Comparison of Perceptions of Activities of Daily Living of Adult Children with Autism Among Three Groups of Aging Caregivers

Many aging parents care for adult children with autism spectrum disorder (ASD) and an additional loved one. This exploratory study compared differences among compound 1 (caring for an additional family member), compound 2 (caring for a typically developing minor child), and noncompound (solely caring for an adult child with ASD) caregivers on perceptions of the degree of support that care recipients need to perform specific types activities of daily living (ADL) that care recipients need assistance to complete. Each caregiver cared for at least one adult child with ASD. Results from a web-based survey completed by 320 aging caregivers were examined using Kruskal-Wallis ANOVA tests for independent samples. Compound 1 and noncompound caregivers were more likely to be involved in assisting their adult children with some ADLs when compared with compound 2 caregivers. Findings provide insight into the realities of caregivers with regard to ADL needs of their adult children.

Predictors of the Quality of Life of Informal Carers of Adults on the Autism Spectrum

Carers of adults on the autism spectrum often experience high levels of stress, worry, and caregiver burden. There are few studies identifying the predictors of carer mental well-being and none have been conducted in Australia. Data from the Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Autism in Adulthood was used to test the conceptual model by Sonido et al. (Rev J Autism Dev Disord, 2019, https://doi.org/10.1007/s40489-019-00177-8 ) by (a) identifying the predictors of mental well-being for carers of adults on the spectrum, (b) using model selection to determine which predictors contribute to the model of best fit, and (c) testing for mediating relationships between the predictors. Several predictors were directly associated with carer psychological quality of life, including carer age, care recipient intellectual disability, and carer intolerance of uncertainty. Model selection strongly supported the inclusion of most clusters from the conceptual model. Some mediating relationships were found, such as care recipient depressive behaviours mediating the relationships between caregiver burden and psychological quality of life. Future studies of the conceptual model will improve understanding of the predictors of carer mental well-being and enable tailored interventions to improve the psychological health of carers of adults on the autism spectrum.

Receipt of Social Support among Compound and Noncompound Caregivers of Adults with Autism

For parents of adult children with autism spectrum disorder (ASD), caregiving can be ongoing, beginning at diagnosis and continuing throughout adulthood. As parental caregivers age, many may be faced with additional caregiving responsibilities, such as caring for another loved one. This study examined differences in formal and informal social support used by caregivers providing care to more than one person with at least one being an adult child with ASD (compound caregivers) and those caring for a single adult child with ASD (noncompound caregivers). A nationwide sample of 320 parents (age 50 or older) of adult children with ASD completed a web-based survey to understand use of formal and informal social support. Fisher's exact probability tests were used to determine significant differences in the extent to which the services were used by the two groups of caregivers. Results indicated that 4 of the 12 formal and 2 of the 6 informal social support services differed significantly between compound and noncompound caregivers. Given that both groups of caregivers were aging, future research should focus on understanding what services are anticipated to be needed as these changes occur and as changes to future care plans are needed, to best support their care-recipients.

Explicit Associations with Autism and Disability

Objectives

Autistic people call for greater acceptance even though the general public has greater awareness of the autism spectrum. This study investigated explicit or conscious attitudes toward the autism spectrum and disability in college students and the general population. We hypothesized that both samples would associate "a person on the autism spectrum" with more negative attributes than other types of people except for "a person with a disability."

Methods

In Phase 1, participants generated 10 word associations for 8 labels: a person on the autism spectrum, a person not on the autism spectrum, a person with a disability, a person without a disability, a college student, a professor, a child, and a parent. In Phase 2, participants rated the 10 most common words for each label (type of person) in Phase 1 on a 7-point Likert scale from extremely negative to extremely positive. Ninety-nine undergraduate students and 106 adults recruited through Amazon Mechanical Turk completed Phase 1. One hundred twenty-two undergraduate students and 101 adults recruited through Amazon Mechanical Turk completed Phase 2.

Results

Only "a person with a disability" in the general population sample was rated as having significant negative associations. However, the associations of "a person with a disability" were rated more negatively than all other labels in both samples, and the associations of "a person on the autism spectrum" were rated as second most negative in the general population sample.

Conclusion

Explicit associations toward disability and autism were somewhat mixed. Adults in the general population tended to have more negative explicit associations with disability, and to a lesser extent autism. These results underscore the need to examine attitudes in samples more representative of the general population. Furthermore, evidence of possible explicit negative associations is concerning and highlights the imperative need to confront ableism.

Lay summary

Why was this study done?: The general public claims to be aware of the autism spectrum and recent research suggests that they have greater knowledge about the autism spectrum than they did in the past. However, as autistic individuals have articulated, autism awareness is not the same as autism acceptance. In order for autistic individuals to be fully included into society, we must move to autism acceptance. One way researchers examine potential discrimination is by studying attitudes.What was the purpose of this study?: This study examines people's explicit attitudes toward the autism spectrum and to disability. Explicit attitudes are attitudes that are conscious and controllable.What did the researchers do?: Two groups of adults participated in the study: a group of college students and a noncollege sample of adults designed to better represent the general population of adults. Participants completed an online study wherein they were asked to list word associations for different types of people including "a person on the autism spectrum" and "a person with a disability." In a second study, participants then rated the most common associations from extremely negative to extremely positive.What were the results of the study?: The results were somewhat mixed. Only the set of associations of "a person with a disability" were rated by participants in the noncollege group as negative. However, the associations of "a person with a disability" were rated more negatively than all other types of people in both groups, and the associations of "a person on the autism spectrum" were rated as second most negative in the noncollege sample.What do these findings add to what was already known?: The majority of research on explicit attitudes toward autism has focused on children, including how interventions may improve attitudes toward autistic children. Therefore, this research provides much needed information on the state of attitudes toward autistic individuals more generally. This research also provides a comparison of attitudes toward autism, disability, and other groups. Furthermore, research assessing attitudes toward autism in adults has largely focused on college students, whereas this research considered both college students and a noncollege sample.What are the potential weaknesses in the study?: These findings may not extend to a more diverse population as both groups had relatively high education levels, were primarily White non-Hispanic and were living in the United States. Furthermore, participants may have generated more positive associations for "a person on the autism spectrum" and "a person with a disability" because they wanted to be viewed in a favorable light. This is known as a social desirability bias.How will these findings help autistic adults now or in the future?: Unfortunately, possible explicit negative associations with the autism spectrum and with disability are concerning as they reflect people's conscious and controllable attitudes. These results highlight a need for action and also support autistic individuals' demand for actions toward autism acceptance.

Autism aging

Many people perceive autism spectrum disorder (ASD) as a childhood disorder, yet ASD is a lifelong condition. Although little is known about the mental and physical health issues of aging individuals with ASD, there are increasing numbers of older adults being diagnosed with ASD. Although there has been a recent "call to action" (to address lack of knowledge and the dearth of services and programs for aging individuals with autism, the authors think it is also important for those who are involved in educational programs related to gerontology and geriatrics settings to be aware of "autism aging." This term conceptualizes the demographics, person and contextual factors, and intellectual awareness of the trends and patterns of ASD as a life course challenge and opportunity for well-being and quality of life. The purposes of this article are to (1) provide a general overview of autism issues and to examine several dimensions of ASD in the context of the emergent and relevant scholarship in the adult and aging domain, (2) propose how to address the "gap" in the literature on autism and aging in terms of a conceptual model and by improving the methodology, and (3) to discuss the implications of these dimensions for educators in gerontology and geriatrics, and for those professionals who work in clinical and health care services. It is the goal of the authors to have this article represent a general introduction to ASD and to be a part of the foundation for educational awareness for educators in gerontology and geriatrics.

Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder

Background

The Developmental, Individual-differences, Relationship-based model (DIR/Floortime) is one of the well-known therapies for autism spectrum disorder (ASD), in which its main principle is to promote holistic development of an individual and relationships between the caregivers and children. Parental engagement is an essential element to DIR/Floortime treatment and involved with various factors. Finding those supporting factors and eliminating factors that might be an obstacle for parental engagement are essential for children with ASD to receive the full benefits of treatment.

Aim

To examine the association between parents, children and provider and service factors with parental engagement in DIR/Floortime treatment.

Methods

This is a cross-sectional study of parents with children aged 2–12 years who were diagnosed with ASD. Data were collected using a parent, child, provider and service factors questionnaire. Patient Health Questionaire-9, Clinical Global Impressions-Severity and Childhood Autism Rating Scale were also used to collect data. For parent engagement in DIR/Floortime, we evaluated quality of parental engagement in DIR/Floortime and parent application of DIR/Floortime techniques at home. Finally, Clinical Global Impressions-Improvement and Functional Emotional Developmental Level were used to assess child development.

Results

Parents who were married, had lower income and higher knowledge of DIR/Floortime theory were more likely to have higher parent engagement (χ²=4.43, p=0.035; χ²=13.1, p<0.001 and χ²=4.06, p=0.044 respectively). Furthermore, severity of the diagnosis and the continuation of the treatment significantly correlated with parent engagement (χ²=5.83, p=0.016  and χ²=4.72, p=0.030 respectively). It was found that parents who applied the techniques for more than 1  hour/day, or had a high-quality parent engagement, significantly correlated with better improvement in child development (t=−2.03, p=0.049; t=−2.00, p=0.053, respectively).

Conclusion

Factors associated with parents, children, and provider and service factors had a significant correlation with parent engagement in DIR/Floortime in which children whose parents had more engagement in DIR/Floortime techniques had better improvement in child development.

Aging in Place in Every Community: Social Exclusion Experiences of Parents of Adult children With Autism Spectrum Disorder

This article offers an examination of aging processes of lifelong caregivers and the possibilities for social exclusion place experienced by parents of adult children with autism spectrum disorder (ASD). This study of parental caregivers ( n = 51) sheds light on how enduring caregiving roles can lead to social exclusion in three ways: misunderstanding of ASD and stigma, the complexity of the caregiving roles, and impact on daily routines including challenges with long-term planning for both the adult children and the parental caregivers. Implications for practice to address social exclusion include education and building greater communication ties among family member for family members and advocacy for more and higher quality services including respite care. This article concludes with discussion of the impact of this aging, yet caregiving population and the need for knowledge about aging processes and anticipating aging for these caregivers.

Factors Mediating Dysphoric Moods and Help Seeking Behaviour Among Australian Parents of Children with Autism

This study compared levels of state affect, dysphoric mood, and parenting sense of competence in Australian parents of children with or without autism. The effects of personality and location on the parents' experience were also examined, while controlling for current affect. Possible relationships among personality, location factors and help-seeking behavior were also explored in parents of children with autism. Prior findings of higher dysphoric mood levels in parents of children with autism were supported, as was the positive correlation between dysphoric moods and Neuroticism levels. Parenting Sense of Competence did not differ across locations, and there were no parent type by location interactions. Access to services among parents of a child with autism did not moderate dysphoria levels.

Accurate or assumed: visual learning in children with ASD

Children with autism spectrum disorder (ASD) are often described as visual learners. We tested this assumption in an experiment in which 25 children with ASD, 19 children with global developmental delay (GDD), and 17 typically developing (TD) children were presented a series of videos via an eye tracker in which an actor instructed them to manipulate objects in speech-only and speech + pictures conditions. We found no group differences in visual attention to the stimuli. The GDD and TD groups performed better when pictures were available, whereas the ASD group did not. Performance of children with ASD and GDD was positively correlated with visual attention and receptive language. We found no evidence of a prominent visual learning style in the ASD group.

Development of a Transition Process Scale for High-risk Infant's Caregiver

BACKGROUND

Transition into parenthood is a major developmental life event and is very significant because development in infanthood is affected by the transition process of mothers parenting an infant. This study aimed to develop the assessment tool for transition process of high risk infant's caregiver in Korea.

METHODS

The participants were 246 mothers of premature infant born with gestational age (< 37 weeks) or low birth weight (< 2500 gm), of less than 24 months of age. Preliminary items were derived from transition process scale for parent of children with autism. Factor analysis was performed to test construct validity of the scale, the correlation between transition processes and parenting efficacy was used for testing predictive validity.

RESULTS

The final scale was composed of 23 items divided into 5 factors: wandering (7 items), devotion (5 items), acceptance (4 items), denial (4 items), frustration (3 items). The total variance for validity described by the 5 factors was 60.8% and the reliability of the scale was total Cronbach's α 0.90 and wandering 0.85, devotion 0.78, acceptance 0.72, denial 0.72, and frustration 0.71. Correlation between transition process and parenting efficacy was statistically significant; wandering(r=-0.61, P <.001), devotion (r=-0.60, P<.001), acceptance (r=0.30, P <.001), denial (r=-0.31, P <.001) and frustration (r= -0.27, P <.001).

CONCLUSION

This final assessment scale will be used to investigate high-risk infant caregiver's transition process and provide basic data for program development to provide differentiated support and care at each process.

Family wellbeing of individuals with autism spectrum disorder: A scoping review

Families play an important role in supporting individuals with autism spectrum disorder across the lifespan. Indicators of family wellbeing can help to establish benchmarks for service provision and evaluation; however, a critical first step is a clear understanding of the construct in question. The purpose of the current scoping review was to (a) summarize current conceptualizations and measurements of family wellbeing, (b) synthesize key findings, and (c) highlight gaps and limitations in the extant literature. A final review of 86 articles highlighted the difficulty of synthesizing findings of family wellbeing in the autism spectrum disorder literature due to varied measurement techniques and the limited use of a common theoretical direction. Considerations for future research are presented with an eye toward policy relevance.

[Construct validity of the life transition scale for parents of children with autism]

PURPOSE

The study was done to identify the construct validity and reliability of the life transition scale (LTS) for parents who have children with autism.

METHODS

Exploratory factor analysis (EFA) and confirmative factor analysis (CFA) were conducted to identify the most adequate measurement model for structural validity. Convergent validity and discriminant validity were also conducted for structural validity. Data were collected from 208 parents through self-reported questionnaires and analyzed with SPSS/WIN 15.0 and AMOS 20.0 version.

RESULTS

A four factor-structure was validated (χ²=541.23, p<.001, GFI=.82, RMSEA=.07, IFI=.89, CFI=.89, PNFI=.73, Q (χ²/df)=2.20) at the 3rd order of EFA and CFA, and factors were named as denying, wandering, despairing, and accepting. Both convergent and determinant validity for LTS were 100%. Cronbach's alphas for the reliability of each structure were .77-.90 and .83 for total structure.

CONCLUSION

The four structures, 24-item instrument showed satisfactory reliability and validity. LTS has the potential to be appropriate for assessing the transition process of life for parents who have children with autism and provides basic directions for differentiated support and care at each stage.

The association of illness perceptions with depressive symptoms and general psychological distress in parents of an offspring with autism spectrum disorder

BACKGROUND

Raising a child with an autism spectrum disorder (ASD) is a severe stressor and parents often present high levels of depression. Depression is associated with illness perceptions but this association has not been studied in parents of ASD offspring.

OBJECTIVE

We aimed to assess the prevalence of psychological distress symptoms and their associations with illness perceptions in parents with an ASD offspring.

METHODS

In 111 parents of ASD offspring we assessed depressive symptoms (PHQ-9), illness perceptions (B-IPQ) and general psychological distress (GHQ-28). Multiple linear and logistic regressions were used to assess their independent associations.

RESULTS

The prevalence of parental clinically significant depressive symptoms was 34.2%, while 55% presented clinically significant levels of general psychological distress. Younger parents and those with lower financial resources had greater psychological distress and more severe depressive symptoms. Parents felt that the condition impacted their lives and believed it would be chronic. Their beliefs about the consequences and the chronicity of the disorder were significant independent correlates of their psychological distress and depressive symptoms severity.

CONCLUSIONS

These findings indicate that a remarkable proportion of parents with an ASD offspring present clinically significant depressive symptoms, which were associated with illness perceptions relevant to the consequences and the chronicity of the disorder. Our data encourage psychotherapeutic interventions aiming to support parents to deal with the consequences and chronicity of their offspring's disorder, in order to reduce parental psychological distress.

[Development of a scale to measure life transition process in parents of children with autism]

PURPOSE

The purpose of this research was to develop a scale to measure the life transition process of parents of children with autism, against the backdrop of a lack of research on this topic.

METHODS

Seventy preliminary items were drawn from previous qualitative research, and content validity was tested by three professors as well as three parents of children with autism. A questionnaire survey was also done between August 2011 and February 2012. Data were collected from 207 parents of children with autism and analyzed using descriptive statistics, item analysis, Cronbach's alpha, Pearson correlation coefficients, and factor analysis with the SPSS Win 15.0 program.

RESULTS

Twenty-nine items were selected to constitute the appropriate measuring scale and categorized into 5 factors explaining 63.2% of the total variance. The 5 factors were named; stages of denial (5 items), wandering (6 items), devotion (7 items), frustration (3 items), and finally acceptance (8 items). Cronbach's alpha for the 29 items was .80.

CONCLUSION

The results of this study not only suggest assessment criteria for the life transition process of parents who have children with autism but also provide basic directions for program development to provide differentiated support and care at each stage.

"We are all there silently coping." The hidden experiences of parents of adults with Asperger syndrome

BACKGROUND

The experiences of older parents of adults with Asperger syndrome have not been explored in the research literature.

METHOD

Four families who had middle-aged offspring with Asperger syndrome were interviewed (3 mothers and 1 couple), and the interviews were analysed using interpretative phenomenological analysis (IPA).

RESULTS

Six themes emerged from the analysis: (a) providers of "hidden" support, (b) role of advocate, (c) social isolation, (d) intrafamilial relationships, (e) support for parents, and (f) future concerns.

CONCLUSIONS

The findings of this study offer insight into the experience of parents of adult sons with Asperger syndrome. Implications for future support interventions and research are suggested.