Stress in mothers of children with autism: Trait mindfulness as a protective factor

Mindfulness-based interventions may reduce parents’ stress and improve parent–child relationships. Given the chronic nature of autism spectrum disorder (ASD) and its influence on parents’ stress, interventions to promote mindfulness may be especially helpful for parents of children with ASD. Prior to undertaking intervention development, it is first necessary to establish the relationship between mindfulness and stress, as other factors like child behavioral difficulties may overshadow the mother's regulation strategies. In a sample of mothers of children with ASD (n = 67) and a comparison sample of mothers without ASD (n = 87), mindfulness was significantly associated with the level of maternal stress above and beyond child behavior problems (non-ASD: β = −.232; F(1, 64) = 15.749, p < .000; ASD: β = −.206; F(1, 84) = 15.576, p < .000). Results suggest that interventions to promote mindfulness may be helpful in reducing parenting stress among mothers of children with ASD, as well as mothers of typically developing children. Due to the chronic nature of ASD, such interventions may be particularly applicable.     

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.     

Behavior problems among school-aged children with autism spectrum disorder: Associations with children's communication difficulties and parenting behaviors

Research has clearly demonstrated that behavior problems are common among children with ASD. These co-occurring behavior problems place children with ASD and their families at risk for a range of negative outcomes. This questionnaire study aimed to investigate whether and how age, gender, and communication difficulties at the child level and parenting behaviors at the family level are associated with externalizing and internalizing problems among children with ASD (n = 206) and without ASD (n = 187) aged 6–12 years. Results indicated that pragmatic language difficulties of the child and negative controlling parenting behaviors both made a significant and unique contribution to externalizing behavior problems for the ASD group. In the control group, chronological age and pragmatic language difficulties were the most robust concurrent predictors of externalizing problems. With regard to internalizing problems, pragmatic language difficulties and ASD adapted parenting behaviors were significant predictors for both the ASD and control group.     

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N = 124) as compared to adults with ID only (N = 562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.     

The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence

This paper reports on the effects of two types of parent-focused intervention, for parents of children with autism spectrum disorder (ASD) aged 2–4 years and within 6 months of diagnosis, on parent's perceptions of stress and competence. Interventions aimed to decrease parenting stress and increase parenting competence by embedding empirically supported parenting strategies within family routines. Families were assigned to a professionally supported intervention that included a workshop and 10 home-visits (n = 17) or to a self-directed video based intervention (n = 22). Development in social communication was greater for children of families receiving professional support as measured by a caregiver questionnaire but not on a clinically measured behavior sample. Improvements in adaptive behavior were greater for children in the professionally supported intervention when relatively low adaptive behavior scores had been demonstrated at pre-intervention. The professionally supported intervention resulted in reduced child-related parenting stress and increased parenting self-efficacy relative to the self-directed intervention. The findings support the importance of providing individualized information and professional support around the time of diagnosis for families who have a child with ASD.     

Association of schizophrenia spectrum and autism spectrum disorder (ASD) symptoms in children with ASD and clinic controls

ObjectiveThis study examines relations between the severity of specific symptoms of schizophrenia spectrum disorder (SSD) and severity of the three defining symptom domains of autism spectrum disorder (ASD) in children with ASD (N = 147) and child psychiatry outpatient referrals (Controls; N = 339).MethodParticipants were subdivided into four groups depending on ASD status (±) and whether they met symptom criteria for attention-deficit/hyperactivity disorder (±ADHD). Their mothers and teachers evaluated them with a DSM-IV-referenced rating scale.ResultsCorrelations between schizoid personality symptoms and ASD social skills deficits were moderate to large, and this was true for children with ASD and Controls, regardless of ADHD status, and for mother's and teachers’ ratings. Conversely, severity of hallucinations, delusions, and disorganized thinking were minimally correlated with ASD severity with the exception of Controls with ADHD. The disorganized behavior and negative symptoms of schizophrenia evidenced the strongest pattern of associations with ASD symptoms, and this was particularly true for children with co-morbid ADHD (±ASD, all three ASD symptom dimensions), and for teachers’ ratings of all four groups. Nevertheless, there was considerable variability in relations for specific symptoms across informants and groups. Correlations between SSD symptom severity and IQ were generally low, particularly among the ASD Only group and for all teacher-rated symptoms.ConclusionAssociations between ASD and SSD symptoms were often dimension-specific, and this was particularly evident in children without ADHD (±ASD; mothers’ ratings). Findings were interpreted as supporting the deconstruction of complex clinical phenotypes as a means of better understanding interrelations among psychiatric syndromes.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Prenatal pregnancy complications and psychiatric symptoms: Children with ASD versus clinic controls

The current study examined the association between prenatal pregnancy complications (PPC) and childhood psychiatric symptoms in children with an autism spectrum disorder (ASD) and non-ASD children who were referred to a psychiatric clinic (Controls). Parents completed a DSM-IV-referenced rating scale and developmental history questionnaire. Participants were classified as having ≥1 PPC (+PPC) versus none (?PPC). Children with ASD were significantly more likely to have PPC than Controls. Intra-group comparisons demonstrated that children in the ASD + PPC group had more severe anxiety than ASD/?PPC group. The Control + PPC group obtained higher symptom ratings of inattention, hyperactivity, and oppositional behavior than Control/?PPC. Children in the ASD + PPC group were rated as having more severe anxiety and depression symptoms than Control + PPC. Dissimilar associations in ASD and non-ASD samples were found, suggesting divergent pathogenic processes in different clinical phenotypes.     

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.     

An examination of Anglo and Latino parenting practices: Relation to behavior problems in children with or without developmental delay

The transactional model of development has received empirical support in research on at-risk children. However, little is known about the role of ethnicity or child delay status (i.e., developmental delay [DD] or typical cognitive development [TD]) in the process of parents adapting to their child's behavior problems and special needs. We examined whether Latina (N = 44) and Anglo (N = 147) mothers of 3-year-old children with or without DD differed in their use of two parenting practices, maternal scaffolding and sensitivity. We also examined how the status and ethnic groups differed in child behavior problems at ages 3 and 5 and whether parenting predicted change in behavior problems over time in the ethnic and status groups. Analyses generally supported previous research on status group differences in behavior problems (DD higher) and parenting practices (TD higher). Parenting practices predicted a decrease in externalizing problems from child age 3 to 5 years among Latino families only. Child developmental status was not associated with change in behavior problems. Cultural perspectives on the transactional model of development and implications for intervention are discussed.     

Theory of own mind and autobiographical memory in adults with ASD

While there is solid evidence of other-related theory of mind (ToM) deficits in autism, there is less research addressing self-related ToM impairments. To date, relations between self-related ToM and other cognitive skills related to representing own mental states such as autobiographical memory have scarcely been investigated. Thus, the purpose of this study was to investigate the differential relations of self-and other-related theory of mind skills and autobiographical memory in n = 20 adults with Autism Spectrum Disorder and n = 20 matched controls using standardized measures. The overall results indicated a specific relation between recalled episodic autobiographical memories on the episodic and semantic autobiographical memory interview and the performance on the mind-mindedness for oneself task in adults with ASD, which proved to be largely independent of verbal and nonverbal IQ.     

Death concerns and psychological well-being in mothers of children with autism spectrum disorder

PurposeUtilizing a terror management theory perspective, the present research examined whether having a child with autism spectrum disorder (ASD) is associated with underlying cognitions and explicit worries about death, and their roles in psychological well-being.Method147 mothers of children with ASD (n = 74) and typically developing children (n = 73) completed a fear of death scale, as well as measures of death-thought accessibility, positive and negative affect, depression, and anxiety.ResultsFollowing previous research, mothers of children with ASD reported worse psychological health. Additionally, they evidenced greater death-thought accessibility compared to mothers of typically developing children, but did not differ in explicit worries about mortality. Greater death-thought accessibility, in turn, mediated the influence of ASD diagnosis on negative affect, depression, and anxiety.ConclusionThe current study offers an initial understanding of the association between mortality concerns and psychological health for mothers of children with ASD. Further, it underscores the importance of health care providers’ efforts to attend to, and educate parents about, their thoughts of mortality, even if the parent does not acknowledge such concerns.What this paper addsThe present study examined the impact of both implicit and explicit worries about death in parents of children with Autism Spectrum Disorder (ASD). Specifically, we were able to demonstrate that increased death-thought accessibility among mothers of children with ASD was associated with worse psychological health. While it is possible for parents of children with ASD to report conscious worries about death, there were no observed differences on this measure. As far as we know, this work is the first to empirically examine the prevalence of mortality-related concerns in this population and the subsequent effects of death-thought accessibility on psychological health. This is an important avenue of research as parents of children with ASD may experience greater worries about leaving their children upon death with no one to care for them, or to leave their children in the care of individuals who may not understand their son or daughter's unique needs. Additionally, the current findings highlight the importance of addressing mortality-related concerns, even when they may not be explicitly recognized, among parents of children with ASD. Given the effectiveness of parent education programs for children with ASD, a primary avenue for intervention may be education. Training care providers in ways to better discuss thoughts of death may help to alleviate stress and foster greater psychological well-being.     

The relation among sleep,routines, and externalizing behavior in children with an autism spectrum disorder

The present study examined relations among sleep, routines, and externalizing behavior (based on parent report) in 115 children ages 6 to 12 years in two groups: 58 children with an autism spectrum disorder (age M = 9.0, SD = 2.09) and 57 non-ASD children (age M = 8.25, SD = 1.98). Within the ASD group, sleep hygiene and sleep quality were related to both routines and externalizing behaviors. In the combined sample, a significant interaction was found between diagnostic status and general routines in predicting externalizing behaviors. Specifically, lower levels of routines were related to higher levels of externalizing behaviors for both groups, whereas higher levels of routines were related to lower levels of externalizing behaviors for the non-ASD group. Further research among these constructs may focus on children with an ASD who experience less consistent routines or significant sleep disturbance.     

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.     

Prevalence,structure and correlates of anxiety-depression in boys with an autism spectrum disorder

BackgroundComorbidity of anxiety and depression predicts impaired treatment outcomes, poor quality of life and increased suicide risk. No study has reported on a combined measure of anxiety-depression in boys with an Autism Spectrum Disorder.AimsTo explore the prevalence, underlying factor structure and relationships between anxiety-depression, physiological stress and symptoms of Autism Spectrum Disorder (ASD).Methods150 boys (aged 6–18 years; IQ M = 94.9, range = 73–132) with an ASD plus their parents (135 mothers, 15 fathers) completed scales about the boys’ anxiety and depression, and the boys provided samples of their saliva in the morning and afternoon. Parents also completed the ASD Behaviour Checklist about the boys’ ASD symptoms.ResultsThe two sources of ratings were not significantly different for prevalence of anxiety-depression but the factor structures varied between the parents’ and boys’ responses, with a four-factor solution for the boys’ ratings and a three-factor solution for the parents’ ratings. There were also differences in the correlations between cortisol and anxiety-depression and between ASD symptoms and anxiety depression across the boys’ and parents’ data.ConclusionsAssessment of anxiety and depression comorbidity from parents and from children with an ASD themselves could provide a valuable adjunct datum when diagnosing ASD.     

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.     

The effect of telephone-based cognitive-behavioural therapy on parenting stress: A randomised controlled trial

ObjectiveStress related to parenting has detrimental effects on the well-being of children, parents and the family system as a whole. There are limited studies about the efficacy of cognitive-behavioural therapy delivered by telephone in reducing parenting stress. The present study investigates the effect of telephone-based cognitive-behavioural therapy on parenting stress at six weeks and six months postpartum.MethodsThis is a multi-site randomised controlled trial. A total of 397 Chinese mothers at risk of postnatal depression were randomly assigned to receive either telephone-based cognitive-behavioural therapy or routine postpartum care. Parental stress was assessed by the Parenting Stress Index Short Form at six weeks and six months postpartum.ResultsThe findings revealed that mothers who had received telephone-based cognitive-behavioural therapy showed significantly lower levels of parenting stress than women only receiving routine postpartum care at six weeks (mean difference = 9.42, 95% confidence interval 5.85–12.99, p < 0.001, Cohen's d = 0.52) and six months postpartum (mean difference = 3.58, 95% confidence interval 0.07–7.09, p = 0.046, Cohen's d = 0.20).ConclusionTelephone-based cognitive-behavioural therapy is a promising treatment modality for supporting parenting and reducing stress during the transition period. Integration of telephone-based cognitive-behavioural therapy into routine postpartum care might facilitate positive adaptation in particular for mothers at risk of postnatal depression.     

Adaptive behavior profiles in young children with autism spectrum disorder diagnosed under DSM-5 criteria

BackgroundThis study explored adaptive behavior profiles in a clinical sample of well-characterized children aged one to three years with ASD.MethodProfiles were compared to a sample of children with non-ASD developmental delays. Cluster analyses were performed to determine whether differences in adaptive skills effectively distinguished children with ASD from other young children presenting for assessment due to behavioral or other concerns, but who received other non-ASD diagnoses.ResultsA profile of motor > daily living > socialization > communication skills was found in both children with ASD and children with non-spectrum diagnoses, showing that this profile is not unique to young children with ASD. A two-group cluster solution was found which differentiated children by developmental functioning level rather than by diagnosis.DiscussionThe results of this study provide support for two developmental profiles for adaptive functioning in children with ASD: an average to borderline delayed profile and a borderline to more severely delayed profile that may remain stable or worsen over time. They additionally highlight the importance of delivering early targeted interventions to children with ASD who have greater deficits in adaptive functioning due to their association with poorer long-term outcomes.     

Women's posttraumatic stress symptoms and autism spectrum disorder in their children

Maternal posttraumatic stress disorder (PTSD) may be associated with autism spectrum disorder (ASD) in offspring through multiple pathways: maternal stress may affect the fetus; ASD in children may increase risk of PTSD in mothers; and the two disorders may share genetic risk. Understanding whether maternal PTSD is associated with child's ASD is important for clinicians treating children with ASD, as PTSD in parents is associated with poorer family functioning. We examined the association of maternal PTSD with offspring ASD in a large US cohort (N ASD cases = 413, N controls = 42,868). Mother's PTSD symptoms were strongly associated with child's ASD (RR 4–5 PTSD symptoms = 1.98, 95% CI = 1.39, 2.81; RR 6–7 symptoms = 2.89, 95% CI = 2.00, 4.18). Clinicians treating persons with ASD should be aware of elevated risk of PTSD in the mother. Genetic studies should investigate PTSD risk alleles in relation to ASD.