Effects on resilience of caregivers of persons with autism spectrum disorder: the role of positive cognitions

An Exploratory Study of Resilience to Stressful Life Events in Autistic Children

Background

Autistic children experience more stressful life events (SLEs) than their neurotypical peers, which are related to poor mental health outcomes in both neurotypical and autistic individuals. However, there is a lack of longitudinal research assessing the perceived impact of stressful life events on autistic children's mental health.

Method

Utilizing a novel statistical technique (Ratcliff et al., 2019), called 'area of resilience to stress events' or ARSE in R, we aimed to quantify aspects of resilience, growth, and non-resilience for 67 autistic children (6-13 years old) enrolled in a larger longitudinal study who experienced a SLE. Parents reported demographic information (e.g., child age, biological sex, household income) as well as the child's internalizing and externalizing symptoms and autism characteristics across multiple time points spaced one year apart (baseline, T2, T3, T4).

Results

There was substantial variability in the resilience process within the sample. Older children exhibited a less adaptive resilience process (i.e., higher total scaled scores or arsets). Perceived stress of the disruptive event was not correlated with resilience; however, there was a significant child age x stress severity interaction, suggesting that younger children in households that perceived the disruptive event as highly stressful exhibited more efficient resilience, or lower arsets scores, compared to other children.

Conclusions

This study introduces an innovative methodological approach to understanding the effects of stressful life events on the mental health of autistic children. Results have implications for family-based policy and practice and highlight for whom services may be most beneficial.

Coping with the Stress through Individual and Contextual Resilient Factors in Primary School Settings

Children face school stress as students through all educational stages. A negative association between resilience and stress has been demonstrated by many authors, but most of these studies have been carried out in higher educational stages. So, the aim of the present study is, on the one hand, to find out the level of stress of primary school children and also the types of stressful situations in school settings, and on the other hand, to analyze the effect of individual and contextually resilient factors on their level of school stress. The study involved 427 children between 6 and 12 years of age, who were administered the IECI school stress scale and the RES-PRIM Resilience questionnaire for children. Descriptive analyses, correlations, and regression analyses were performed on the data. Results showed an average level of school stress, with the most stressful situations being: participating in too many activities, concentration problems, and nervousness when being asked by the teacher in class. Predictive analysis showed that part of the school stress could be explained by both individual factors (self-esteem, introspection, future purpose, and social skills) and resilient contextual factors (teacher support, parental support, and peer support). It is concluded that it is necessary to pay more attention to the transitions between different educational stages with programs that reinforce academic information and encourage the development of individual resilient skills, stressing the importance of the role of teachers, peers, and parents as support groups.

What factors are associated with posttraumatic growth among mothers of children with developmental disabilities in South Korea?

BACKGROUND

The identification of PTG and its correlates in the aftermath of a traumatic event would assist professionals in recognizing and amplifying individual's potential strengths. However, there are few studies on PTG and its correlates in mothers who have birthed or raised children with developmental disabilities in South Korea.

AIM

This study examined the predictive role of caregiving strain and social support on the subdimensions of PTG among South Korean mothers of children with developmental disabilities.

METHODS AND PROCEDURES

The participants were 344 mothers of children with intellectual disabilities or autism. PTG was divided into four sub-dimensions (change in self-perception, increase in interpersonal depth, finding new possibilities, and increase in spiritual interest), and the predictive roles of caregiving strain and social support on each sub-dimension were identified using hierarchical multiple regression.

OUTCOMES AND RESULTS

Subjective caregiving strain; family support services; and support from family, friends, or significant others were significantly related to the subdimensions of PTG. Interestingly, support from significant others was positively associated with PTG.

CONCLUSIONS AND IMPLICATIONS

Social support was more likely to influence all subdimensions of PTG, except for changes in self-perception while only subject caregiving strain was associated with PTG. Thus, policymakers and practitioners should prioritize expanding family support services and strengthening various informal supportive resources for mothers with higher PTG.

Theoretical Substruction of Resilience Theory: Dementia Caregivers' Burden and Their Care Recipients' Behavior

Theoretical substruction is vital in clarifying models and guiding research. In this article, the process of theoretical substruction was examined through resilience theory to provide an example of the congruence between theoretical and operational definitions in nursing research. The author examines the significance of resilience theory in the context of dementia caregivers' burden and their care recipients' behavioral problems. The steps of theoretical substruction are included, and a model of resilience is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. The rigorous process of theoretical substruction provides an example of a theoretically sound basis for exploring the role of positive thinking in the lives of dementia caregivers and their care recipients. Geropsychiatric nurses working with dementia patients and their caregivers should consider the role of positive thinking in decreasing caregivers' burden.

The spectrum of attitudes towards the spectrum of autism and its relationship to psychological distress in mothers of children with autism

LAY ABSTRACT

Mothers of children on the autism spectrum experience high levels of emotional distress. Mothers cope with stress by having their own thoughts and opinions about their children. In this study, we tested whether the way mothers perceive autism may contribute to the level of distress they feel. Some mothers see autism as a developmental disorder that needs to be cured, but some see autism as a type of mind that needs to be accepted. Our findings showed that mothers who see autism more as a type of mind are generally less stressed. But we also showed that it matters how severe are the child's symptoms, and how heavy was the perceived burden of caring for the child. These results imply that it is worth working on attitudes towards autism to help mothers cope better. But at the same time, we argue that mothers should not be judged for their perceptions of autism, as there is a huge spectrum of a child's characteristics and family's life circumstances.

Factors influencing resilience of parents with children with neurodevelopmental disorders: The role of structural language, social cognition, and social support

BACKGROUND

Resilience allows a more positive coping and improves parents' wellbeing when they face a difficult situation like having a child with a neurodevelopmental disorder (NDD). We aim to analyze the development of resilience in parents of children with different NDD (ASD, DLD and ADHD) with different levels of structural language and social cognition, as well as the social support available for their families, and compare it to children with typical development (TD).

METHOD

We analyzed the level of resilience of 156 parents, 73 with children with TD and 73 with three different NDD, taking into account variables such as age, structural language (receptive grammar) and social cognition (emotional understanding) of the children, and also the type of social support available to them.

RESULTS

Children with DLD and ASD showed lower receptive grammar and emotional comprehension skills, although only parents of children with ASD obtained better resilience scores. Moreover, age of children and formal support variables predicted the resilience of the parents according to the type of NDD.

DISCUSSION

The severity of social cognition and structural language difficulties of children with NDD and the fact of having support from professionals and family associations have a significant influence on the development of parental resilience.

Resourcefulness revisited: Further psychometric evaluation of resourcefulness scale

Resourcefulness, a collection of problem-solving, coping, self-control and emotion regulation skills, has been shown to moderate health outcomes in various caregiver populations. Caregivers of children with neurodevelopmental disorders, such as autism spectrum disorder (ASD), report higher levels of stress, anxiety and depressive symptoms with poorer health-related quality of life. The current study replicated and extended psychometric research on the Resourcefulness Scale (RS) among caregivers of children with ASD (n = 287) and a comparison group of caregivers of non-affected children (n = 207). Results suggest acceptable internal consistency and construct validity when using the RS among caregivers of children with and without ASD. The RS demonstrated poor temporal stability over an average of 4 weeks (r = 0.087, p = 0.434). Caregivers of children with ASD report higher levels of general, social, and personal resourcefulness than non-affected caregivers. Findings validate the use of the RS within caregiving populations with implications for clinical use and future research in the development of interventions to enhance caregiver QoL.

The relationship between the positive aspects of caring and the personal growth of caregivers of patients with advanced oncological illness : Postraumattic growth and caregiver

OBJECTIVE

Examine the relationship between the positive aspects of care and the personal growth of caregivers of patients with advanced oncological illness.

METHODS

This research was a quantitative study with a transversal design. One hundred (100) informal caregivers filled out self-applied questionnaire on resilience, aspects of care, emotional distress, spirituality, and posttraumatic growth. Descriptive statistics were applied to the data, later correlation, and regression, and comparative analyses were conducted.

RESULTS

The participants were mainly women (86%) with an average care period of 12 months. The average age was 46.52 years. The highest scores were evidenced in positive aspects of caretaking, spirituality, personal growth, and distress, while the lowest score was seen in questions related to resilience. There was a negative inverse correlation among emotional distress, resilience, spirituality, and posttraumatic growth (p < .05) and a positive correlation among resilience, spirituality, posttraumatic growth, and the positive aspects of caretaking (p < .01). There were significant differences among the items related to emotional distress, resilience, and posttraumatic growth. The linear regression analysis showed that as resilience, spirituality, and the positive aspects of care increased, so did posttraumatic growth.

SIGNIFICANT RESULTS

To promote the perception of benefits among caregivers, resilience and the identification of meaning in the caregiving experience of patients with advanced oncological illness can be considered protective factors favoring adaptation and reducing negative moods.

Effects of mindfulness, coping styles and resilience on job retention and burnout in caregivers supporting aggressive adults with developmental disabilities

BACKGROUND

Considering the growing body of studies investigating the effects of mindfulness-based interventions on caregivers supporting people with developmental disabilities, the current study aimed to explore the role that the cognitive processes of mindfulness, coping style and resilience played in predicting caregiver retention and burnout among a sample of direct support professionals working with aggressive adults with developmental disabilities.

METHODS

Ninety-seven direct support professionals were surveyed to determine level of mindfulness, coping styles, resilience and burnout and were interviewed 3 months later to determine if they were still working with the aggressive adult.

RESULTS

Mindfulness skills of describing non-judgmentally and observing one's environment, as well as problem-focused coping, emerged as protective factors against burnout, while avoidance-focused and maladaptive coping emerged as risk factors. Mindful openness acted as the only predictor of job retention.

CONCLUSIONS

These results support that paid caregivers should receive trainings in mindfulness and positive coping mechanisms as part of their job trainings, to promote positive outcomes for both themselves and the people they support.

Stigma of living as an autism carer: a brief psycho-social support intervention (SOLACE). Study protocol for a randomised controlled feasibility study

BACKGROUND

Stigma is prominent in the lives of autistic individuals and their families and contributes significantly to the challenges faced by families raising an autistic child. Parents and carers can feel blamed for their child's behaviour, feel socially excluded and isolated and suffer from low self-esteem and poor psychological well-being. This increases the risk of experiencing self-stigma which further exacerbates these and other negative consequences. Therefore, there is a need for interventions that help parents/family carers cope with autism-related stigma as well as prevent the internalisation of stigma.

OBJECTIVES

The primary objective of this study is to assess the feasibility and acceptability of a stigma support intervention for parents and carers of autistic children titled 'Stigma of Living as an Autism Carer (SOLACE)'. The secondary objective is to explore the preliminary impact of the intervention on the mental health of the parents and carers.

METHODS

A pilot randomised controlled trial feasibility study will be implemented. A group receiving the SOLACE stigma support intervention (n = 12) will be compared against a control group not receiving any additional intervention (n = 12). Family carers of autistic children up to the age of 10, who have been recently diagnosed or are currently undergoing diagnosis, will be recruited for the study. Participants will be randomly allocated to the intervention or control group and will take part in eight weekly group-based sessions designed to improve the well-being of the parents primarily through increasing their resilience to stigma. Feasibility will be determined by recruitment and retention rates and a qualitative focus group evaluating the acceptability of the intervention and outcome measures. The primary outcome of interest is psychological well-being, and depending on the normality of distribution, independent samples T tests will be used to compare the outcome scores between the two groups and dependent samples T tests for differences within the group. Other outcomes of interest are stigma, self-stigma, self-esteem, self-blame, social isolation, self-compassion and perceived responsibility and control.

DISCUSSION

Results from the feasibility randomised controlled trial will be used to refine the study protocol and inform the design of an intervention for future use in a larger, powered trial. SOLACE could potentially improve the psychological well-being of parents/family carers of autistic children through increased resistance to stigma.

TRIAL REGISTRATION

ISRCTN Registry number ISRCTN61093625 (October 13, 2017).

Risk and Resilience Among Mothers and Fathers of Primary School Age Children With ASD in Malaysia: A Qualitative Constructive Grounded Theory Approach

Little is known about the coping and resilience experiences of parents of children with autism spectrum disorder (ASD) in the Malaysian cultural context. This study utilized a qualitative methodological approach adopting constructive grounded theory. The study sought to address the lack of research to date exploring the risk and protective experiences that contribute to parental stress and resilience for parents of primary school age children with ASD in the Malaysian setting. Twenty-two parents of children with ASD (13 mothers and 9 fathers) participated in semi-structured interviews. A strength of the study was the inclusion of both mother and father participant perspectives. The interviews lasted 50-80 min (mean: 67.5 min). The 22 parents had a total of 16 children (12 males; 4 females) formally diagnosed with ASD. Child age ranged between 5 and 12 years (mean age: 8.44). Overall, analysis of the 22 interviews revealed four prominent themes - "initial reaction to child's ASD symptoms and diagnosis," "family life affected by a child with ASD," "awareness about ASD in Malaysia," and "coping strategies, wellbeing, and becoming resilient." The first three themes revolved around stress and adversity, and, the adaptability and acceptance of the parents. These processes illustrated the risks experienced by the parents of children with ASD in Malaysia. The last theme especially highlighted the strengths and determination of the parents and illustrated the protective experiences and processes that helped parents to develop and enhance resilience. Overall, the findings revealed that resilience develops synergistically and dynamically from both risk and protective experiences across different levels - individual, family, community, society and government. The findings motivated the development of our theoretical model of resilience that can help health and education professionals tailor assessment and interventions for parents of children with ASD in the Malaysian context. Clinical, policy, and research suggestions were discussed.

Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.

Effectiveness of parent training in improving stress-coping capability, anxiety, and depression in mothers raising children with autism spectrum disorder

PURPOSE

Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD children often present with high levels of stress and depression. Interventional steps to enhance parental coping skills and resiliency are more important for parental mental health and the family-centered care of children with ASD than merely reducing parental stress. Although the importance of stress-coping skills is well established, only a few studies have investigated interventional steps to improve parental coping or resiliency. Parent training (PT) is known to improve a mother's mental health. Here, we aimed to assess the effectiveness of PT in improving the stress-coping style of mothers raising children with ASD.

PATIENTS AND METHODS

Thirty mothers of children with ASD aged 4-11 years participated in this study. The mothers underwent PT based on the Hizen Parenting Skills Training in Japan, which comprised seven sessions. Each session included education on behavior therapy, individual consultation, and workshops in small groups. Sixteen mothers completed psychological assessment, including the Stress Coping Inventory, the Beck Depression Inventory Second Edition, the State-Trait Anxiety Inventory, and the Child Behavior Checklist conducted before and after 2 months of PT.

RESULTS

The outcomes before and after the PT program were compared using the paired t-test and Pearson's correlation. After the PT program, the mothers' stress-coping strategy "positive appraisal" significantly increased (P<0.01) and "escape/avoidance" significantly decreased (P<0.01). The Beck Depression Inventory Second Edition (P<0.05) and the trait anxiety scores (P<0.01) also significantly decreased. The change in the stress-coping strategy "distancing" had a significantly negative correlation with the change in the externalizing Child Behavior Checklist T-scores of children with ASD (Pearson r=-0.518, P<0.05).

CONCLUSION

PT may be effective for mothers of children with ASD to improve their stress-coping style and to decrease their depression and trait anxiety.

Risk and Protective Factors in the Lives of Caregivers of Persons With Autism: Caregivers' Perspectives

PURPOSE

The purpose of this descriptive exploratory study is to understand the experience of being a caregiver of a person with autism spectrum disorder (ASD) in the light of the resilience theory.

METHODS

Qualitative data were collected as a part of a larger quantitative study. Ninety-three caregivers completed this qualitative study and responded to the two open-ended questions. In the parent study, subjects were recruited by convenience sampling from the Interactive ASD Network (IAN).

FINDINGS

The identified categories appeared to reflect three distinct categories consistent with the resilience theory, labeled as follows: risk factors, protective factors, and overlapping factors.

PRACTICE IMPLICATIONS

These findings help to inform the planning of tailored interventions to enhance caregivers' resilience.

Online Positive Thinking Training Intervention for Caregivers of Individuals with ASD: Necessity, Acceptability and Feasibility

BACKGROUND

More than 3.5 million people in the United States are diagnosed with autism spectrum disorder (ASD). Caring for children with ASD can be stressful and can be detrimental to the well-being of the caregivers (CGs). However, the adverse effects of caregiving on the well-being of CGs may be avoided with appropriate interventions. CGs of persons with ASD might benefit from a positive thinking training (PTT) intervention to help them cope with the stress of caregiving. However, the necessity, acceptability and feasibility for PTT in ASD CGs have not been studied.

OBJECTIVE

To examine the necessity, acceptability and feasibility of a six-week online PTT intervention designed to improve the well-being of the CGs.

DESIGN

Random assignment of ASD CGs to one of two conditions: (1) PTT online intervention or (2) Control group.

RESULTS

The mean score on the depressive cognition scale (DCS) was 20, indicating a high need of PTT to all enrolled CGs. High depressive cognitions in ASD CGs were associated with lower positive thinking (r = -.39; p <.001). Regarding acceptability, CGs indicated that the different strategies and references to real life were the most interesting parts of the intervention. Regarding feasibility, CGs mentioned that listening to the voice-over PowerPoint and visualization was the easiest part of the PTT.

CONCLUSIONS

Examination of the fidelity and effectiveness of the PTT are the next steps in the refinement of this intervention.

Journaling as reinforcement for the resourcefulness training intervention in mothers of technology-dependent children

Resourcefulness, a set of cognitive and behavioral skills used to attain, maintain, or regain health, is a factor related to depressive symptoms in mothers of children with chronic conditions and complex care needs who are dependent on medical technology such as mechanical ventilation or feeding tubes. The purpose of this secondary analysis of a randomized, controlled pilot intervention study was to determine the feasibility, acceptability and fidelity of daily journal writing as a method of reinforcement of resourcefulness training (RT) that teaches the use of social and personal resourcefulness skills. Participants returned their journals to the study office at the end of the four-week journaling exercise. Content analysis from exit interviews and journals supported the feasibility, acceptability and fidelity of daily journaling for reinforcement of RT in this population. Journal writing can be used by pediatric nurses to reinforce and promote resourcefulness skill use in parents of technology-dependent children.

Reframing Autism: Young Adults With Autism Share Their Strengths Through Photo-Stories

A dearth of research describes the lives of young adults with autism spectrum disorder (ASD) from the perspectives of young adults themselves. We explored young adults' strengths using Photovoice, a method in which participants use images and discussions to express themselves. Images were purposefully chosen to help young people participate in the research process.

DESIGN AND METHODS

Eleven young adults captured their experiences growing up with ASD via images, and participated in three group photo discussions, an individual photo interview, and a photo exhibit. Qualitative data for analysis included session transcripts and photographs. We used strategies of theme analysis to understand participants' experiences.

RESULTS

The mean age of the sample was 20years, and 7 participants were male. Three sub-themes describe youth's strengths: 1) special interests that cultivated positive emotions and coping strategies; 2) skills and activities that evoked pride; and 3) reframing ASD as special versus a disadvantage.

CONCLUSIONS

The Photovoice method is well-suited to help young adults identify and express their strengths. Self-generated images and stories may offer a creative and effective form of communication for young adults with ASD.

PRACTICE IMPLICATIONS

Health care practitioners can capitalize on how Photovoice helps young adults express themselves by using images to understand their health priorities and involve young adults in their care plans. With images of strength, for example, nurses can build young adults' confidence and help these individuals to identify areas of their mental and physical lives in which they can thrive and experience improved quality of life.

Fathers' Experience With Autism Spectrum Disorder: Nursing Implications

INTRODUCTION

Autism spectrum disorder (ASD) is a lifelong condition characterized by very mild symptoms to severe impairments in communication skills, social interactions, and unusual behaviors that interfere with independent functioning and interactions with others. ASD may cause financial, social, and emotional difficulties that negatively affect the entire family. The main focus of current research in caregivers of children with ASD focuses on the mothers rather than fathers or both parents, and no studies have used the fathers' words to describe their experience with ASD. Fathers have an important role to improve outcomes for their children receiving therapy. With more fathers taking on the primary caregiver role, it is important to understand their experience with ASD and their needs to help them actively engage in their role as fathers. The purpose of this study was to describe fathers' experience with ASD using their own words and identify any resources needed to help them actively engage in their role as a father of a child with ASD.

METHODS

A single-case, multiple-participant, phenomenological approach case study was conducted to describe the experience of fathers of children with ASD. The case was defined as White non-Hispanic (the population identified as having the highest incidence of ASD) fathers who are living in the same home with their child(ren) who has/have a formal diagnosis of ASD. Fathers answered open-ended questions about their experience with ASD, including the challenges they face, their advice for other fathers of children with ASD, and what they need to overcome the challenges of ASD. The theoretical model for the study was the Resiliency Model of Family Stress, Adjustment, and Adaptation. The model was designed to help health care professionals identify a family's strengths and weaknesses as they face existing and new stressors related to a long-term medical condition and then provide interventions to help the family become resilient so they can meet the challenges.

RESULTS

Fathers in this study had experiences similar to those described in previous studies with regard to mothers of children with ASD. The similarity of the findings in the small sample size of fathers and those in studies with larger sample sizes of mothers supports development of clinical interventions that will benefit both mothers and fathers of children with ASD. Fathers described the adjustments made by each member of the family to face the challenges of ASD. Fathers also explained their needs, including money, teamwork, honesty, information, and time. The fathers experienced stages of grief and loss that are similar to those that occur when experiencing a death.

DISCUSSION

Nurses are the eyes and ears of the health care team and the voice for the parents, thus creating a critical connection between the parents and health care team. Fathers in the current study and mothers in previous studies described their need for someone to listen to them, educate them and others about ASD, acknowledge their experience and emotions, and direct them to appropriate resources. Nursing implications include taking action to lead the parents through the challenges and helping them develop resiliency and facilitating improved outcomes for the children and the entire family. A resource book or computer file including information about available resources and information about ASD and treatment can be a valuable tool to help overcome challenges related to ASD.

Parenting African American Children With Autism: The Influence of Respect and Faith in Mother, Father, Single-, and Two-Parent Care

PURPOSE

Parents are the most significant contributor to care of children with autism spectrum disorder (ASD), and as such research on African American parenting in ASD is conspicuously absent. Findings relevant to parenting are discussed from a study with urban African American families caring for children with ASD.

DESIGN

An ethnonursing study was conducted with 24 African American family members of children with ASD and 28 professionals. Data were analyzed and reported as themes.

FINDINGS

Two universal themes of were found of respect and faith in God and family that influenced parental care. Two diverse themes of mother's watchful care and father's protective care, along with differences in feelings of isolation and dependence on supports were found among single- and two-parent families. Discussion and Practice Implications: When health care professionals increase their knowledge and understanding of cultural practices in the parental care of children with ASD, they provide health care that is culturally congruent.

The Mediating Effects of Positive Cognitions on Autism Caregivers' Depression and Their Children's Challenging Behaviors

Caregivers of persons with Autism Spectrum Disorders (ASD) are prone to depression and psychological problems, which have an impact on their children's challenging behaviors. Positive cognitions include specific positive thinking patterns that enhance one's ability to effectively manage daily activities and promote mental health. The purpose of this research is to test the mediating effects of positive cognitions on the relationship between caregivers' depression and their children's challenging behaviors among 117 caregivers of persons with ASD. Positive cognitions were found to have mediating effects on the relationship between caregiver's depression and their children's challenging behaviors in this sample of caregivers of persons with ASD. Nurses are in a strategic position to include in their interventions those strategies that strengthen positive cognitions in order to improve the caregivers' positive cognitions and well-being, which, in turn will have an impact on their children's challenging behaviors.

Is sense of coherence helpful in coping with caregiver burden for dementia?

BACKGROUND

Sense of coherence (SOC) is associated with a reduced risk of various health problems and is thought to be a major factor related to the ability to cope with stress. In the present study, we examined the association between caregiver burden and SOC among caregivers to persons with dementia.

METHODS

Participants included 274 caregivers or family members of community-dwelling elderly dementia patients. To assess the cognitive function of patients, neuropsychological tests (e.g. Mini-Mental State Examination, Clinical Dementia Rating) were conducted by a clinical psychologist who was well trained in interviewing participants; the tests used a semi-structured interview protocol. Senior neurologists and psychiatrists also independently evaluated the dementia status of patients. To assess the SOC and caregiver burden, a social welfare counsellor asked questions from a 13-item version of the SOC scale and the short, eight-item Japanese version of the Zarit Caregiver Burden Interview (ZBI).

RESULTS

Among 78 caregivers of elderly subjects with cognitive impairment due to dementia, the ZBI score was significantly associated with SOC (r = -0.38, P = 0.001). Multiple regression analyses revealed that SOC scores (β = -0.42, P < 0.001) and Mini-Mental State Examination scores (β = -0.28, P = 0.009) were significantly associated with ZBI scores (F(2, 76)  = 10.51, P < 0.001). SOC was closely associated with personal strain in the ZBI (β = -0.41, P < 0.001; F(3, 75)  = 8.53, P < 0.001).

CONCLUSION

Caregivers with a strong SOC may be less prone to experiencing personal strain from their burden. These results suggest that reinforcement of SOC would contribute to reducing the personal strain.

Highly resilient coping entails better perceived health, high social support and low morning cortisol levels in parents of children with autism spectrum disorder

The negative consequences of caring for people with developmental disabilities have been widely described. However, the ability to bounce back from the stress derived from care situations has been less studied. Those caregivers who have shown this ability are considered as resilient. This study aims to evaluate the relationship between resilience and self-reported health and cortisol awakening response (CAR) in a sample of caregivers of people with autism spectrum disorders (ASD). It also aims to evaluate the role of social support as a mediator in the association between resilience and health. Caregivers with higher resilience show better perceived health, lower morning cortisol levels, and less area under the curve with respect to ground (AUCg). Social support was positively related to resilience and mediated the relationship between resilience and perceived health. This mediating effect was not found in the association between resilience and CAR. Resilience could be a protective factor that modulates the negative consequences of chronic stress in the care context. Social support could be an important variable mediating the effects of resilience on health outcomes in caregivers. All these results must be considered when implementing effective psychological programs for helping caregivers.

Psychometric properties of the resourcefulness scale among caregivers of persons with autism spectrum disorder

Caregiving for children with autism spectrum disorder (ASD) can be very costly to caregivers' well-being. Resourcefulness interventions have shown increases in positive health outcomes. However, before delivering the intervention, there should be a reliable and a valid measure to test resourcefulness. The psychometric properties of the Resourcefulness Scale (RS) have not been examined among ASD caregivers. This study examined the psychometrics of the 28-item RS in a convenience sample of 204 ASD caregivers. A Cronbach's alpha of .91 showed the internal consistency of the RS. Construct validity was supported by the emergence of two dimensions of resourcefulness (personal and social) in a confirmatory factor analysis and by substantial intercorrelations between the two subscales (r = .48, p < .001). Findings suggested the reliability and validity of RS among ASD caregivers, which is a necessary step toward implementing resourcefulness interventions to help ASD caregivers to deal with their stress and improve their quality of life.

Psychometric assessment of the depressive cognition scale in caregivers of persons with dementia

Caregivers of persons with dementia are prone to depression. Early identification of cognitive depressive symptoms is important to prevent the development of clinical depression. The Depressive Cognition Scale (DCS) can be used for early detection, but the scale's psychometrics have not been tested in caregivers of persons with dementia. In this study, 80 caregivers of persons with dementia completed the eight-item DCS and measures of caregiver burden and resourcefulness. A Cronbach's alpha of .88 indicated internal consistency. Construct validity was supported by significant correlations with caregiver burden (r = .40; p < .001) and resourcefulness (r = -.54; p < .001). Principal components factor analysis resulted in two factors in which five items loaded cleanly on one factor and two items have cross-loadings. Because prior factor analysis in previous studies resulted in one factor, we did confirmatory factor analysis in which we forced the items on one factor. All the items loaded on the single factor and the amount of variance explained was 55.99%. The findings suggest the DCS is useful for early detection of depression in caregivers of persons with dementia.

Psychometric assessment of the depressive cognition scale among caregivers of persons with autism spectrum disorder

Caregivers of persons with autism spectrum disorders (ASD) are prone to depression, and early identification of cognitive depressive symptoms is important to prevent the development of clinical depression. The Depressive Cognition Scale (DCS) can be used for early detection, but the scale's psychometrics has not been tested in caregivers of persons with ASD. In this study, 95 caregivers of persons with ASD completed the eight-item DCS and measures of caregiver burden and resourcefulness. A Cronbach's alpha of .90 indicated internal consistency. Construct validity was supported by significant correlations with caregiver burden (.59) and resourcefulness (-.57). Principal component factor analysis produced a single factor with 58% of the variance explained. The findings suggest the DCS is useful for early detection of depression in caregivers of persons with ASD.

Measuring use of positive thinking skills: psychometric testing of a new scale

Positive thinking interventions improve adaptive functioning and quality of life in many populations. However, no direct measure of positive thinking skills taught during intervention exists. This psychometric study of a convenience sample of 109 autism spectrum disorder (ASD) caregivers examined a new eight-item Positive Thinking Skills Scale (PTSS), which measures the frequency of use of positive thinking skills. The PTSS was found to be internally consistent (α = .90). Construct validity was supported by significant correlations (p < .01) with positive cognitions (r = .53), resourcefulness (r = .63), depression (r = -.45), and general well-being (r = .40). The findings support use of the PTSS as a potential indicator of intervention fidelity among ASD caregivers. However, because it is not specific for ASD caregivers, the PTSS has the potential for wider usage in other populations for whom the identification of specific positive thinking skills could provide direction for future intervention.