Working with families living with autism: potential contributions of marriage and family therapists

Re-Consenting Pediatric Research Participants as Legal Adulthood Approaches: Lessons from the SPARK Autism Study

To explore issues surrounding re-consenting youth in longitudinal studies as they reach legal adulthood interviews were conducted with 46 parents plus 13 autistic teens enrolled in the Simons Foundation Powering Autism Research for Knowledge (SPARK) study. Qualitative analysis focused on family sensitivities regarding guardianship decisions, transition concerns, and the re-consenting process. Questions regarding guardianship were difficult for parents unsure of a teen's future status. Mothers were key facilitators of re-consenting for soon-to-be-independent teens. As legal adulthood approached, parents were willing to assist teens with re-consenting but needed support, asking for multiple contacts, transition resources, and explanatory materials from the research team. Most teens were not cognizant of SPARK but willing to continue participation once made aware.

Marital Experiences and Parental "Highs" and "Lows" When A Child with Autism Starts School

This study describes parents' daily "highs" and "lows" during their child's transition to school for the first time and examines how those experiences relate to turbulence in the parents' relationship. 106 parents (53 couples) rated their relationship qualities at pre-test and post-test and described "high" and "low" points of their day every three days for 42 days. Content analysis revealed experiences contributing to "high" or "low" points that were primarily related to: the child with ASD, the spouse, other children, personal situations, and other. Latent profile analysis identified three profiles that represented the relationship experiences of couples in the study: resilient couples, couples getting by, and asymmetrically engaged couples. Results highlight the variety of daily experiences these parents encounter.

Relational Uncertainty and Taking Conflict Personally: Comparing Parents of Children with and Without Autism Spectrum Disorder

Previous research suggests that parents of children with ASD experience greater marital conflict than parents of children with neurotypical development (NTD). This study examines how relational uncertainty is associated with taking conflict personally among parents of children with or without ASD. Parents of children with ASD (N = 298) and parents of children with NTD (N = 316) completed an online survey. They reported their relational uncertainty, recalled a conflict related to their child, and completed measures of taking conflict personally. The study provides evidence that spouses' experiences of relational uncertainty may be associated with conflict about topics related to their child. In addition, experiences of self uncertainty may have a greater impact for the parents of children with ASD than parents of children with NTD.

Relational Turbulence and Marital Communication When Children with Autism Start School: A Longitudinal Dyadic Diary Study

Autism spectrum disorder (ASD) is a pervasive and often difficult health condition, the consequences of which ripple through family relationships. This paper engages relational turbulence theory, which addresses communication in romantic relationships, and the experiencing life transitions model, from the field of nursing, to examine how communication between parents affects the marital relationship during a major transition in the life of a child with ASD. Transition processing communication (TPC) includes four forms of communication that can help married partners navigate difficult life events: increasing interaction, promoting connection, promoting feeling situated, and increasing confidence in the relationship. This study examines the effects of partners' TPC on their own and their spouse's experiences of relational uncertainty, changes in interdependence, and relational turbulence. A total of 33 couples and 60 married, female individuals, parents of a child with ASD who was starting school for the first time, completed a pre-test, 14 dairies, and a post-test; diaries were completed every three days over a 42-day period, beginning on the child's first day of school. Findings suggest that partners' engagement in TPC significantly affects some relationship qualities. In addition, an individual's perceptions of his or her spouse's communication were a stronger predictor of relational turbulence than the spouse's self-reported communication. Results point to several implications for understanding the ways in which married partners can protect their marriage in the face of their child's health-related transitions.

The development and implementation of a training program for pediatric dentistry residents working with patients diagnosed with ASD in a special needs dental clinic

Oral health care is the most prevalent unmet health care need among all U.S. children age 17 and under in the U.S., and this includes those with special health care needs (SHCN). Children with SHCN experience unique barriers to receiving oral care including challenging behaviors, inadequate insurance coverage, and a lack of trained dentists. Despite the need for specialized training to successfully provide dental care to children with SHCN, few dental programs offer the necessary educational preparation. The Nova Southeastern University College of Dentistry was funded by the Health Resources and Services Administration to prepare pediatric and Advanced Education in General Dentistry (AEGD) dental residents in the care of children, adolescents, and adults with SHCN. The purpose of this paper is to describe the didactic and clinical training program and to provide data on the program's impact.

Factors associated with stress in families of children with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD).

METHODS

Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression.

RESULTS

Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress.

CONCLUSION

The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.

How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List

Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.

Systemic psychotherapy with families where someone has an autism spectrum condition

BACKGROUND

Families play an important role in facilitating the development and well-being of children with autism spectrum conditions.

OBJECTIVES

After setting the scene with a clinical example, and providing a brief discussion of the current thinking about the aetiology of Autism spectrum conditions, this paper provides a review of the literature regarding the practice of systemic psychotherapy with families in which a child has an autism spectrum condition (ASC).

METHODS

A search of databases and journals revealed a large number of opinion papers regarding how family therapists might work with families of children with ASCs and a smaller number of papers that describe or explore actual clinical practice.

RESULTS

Pilot studies using qualitative methods and practice-based evidence in the form of descriptions of clinical work offer a solid footing on which to develop systemic practice to help families where a person has an ASC.

CONCLUSION

Given the multifactorial nature of the aetiology of ASCs it is suggested that systemic interventions have the potential to influence changes at multiple levels of functioning for the child and the family.

Factors associated with negative co-parenting experiences in families of a child with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with negative co-parenting experiences in parents raising a child with autism spectrum disorder.

METHODS

Questionnaires were sent to families with one or more children with a diagnosis of autism spectrum disorder. Parents of 142 children with autism spectrum disorder indicated that the diagnosis had a very negative impact on their co-parent relationship. A multivariate logistic regression model was run to analyze the association of these experiences with various demographic, family and community factors.

RESULTS

Three factors were associated with negative co-parenting relationships: (1) family stress due to the child's diagnosis, (2) effects of the diagnosis on parents' relationship with their other children and (3) distance travelled to the nearest medical facility.

CONCLUSIONS

Findings highlight the need to further explore family dynamics, particularly the relationships between the co-parenting alliance, other family members and the extra-familial environment.

Multisystemic therapy for disruptive behavior problems in youths with autism spectrum disorders: a progress report

Youths with autism spectrum disorders (ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day-to-day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy (MST) is a comprehensive family- and community-based treatment approach that has been effective with other difficult-to-treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model.

The Roles and Needs of Families of Adolescents with ASD

The transition of a student out of high school and into the adult world can be a stressful time for many families of high school students. This major life transition can be particularly challenging for students with ASD and their families. In this paper we first discuss the roles of families in the transition process for their son or daughter with ASD. Next, we present literature on the unique needs of families of adolescents with ASD during the transition to adulthood. Finally, we highlight current research on best practices for supporting transition-aged students and their families as well as discuss future directions for research and practice.