Factors influencing adjustment in siblings of children with autism spectrum disorders

Siblings of children with autism spectrum disorders (ASD) may be at an increased risk of adjustment problems. To examine possible predictors of adjustment difficulties in siblings, 70 mothers with at least one child with ASD and one typical child completed surveys of symptom severity in the child with ASD, impact of the child with ASD on the sibling, maternal depression, and broader autism phenotype (BAP) and behavioral adjustment in the typical sibling. A path analysis indicated that symptom severity in the children with ASD was positively associated with adjustment difficulties in the typical siblings; this relationship was mediated by maternal depression, but not sibling impact. Further, greater expression of the BAP in the siblings was associated with more adjustment difficulties, and this relationship was moderated by autism severity in the children with ASD, such that the relationship was stronger at high levels of ASD severity than at lower levels. These findings highlight the importance of assessing functioning of all family members when working with individuals with ASD and their families.     

Understanding perceptions underlying the self-reported stress among parents of adolescents with autism spectrum disorder: Considerations for supporting families

BackgroundParents raising adolescents with autism spectrum disorder (ASD) often report higher stress than other parents. The influence of parents’ internal, or cognitive, experiences (i.e., their own perceptions) on this elevated stress has yet to be explored. Addressing this gap may reveal opportunities for enhancing support for families by elucidating malleable targets for reducing parents’ self-reported stress and/or informing family-focused intervention. The Double ABCX Model of Family Adaptation is a framework for understanding how perceptions, social support, and personal resources (i.e., coping) may affect stress.MethodsWe examined parents’ perceptions about ASD, perceived support, and coping among 214 parents of adolescents with ASD. Regression analyses were used to explore whether these factors were associated with parenting stress among those raising adolescents with ASD. Moderation effects of positive coping on the relationship between parent perceptions and parenting stress were also explored.ResultsParent perceptions about within family support, the extent of ASD symptom predictability, and treatment being able to ‘control’ ASD were related to parenting stress. However, positive coping did not moderate the relationship between these perceptions and parenting stress.ConclusionsStudy findings emphasize significant associations between specific parental perceptions and the self-reported stress among families of adolescents with ASD. Particularly important to parenting stress were how much parents’ perceived adequate support within the family, that treatment was useful for controlling their adolescent’s ASD, and that their adolescent’s symptoms were predictable. These findings suggest that the way parents think about their adolescents’ ASD and the adequacy of the support within their own families are associated with parenting stress, and therefore may serve as treatment targets for positively affecting whole family outcomes, as well as foundations for additional research.     

The Impact of Child Symptom Severity on Depressed Mood Among Parents of Children with ASD: The Mediating Role of Stress Proliferation

Stress proliferation (the tendency of stressors to engender additional stressors in other life domains) is explored in a sample of 68 parents of children identified with ASD. Regression analyses showed that parent depression was predicted by both child symptom severity and by stress proliferation and that stress proliferation partially mediated the effect of child symptom severity on parent depression. In addition, informal social support was found to reduce levels of parent stress proliferation and parent depression; however, contrary to the stress buffering hypothesis, the ameliorative effect of support on stress proliferation was shown to be greatest when reported child symptomatology was less (rather than more) severe. Study implications for future research and practice are discussed.     

The broad autism phenotype predicts child functioning in autism spectrum disorders

Background

Broad autism phenotype (BAP) is a milder expression of the social and communication impairments seen in autism spectrum disorders (ASD). While prior studies characterized the BAP in unaffected family members of probands with ASD, the relationship between parental BAP traits and proband symptomatology remains poorly understood. This study utilizes the Broad Autism Phenotype Questionnaire (BAPQ) in parents and the Social Responsiveness Scale (SRS) in children to examine this connection. We hypothesized that in families affected by ASD, elevated maternal and paternal BAPQ scores would correlate with greater autism symptomatology in diagnosed children. In an extension of prior research, we also explored this relationship in families with typically developing children (TDC).

Methods

Two hundred and forty-five children with ASD, 129 TDC and all parents were recruited as part of a larger study investigating relationships between genes, brain and behavior. The Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule (ADOS) and expert clinical judgment confirmed ASD diagnoses in children. SRS was collected for all children. Parents completed a self-report BAPQ and an informant report BAPQ for their spouse; an average of self-report and informant report for each parent was used in all analyses.

Results

Mothers and fathers of children with ASD had significantly higher rates of BAP traits as compared to parents of TDC. Maternal and paternal BAPQ total scores were not correlated with child IQ in either group. In the ASD group, 10% of mothers and 21% of fathers scored above the established BAP threshold compared to 4% of TDC parents. Crude regression analyses showed that maternal and paternal BAPQ total scores accounted for significant variance in child SRS scores in both ASD (17.1%) and TDC (19.8%) families.

Conclusions

Our results suggest that broad autism symptomatology in parents is moderately associated with their child’s autism symptomatology. This result extended to TDC families, suggesting that the BAPQ and SRS capture subtle, subclinical social variation in both children and adults. These findings could help define multi-generational social impairments in future phenotypic and genetic studies.     

Aligning over the child: Parenting alliance mediates the association of autism spectrum disorder atypicality with parenting stress

Children's symptoms of autism are robustly linked to diminished parent well-being and relationship distress, however they are less clearly linked to other aspects of family development. We focused on child atypical symptoms (i.e., behavioral stereotypies) and investigated relations to parental stress and the parenting alliance. We verified that relations between atypicality and parenting stress were partially mediated by a child-focused aspect of the parenting alliance. These results suggested that parents of highly atypical children reported less stress than parents of children with low levels of these behaviors, an effect that acted through an assessment of the parenting partner as highly involved with the child. However, parents with highly atypical children did not report a similarly better self-focused parenting alliance, indicating that direct emotional support from the partner did not differ between the groups. We discuss the possibility that, among parents who stay together in the face of severe child disability, enhanced perceptions of parenting are not uncommon.     

Influences on the psychosocial adjustment of siblings of children with autism spectrum disorder in Taiwan and the United Kingdom

BackgroundThe present paper examined the psychosocial adjustment of typically developing (TD) siblings of children with ASD and the extent to which this is impacted by key demographic and psychosocial variables. A cross-cultural perspective was adopted to compare influences on coping and adjustment in Taiwan and the United Kingdom (UK).Method155 mother-TD sibling dyads participated, 80 in Taiwan and 75 in the UK. Participants reported by questionnaire on family demographics, symptom severity of the child with ASD, TD siblings’ life events, subjective well-being, social support, coping strategies, parent and sibling Broader Autism Phenotype (BAP) level and adjustment outcome.ResultsAccording to their self-report, TD siblings’ in Taiwan were fairly well adjusted, while slightly elevated difficulties were found in the UK sample, with peer problems the biggest concern. Impact of life experience, sibling coping, and social support were related to adjustment in both countries, but with different coping styles important in the two countries. In the UK, parents’ coping style and siblings’ own BAP level also contributed to outcome. Some differences between Taiwan and the UK samples may result from culturally-specific patterns in evaluation of child behaviours.ConclusionsThe findings from this large-scale questionnaire study have implications for clinical practice. UK siblings’ adjustment might be enhanced via intervention on parent coping style, while Taiwanese siblings may be better supported through promotion of their own coping. Health professionals should be aware of the influence of BAP levels in parents and TD siblings, which might change the way they experience stress and respond under pressure.     

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.     

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 stress and coping styles in mothers and fathers of pre‐school children with autism and Down syndrome

Background The study examined the profile of stress in mothers and fathers of preschool children with autism, Down syndrome and typically developing children. A further aim was to assess the association between parenting stress and coping style. Methods A total of 162 parents were examined using Holroyd's 66‐item short form of Questionnaire of Resources and Stress for Families with Chronically Ill or Handicapped Members and the Coping Inventory for Stressful Situations by Endler and Parker. Results and Conclusions The results indicated a higher level of stress in parents of children with autism. Additionally, an interaction effect was revealed between child diagnostic group and parent's gender for two scales of parenting stress: dependency and management and limits of family opportunities. Mothers of children with autism scored higher than fathers in parental stress; no such differences were found in the group of parents of children with Down syndrome and typically developing children. It was also found that parents of children with autism differed from parents of typically developing children in social diversion coping. Emotion‐oriented coping was the predictor for parental stress in the samples of parents of children with autism and Down syndrome, and task‐oriented coping was the predictor of parental stress in the sample of parents of typically developing children. The results strongly supported earlier findings on parenting stress in parents of children with autism. They also shed interesting light on the relationship between coping styles and parental stress.     

The Factors Predicting Stress,Anxiety and Depression in the Parents of Children with Autism

The factors predicting stress, anxiety and depression in the parents of children with autism remain poorly understood. In this study, a cohort of 250 mothers and 229 fathers of one or more children with autism completed a questionnaire assessing reported parental mental health problems, locus of control, social support, perceived parent–child attachment, as well as autism symptom severity and perceived externalizing behaviours in the child with autism. Variables assessing parental cognitions and socioeconomic support were found to be more significant predictors of parental mental health problems than child-centric variables. A path model, describing the relationship between the dependent and independent variables, was found to be a good fit with the observed data for both mothers and fathers.     

Anger,Stress Proliferation,and Depressed Mood Among Parents of Children with ASD: A Longitudinal Replication

Stress proliferation (the tendency for stressors to create additional stressors) has been suggested as an important contributor to depression among caregivers. The present study utilized longitudinal data from 90 parents of children with ASD to replicate and extend a prior cross-sectional study on stress proliferation by Benson (J Autism Develop Disord 36:685–695, 2006). Consistent with Benson’s earlier findings, regression analyses indicated that stress proliferation mediated the effect of child symptom severity on parent depression. Parent anger was also found to mediate the effect of symptom severity on stress proliferation as well as the effect of stress proliferation on parent depression. Finally, informal social support was found to be related to decreased parent depressed mood over time. Implications of study findings are discussed.     

Autism and the broad autism phenotype: familial patterns and intergenerational transmission

Background

Features of the Broad Autism Phenotype (BAP) are disproportionately prevalent in parents of a child with autism, highlighting familial patterns indicative of heritability. It is unclear, however, whether the presence of BAP features in both parents confers an increased liability for autism. The current study explores whether the presence of BAP features in two biological parents occurs more frequently in parents of a child with autism relative to comparison parents, whether parental pairs of a child with autism more commonly consist of one or two parents with BAP features, and whether these features are associated with severity of autism behaviors in probands.

Method

Seven hundred eleven parents of a child with an autism spectrum disorder and 981 comparison parents completed the Broad Autism Phenotype Questionnaire. Parents of a child with autism also completed the Social Communication Questionnaire.

Results

Although parental pairs of a child with autism were more likely than comparison parental pairs to have both parents characterized by the presence of the BAP, they more commonly consisted of a single parent with BAP features. The presence of the BAP in parents was associated with the severity of autism behaviors in probands, with the lowest severity occurring for children of parental pairs in which neither parent exhibited a BAP feature. Severity did not differ between children of two affected parents and those of just one.

Conclusions

Collectively, these findings indicate that parental pairs of children with autism frequently consist of a single parent with BAP characteristics and suggest that future studies searching for implicated genes may benefit from a more narrow focus that identifies the transmitting parent. The evidence of intergenerational transmission reported here also provides further confirmation of the high heritability of autism that is unaccounted for by the contribution of de novo mutations currently emphasized in the field of autism genetics.     

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.     

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.     

Moderators of Stress in Parents of Children with Autism

Parents of children with autism experience more stress and are more susceptible to negative outcomes than parents of children with other disabilities. The present work examines the relationship between stressors, social support, locus of control, coping styles, and negative outcomes (depression, social isolation, and spousal relationship problems) among parents of children with autism. Fifty-eight parents completed surveys. Results indicated that several coping styles corresponded to negative outcomes. Furthermore, the relationship between stressors and negative outcomes was moderated by social support and coping style. Results are discussed in relation to applications for clinical practice.     

Predictors and Course of Daily Living Skills Development in Toddlers with Autism Spectrum Disorders

Self-sufficiency is central to child and family well-being. This report focuses on predictors of adaptive daily living skills (DLS) development in young children with ASD and whether DLS gains predict decreases in parenting stress. Participants were 162 toddlers with ASD and their parents, assessed at 3 annual timepoints. Hierarchical Linear Models showed that age, DQ, and autism symptom severity uniquely predicted initial DLS and DLS growth. Child problem behaviors predicted initial DLS only. DLS was associated with change in parenting stress above and beyond DQ, autism symptom severity, and problem behaviors. Children with lower IQ and more severe symptoms showed slower DLS gains. Given its relation to parenting stress, DLS are an important intervention target in young children with ASD.     

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.     

Parenting stress within mother-father dyads raising a young child with autism spectrum disorder

BackgroundThe present study assessed different facets of parenting stress in families with a child with ASD (perceptions of parenting-related roles, parent-child interactions, and the child’s behaviors) at three timepoints: right after receiving an ASD diagnosis, immediately following specialized intervention services, and one year after receiving services, upon primary school entry.MethodParticipants were 258 mother-father dyads and their child. Parents provided demographic information and completed measures on their parenting stress and their child’s autism symptom severity.ResultsPartial correlations revealed that, at the time of diagnosis, after controlling for children’s age and autism symptom severity, mothers’ and fathers’ stress was positively and significantly associated with each other, suggesting a bidirectional relation between partners’ psychological adjustment. Cross-lagged panel analyses demonstrated different longitudinal and transactional links, depending on the dimension of stress examined.ConclusionsFindings are discussed in terms of supports that could assist mothers and fathers of children with ASD.     

Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) benefit from parent involvement in their therapy, and there is evidence that this involvement may improve parent functioning as well. We examined changes in parent mental health, parenting, and expressed emotion, following participation in a randomized controlled trial of cognitive behavior therapy for 57 children with ASD. Post-intervention, improvements occurred in the treatment group in parent depression and emotion regulation, compared to waitlisted parents. Treatment effects also occurred across all parents in depression, emotion regulation, perceptions of their children and mindful parenting. Though preliminary, these results have implications for intervention development and evaluation by focusing on parent outcomes in child treatment.     

Parenting stress,salivary biomarkers,and ambulatory blood pressure in mothers of children with Autism Spectrum Disorders

Parenting a child with an Autism Spectrum Disorder (ASD) is often associated with high levels of stress. This in turn can undermine the success of early intervention, and lead to poorer health outcomes for parents. The present study investigated the effects of parenting a child with an ASD on self-reported parenting stress, salivary biomarkers, and 24-h ambulatory blood pressure. Seventy-four mothers of 2–14 year olds with an ASD diagnosis completed a questionnaire booklet, which contained measures of parenting stress, and parent and child characteristics. Mothers wore an ambulatory blood pressure monitor, which collected systolic and diastolic blood pressure and heart rate over a 24-h period. Saliva samples were collected for the purpose of measuring cortisol and alpha-amylase levels. High levels of parenting stress and anxiety, and moderately high levels of depression were reported. Mothers were found to have low cortisol levels, suggesting dysregulation of the HPA-axis and cortisol profile. Hierarchical multiple regression analyses revealed that quantity of unmet service needs, sleep problems, socialisation deficits, adaptive behaviour, and the coping strategies of self-blame and behavioural disengagement predicted maternal outcomes. Findings are discussed in relation to their implications for supporting parents of children with ASD.