The Association Between Mental Health, Stress, and Coping Supports in Mothers of Children with Autism Spectrum Disorders

Raising a child with an autism spectrum disorder (ASD) can be a stressful experience for parents. When left unmanaged, high stress levels can lead to the development of depressive symptomatology, highlighting the importance of coping supports. The current paper examined the stress level and psychological wellbeing of mothers with a child with ASD in a national survey. After adjusting for child, mother and family level characteristics, it was determined that mothers of children with ASDs were at greater risk for poor mental health and high stress levels compared to mothers of children without ASDs. The presence of maternal coping strategies, in the form of emotional and neighborhood social supports, as well as strong coping skills, reduced these risks between models.     

Relationship satisfaction in couples raising a child with autism spectrum disorder: A systematic review of the literature

BackgroundCouples raising a child with autism spectrum disorder (ASD) face challenges that may impact on their relationship. The purpose of this review was to compare relationship satisfaction in couples raising children with and without ASD and to identify factors associated with satisfaction in couples with a child with ASD.MethodsThirteen databases were searched and studies were systematically screened against predetermined inclusion criteria. Twenty six articles, ranging from good to strong methodological quality, met the criteria for inclusion. Of these, seven were included in a meta-analysis comparing relationship satisfaction in couples raising a child with ASD with couples raising children without disabilities.ResultsThe meta-analysis showed that couples raising a child with ASD were found to experience less relationship satisfaction than couples raising a child without a disability (Hedges’s g = 0.41, p < 0.001); however, evidence from the narrative synthesis was mixed when compared with couples raising children with other disabilities. The most consistent evidence implicated challenging child behaviours, parental stress and poor psychological wellbeing as risk factors, and positive cognitive appraisal and social support as protective factors.ConclusionFindings demonstrate that couples raising a child with ASD would benefit from support to assist them in maintaining satisfaction in their relationship with their partner. However, further studies are needed to gain a greater understanding of the risk and protective factors and how these co-vary with relationship satisfaction over time. A theoretical framework has been developed to scaffold future research.     

Match or Mismatch? Influence of Parental and Offspring ASD and ADHD Symptoms on the Parent–Child Relationship

Few studies have examined the influence of parental ASD and ADHD symptoms in combination with child pathology on the parent- child relationship as perceived by the child. A sample of 132 families was recruited with one child with ASD (with/without ADHD), and one unaffected sibling. Affected children (regardless of diagnosis) reported lower acceptance and conflict resolution scores than their unaffected siblings, with conflict resolution scores (but not acceptance) being lower than the norm according to both affected and unaffected children in both fathers and mothers. Higher paternal, but not maternal, ASD and ADHD symptoms were related to poorer scores regarding acceptance and conflict resolution, respectively. Treatment targeting conflict resolution skills of parents and the feeling of being less accepted in children with ASD/ADHD may be beneficial.     

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.     

Predictors of Satisfaction with Life in Parents of Children with Autism Spectrum Disorder

This study examined the relationships between autism spectrum disorder (ASD) symptoms, care-related activities, and satisfaction with life (SWL) in 184 parents caring for a child with ASD in New Zealand. The relationships between coping styles and SWL were also examined. The parents’ SWL scores indicated they were slightly dissatisfied with their lives. A stepwise linear regression showed three predictors (care-related health problems, carer esteem and financial difficulties) explained 47% of the variance in SWL scores. Several coping styles were associated with lowered SWL, and only emotional support was related to increased SWL. The regression model provides a focus for monitoring parental wellbeing, and stresses the importance of recognition and support for the substantial responsibilities parents of children with ASD face.     

Parental Depression and Child Behavior Problems: A Pilot Study Examining Pathways of Influence

Parents of children with autism spectrum disorders (ASD) have higher rates of depressive symptoms than parents of typically developing children and parents of children with other developmental disorders. Parental depressive symptoms are strongly associated with problem behaviors in children; however, the mechanisms through which parental depression influences child behavior in families of children with ASD are unclear. The purpose of this study was to examine the relationship between parental depression and child behavior problems among families of children with ASD, more specifically to investigate the mediating variables that may explain the processes through which parental depression and child behavior problems are associated. The sample consisted of 33 parents of children with ASD (ages 2 to 5 years old). Findings suggested that authoritative parenting style significantly mediated the relationship between parental depression and behavior problems. This study highlights the importance of considering parental mental health and its impact on parenting behavior in interventions targeting child behavior problems.     

Stress and Family Quality of Life in Parents of Children with Autism Spectrum Disorder: Parent Gender and the Double ABCX Model

Past research has supported the utility of the Double ABCX model of family adaptation for parents raising a child with autism spectrum disorder (ASD). What remains unclear is the impact of family-related variables on outcomes in both mothers and fathers within the same family. We explored the potential predictors of maternal and paternal stress and family quality of life in an Australian sample of 196 parents of children with ASD aged 3–16 years. Using a cross-sectional design, parents completed questionnaires assessing factors within the Double ABCX model attributed to family adaptation. Findings provide further evidence of the negative impact of child externalising behaviours and highlight the importance of family sense of coherence on positive parental outcomes.     

Parenting behaviours among mothers of pre-schoolers on the autism spectrum: Associations with parenting stress and children’s externalising behaviour problems

BackgroundParents of pre-schoolers diagnosed with Autism Spectrum Disorder (ASD) report increased parenting stress (i.e., stress related to the parent role) and more behaviour problems of the child compared with parents of non-autistic pre-schoolers. Parenting stress and children’s behaviour problems are both associated with parenting behaviours, but have not yet been investigated together.Method42 mothers of autistic and non-autistic pre-schoolers were observed during mother-child interaction and they reported on parenting behaviours, parenting stress, and children’s externalising behaviour problems. Spearman correlations between all variables were calculated for the ASD group and the non-ASD group separately, and Linear Mixed Models were built to investigate whether parenting stress and externalising behaviour problems were similarly associated to parenting behaviours in both groups.ResultsMothers in the ASD group reported more parenting stress and more externalising behaviour problems than mothers in the non-ASD group. In the ASD group only, parenting stress was related to externalising behaviour problems but not to the level of autism characteristics. In both groups, more externalising behaviour problems were associated with more observed negative parenting behaviours (i.e., criticising and ignoring the child), and more parenting stress was associated with less reported autonomy support.ConclusionsOur findings indicate that in the case of possibly problematic parenting behaviours, such as negativity and lack of autonomy support, it is important to investigate associated factors like parenting stress and children’s behaviour problems. An individualised strengths and needs assessment could then offer a tailored intervention to families with an autistic pre-schooler.     

The relationship between the broader autism phenotype,child severity,and stress and depression in parents of children with autism spectrum disorders

This study examined the relationship between child symptom severity, parent broader autism phenotype (BAP), and stress and depression in parents of children with ASD. One hundred and forty-nine parents of children with ASD completed a survey of parenting stress, depression, broader autism phenotype, coping styles, perceived social support, and child symptom severity. Parents reported elevated parenting stress and depression relative to normative samples. A path analysis indicated that both child symptom severity and parent BAP were positively correlated with these outcomes. The relationship between BAP and the outcome measures was partially mediated by maladaptive coping and social support and the relationship between child symptom severity and outcomes was partially mediated by social support.     

Child behaviour problems mediate the association between coping and perceived stress in caregivers of children with autism

Coping and child behaviour problems (CBP) predict psychological distress in caregivers of children with autism. Whether CBP mediate the relationship between coping and caregivers’ psychological functioning has yet to be determined. This was the aim of the current study. A sample of 56 caregivers of children with autism completed an electronic survey assessing perceived stress, disengaged and problem focused coping, and CBP. Disengaged and problem focused coping predicted both CBP and perceived stress, albeit in different directions. CBP was also predictive of perceived stress. Data revealed an indirect effect of both disengaged and problem focused coping on perceived stress through CBP. In conclusion, caregivers who use more disengaged coping might be less effective at managing the problematic behaviours of the child with autism, thus resulting in poorer psychological functioning. Conversely, caregivers who use more problem focused strategies might, due to fewer CBP, be relatively protected against the psychological sequelae associated with the caregiving experience. Whether interventions that enhance problem focused coping have adaptive effects for caregivers’ psychological functioning, and whether these effects are mediated by fewer CBP might be the focus of subsequent research.     

Parenting Stress in Mothers and Fathers of Toddlers with Autism Spectrum Disorders: Associations with Child Characteristics

Elevated parenting stress is observed among mothers of older children with autism spectrum disorders (ASD), but little is known about parents of young newly-diagnosed children. Associations between child behavior and parenting stress were examined in mothers and fathers of 54 toddlers with ASD (mean age = 26.9 months). Parents reported elevated parenting stress. Deficits/delays in children's social relatedness were associated with overall parenting stress, parent-child relationship problems, and distress for mothers and fathers. Regulatory problems were associated with maternal stress, whereas externalizing behaviors were associated with paternal stress. Cognitive functioning, communication deficits, and atypical behaviors were not uniquely associated with parenting stress. Clinical assessment of parental stress, acknowledging differences in parenting experiences for mothers and fathers of young children with ASD, is needed.     

Coping,distress, and well-being in mothers of children with autism

As is the case in stress research generally, studies examining the relationship between coping and mental health outcomes in parents of children with autism frequently classify parental coping methods as being either problem- or emotion-focused. We argue that this dichotomization of coping strategies oversimplifies the way parents respond to their child's autism. In the present study, the coping methods employed by 113 mothers of children with autism were investigated using the Brief COPE (Carver et al., 1989). Exploratory factor analysis of Brief COPE subscales identified four reliable coping dimensions: engagement coping, distraction coping, disengagement coping, and cognitive reframing coping. In addition, using multiple regression, we examined the relationship of coping strategies to negative and positive maternal outcomes (depression, anger, and well-being). In general, maternal use of avoidant coping (distraction and disengagement) was found to be associated with increased levels of maternal depression and anger, while use of cognitive reframing was associated with higher levels of maternal well-being. In several instances, child characteristics, particularly severity of child maladaptive behavior, moderated the effect of coping on maternal outcomes. Study findings are discussed in light of previous research in the area; in addition, study limitations and clinical implications are highlighted.     

Are Anxiety Disorders in Children and Adolescents Less Impairing Than ADHD and Autism Spectrum Disorders? Associations with Child Quality of Life and Parental Stress and Psychopathology

We compared clinically referred children with anxiety disorders (AD; n?=?63) to children with autism spectrum disorder (ASD; n?=?39), ADHD Combined (ADHD-C; n?=?62), ADHD Predominantly Inattentive (ADHD-I; n?=?64), and typically developing children (n?=?42) on child quality of life (QOL), paternal and maternal psychopathology and parental stress. Diagnoses were based on DSM-IV-TR criteria. Multilevel analyses showed that QOL in AD was higher on school and social functioning, compared to respectively ADHD and ASD, and lower compared to normal controls on all five domains. Fathers reported their AD children higher QOL than mothers. Also, AD appeared to be associated with less parental stress and parental psychopathology than other child psychopathology. Therefore, parental factors may need to be considered more in treatment of children with ADHD/ASD than AD.     

It takes two! Exploring sex differences in parenting neurobiology and behaviour

Parents lay the foundation for their children's socio‐emotional experiences by sensitively responding to their needs. The hormonal and neurobiological changes that occur during the transition to parenthood importantly contribute to the parents’ caregiving behaviour toward their children. Much research has emphasised the relationship between the mother, who is most often the primary caregiver, and her infant, with less focus on the role of fathers in child development. However, recent accounts have suggested that fathers also play an important role in promoting the health, development and psychosocial wellbeing of their children. Evidence from the behavioural literature has indicated that there are significant differences between typical mother‐infant versus father‐infant interactions. The current review aims to outline differences between maternal and paternal caregiving by discussing the differences in their biological mechanisms. First, we focus on the different hormones that are correlated with sensitive parenting behaviours in mothers and fathers. Next, we discuss the differences between neural bases of motherhood and fatherhood. Lastly, we discuss ways in which parental hormones, parental brain and parental exposure to infant cues interact to shape parental caregiving behaviour. In summary, this review highlights the distinct but complementary nature of maternal and paternal caregiving.     

Vicarious futurity,hope, and well-being in parents of children with autism spectrum disorder

Hope is shown to provide resiliency for parents of children with autism spectrum disorders (ASDs) against the negative effects related to extreme parenting stressors. The broad positivity of hope may overlook opposing parental feelings about their child that may be important for well-being. Vicarious futurity (VF) is the hope and despair a parent feels for the future of their child, which reflects both positive and negative components of parental attitudes directed toward their child. In this study we examined how vicarious futurity related to hope, and how each predicted well-being in 71 parents (53 mothers) of children with ASD. Results indicated that regardless of child symptom severity, vicarious futurity strongly predicted stress experienced by parents, hope predicted depressive symptoms, and both predicted life satisfaction. Vicarious futurity and hope were found to be weakly correlated, indicating that both constructs are largely independent when influencing the well-being of parents raising a child with ASD. General hopefulness is important for parental well-being, but in the unique context of parents raising children with ASD, child focused constructs that measure both positive and negative components, such as vicarious futurity, may be more informative and useful when understanding how parental feelings about their child influence their own well-being.     

Parenting dimensions in mothers and fathers of children with Autism Spectrum Disorders

Rearing a child with Autism Spectrum Disorder (ASD) is a unique challenge for both parents. Previous studies addressed how mothers are affected by the challenges of raising a child with ASD, mostly in terms of stress pattern. In this study, we focused on comparisons between mothers and fathers of children with ASD in parental stress, attitude and mental health. We examined 99 parents of children with ASD using the Parenting Stress Index-Short Form, the Parental Style Questionnaire, the Self-Perceptions of the Parental Role and the Symptom Checklist-90-Revised. The results revealed the gender differences in the parental attitude and mental health. Mothers reported that they engaged in more social behaviors with their children than fathers. In addition mothers reported higher level of depression than fathers. No difference among parents emerged in the Parenting Stress Index-Short Form. The results of a multiple regression analysis revealed that parenting distress is associated with depression, balance of parents’ diverse roles in their life and dysfunctional interaction between parents and children. These findings highlight both similarities and differences between mothers and fathers of children with ASD and the existence of a relationship between parental stress, mental health and attitude. Results suggest the importance of developing specific intervention programs which incorporate these fundamental parenting domains.     

Dilemmas, diagnosis and de-stigmatization: parental perspectives on the diagnosis of autism spectrum disorders

Many children who display autistic behaviours at clinical levels do not receive a formal diagnosis. This study used qualitative methods to examine parental influence in pursuing or avoiding a diagnosis of autism spectrum disorder (ASD). The aim was to explore the function of ASD diagnosis for parents, and examine whether a diagnosis affected how parents perceived ASD. Seventeen parents participated in in-depth semi-structured interviews, which were analyzed using thematic and grounded theory approaches. Data analysis revealed dilemmas faced by parents: whether to act to retain the 'normal' status of the child or to 'normalize' the child through diagnosis and subsequent remediation. Parents who had received an ASD diagnosis for their children became proactive in trying to reduce stigmatization of ASD more widely, and in some cases actively advocating ASD diagnosis to other parents. Thus their actions may make it more likely that others will opt for diagnosis in the future.     

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.     

Are child autism symptoms,developmental level and adaptive function associated with caregiver feelings of wellbeing and efficacy in the parenting role?

BackgroundMany parents of children with autism have low levels of mental wellbeing, which may be related to low self-efficacy in the parenting role. Few studies have investigated the impact that child characteristics such as autism symptoms, development and functioning have on parental wellbeing and self-efficacy. In this study, we investigated associations between parental mental wellbeing, self-efficacy and child measures of behaviour and function, for families participating in the Paediatric Autism Communication Trial-Generalised (PACT-G).MethodParents of children with autism (N = 248, aged 2–11 years) completed self-report measures of mental wellbeing and self-efficacy. We used a range of parent-report and researcher administered assessments of autism symptoms, child development, emotional and behavioural difficulties, language and adaptive skills. Nonparametric tests (Spearman’s correlations) and multiple linear regression analyses were used to examine the associations between child characteristics and parent wellbeing and parental self-efficacy.ResultsParent mental wellbeing and self-efficacy were highly related. Results of bivariate analyses showed significant negative associations between parent-reported child autism symptoms and parental self-efficacy. Higher child adaptive behaviour was also associated with better parental-self-efficacy. However, in a multivariate regression model, only high parent reported autism symptoms were associated with lower parental self-efficacy. Parent wellbeing was not related to any feature of the child’s profile.ConclusionThese findings indicate that parent-reported autism symptoms are associated with parental self-efficacy, and that self-efficacy may be an important secondary outcome of interventions for children with autism.     

The predictors of distress in parents of children with autism spectrum disorder

Abstract

Background It is well recognised that parents of children with autism spectrum disorder (ASD) often experience clinically significant levels of stress and depression. This study examined which ASD characteristic best predicted parental distress.

Method Parents of 109 children aged between 4 and 12 (M age = 7.89, SD = 2.43) completed self-report measures of anxiety, depression, stress, and parenting-specific stress. They also completed rating scales regarding their child's ASD characteristics.

Results This study found that the child's behavioural and emotional impairments predicted the parents’ overall levels of distress (i.e., stress/tension, anxiety, and depression), but not the stress associated with parenting. Instead, the child's social impairment severity was found to predict parenting-specific stress.

Conclusion This study highlights the pervasive influence of ASD symptomatology on the mental wellbeing of the parents and the importance of assisting parents to cope with the behavioural and social impairments of their child.