the ability to maintain routines, aggressive or repetitive behaviour, is also recommended.
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Affiliation(s)
- Talal Alhuzimi
- Department of Special Education, College of Education, King Saud University, Riyadh, Saudi Arabia.
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Hamama L, Gaber S. Seeing the siblings: Gender differences in emerging-adult siblings of individuals with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103829. [PMID: 33310400 DOI: 10.1016/j.ridd.2020.103829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/05/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The present study focused on typically developing siblings (TDS) in emerging adulthood of individuals with autism spectrum disorder (ASD) and sought insight into how gender may interact with positive and negative affects in this population. In addition, we aimed to explore the gender differences as a moderator in the link between personal resources (i.e., family cohesion and flexibility coping strategy) and positive and negative affects among such TDS. An understanding of gender differences in this population should prove relevant to the development of potential interventions. METHOD A total of 116 emerging adult (age 18-29) TDS of younger siblings with ASD (the latter were under the age of 18 at the time of data collection), 80 females and 36 males, participated in the study. All participants completed self-report measures. RESULTS Female TDS reported higher negative affect than male TDS, while no differences emerged regarding positive affect. Female siblings reported higher family cohesion and higher flexibility in the forward-focused subscale of flexibility coping strategy, but not in its trauma-focused subscale, compared to male siblings. Additionally, gender moderates the links between family cohesion and positive affect but not negative affect. Gender also moderates the association between flexibility and negative affect, but not positive affect. CONCLUSIONS This study highlights the gender differences among TDS in emerging adulthood of individuals with ASD in relation to negative affect, family cohesion, and flexibility coping strategy. Understanding the gender-specific internal and external experiences of TDS as interplaying with their resources, at the unique developmental stage of emerging adulthood, may afford to identify TDS in need and to suggest potential interventions.
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Affiliation(s)
- L Hamama
- Bob Shapell School of Social Work, Tel Aviv University, Israel.
| | - S Gaber
- Bob Shapell School of Social Work, Tel Aviv University, Israel.
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Long KA, Gordillo M, Orsmond GI. Improving the Validity and Generalizability of Adult Autism Research Through Incorporating Family and Cultural Contexts. AUTISM IN ADULTHOOD 2020; 2:177-184. [PMID: 32959029 DOI: 10.1089/aut.2019.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relatively nascent empirical knowledge base regarding autism in adulthood provides an opportunity to adopt a contextual approach that conceptualizes autism features, outcomes, and supportive services as interactions between the characteristics of the condition and contextual factors across the life course. Although a contextual approach encompasses many aspects of a person's identity and social ecology, we focus here on the closely interrelated family and cultural contexts, which have been poorly integrated into adult autism research. We argue that designing studies with a priori attention to context (e.g., family and culture) will improve the relevance and comprehensiveness of findings, which in turn will improve construct validity and provide a more accurate understanding of autism-related outcomes in adulthood. Similarly, designing and/or selecting measures that have been validated with culturally and linguistically diverse samples will improve the utility of findings and reduce spurious or null effects. More contextually informed methodologies will lead to improved generalizability and practical applications of findings. We offer concrete guidance regarding how to increase the social ecological perspective within adult autism research as it relates to study conceptualization, methodology, and measurement.
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Affiliation(s)
- Kristin A Long
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Monica Gordillo
- Department of Psychological & Brain Sciences and Boston University, Boston, Massachusetts, USA
| | - Gael I Orsmond
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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Fitzpatrick SE, Schmitt LM, Adams R, Pedapati EV, Wink LK, Shaffer RC, Sage J, Weber JD, Dominick KC, Erickson CA. Pediatric Quality of Life Inventory (PedsQL) in Fragile X Syndrome. J Autism Dev Disord 2020; 50:1056-1063. [PMID: 31728808 DOI: 10.1007/s10803-019-04292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, health related quality of life (QoL) has not been systematically evaluated in youth with fragile X syndrome (FXS), the most common single gene cause of autism and the most common inherited form of developmental disability. We describe QoL data gathered using the Pediatric Quality of Life Inventory (PedsQL) completed online by 364 parents of youth with FXS. Parents consistently reported across all gender and age groups that their children experienced the highest QoL in Physical functioning and the lowest QoL in Cognitive functioning. Overall, older children with FXS had increase QoL ratings in the domains of School and Cognitive function.
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Affiliation(s)
- Sarah E Fitzpatrick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Lauren M Schmitt
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Ryan Adams
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan K Wink
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca C Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica Sage
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | | | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA. .,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Anderson J, Marley C, Gillespie-Smith K, Carter L, MacMahon K. When the mask comes off: Mothers' experiences of parenting a daughter with autism spectrum condition. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1546-1556. [PMID: 32338537 DOI: 10.1177/1362361320913668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
LAY ABSTRACT Parents of children with autism spectrum condition report increased stress and difficulties compared with parents of typically developing children. Our knowledge and understanding of how autism spectrum condition presents in autistic females is currently limited and parents of this population may experience challenges when raising their daughter. Given that mothers are often the main caregiver of a child with autism spectrum condition, they may have useful insights into the experiences of parenting a daughter with autism spectrum condition. Therefore, a qualitative study was undertaken to explore what mothers' experiences are of parenting a daughter with autism spectrum condition. Semi-structured interviews were conducted with 10 mothers of daughters with autism spectrum condition. The interviews were analysed using interpretative phenomenological analysis. Five main themes emerged from the qualitative study ('Girls have autism too', 'She's a chameleon', 'The impact of the diagnosis', 'Impact on mums' and 'Day-to-day life'). The findings of this study expand our current knowledge of the experiences and challenges faced by mothers raising a daughter with autism spectrum condition. Mothers hold a vast amount of knowledge on their daughters' autism spectrum condition which could inform the diagnostic process and clinical practice. Considering these results, it is important that clinicians support mothers and the family system around children with an autism spectrum condition diagnosis.
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Coffman MC, Shaffer RC, Schmitt LM, Dominick KC, Pedapati E, Wang A, Berry-Kravis E, Tartaglia N, Erickson CA. Examination of Correlates to Health-Related Quality of Life in Individuals with Fragile X Syndrome. Brain Sci 2020; 10:E213. [PMID: 32260381 PMCID: PMC7226021 DOI: 10.3390/brainsci10040213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept involving physical, psychological, social, and cognitive aspects of life. Individuals with Fragile X syndrome (FXS) experience a life-long disorder that impacts the HRQoL of the affected individual and their family. Thus, HRQoL may be an important outcome measure following intervention. However, it is yet not known whether HRQoL concerns relate to observed impairments in FXS. In the present study, we examined the nature and degree of association between HRQoL and established measures of functioning in FXS using the Parent Report for Children version of the PedsQL 4.0 Generic Core Scales and Cognitive Functioning Scale. We observed significant relationships between HRQoL a nd measures of adaptive behavior, maladaptive behaviors, and social functioning. The present study has implications for treatment outcomes for clinical trials in FXS.
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Affiliation(s)
- Marika C. Coffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
| | - Rebecca C. Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Lauren M. Schmitt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Kelli C. Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ernest Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Child Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Angel Wang
- Departments of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Nicole Tartaglia
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Neupane KG. Autism Spectrum Disorder: The Parental Experience. J Psychosoc Nurs Ment Health Serv 2020; 58:14-19. [PMID: 31710368 DOI: 10.3928/02793695-20191022-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
Abstract
In 2018, one in every 59 children was diagnosed in the United States with autism spectrum disorder (ASD). ASD is a developmental disability, which is a biologically based neurodevelopmental disorder that affects a child's social interaction and communication skills. ASD includes repetitive patterns and restrictive behaviors, which could last a lifetime. Limited awareness of disease condition, less effective coping strategies, and inadequate guidance lead to increased stress levels among parents of children with ASD. Parents experience peaks and troughs of social, emotional, and financial challenges as they go through a pre-diagnosis phase, diagnosis phase, and post-diagnosis phase. The shortage of health care providers and fragmentation of care in the health care delivery system delays early diagnosis and management of ASD. Primary care providers along with the U.S. physician workforce for patients with ASD are strongly encouraged to review their practices on early screening and diagnosis and have clearly planned out care for every child with a family-centered approach. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 14-19.].
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Fingerman KL, Huo M, Birditt KS. A Decade of Research on Intergenerational Ties: Technological, Economic, Political, and Demographic Changes. JOURNAL OF MARRIAGE AND THE FAMILY 2020; 82:383-403. [PMID: 38831801 PMCID: PMC11145410 DOI: 10.1111/jomf.12604] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/29/2019] [Indexed: 06/05/2024]
Abstract
Due to extended transitions to adulthood and declining marital rates, bonds between adults and parents have grown increasingly salient in individuals' lives. This review organizes research around these topics to address ties between parents and grown children in the context of broader societal changes over the past decade. Literature searches included tables of contents of premier journals (e.g., Journal of Marriage and Family), Psychological Info, and Google Scholar. The literature review revealed patterns of social and intergenerational changes. Technological advances (e.g., introduction of the smart phone) co-occurred with more frequent contact and interdependence between generations. The Great Recession and financial strains altered the nature of many parent/child ties, including increased rates of intergenerational coresidence. Individual life problems such as divorce, addiction, and physical health problems were reflected in complex changes in positive and negative relationship qualities, ambivalence, and intergenerational support. Government policies reflect societal values and in turn, affected the distribution of parents' and grown children's resources. Political disruptions instigated migration, separating generations across large geographic regions. Political disruptions instigated migration, separating generations across large geographic regions. Demographic changes (e.g., constellation of family members, delayed marriage, same sex marriage) were also manifest in ties between adults and parents. Findings were consistent with the Intergenerational Systems in Context Model, which posits that societal transformations co-occur with changes in intergenerational relationships via reciprocal influences.
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Ruiz SK, Waters TEA, Yates TM. Children’s secure base script knowledge as a mediator between early life stress and later behavior problems. Attach Hum Dev 2019; 22:627-642. [DOI: 10.1080/14616734.2019.1672079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sarah K. Ruiz
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Tuppett M. Yates
- Department of Psychology, University of California, Riverside, CA, USA
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Blacher J, Baker BL. Collateral Effects of Youth Disruptive Behavior Disorders on Mothers' Psychological Distress: Adolescents with Autism Spectrum Disorder, Intellectual Disability, or Typical Development. J Autism Dev Disord 2019; 49:2810-2821. [PMID: 29071563 DOI: 10.1007/s10803-017-3347-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Disruptive behavior disorders were assessed in 160 youth aged 13 years, with Autism Spectrum Disorder (ASD, n = 48), intellectual disability (ID, n = 28), or typical development (TD, n = 84). Mothers' reported collateral effects on their psychological adjustment were related to both youth disability status and clinical level behavior disorders. More youth with ASD or ID had clinical level behavior disorders than their TD peers, and their mothers reported significantly higher personal stress and psychological symptoms, as well as lower positive impact of the youth on the family. The youth's clinical level behavior disorders accounted for these differences more than the diagnostic status. Mothers high in dispositional optimism reported the lowest stress and psychological symptoms in relationship to youth behavior challenges.
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Affiliation(s)
- Jan Blacher
- Graduate School of Education, University of California, UCR, Sproul Hall, Riverside, CA, 92521, USA.
| | - Bruce L Baker
- Department of Psychology, University of California, Los Angeles (UCLA), Franz Hall, Los Angeles, CA, 90095, USA
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Scherer N, Verhey I, Kuper H. Depression and anxiety in parents of children with intellectual and developmental disabilities: A systematic review and meta-analysis. PLoS One 2019; 14:e0219888. [PMID: 31361768 PMCID: PMC6667144 DOI: 10.1371/journal.pone.0219888] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/04/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Although caring for a child with intellectual and developmental disabilities (IDD) can have positive outcomes, parents may be at a greater risk of depression and anxiety, due to a number of associated stressors, such as increased caregiver demands and financial strain. This systematic review updates previous data, exploring the relationship between parenting a child with IDD and parental depression and anxiety. METHODS Five electronic databases were searched for eligible English-language articles, published between January 2004 and July 2018. All epidemiological study designs were eligible, provided the level of depression and/or anxiety was compared between parents of children (aged <18) with and without IDD. No limit was placed on geographic location. The proportion of positive associations between parenting a child with IDD and depression/anxiety were disaggregated by disability type, geographic region, and sample size. The percentage of parents at risk of moderate depression or anxiety were calculated using recognised clinical cut-off scores for each screening tool. Meta-analyses, in which pooled effect sizes of elevated depression and anxiety symptoms were calculated, were conducted across two IDD conditions, autism and cerebral palsy. RESULTS Of the 5,839 unique records screened, 19 studies fulfilled the inclusion criteria. The majority of studies were conducted in high-income (n = 8, 42%) or upper-middle income countries (n = 10, 53%). Of the 19 studies, 69% focused on parents of children with cerebral palsy (n = 7, 37%) or autism (n = 6, 32%). Nearly all studies found a positive association between parenting a child with IDD and depression (n = 18, 95%) and anxiety (n = 9, 90%) symptoms. Factors associated with higher levels of depression symptoms amongst parents of children with IDD included disability severity (n = 8, 78%) and lower household income (n = 4, 80%). Approximately one third (31%) of parents of children with IDD reach the clinical cut-off score for moderate depression, compared with 7% of parents of children without IDD. 31% of parents of children with IDD reach the cut-off score for moderate anxiety, compared with 14% of parents of children without IDD. The meta-analyses demonstrated moderate effect sizes for elevated depression amongst parents of children with autism and cerebral palsy. CONCLUSIONS Results indicate elevated levels of depressive symptoms amongst parents of children with IDD. Quality concerns amongst the existing literature support the need for further research, especially in low- and middle-income countries.
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Affiliation(s)
- Nathaniel Scherer
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Ibone Verhey
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine and King’s Health Partners, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Estes A, Swain DM, MacDuffie KE. The effects of early autism intervention on parents and family adaptive functioning. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:21. [PMID: 31583390 PMCID: PMC6776235 DOI: 10.21037/pm.2019.05.05] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This review describes the effects of intervention for young children with autism spectrum disorder (ASD) on parents. Like all children, children with ASD bring both negative and positive experiences for parents and families-from increased resource needs, to higher levels of parenting-related stress, to positive personal growth for family members. It is increasingly recognized that, although children with ASD are the primary targets of early ASD intervention, ASD intervention also impacts parents. From the time emerging developmental concerns begin to be identified, through the process of obtaining a diagnosis and initiating services, parents play a central role in addressing the needs of young children with ASD, including implementing and supporting early intervention. Parents experience the impact of intervention directly, through interaction with providers within the health care and educational systems. Parents also experience indirect impacts of ASD intervention due to accelerated developmental progress of children who are benefitting from services and when children make slower progress than expected or have challenging behaviors. Parental stress and psychological well-being are legitimate targets of intervention and compelling research objectives, needing no additional justification. However, parents are also the major contributors to family adaptive functioning-the activities families employ to support positive outcomes for children with ASD (e.g., family-orchestrated child experiences, parent-child interaction, child health and safety functions; Guralnick, 1997). A parent's ability to carry out adaptive functions is, in part, related to their levels of stress and psychological well-being. Thus, there is a transactional process in which parents are both impacted by and have an impact on ASD interventions for their child. Evaluating the effect of ASD intervention on parents is needed to develop new strategies for helping parents and children with ASD reach their full potential. This review will provide an overview of research on the impact of early ASD intervention on parents. Evidence regarding the impact of three types of intervention (i.e., early intensive behavioral intervention, parent-implemented intervention, and programs directly targeting parent stress) on parent well-being and family adaptive functioning will be reviewed. Potential moderators of the impact of ASD intervention on parents and family adaptive functioning will be discussed. We conclude that research on the impact of ASD intervention on parents of young children with ASD is a promising avenue for improving the lives of children with ASD and their families.
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Affiliation(s)
- Annette Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Deanna M. Swain
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Schnabel A, Youssef GJ, Hallford DJ, Hartley EJ, McGillivray JA, Stewart M, Forbes D, Austin DW. Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:26-40. [DOI: 10.1177/1362361319844636] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.
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Affiliation(s)
| | - George J Youssef
- Deakin University, Australia
- Murdoch Children’s Research Institute, Australia
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A Model of Family and Child Functioning in Siblings of Youth with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:1210-1227. [PMID: 29067588 DOI: 10.1007/s10803-017-3352-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The potential clinical needs of typically developing (TD) siblings of youth with autism spectrum disorder (ASD) remain disputed. A total of 239 mothers of youth aged 6-17, including one youth with ASD (M = 11.14 years; simplex families) and at least one other youth (M = 11.74 years) completed online standardized measures of various familial factors and TD youth outcomes. Overall, only 6-23% of siblings were identified within the clinical range of emotional, behavioral, or social functioning. Both maternal depression and sibling relationship were identified as key pathways in predicting siblings' functioning within a good-fitting path analysis model. The current model is presented as a novel base for the development of future research and services for this unique population of children.
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Shochet IM, Saggers BR, Carrington SB, Orr JA, Wurfl AM, Duncan BM. A Strength-Focused Parenting Intervention May Be a Valuable Augmentation to a Depression Prevention Focus for Adolescents with Autism. J Autism Dev Disord 2019; 49:2080-2100. [DOI: 10.1007/s10803-019-03893-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Parenting an Adult with High-Functioning Autism Spectrum Disorder. AUTISM IN ADULTHOOD 2019. [DOI: 10.1007/978-3-030-28833-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goltzer G, Pearlman-Avnion S. Feelings of Parents with Broader Autism Phenotype Towards Their Autistic Child. AUTISM IN ADULTHOOD 2019. [DOI: 10.1007/978-3-030-28833-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Derguy C, Roux S, Portex M, M'bailara K. An ecological exploration of individual, family, and environmental contributions to parental quality of life in autism. Psychiatry Res 2018; 268:87-93. [PMID: 30015111 DOI: 10.1016/j.psychres.2018.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/12/2018] [Accepted: 07/05/2018] [Indexed: 01/26/2023]
Abstract
The aim of this study was to assess the respective weight of individual and environmental factors on quality of life (Qol) of parents of children with autism spectrum disorders (ASD). Few studies have investigated both individual and environmental predictors of Qol but to our knowledge, none of them has considered the child's and parents' characteristics, family context and services available in the same design. Participants were 115 parents (73 mothers and 42 fathers) of children with ASD aged from 3 to 10 years. Hierarchical regression analyses were conducted to investigate predictors of parental Qol among child-related, parent-related and environmental factors. Findings indicate that a higher Qol is associated with a good quality of interaction in marital and parent-grandparents dyads, no family medical history and access to psycho-educational interventions for the child, regardless of child's developmental quotient, comorbidity, parent sex and working time. This final model best fits the data and explains 31.5% of the variance of parents' Qol. This study highlights that it is crucial to consider both individual and environmental variables as potential protective factors of parental adjustment. An ecological approach seems to be relevant to understand which parenting resources should be targeted in support programs.
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Affiliation(s)
- Cyrielle Derguy
- Laboratoire de Psychopathologie et Processus de Santé, EA 4057, Université Paris Descartes, Sorbonne Paris Cité, 71 Avenue E. Vaillant 92100 Boulogne-Billancourt, France.
| | - Solenne Roux
- Laboratoire Psychologie, Univ. Bordeaux, EA 4139, 3ter place de la Victoire F-33000 Bordeaux, France
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- Laboratoire Psychologie, Univ. Bordeaux, EA 4139, 3ter place de la Victoire F-33000 Bordeaux, France
| | - Katia M'bailara
- Laboratoire Psychologie, Univ. Bordeaux, EA 4139, 3ter place de la Victoire F-33000 Bordeaux, France; Charles Perrens Hospital, Pôle 3-4-7, 121 rue de la Bechade 33076 Bordeaux Cedex, France
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