Associations between child behavior problems,family management,and depressive symptoms for mothers of children with autism spectrum disorder

PurposeThe purpose of the current study was to examine the relationships between child behavior problems and mothers’ depressive symptoms and to determine whether family management mediates this relationship.MethodsWe conducted a cross-sectional survey of parents in a southeastern state. Mothers of children with ASD (n = 234) completed self-reported measures of child behavior problems, depressive symptoms, and family management using ad-hoc questions, CES-D-Boston short form, and family management measure (FaMM), respectively. We used a parallel multiple mediator model to address the study hypotheses.ResultsChildren’s behavior problems were significantly associated with mothers’ depressive symptoms and with all five subscales of the FaMM. However, only the Family Life Difficulty subscale was a significant predictor of parent depressive symptoms, suggesting that Family Life Difficulty was the only mediator of the association between child behavior problems and mothers’ depressive symptoms. After accounting for the mediators, the direct effect of child behavior problems on parent depressive symptoms was non-significant.ConclusionAs the severity of child behavior problems increased, mothers of children with ASD perceived a greater impact of ASD on their family life, which in turn increased the levels of the mothers’ depressive symptoms. Family Life Difficulty assesses parent perceptions of the extent to which their child with ASD influences family relationships and routines, suggesting a need for family-centered services that assist the family in maintaining or adapting to their routines.     

Families of adolescents and adults with autism spectrum disorders in Taiwan: The role of social support and coping in family adaptation and maternal well-being

In this study we examined differences in social support and coping between mothers of adolescents and adults with an autism spectrum disorder (ASD) in Taiwan and the United States and to investigate the effects of social support and coping strategies on family adaptation and maternal well-being. Participants were 76 Taiwanese mothers who had at least one son or daughter with an ASD (10 years old and older), and a comparison group of 325 mothers in the United States matched on the age range of the child with an ASD. Mothers completed self-administered, written questionnaires and participated in an interview. Taiwanese mothers reported significantly greater use of problem-focused and emotion-focused coping strategies than did mothers in the United States. For Taiwanese families, greater use of problem-focused coping strategies was associated with lower levels of depressive symptoms and anxiety. Emotion-focused coping mediated the relationships between ethnicity/culture and several outcome measures: family adaptability, family cohesion, and maternal depressive symptoms. The higher levels of emotion-focused coping in Taiwanese mothers appeared to account for their lower levels of family adaptability and cohesion and higher levels of maternal depressive symptoms. The results from this cross-cultural study helped determine the role of social support and coping strategies in family adaptation and maternal well-being in families of individuals with an ASD in each culture. Implications for service delivery are discussed.     

The role of family cohesion in the psychological adjustment of non-Hispanic White and Hispanic mothers of children with autism spectrum disorder

The current study utilizes a process-oriented approach to understand both personal and family factors influencing the development of depressive symptoms among non-Hispanic White and Hispanic mothers of children with ASD. Family cohesion was hypothesized to mediate the associations between the personal factors (optimism, benefit finding, social support) and depressive symptoms. Mothers of 117 children with ASD (Hispanic n = 73; non-Hispanic White n = 44) completed measures of depressive symptoms, family cohesion, social support, optimism, and benefit finding. Results from this study indicate that optimism, benefit finding, and social support are important predictors of positive maternal adjustment. Furthermore, these factors contribute to better family functioning, namely family cohesion. The mediation models containing optimism, benefit finding, partner and family support were significant for both Hispanic and non-Hispanic White mothers, suggesting a similar mediation process for both racial/ethnic groups. However, family cohesion was a significant mediator of the relationship between friend support and depressive symptoms for Hispanic mothers only. The results of this study complement and extend previous research examining family functioning among mothers of children with ASD and have implications for the development of interventions aimed at increasing maternal well-being.     

Moderators and mediators of a maternal depression treatment study: Impact of maternal trauma and parenting on child outcomes

ObjectiveTreatment of maternal depression with psychotherapy has been shown to confer indirect benefits to school-age offspring with psychiatric disorders. The current study sought to understand mechanisms by which improvement in depressed mothers, with and without histories of trauma and treated with psychotherapy, produce changes in children who struggle with psychiatric illnesses themselves. We hypothesized that maternal history of childhood trauma would moderate the relationship between maternal and child outcomes and that increased positive and decreased negative parenting behaviors would mediate the relationship between maternal and child outcomes. We also examined whether maternal history of trauma would moderate the mediational effects of parenting behaviors.MethodsParticipants were dyads (n = 62) of mothers with major depressive disorder and their children, ages 7–18, with at least one internalizing disorder. Mothers were treated with nine sessions of psychotherapy and children were treated openly in the community. Dyads were evaluated every three months over one year.ResultsMaternal improvement in depressive symptoms was associated, in a lagged fashion, with child improvement in functioning six months later. There was a significant interaction of time and change in maternal symptoms [F(1, 45) = 5.84, p = 0.02], where change in maternal depressive symptoms from baseline to six months was robustly associated with change in child functioning from baseline to 12 months (β = 0.49, p = 0.0002). Maternal history of childhood sexual abuse moderated the association between change in maternal and child depressive symptoms [F(1,87) = 5.8, p = 0.02], and maternal history of physical neglect moderated the relationship between improvement in maternal depression and improvement in child functioning [F(1,36) = 4.34, p = 0.04], where significant associations between maternal and child outcomes were only found in mothers without histories of sexual abuse or physical neglect. Increase in positive parenting strategies (acceptance) by mothers mediated 6-month lagged associations between maternal and child outcomes, but reduction in negative parenting strategies (psychological control) did not. Maternal history of childhood emotional neglect moderated the mediational model, such that improved positive parenting did not explain lagged improvement in child depression among the subset of mothers with childhood histories of emotional neglect.ConclusionsIn dyads comprised of depressed mothers and school-age children with internalizing disorders, children improved when mothers improved, but not among those whose mothers who had histories of sexual abuse or physical neglect. Increased use of positive parenting strategies among mothers accounted for lagged relationships between improvement in maternal depressive symptoms and improvement in child functioning. This pattern was not, however, observed among mothers with childhood histories of emotional neglect. Interventions that directly enhance positive parenting and more rapidly change these behaviors may hasten improvement in offspring. Offspring of depressed mothers with histories of early trauma are at high risk for poor outcomes, even when their mothers receive depression treatment.     

Parenting stress in Chinese mothers of children with autism spectrum disorders

Objective

Elevated parenting stress has been observed among mothers of children with autism spectrum disorders (ASDs) in western countries, but little is known about mothers of Han Chinese children. The aim of the current study was to further the knowledge about stress experienced by Chinese mothers of children with ASD by examining maternal parenting stress in Heilongjiang province of China.

Methods

In this cross-sectional study, data about participants’ demographic characteristics, parenting stress, anxiety, depression, child’s behavioral problems, coping strategies, and social support were collected though a questionnaire survey. The participants included 150 families with ASD children, who were consecutively admitted to the clinics of the Children Development and Behavior Research Center in Harbin Medical University, Heilongjiang Disabled Persons Federation, and Mudanjiang Child Welfare Home.

Results

The participants reported elevated parenting stress. Mothers’ parenting stress was associated with levels of depression and anxiety, and child’s behavioral symptoms. Child’s behavioral symptoms, maternal anxiety, maternal depressive symptoms, and lack of governmental financial support were associated with overall parenting stress.

Conclusions

Government support may play an important role in reducing parenting stress in this population.     

The psychophysiological impact of childhood autism spectrum disorder on siblings

ObjectiveThe negative impact of caring for a child with autism spectrum disorder (ASD) on parents’ psychophysiological functioning has been widely evidenced. However, siblings, who also face emotional, social and physical challenges associated with having a brother/sister with ASD, have been less widely studied. This study examined the psychophysiological impact of childhood ASD on siblings.MethodsA sample of 25 siblings of children with ASD (and their mothers) and a control group of 20 siblings of neuro-typical children (and their mothers) completed questionnaires assessing: (a) demographic and lifestyle information, (b) family characteristics, (c) child behaviour problems, (d) social support and (e) depressive symptomology. Saliva samples were collected at several time points on two consecutive days, and estimates of the cortisol awakening response (CAR), diurnal cortisol slope and mean diurnal cortisol output were derived.ResultsTotal depressive symptoms were higher in siblings of children with ASD compared with controls. Group differences with respect to depressive symptomology were driven more by emotional than functional problems. With respect to physiological functioning, groups were comparable on all cortisol indices. In siblings of children with ASD, social support, especially from parents and close friends, predicted total depressive symptoms, as did the behaviour problems of their brother/sister with ASD.ConclusionSiblings of children with ASD experience greater emotional problems and overall depressive symptoms compared with a control group. Interventions that enhance social support, as well as helping siblings better understand the behaviour problems of their brother/sister with ASD, might be effective for alleviating depressive symptoms.     

Maternal depressive symptoms in pediatric major depressive disorder: relationship to acute treatment outcome

Objective:In the present study, we assess maternal depressive symptoms at the beginning and end of treatment to investigate the possible reciprocal relationship of maternal illness with the child's depressive illness and treatment.Method:We present data on 146 children and their mothers who were participating in a pediatric acute treatment study of fluoxetine. Patients were assessed with the Children's Depression Rating Scale-Revised at baseline and at each treatment visit. Mothers completed the Quick Inventory of Depressive Symptomatology-Self Report at baseline and end of acute treatment.Results:Thirty percent of mothers had moderate to severe levels of depressive symptoms at the child's baseline assessment. Overall, mothers reported improvement in maternal depressive symptoms at the end of their child's acute treatment, although maternal depression was not specifically targeted for intervention. Furthermore, mother's depressive symptoms appear to be associated with the child's depression severity both at the beginning and end of treatment. Mothers with higher levels of depressive symptoms had children with higher levels of depression severity at baseline and over the course of treatment. However, maternal depressive symptoms at baseline had no association with the rate of improvement of child depression severity.Conclusions:This study indicates a positive relationship between the depression severity of mothers and their children. These findings highlight potential areas of intervention in the acute treatment of childhood depression.     

Applied behaviour analysis: does intervention intensity relate to family stressors and maternal well‐being?

Background Interventions based on applied behaviour analysis (ABA) are commonly recommended for children with an autism spectrum disorder (ASD); however, few studies address how this intervention model impacts families. The intense requirements that ABA programmes place on children and families are often cited as a critique of the programme, although little evidence is available to support this claim. Using Pearlin's (1999) stress process model, this study assessed: (1) whether mothers of children participating in a home‐based ABA programme reported elevated depressive symptoms; and (2) whether ABA intensity related to unmet family needs and maternal feelings of depression, personal strain and mastery. Method Forty‐one mothers of children diagnosed with an ASD participated in this study by completing questionnaires about their child's ASD behaviours, unmet family needs, and maternal feelings of depression, personal strain and mastery. Additionally, mothers provided information about their child's intervention programme and their own level of involvement in the programme. At the time of data collection, all families had been running a home‐based ABA programme for at least 6 months. Results Single‐sample t‐tests and multiple regression analyses were used to test the proposed hypotheses. Mothers of children participating in a home‐based ABA programme reported more depressive symptoms than mothers of children with other developmental disabilities. Comparisons revealed comparable depressive symptoms between the mothers of the present sample and those in other ASD samples. When considering weekly ABA intensity, mothers reported fewer depressive symptoms when their child was older and when their child participated in more ABA therapy hours. Conversely, mothers who were more involved in their child's ABA programme reported more personal strain. Conclusions The findings of this study supported the hypothesis that families participating in ABA experienced elevated depressive symptoms, much like any family raising a child with an ASD, suggesting a potential area for family‐level intervention. Additionally, ABA intensity related to maternal depression and personal strain, and therefore deserves continued attention. Future studies should attempt to replicate these findings with a larger and more representative sample and seek to identify mechanisms through which ABA intensity may influence maternal and family well‐being.     

Mother-child interactions in depressed children and children at high risk and low risk for future depression

ObjectiveTo compare mother-child interactions and parenting styles in families of children with major depressive disorder, youths at high risk for depression, and healthy controls.MethodCurrently depressed (n = 43), high-risk (n = 28), and healthy control (n = 41) youths and their mothers engaged in a standardized videotaped problem-solving interaction. Measures of affect and behavior for both mothers and children were obtained, in addition to global measures of parenting.ResultsDepressed children demonstrated more negativity and less positivity in dyadic interactions than did children at high risk and control children. Mothers of depressed children were more disengaged than control mothers. Exploratory repeated-measures analyses in a subgroup of depressed children (n = 16) suggested mother-child interactions do not significantly change when children recover from depression. Children at high risk demonstrated less positivity in dyadic interactions than did controls. Mothers with a history of major depressive disorder and mothers with higher current depressive symptoms demonstrated patterns of disengagement and low control in interactions with children.ConclusionsMother-child interactions in depressed youths are marked by maternal disengagement and low child positivity that may not improve when children recover. The bidirectional effects of maternal disengagement and low levels of child positivity may precede onset of major depressive disorder in children and serve as risk factors for recurrent depression in youths.     

Multilevel approach to gender differences in adaptation in father-mother dyads parenting individuals with Autism Spectrum Disorder

BackgroundMost studies of gender differences in the ASD literature present methodological limitations regarding the treatment of dyadic data. This work explored gender differences in the psychological adaptation of a sample of Spanish fathers and mothers of individuals with Autism Spectrum Disorder (ASD) using a multilevel modeling approach (MLM) that accounts for nested data.MethodQuestionnaires including different adaptation measures were completed by 120 father-mother dyads raising individuals with ASD. We designed a two-level model (parents nested in dyads) with three predictor variables at level 1 (parent gender, parent age, and perception of child’s behavior problems) and four predictor variables at level 2 (child age, family income, ASD severity, and time since diagnosis) to examine the influence of these variables on negative and positive psychological outcomes (stress, anxiety, depression, and psychological well-being).ResultsMothers experienced higher levels of stress and anxiety than fathers, even after controlling for interdependence and sociodemographic factors. ASD severity was a significant predictor of both progenitors’ stress and well-being, and family income was also related to psychological well-being, although no gender differences were observed in the way these variables are related to parental outcomes.ConclusionsProfessionals should offer parents support to adjust expectations according to their child’s ASD severity given its relationship to parental stress and well-being. Considering that mothers experience higher levels of stress and anxiety than fathers, clinicians should encourage maternal protective factors. Finally, governments should consider new policies aiming to support ASD families’ treatment expenses.     

Maternal stress,well-being,and impaired sleep in mothers of children with developmental disabilities: A literature review

Having children with developmental disabilities (DDs) requires a high level of caregiving responsibilities, and existing studies support that mothers of children with DDs experience high levels of maternal stress as well as poor sleep and well-being. Given the fact that the number of children with DDs has increased, an up-to-date literature review is necessary to identify factors associated with maternal stress, sleep, and well-being. In addition, understanding these factors and their relationships may provide better strategies in designing effective interventions that can reduce the burden in mothers of children with DDs. This review summarized 28 scientific research papers that examined maternal stress, sleep, and well-being in mothers of children with DDs in past 12 years. The study findings indicate that mothers of children with DDs experience higher levels of stress than mothers of typically developing children, and it remains high over time. In addition, these mothers often encounter depressive symptoms as well as poor sleep quality. The study results also reveal that there is a bidirectional relationship between maternal stress and depressive symptoms as well as between poor sleep quality and depressive symptoms. For example, higher stress mothers experienced more depressive symptoms. Mothers of children with DDs with poor sleep quality are significantly associated with more depressive symptoms. Child behavior problems were significantly associated with both maternal stress and depressive symptoms, but cautious interpretation is warranted due to the shared variance between child behavior problems, maternal stress, and depressive symptoms. Methodological guidelines for future research involve the use of reliable and valid instruments for the measurement of child behavior problems, maternal stress, and sleep. Recommendations for future research are included.     

Hope, social support, and behavioral problems in at-risk children

This study investigated the effects of hope, social support, and stress on behavioral problems in a high-risk group of 65 children of incarcerated mothers. Children with low levels of hope had more externalizing and internalizing problems. Children who perceived less social support had more externalizing problems, and children who had experienced more life stressors reported more internalizing problems. Regression analyses indicated that hope contributed unique variance to both internalizing and externalizing behavioral problems after social support and stress were controlled. These findings suggest that being confident in one's ability to overcome challenges and having a positive outlook function as protective factors, whereas being less hopeful may place a child at risk for developing adjustment problems. Whether it is possible to foster agency and teach pathways to children with lower levels of hope is discussed.     

Depressive symptoms in mothers of pre-school children

Abstract Background Depressive symptoms in mothers of young children can have serious consequences for the health of the child. In particular, children whose mothers are experiencing depressive symptoms are at significantly greater risk of poisoning and accidental injury. A mothers risk of developing depressive symptoms has been shown to be related to socio-economic disadvantage, high levels of stress and a perceived lack of social support. Residents who perceive their neighbourhoods to be of low social capital are more likely to report poor mental health. The aim of this study was to investigate the relationship between maternal depressive symptoms, deprivation, social support, stress and neighbourhood social capital in a group of mothers living in deprived areas of Nottingham, United Kingdom (UK). Design and setting A postal questionnaire at entry to a randomised controlled trial (RCT) assessed socio-demographic characteristics and a second questionnaire, 21 months later, assessed depressive symptoms, perceived lack of social support, self-reported stress and individual-level assessment of neighbourhood social capital. Participants A total of 846 mothers of young children living in deprived areas in Nottingham, UK, enrolled in the control group of an RCT. Results One-third of mothers reported high levels of depressive symptoms. Neighbourhood-level deprivation and receiving means-tested benefits were independently associated with maternal depressive symptoms. A lack of social support and high levels of self-reported stress were also strongly associated with depressive symptoms. Individual-level assessment of neighbourhood social capital was not associated with depressive symptoms amongst mothers after adjusting for self-reported stress. Conclusions Neighbourhood- and individual-level variables of deprivation and psychological distress are more important than mothers assessment of the social capital of the neighbourhood in which she lives in determining the risk of depressive symptoms. Interventions aimed at supporting mothers of young children may be more effective at reducing the risks of depressive symptoms and consequent risks to the childs health than interventions aimed at improving a neighbourhoods social capital.     

Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement,Fear Regulation,and Stress Reactivity

ObjectiveTo examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome.MethodsUsing an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother–infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery.ResultsThe infants of depressed mothers scored the poorest on all three outcomes at 9 months—lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity—with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity.ConclusionsPathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.     

Prospective associations between social anxiety and depression in youth: The moderating role of maternal major depressive disorder

IntroductionAlthough social anxiety symptoms and exposure to maternal major depressive disorder (MDD) have each been conceptualized as key contributors to the development of depression symptoms in youth, these risk factors have not been integrated into a single model of risk. The current study evaluated a two-hit model of risk to determine whether the impact of social anxiety on prospective changes in youth depressive symptoms is stronger among youth exposed to maternal MDD than among those of never-depressed mothers.MethodsParticipants were youth (aged 8–14 at baseline, 50.4% girls, 80.9% Caucasian) and their biological mothers recruited from the community in the United States. Of the mothers, 129 had a history of MDD during their youth's lifetime and 117 had no lifetime history of MDD. At the initial assessment, mothers completed diagnostic interviews and youth completed self-report measures of social anxiety and depressive symptoms. Participants were reassessed every 6 months for 2 years during which youth again completed the symptom measures.ResultsResults of hierarchical linear modeling revealed that levels of social anxiety predicted prospective increases in depressive symptoms among offspring of mothers with a history of MDD, but not among those of never-depressed mothers. Depressive symptoms did not predict prospective changes in social anxiety (alone or in interaction with maternal MDD).ConclusionsThese results provide preliminary evidence for an integrated model of risk such that social anxiety symptoms may be a particularly strong risk factor for the subsequent development of depression symptoms among youth with exposure to maternal MDD.     

Associations between the dimensions of perceived togetherness,loneliness, and depressive symptoms among older Finnish people

ABSTRACT

Objectives: We studied the associations between perceived togetherness, depressive symptoms, and loneliness over a six-month period among 222 people aged 75–79 who reported loneliness or depressive mood at baseline.

Method: The present cross-lagged models utilized baseline and six-month follow-up data of a randomized controlled trial that examined the effects of a social intervention on loneliness and depression (ISRCTN78426775). Dimensions of perceived togetherness, i.e. attachment, social integration, guidance, alliance, nurturance, and reassurance of worth, were measured with the Social Provisions Scale, depressive symptoms with a short form of the Geriatric Depression Scale, and loneliness with a single item.

Results: After controlling for baseline loneliness and depressive symptoms, baseline higher attachment in all participants and baseline higher opportunity for nurturance in the social intervention group predicted lower depressive mood at follow-up. No cross-lagged associations between the dimensions of perceived togetherness at baseline and loneliness at follow-up were observed. In addition, depressive symptoms and loneliness at baseline tended to negatively predict the dimensions of perceived togetherness at follow-up.

Discussion: Depressive symptoms and loneliness appear to be precursor for perceived togetherness, rather than dimensions of perceived togetherness to be antecedents of loneliness and depressiveness among older people.     

The Reciprocal Relationship of ASD,ADHD, Depressive Symptoms and Stress in Parents of Children with ASD and/or ADHD

This study investigated the role of parental Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and depressive symptoms on parenting stress in 174 families with children with ASD and/or ADHD, using generalized linear models and structural equation models. Fathers and mothers reported more stress when parenting with their child with ASD and/or ADHD than when parenting with the unaffected sibling; they also experienced more stress than a norm population. Depressive symptoms were most pronounced in the parents of children with ASD and ASD+ADHD. Spouse correlations were found for ASD, depression, and parenting stress. Paternal ASD and maternal ADHD symptoms were related to increased parenting stress, and parental ADHD symptoms with depressive symptoms and parenting stress. The results highlight the increased burden of raising a child with ASD and/or ADHD and the reciprocal relationship this has with parents’ ASD, ADHD, and depressive symptoms, and levels of stress.     

Social Isolation,Loneliness, and Cognitive Performance in Older Adults: Evidence From the ELSI-Brazil Study

BackgroundThe association between social isolation and cognitive performance has been less investigated in low-to-middle-income countries (LMIC) and the presence of depression as a moderator on this association has not been examined. The authors examined the associations of social isolation and perceived loneliness with cognitive performance in the Brazilian Longitudinal Study of Aging.MethodsIn this cross-sectional analysis, social isolation was evaluated by a composite score including marital status, social contact, and social support. The dependent variable was global cognitive performance, which considered memory, verbal fluency, and temporal orientation tests. Linear and logistic regressions were adjusted for sociodemographic and clinical variables. The authors added interaction terms of depressive symptoms with social isolation and loneliness to examine whether depression, measured through the Center for Epidemiologic Studies-Depression Scale, modified these associations.ResultsAmong 6,986 participants (mean age = 62.1 ± 9.2 years), higher levels of social connections were associated with better global cognitive performance (B = 0.02, 95%CI: 0.02; 0.04). Perceived loneliness was associated with worse cognition (B = −0.26, 95%CI = −0.34; −0.18). Interactions of depressive symptoms with social connections scores were found on memory z-score and with loneliness on global and memory z-scores, suggesting a weaker association between social isolation or loneliness and cognition among those with depressive symptoms.ConclusionIn a large sample from an LMIC, social isolation and loneliness were associated with worse cognitive performance. Surprisingly, depressive symptoms decrease the strength of these associations. Future longitudinal studies are important to assess the direction of the association between social isolation and cognitive performance.     

Examining the utilisation and usefulness of social support for mothers with young children with autism spectrum disorder

ABSTRACT

Background Social support has been described as a vital resource for families with children with disability. Although the benefits of social support have been described, little is known about the utilisation patterns in families of young children with autism spectrum disorder (ASD).

Method In a community sample of 78 American families with children (2–6 years) with ASD, this study examined the utilisation and usefulness of social support. Child, family, and service variables related to social support were explored.

Results Mothers of children with ASD reported using a combination of formal and informal supports, and these were perceived to be helpful. Sociodemographic variables, child behaviour problems, satisfaction with the autism diagnostic process, and access to information about ASD predicted social support utilisation.

Conclusion Social support utilisation varies as a function of different child, family, and service variables. Understanding these variables may help professionals guide families in access to and use of social support.     

Maternal Schizophrenia,Skin-to-Skin Contact,and Infant Feeding Initiation

BackgroundThe World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia.MethodsWe conducted a population-based cohort study using administrative health data from Ontario, Canada (2012–2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes.ResultsMaternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82–0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71–0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services.ConclusionsReduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal–child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.