Autism Spectrum Disorders: Family Demographics, Parental Stress, and Family Quality of Life

Relationships Between Family Sense of Coherence, Coping and Role Performance in Parents of Children with Disabilities: Structural Equation Modeling

This descriptive study was designed with a clear focus: to use structural equation modeling to determine the intricate relationships between family sense of coherence, coping, and role performance in parents of children with disabilities. The study was conducted with a sample of 185 parents of children receiving special education at the primary school level in a province in Türkiye. Data was collected using a parent introduction form, the Family Sense of Coherence Scale-short form (FSOC-S), the Family Role Performance (FRP) scale, and the Revised-COPE Scale (R-COPE). The effect of FSOC-S on FRP and R-COPE was statistically significant. The effect of FRP on R-COPE was statistically significant. Moreover, FSOC-S predicted 22.4% of FRP, while FSOC-S and FRP predicted 17.1% of R-COPE. The study's findings underscore the urgent need for interventions to improve the family's sense of coherence and positive coping attitudes. These interventions are crucial for parents to effectively manage the challenges they face while caring for a child with a disability. The study also highlights the significant role of positive coping attitudes and family sense of coherence in enhancing role performance in parents of children with disabilities.

Oral habits, sociopsychological orthodontic needs, and sociodemographic factors perceived by caregivers impact oral health-related quality of life in children with and without autism?

BACKGROUND

Caregivers play a crucial role in assessing the oral health-related quality of life (OHRQoL) of young individuals with autism spectrum disorder (ASD).

AIM

This study assessed the impact of sociodemographic and oral conditions on OHRQoL and family dynamics in young individuals with and without autism, as perceived by guardians.

DESIGN

This comparative cross-sectional study included young individuals aged 6 to 14 years and their guardians. Data were collected at a specialized institution and dental schools. Guardians completed the Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS), and sociodemographic and oral habits questionnaires. The sociopsychological need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The sample included 144 youths and caregivers. The ASD group had higher P-CPQ and FIS scores. Factors associated with poorer perceived OHRQoL included higher youth age, lower caregiver education, higher IOTN scores, teeth clenching (RR = 1.20; 95% CI: 1.01-1.41), and lip sucking. Lower parental education (RR = 1.75; 95% CI: 1.10-2.80) and higher IOTN scores from the caregiver's perspective impacted family dynamics.

CONCLUSION

Caregivers of young individuals with ASD perceived a lower OHRQoL, and families in this group were more affected by sociodemographic and oral conditions.

Neurodevelopmental disorders and family quality of life: emerging trends and future research directions

Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are the most prevalent neurodevelopmental disorders. There is a growing body of literature investigating factors affecting quality of life in families (FQoL) with a child with these disorders. However, there are no studies that trace their knowledge anatomy. Thus, we conducted a scientometric analysis to describe this literature, detect certain variables that could be related to FQoL, and identify tendencies and open questions for future research. A literature search in the Web of Science, PubMed, and Scopus was run and identified 3281 publications published between 1975 and 2022. The results suggest an increase in the quantity of publications on FQoL in ASD and ADHD over the last few years (14% and 12%, respectively). For both research fields, the USA published the highest number of documents, showing that the production related to ADHD and FQoL is concentrated in just a few countries. Thematic analysis revealed several clusters, considering quality of life and children as core themes that are still setting trend lines. Moreover, it would be worthwhile to describe and analyze FQoL not only during the childhood of children with ASD and ADHD but also during their adolescence. IMPACT: Although the relationship between family quality of life and neurodevelopmental disorders could be considered novel, there is a growing interest from an interdisciplinary perspective. Family quality of life should be monitored not only during the childhood of children with ASD and ADHD, but also during their adolescence and adulthood. The analysis of the family quality of life in first-degree relatives and its relationship with protective factors (e.g., resilience and social support) should be explored in future studies.

The effect of social activities on the alienation and family resilience of Chinese caregivers for children with autism: a latent class analysis

Introduction

Caregivers of children with autism spectrum disorder (ASD) in China often experience alienation due to societal stigma. While this alienation detrimentally impacts their mental well-being, family resilience serves as a protective factor. Previous research has predominantly examined the social support derived from social activities but has neglected to delve into the specific patterns of these activities. The primary objective of this study was twofold: firstly, to gain insights into the various social activities engaged in by caregivers of children with autism in China, and secondly, to ascertain the influence of these social activities on alienation and family resilience.

Methods

Between June and August 2023, a cross-sectional survey was carried out across multiple cities in Jilin Province, aiming to gather data from a total of 205 Chinese caregivers of children with autism. Data collection was conducted through the utilization of a structured questionnaire. The assessment of social activity involved the completion of 12 questionnaires, while alienation was evaluated using the Generalized Alienation Scale (GSAS), and family resilience was gauged through the Chinese version of the Family Resilience Scale (FaRE). The classification of social activities was conducted through latent class analysis (LCA), while the impact of these social activities on alienation and family resilience was examined using linear regression analysis.

Results

The findings revealed that social activities can be categorized into five types (Low, Self-Recreation, Communication, Web Surfing, High). Communication social activities were found to reduce family resilience(β=.332, p<0.01), while high social activities were associated with reduced alienation(β=-.349, p<0.05) and increased family resilience(β=.417, p<0.01).

Conclusion

Supporting these particular types of social activities has the potential to reduce alienation and bolster family resilience among caregivers for children with autism in China.

Experiences of families with children diagnosed with Autism Spectrum Disorder in World Health Organization Afro-Regions: A scoping review

A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region.

What do parents want from healthcare services? Reports of parents' experiences with pediatric service delivery for their children with disabilities

PURPOSE

Family-centred service (FCS) is an established approach for delivering services in children's rehabilitation and healthcare. This article describes that parents continue to report mixed experiences with healthcare services for their children, as well as their ideas about what they need and want from these services. These findings will inform the development of an up-to-date measure of Family-Centred Service called Measure of Processes of Care (MPOC 2.0).

METHODS

A qualitative descriptive study was conducted with parents, using focus groups and open-ended interviews. Data were analyzed using inductive content analysis.

RESULTS

Parents want care that is individualized, co-ordinated, easily accessible, and takes into account the entire family dynamic. They want service providers (SPs) to be informed and invested in their child's care, and to provide parents with practical assistance. They also want to be treated with respect, caring and empathy, and to work together with SPs on the care plan. Novel components of care not identified in the original FCS guiding principles include: responsiveness to needs and mental health; effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling.

CONCLUSIONS

This article identifies components of healthcare that families find helpful and desirable.

Family quality of life of parents of children with intellectual disability: Do psychological stress and parental involvement matter?

Background: The psychological stress of parents and improving family quality of life (FQoL) are continuing concerns for families of children with intellectual disability. We need to identify further ways to reduce their stress and improve their FQoL in China. Method: Examine the interrelations between psychological stress, parental involvement, and FQoL for parents with intellectual disability in mainland China. 467 parents of children with intellectual disability completed instruments measuring variables. Structural equation modelling (SEM) was employed to examine the interrelations. Results: Psychological stress, directly and indirectly, influenced parental involvement in FQoL. Physical and mental response (PMR) and risk awareness (RA) had a positive direct effect on FQoL, and optimistic hope (OH) had a negative effect on FQoL. Conclusions: Psychological stress affects FQoL of parents with children with intellectual disability in complex ways. Policies should be developed to help parents with children with disability decrease stress and develop scientific parental involvement.

Family Quality of Life Perceived by Mothers of Children with ASD and ADHD

Existing research has compared Family Quality of Life (FQOL) in autism spectrum disorder (ASD) populations and typically developing populations but has not yet explored differences in FQOL across ASD, attention-deficit/hyperactivity disorder (ADHD), and comorbid ASD and ADHD populations (ASD + ADHD). In the present study, 117 North American mothers of 92 sons and 25 daughters (ages 6-11) with ASD, ADHD, or ASD + ADHD completed an online survey exploring FQOL. An ANOVA failed to show group differences in overall FQOL, however, mothers of children with ASD + ADHD reported significantly lower family Emotional Well-being than mothers of children with ASD only. The results of this study provide insight into FQOL in families of children with ASD and/or ADHD. Greater research is needed in this area to understand how mothers of children with ASD, ADHD, or ASD + ADHD experience FQOL. The COVID-19 pandemic, which ran concurrent with this study, potentially influenced results.

Object-centered family interactions for young autistic children: a diary study

Autistic Children often struggle with social interaction and communication, studies have found that many of them prefer to interact with objects than people. However, there is a lack of research exploring the specific characteristics and factors involved in interactions within families with autistic children where objects are the center of the interaction. This paper describes the process and findings of a diary study exploring how young autistic children interact with their families through objects in natural scenarios. A one-week diary study was conducted with six families with young autistic children. Diary videos were recorded onsite and coded later according to a social interaction behavior scheme with corresponding diary entries. Qualitative data analysis was conducted to reveal possible patterns. Results revealed ongoing difficulties in establishing and maintaining family interaction and identified influential factors of object-centered family interaction. The most prevalent pattern observed was parents taking the lead in interactions, followed by the child's confirmation response. Remarkably, daily necessities emerged as potential physical mediums for enhancing family interactions, opening avenues for exploring tangible designs in human-computer interaction. These findings offer valuable implications for future research and the development of innovative designs that promote enriching interactions for autistic children and their families.

Exploring Sleep in Caregivers of Children with Autism Spectrum Disorder (ASD) and the Relationship to Health-Related Quality of Life (HRQoL) and Family Quality of Life (FQoL)

Background and Objectives: To investigate (1) the prevalence of sleep disorder symptoms in caregivers of children with autism spectrum disorder (ASD) and (2) the relationships between caregiver sleep problems and their health-related quality of life and family quality of life. Materials and Methods: Descriptive cross-sectional study of caregivers (N = 62) of children aged 6 to 11 years old diagnosed with ASD and receiving care at a regional autism research and resource center. Results: Participants completed the Sleep Habits Questionnaire (SHQ), the Medical Outcomes Study (MOS) SF-12, and the Beach Center Family Quality of Life Scale (FQoL). Caregivers with longer sleep duration reported better mental health and better family quality of life. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. Caregivers with obstructive sleep apnea and restless legs syndrome experienced worse physical quality of life. Conclusions: The physical and mental health of the primary caregiver is essential to the support of the child with ASD and to the functioning of the family. The study findings point to the importance of future research and interventions to enhance sleep health in order to improve quality of life for caregivers of children with ASD.

Impact of Respite Care Services Availability on Stress, Anxiety and Depression in Military Parents who have a Child on the Autism Spectrum

OBJECTIVE

Parenting an autistic child can affect a family's well-being. Finding resources is critical. This pilot study looked at respite's impact on parental stress, anxiety, and depression in military families and demographic factors associated with presence of respite care.

METHOD

Participants completed three surveys on anonymous basis, including two standardized surveys measuring parental stress and anxiety/depression. Data analysis used Chi-square test and regression analysis.

RESULTS

Parents receiving respite reported less stress and anxiety/depression. Respite utilization was associated with absence of comorbid conditions in child and other variables. Predictor variables for parental stress and anxiety/depression included presence of comorbid conditions in child.

CONCLUSION

Respite care may be linked to lower parental stress, anxiety, and depression, but more study is needed.

The care burden of mothers of children with disability: Association between family quality of life and fatigue

AIM

This study was performed with the aim of investigating the correlation between care burden, family quality of life and fatigue of mothers of children with disability.

MATERIAL AND METHOD

The sample for this descriptive study comprised the mothers of 280 children with disabilities accepting participation in the study, meeting the inclusion criteria, and registered in special education and rehabilitation centers in Turkey. Data were collected with the Mother-Child Descriptive Information Form, Bakas Caregiving Outcomes Scale (BCOS), Beach Center Family Quality of Life Scale (BCFQOLS) and Fatigue Severity Scale (FSS).

RESULTS

Mothers, mean BCOS scores were 63.29 ± 17.47, mean BCFQOLS scores were 93.74 ± 14.63, and mean FSS scores were 3.84 ± 1.43. There was a statistically significant positive, moderate intensity correlation between the BCOS scores and BCFQOLS scores of mothers (r = 0.404, p < 0.001); a statistically significant negative weak correlation between BCOS scores and FSS scores (r = -0.346,p < 0.001); and a statistically significant negative weak correlation between BCFQOLS scores with FSS scores (r = -0.22,p < 0.001). According to regression analysis, the care burden of mothers was identified to be a significant determinant of family quality of life and fatigue severity (p < 0.05).

CONCLUSION

The results of the study showed that as the care burden of mothers of children with disability increases, family quality of life reduces and fatigue levels increase.

PRACTICE IMPLICATIONS

It is recommended to support the mother in the care process, to plan activities and trainings to reduce the burden and fatigue of care, to increase the quality of family life, and to provide psychological support.

Participants' Bias in Disability Research on Family Quality of Life during the 0-6 Years Stage

BACKGROUND

Over the past two decades, various research teams have designed and applied instruments to measure the quality of life of families with a member who has a disability. A recent systematic review on the state of the Family Quality of Life in early care identified that many of these studies collected data only from the mothers. The present study aimed to investigate whether there is a bias in participant selection in these types of studies.

METHOD

A systematic review of the scientific literature was conducted in three databases-Scopus, Web of Science, Eric-from 2000 to 2022. A total of 72 empirical studies were identified.

RESULTS

The findings indicate that most studies examining the Family Quality of Life were based on the information of a single informant per family unit. The profiles of participants according to the research objective are quite similar. In one-third of studies, the authors reported that family members who participate cannot be represented by only mothers or one participant per household.

CONCLUSIONS

Given the dynamic and collective nature of the construct, the application of a systemic approach is necessary.

A preliminary exploration of different coping strategies used by Korean immigrant parents of autistic children in high versus low family quality of life ratings

The experiences of coping in parents of autistic children have been extensively studied in the literature. While this research has identified both effective and ineffective coping strategies used by caregivers, no studies to date have examined how coping strategies used by parents might be linked to family quality of life outcomes. Furthermore, few studies exist examining both coping strategies and family quality of life in culturally and linguistically diverse populations. Thus, this study aimed to address both limitations. A total of 12 Korean immigrant parents of autistic children, 6 representing the high family quality of life group and 6 representing the low family quality of life group, shared their experiences related to coping and managing stress. Responses fell under three broad categories (problem-focused, emotion-focused, and adjustment-focused) with differences observed when comparing the high versus low family quality of life groups. A better understanding of the link between coping strategies and family quality of life outcomes may help identify effective and culturally sensitive supports for caregivers and families to improve their quality of life and well-being.

Quality of life in parents of children with Autism spectrum disorder: Emphasizing challenges in the Indian context

Purpose: Research has raised concerns about the quality of life (QOL) of parents of children with Autism spectrum disorder (ASD). Parents in different cultures show different psychological functioning when caring for a child with ASD. Hence, we examined QOL in parents of children with ASD in India and its relationship with socio-demographic factors. Materials and methods: We used a self-reported questionnaire and WHOQOL-BREF instrument to collect data on socio-demographic details and QOL respectively. Data were collected from two groups of participants - parents of children with ASD and parents of typically developing children (N = 60). Results: Results revealed significant differences in QOL between the two groups. Further, we found a positive correlation between socio-demographic variables and QOL in parents of children with ASD. Conclusions: Findings emphasize the need for intervention approaches aimed at family functioning, improving support services, and assisting parents to develop healthy coping strategies.

Struggle for recognition, rights, and redistribution: Understanding the identity of parents of children with autism spectrum disorder in China

Introduction

The number of children diagnosed with autism spectrum disorders (ASD) worldwide has increased rapidly in the past decade and China is no exception. Yet the identity development of Chinese parents of children with ASD is little understood. This study employed an ethics of care perspective to explore the identity of parents of children with ASD as shaped in their social-cultural context in mainland China.

Methods

Qualitatively driven mixed-method design was adopted. Qualitative data about their experiences were obtained from in-depth interviews with 20 parents from 17 families of children with ASD in Beijing and participant observation of 9 participants' daily parenting experience.

Results

A complex and dynamic parenting identity was revealed. With limited recognition within and external to the family, parents experienced constant challenges toward their sense of self. The parents used strategies to assert their rights as carers and develop positive self-perceptions. Yet because of the unjust distribution of care work within families and with the state, the parents retained a sense of insecurity throughout the process of parenting. The parents' sense of inferiority due to devaluing children with disabilities was accentuated by traditional Chinese cultural values about good parenting. They were intensely worried about the lack of policy for support as they and their children grew older.

Discussion

The findings reinforce the need for recognition of parents' dignity, capacity, and efforts in caring.

Measuring Family Quality of Life: Scoping Review of the Available Scales and Future Directions

The lack of quality of life is a key issue for families with children with an intellectual disability. While the quality of life for people with disabilities has previously been researched as an individual variable, this has now shifted to include family members. The purpose of this study was to conduct a review of the studies measuring the quality of life of families with an intellectually disabled member, in order to identify the most commonly used scales and their psychometric properties.

METHOD

Data were collected from six databases (ERIC, Web of Science, Scopus, CINAHL, MedLine, and Google Scholar), and this search yielded 3948 studies. One hundred and twenty studies that met the inclusion criteria were included in this study.

RESULTS

Nine scales were used in the last years to measure the quality of life for families with individuals with an intellectual disability. The Beach Center scale was the most common scale, followed by the Family Quality of Life Survey and the World Health Organization's quality of life assessment (WHOQoL-BREF). The results showed that the included studies in the review lack the consideration of a broader population representing the different types of cultures with different socioeconomic backgrounds. Key aspects used to assess the FQoL are environmental factors (proximal and distal factors), as well as economic factors.

CONCLUSION

Although the operationalization of the FQoL often incudes several subthemes, a general agreement regarding which domains of the FQoL need to be included in the measurements, and these do not exist right now. Moreover, multidimensional scales are still rare.

The conditional effect of family resilience on family quality of life during the Covid-19 pandemic

Introduction: The Covid-19 pandemic has brought unprecedented challenges, both economically and psychologically, to most families across the world. Yet, little study has been done on this topic in Indonesia, even after the second year of the pandemic. This study examines how the Covid-19 economic impact and parental stress are related to the family quality of life (FQOL) and how the relation is moderated by family resilience. Methods: To this end, we employed previously tested measures to assess the level of parental stress, family resilience and FQOL. Especially for the latter, we modified the measure, developed by Beach Center on Disability, by including only four domains (i.e., family interaction, parenting, emotional well-being, and material well-being) to adjust to our research context. Results: Based on 169 participants, our confirmatory factor analysis (CFA) displays that all employed measures in the study are valid and reliable. Our regression analysis shows that there are significant direct relations of parental stress & family resilience with FQOL. However, we find that family resilience only positively moderates the relation between the Covid-19 economic impact and FQOL but not the relation between parental stress and FOQL; indicating that high family resilience can only buffer the effect of economic impact on FQOL. Discussion: This study presents a view on how the Covid-19 pandemic affects the way families live and hence, their quality of life. In addition, the findings suggest the importance of family relationship and support in times of crisis, not limited to the Covid-19 pandemic.

The conditional effect of family resilience on family quality of life during the Covid-19 pandemic

Introduction This study examines how the Covid-19 economic impact and parental stress are moderated by family resilience to relate to the family quality of life (FQOL). Methods We modify the measure of FQOL, developed by Beach Center on Disability, by including only four domains (i.e., family interaction, parenting, emotional well-being, and material well-being) to adjust to our research context. Results Based on 169 participants, our CFA displays that all employed measures in the study are valid and reliable. Our regression analysis shows that there are significant direct relations of parental stress & family resilience with family quality of life. However, we find that family resilience only positively moderates the relation between the Covid-19 economic impact and family quality of life. Discussion This study presents a view on how the Covid-19 pandemic affects the way families live and hence, their quality of life.

The conditional effect of family resilience on family quality of life during the Covid-19 pandemic

Introduction: The Covid-19 pandemic has brought unprecedented challenges, both economically and psychologically, to most families across the world. Yet, little study has been done on this topic in Indonesia, even after the second year of the pandemic. This study examines how the Covid-19 economic impact and parental stress are related to the family quality of life (FQOL) and how the relation is moderated by family resilience. Methods: To this end, we employed previously tested measures to assess the level of parental stress, family resilience and FQOL. Especially for the latter, we modified the measure, developed by Beach Center on Disability, by including only four domains (i.e., family interaction, parenting, emotional well-being, and material well-being) to adjust to our research context. Results: Based on 169 participants, our CFA displays that all employed measures in the study are valid and reliable. Our regression analysis shows that there are significant direct relations of parental stress & family resilience with family quality of life. However, we find that family resilience only positively moderates the relation between the Covid-19 economic impact and family quality of life. Discussion: This study presents a view on how the Covid-19 pandemic affects the way families live and hence, their quality of life. In addition, the findings suggest the importance of family relationship and support in times of crisis, not limited to the Covid-19 pandemic.

The relationship between family quality of life, mindful attention, and social support in families of people with autism spectrum disorder

Background: In families of individuals with autism spectrum disorder (ASD), the added difficulties they face may influence their perception of family quality of life (FQoL). It is important to identify factors which foster their perceived wellbeing and are susceptible to intervention. Our aim was to explore the association between mindful attention and FQoL in these families controlling their perceived social support. Method: Ninety-six parents of people with ASD were evaluated using the Mindful Attention and Awareness Scale (MAAS), the Support Questionnaire for Parents with Children with Disability, and the Spanish Family Quality of Life Scale for families with underage members with intellectual and developmental disabilities. Results: Multiple regression analyses revealed that high levels of mindful attention positively predicted FQoL after controlling the influence of social support. Conclusions: Practical implications are discussed in terms of family support interventions. We conclude that mindful attention interventions may be useful for families with children and adolescents with ASD to improve their FQoL.

Cannabidiol in Treatment of Autism Spectrum Disorder: A Case Study

This case study aims to demonstrate the use of cannabidiol (CBD) with low-dose tetrahydrocannabinol (THC) in managing symptoms associated with autism spectrum disorder (ASD) to increase the overall quality of life for these individuals and their families. ASD is a neurodevelopmental disorder affecting cognitive development, behavior, social communication, and motor skills. Despite the increasing awareness of ASD, there is still a lack of safe and effective treatment options. The study includes a nine-year-old male patient who was diagnosed with nonverbal ASD. He exhibited emotional outbursts, inappropriate behaviors, and social deficits including challenges in communicating his needs with others. Since the patient was unable to attain independence at school and at home, his condition was a significant burden to his caregivers. The patient was treated with full-spectrum high CBD and low THC oil formulation, with each milliliter containing 20 mg of CBD and <1 mg of THC. CBD oil starting dose was 0.1ml twice daily, increased every three to four days to 0.5ml twice daily. Overall, the patient experienced a reduction in negative behaviors, including violent outbursts, self-injurious behaviors, and sleep disruptions. There was an improvement in social interactions, concentration, and emotional stability. A combination of high CBD and low-dose THC oil was demonstrated to be an effective treatment option for managing symptoms associated with autism, leading to a better quality of life for both the patient and the caregivers.

Quality of Life among Mothers of High Functioning Autism Spectrum Disorder (HFASD)Adolescents

Autism Spectrum Disorder (ASD) has become more prevalent globally. The disorder is predominantly characterised by low social skills noted explicitly in people with High Functioning Autism Spectrum Disorder (HFASD). The individuals usually possess a normal or superior intelligence quotient (IQ) but the disability impedes the achievement of their actual high potential, hence compromising their quality of life (QoL). Managing adversities encountered by children with HFASD often compromises the QoL of the entire family. Thus, this study aimed to identify specific domains of QoL among mothers of high-functioning autistic adolescents. The study assessed seven mothers of adolescents with HFASD using a semi-structured interview format. A thematic qualitative analysis was conducted to analyse the data. The results suggested that mothers perceived their QoL based on physical and emotional well-being, material well-being, interpersonal relationship, and environmental well-being. Intervention for HFASD is multidisciplinary, which targets a broad spectrum of symptoms and skills deficits and customises the programme to meet each individual’s different needs. Nonetheless, intervention facilities in Malaysia are seriously limited, particularly in supporting QoL for children with HFASD. Therefore, by identifying the domains of QoL would improve the mothers’ resilience in raising their children with HFASD.

Sense of Parenting Efficacy, Perceived Family Interactions, and Parenting Stress Among Mothers of Children With Autistic Spectrum Disorders

This study examined the relationship between maternal sense of parenting efficacy and parental stress in children with autism and the moderating effect of family interaction. A total of 263 mothers of children with autism were investigated with the Parenting Ability Scale, Family Interaction Scale (FIS), and Parental Stress Scale. The results showed that (1) maternal sense of parenting efficacy significantly predicted parental stress in children with autism; and (2) family interaction significantly moderated the relationship between maternal sense of parenting efficacy and parental stress in children with autism, that is, when family interaction was lower than -1.54 standard deviation (SD), the sense of parenting efficacy did not significantly predict parental stress. When family interaction was higher than -1.54 SD, parenting efficacy had a significant negative predictive effect on parenting stress.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Impact of Health and Social Services on the Quality of Life in Families of Adults with Autism Spectrum Disorder (ASD): A Focus Group Study

Background: Autism spectrum disorder (ASD) is a complex developmental condition that affects the whole family. The gap between childrens’ needs and their satisfaction, especially regarding what concerns the presence of social and healthcare services, is still a source of burden, particularly after the transition to adulthood. Our study aimed to gather a comprehensive view on how parents of adults with ASD perceive (and interact with) health and social services, and how the provision of care impacts family quality of life with the aim to advise ASD intervention programs. The goal is to identify specific areas of change useful to influence autism intervention strategies so that they more effectively meet the needs of young people with autism and their families. Methods: We conducted two focus groups with parents of young adults with ASD. A semi-structured focus group methodology was adopted. The QoL conceptual framework guided data collection and analysis as part of a directed theory-driven content analysis approach. Results: The lack of structured care pathways and the low level of integration of different services were the main limits reported by parents during the focus group, while a shared positive perception of the experience conducted together as caring families emerged. Conclusions: The experience here reported claims for a greater role of the institutions in order to facilitate the building of networks that are really inclusive for persons with autism in society and to support the implementation of innovative solutions for the welfare system. Furthermore, parents stressed the need for the provision of support to the family.

The Association between Parenting Stress, Positive Reappraisal Coping, and Quality of Life in Parents with Autism Spectrum Disorder (ASD) Children: A Systematic Review

Parents with autism spectrum disorder (ASD) children generally suffer from poor coping and an impaired quality of life (QoL). This systematic review investigates parenting stress, positive reappraisal coping, and QoL in parents with ASD children. A literature search was carried out for publications written in English on the selected investigation topics using five databases, namely, Scopus, PubMed, Wiley, ScienceDirect Online, and EBSCO. Only studies investigating or measuring parenting stress, positive reappraisal coping, and QoL in ASD were included. Our results indicate that parents with ASD children have high stress levels. This is associated with the ineffective use of coping strategies and a low QoL. Adaptive coping strategies are related to a higher QoL, whereas maladaptive coping techniques are related to a worse QoL. Positive reappraisal coping is negatively correlated to meaningfulness, and it is used by parents to change their daily routines in order to motivate themselves towards new and evolving goals in life. Finally, we found a significant negative correlation between parenting stress, positive reappraisal coping, and the QoL of parents with ASD children. Positive reappraisal coping as a strategy helps parents adapt to stress and was found to be a potential mediatory function between parental stress and QoL.

Investigating the Associations Between Child Autistic Symptoms, Socioeconomic Context, and Family Life: A Pilot Study

Objective: The day-to-day experience of families with an Autistic child may be shaped by both, child characteristics and available resources, which often are influenced by the socioeconomic context of the family. Using a socioecological approach, this study explored the quantitative associations between child autistic symptoms, family socioeconomic status, and family life.

Methods: Data came from the Pediatric Autism Research Cohort—PARC Study (pilot). Parents of children with a recent diagnosis of autism completed a set of assessments, including the Autism Family Experience Questionnaire, Autism Impact Measure, and a Sociodemographic Questionnaire. A series of multiple, iterative linear regression models were constructed to ascertain quantitative associations between child autistic symptoms, socioeconomic context, and family life.

Results: A total of 50 children (mean age: 76 months; SD: 9.5 months; and 84% male) with data on the variables of interest were included in the analysis. The frequency of child autistic symptoms was associated with family life outcomes (p = 0.02 and R² = 24%). Once autistic symptom frequency, symptom impact, and sociodemographic variables were considered, parents of higher educational attainment reported worse family life outcomes compared to their lesser-educated counterparts. This cumulative regression model had considerable explanatory capability (p = 0.01, R² = 40%).

Conclusion: This study demonstrates the utility of using a socioecological approach to examine the dynamic interplay between child characteristics and family circumstances. Our findings suggest that family life for parents (of an autistic child) who have obtained higher education is reported (by the parents themselves) as less satisfactory compared to that of parents without higher education, once adjusted for the autistic symptom frequency of child, symptom impact, and income. These findings can inform the design and delivery of more family-centered care pathways during the years following a diagnosis of autism.

Informing Developmental Milestone Achievement for Children With Autism: Machine Learning Approach

Background

Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in low- and- middle-income countries such as Bangladesh. To improve family–practitioner communication and developmental monitoring of children with ASD, mCARE (Mobile-Based Care for Children with Autism Spectrum Disorder Using Remote Experience Sampling Method) was developed. Within this study, mCARE was used to track child milestone achievement and family sociodemographic assets to inform mCARE feasibility/scalability and family asset–informed practitioner recommendations.

Objective

The objectives of this paper are threefold. First, it documents how mCARE can be used to monitor child milestone achievement. Second, it demonstrates how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, it describes family/child sociodemographic factors that are associated with earlier milestone achievement in children with ASD (across 5 machine learning models).

Methods

Using mCARE-collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used 4 supervised machine learning algorithms (decision tree, logistic regression, K-nearest neighbor [KNN], and artificial neural network [ANN]) and 1 unsupervised machine learning algorithm (K-means clustering) to build models of milestone achievement based on family/child sociodemographic details. For analyses, the sample was randomly divided in half to train the machine learning models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons.

Results

This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child sociodemographic characteristics. For Brushes teeth, the 3 supervised machine learning models met or exceeded an accuracy of 95% with logistic regression, KNN, and ANN as the most robust sociodemographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family sociodemographic predictors of “family expenditure” and “parents’ age” accounted for most of the model variability. The last 2 parameters, Urinates in toilet or potty and Buttons large buttons, had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, “family expenditure,” “family size/type,” “living places,” and “parent’s age and occupation” were the most influential family/child sociodemographic factors.

Conclusions

mCARE was successfully deployed in a low- and middle-income country (ie, Bangladesh), providing parents and care practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child sociodemographic elements can inform child milestone achievement. Specifically, families with fewer sociodemographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement.

The Actor-Partner Effects of Parenting Stress on Quality of Life Among Parents of Children with ASD: The Mediating Role of Mental Quality of Life

The present study investigated the actor-partner effects of parenting stress (PS) on quality of life (QoL) among parents (96 couples) of children with autism spectrum disorder (ASD). Data were collected using the QoL Scale and the PS Index. Structural equation modeling was also utilized to test the hypothesis. The results revealed the effects of PS in each parent on mental QoL of that parent. Maternal PS further shaped physical QoL in mothers. However, PS in one parent did not influence QoL of his or her partner. Accordingly, mental QoL had a mediating role between PS and physical QoL. It was ultimately suggested to take account of QoL among parents in addition to the treatment of children with ASD.

Parental stress, involvement, and family quality of life in mothers and fathers of children with autism spectrum disorder in mainland China: A dyadic analysis

BACKGROUND

Research shows that parents of children with autism spectrum disorder (ASD) are burdened with childcare responsibilities and at increased risk for elevated stress and poor family quality of life (FQOL). Little is known, however, about the dynamic interactions between mothers' and fathers' perceived parenting stress in relating to parental involvement and FQOL, especially in the Chinese cultural context.

AIMS

This study examined the intrapersonal and interpersonal effects of parenting stress on parental involvement and FQOL for families of children with ASD in mainland China.

METHOD

A total of 210 Chinese couples (total N = 420) completed measures of caregiving involvement, perceived parenting stress, and FQOL. The Actor-Partner Interdependence Mediation Model (APIMeM) was employed to examine the dyadic relationships among the variables.

RESULTS

Both parents' parenting stress was negatively associated with their own involvement and FQOL. Moreover, fathers' parenting stress was indirectly related to mothers' perceptions of FQOL through their involvement in the care of their child with ASD.

CONCLUSIONS

The findings highlight the important roles of fathers' parenting stress and involvement in affecting their own and their partners' satisfaction with FQOL within Chinese families raising a child with ASD.

The Spanish Family Quality of Life Scales under and over 18 Years Old: Psychometric Properties and Families' Perceptions

BACKGROUND

Family quality of life (FQoL), just like individual quality of life, has become a priority outcome in the policies and services received by persons with intellectual and developmental disabilities (IDD) and their families. Conceptualizing, measuring, and theorizing FQoL has been the object of investigation in recent decades. The goal of this paper is to present a revision of the Spanish Family Quality of Life Scales, the CdVF-E < 18 and the CdVF-E >18, and describe the FQoL of Spanish families with a member with IDD.

METHODS

The sample included a total of 548 families with a member under 18 years old and 657 families with a member over 18. Based on an Exploratory Factor Analysis (EFA) firstly and a Confirmatory Factor Analysis (CFA) secondly, the two scales' psychometric properties were explored.

RESULTS

The CdVF-ER < 18 and the CdVF-ER > 18 comprise 5 dimensions, containing 35 and 32 items, respectively, and they show good validity and reliability. The families obtained a high FQoL score, although some differences exist between the dimensions on which families with children under and over 18 score highest and lowest.

CONCLUSION

The characteristics of the revised scales facilitate their use by professionals, administrations, and services.

State of the Art of Family Quality of Life in Early Care and Disability: A Systematic Review

Background: In recent years, there has been a growing international interest in family quality of life The objective of this systematic review is to understand and analyze the conceptualization of the quality of life of families with children with disabilities between 0 and 6 years of age, the instruments for their measurement and the most relevant research results. Method: A bibliographic search was conducted in the Web of Science, Scopus and Eric databases of studies published in English and Spanish from 2000 to July 2019 focused on "family quality of life" or "quality of family life" in the disability field. A total of 63 studies were selected from a total of 1119 and analyzed for their theoretical and applied contributions to the field of early care. Results: The functional conceptualization of family quality of life predominates in this area, and a nascent and enriching holistic conceptualization is appreciated. There are three instruments that measure family quality of life in early care, although none of them is based on unified theory of FQoL; none of them focus exclusively on the age range 0-6 nor do they cover all disabilities. Conclusions: The need to deepen the dynamic interaction of family relationships and to understand the ethical requirement that the methods used to approach family quality of life respect the holistic nature of the research is noted.

Behavior skills training for family caregivers of people with intellectual or developmental disabilities: a systematic review of literature

People with intellectual or developmental disabilities (IDDs) face lifelong challenges in areas such as self-care, learning and socializing abilities. Having such individuals at home brings family caregivers extra stress, especially when support is insufficient. Because of the inadequacy of professional support available globally, the need to increase the ability of the caregivers to provide effective support is evident. Behavior skills training (BST), an approach consisting of instruction, modelling, rehearsal, and feedback, has been used in numerous studies to train caregivers in necessary skills to help their family members with IDDs. This study conducted a systematic review of past literatures, wherein BST was used to train family caregivers of individuals with IDDs. Seventeen relevant studies were summarized according to their countries, participant characteristics, training focus, intervention details, and outcomes. Outcomes revealed that BST had been used to train caregivers of varying demographics, various target skills (e.g. discrete trial training, incidental training, etc.), order of delivery, and sometimes the introduction of novel components. Most studies showed an improvement for both caregivers and the individuals with IDDs. However, some studies did not present desired outcomes in relation to the individuals. Possible reasons and future measures were also discussed in this review.

A Comparison of the Stress Survey Schedule in Children with Autism and Typically Developing Children: A Brief Report

Past research suggests that stress and anxiety are more prevalent in persons with autism as compared to typically developing persons. The Stress Survey Schedule (SSS) was developed in 2001 as a means to measure stressors common to persons with Autism Spectrum Disorder (ASD). The present study compared SSS responses of a sample of students diagnosed with ASD and intellectual disability with a group of typically developing students to explore the divergent validity and internal consistency of this measure, and to assess changes in scores among pre-adolescent and adolescent populations. Results indicated significant mean differences in SSS scores between persons with ASD and persons who are typically developing, and mean score differences among identified ASD age groups.