Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.

High Depressive Symptoms, Low Family Functioning, and Low Self-Efficacy in Mothers of Children With Autism Spectrum Disorder Compared to Two Control Groups

BACKGROUND

Parents of children with autism spectrum disorder (ASD) face unique challenges in raising their children, and they are at higher risk for depression compared to parents of children with typical development (TD) and other disabilities.

AIMS

(1) To compare prevalence of depressive symptoms among mothers of children with ASD (n = 101), Down syndrome (DS, n = 101), and TD (n = 43) and (2) to describe the relationships among depression, self-efficacy, and family functioning, and describe the mediating role of maternal child care self-efficacy between depressive symptoms and child behavior.

METHODS

In this cross-sectional study, mothers completed the Social Communication Questionnaire, Aberrant Behavior Checklist, Patient Health Questionnaire-9 (PHQ-9), Family Assessment Device General Functioning Scale, and Maternal Self-Efficacy Scale.

RESULTS

Mothers of children with ASD had significantly higher mean PHQ-9 scores (p < .001), higher proportion of positive depression screening (p < .001), and lower family functioning (p < .001). Better family functioning is associated with less depression, better self-efficacy, and less severe ASD symptoms and behaviors. Self-efficacy mediated the relationship between depression and child ASD symptoms, and problematic behavior.

CONCLUSIONS

The rates of reported history of depression and low family functioning in mothers of children with ASD are twice the rate in mothers of children with DS and TD. Maternal child care self-efficacy is protective against maternal depression, even in the presence of severe child problematic behaviors and ASD symptoms. Interventions that increase child care self-efficacy and family functioning may be helpful in addressing depression in mothers of children with ASD.

Effects of service dogs on children with ASD's symptoms and parents' well-being: On the importance of considering those effects with a more systemic perspective

The integration of a service dog can have numerous benefits for children with Autism Spectrum Disorder (ASD). However, although integration takes place within a family, little is known about the dynamics of these benefits on the family microsystem. Thus, the aim of our study was to propose a more systemic perspective, not only by investigating the benefits of SD integration, but also by exploring the relationships between improvements in children with ASD, parents' well-being, parenting strategies and the quality of the child-dog relationship. Twenty parent-child with ASD dyads were followed before, as well as 3 and 6 months after service dog integration. At each stage, parents completed an online survey which included: the Autism Behavior Inventory (ABI-S), the State-Trait Anxiety Inventory (STAI-Y), the Parenting Stress Index Short Version (PSI-SF), the Monash Dog Owner Relationship Scale (MDORS) and the Parenting Styles and Dimensions Questionnaire (PSDQ). First, repeated measure one-way ANOVAs revealed that both children's ASD symptoms and parents' anxiety decreased significantly after service dog integration. Additionally, Spearman correlations revealed that the more ASD symptoms decreased, the more parent's anxiety and parenting stress also decreased. Second, the quality of the child-dog relationship appeared to contribute to those benefits on both children's ASD symptoms and parents' well-being. Interestingly, parenting strategies seemed to adapt according to these benefits and to the quality of the child-dog relationship. Through a more systemic perspective, this study highlighted that the integration of a service dog involved reciprocal and dynamic effects for children with ASD and their parents, and shed new light on the processes that may underlie the effects of a service dog for children with ASD.

Changes in mothers' and fathers' stress level, mental health and coping strategies during the 3 years following ASD diagnosis

BACKGROUND

ASD in a child affects parental mental health, with elevated levels of stress, anxiety and depression reported in parents.

METHOD

In this study, we examined mothers' and fathers' stress, anxiety and depression, as well as their coping strategies in a sample of 103 children and adolescents enrolled in the ELENA cohort study in France at diagnosis and three years after diagnosis.

RESULTS

Results showed that mothers had higher levels of stress and anxiety / depression than fathers and used more social support coping strategies at diagnosis, which might be explained by increased levels of parental involvement. Mothers' stress level significantly decreased during the three years following ASD diagnosis but no such decrease was observed in fathers' stress level. A significant decrease in anxiety and depression was observed for both parents, suggesting that parental distress is particularly elevated during the critical diagnosis period. Results finally yielded a significant decrease in emotion-focused coping strategy in mothers over the three-year period, an ineffective strategy that takes places at the time of diagnosis but then decreases during the period following ASD diagnosis, in relation to the acceptance process.

CONCLUSIONS

Implications in terms of addressing the unmet mental health needs of parents and their coping strategies are discussed.

Testing Models of Associations Between Depression and Parenting Self-efficacy in Mothers: A Meta-analytic Review

Numerous cross-sectional studies confirm the long-theorized association between mothers' depression and lower parenting self-efficacy (PSE) beliefs. However, cross-sectional studies leave unanswered the direction of this association: Does depression predict PSE? Does PSE predict depression? Are both true? Does the strength of the association between depression and PSE, regardless of the direction, generalize across participant characteristics and study design features? How stable is PSE over time? And how effective are interventions at enhancing PSE? To answer these questions, we conducted a meta-analytic review of longitudinal studies. With 35 eligible studies (22,698 participants), we found support for both models: there was a significant pooled effect of both depression on PSE and of PSE on depression, with nearly identical effect sizes (d =   - 0.21 and - 0.22, respectively). The association was stronger in samples with mothers' younger average age and studies that measured PSE among mothers relative to during pregnancy. We found a medium degree of stability in the index of PSE, d = 0.60. Finally, the estimated pooled effect size between being in an intervention group versus control group and PSE was 0.505. Overall, we found support for (1) bidirectional associations between depression and PSE in mothers, (2) the stability of PSE over time, and (3) the strength of the relationship between PSE and depression with intervention. These results suggest the importance of continuing to develop, test, and disseminate interventions to enhance PSE. We interpret these findings in the context of both depression and low PSE having serious consequences for child outcomes and maladaptive parenting.

Understanding Stability and Change in Perceived Social Support in Parents of Autistic Children and Adolescents

Parents of children with autism often have their own support needs. Informal social support can be an important component of managing parenting-related stressors. We know very little about the factors that lead to higher levels of perceived social support or the potential reciprocal relationship social support has with other factors in parents of children with autism. The current longitudinal study examined the reciprocal relations of perceived social support and parent stress and child behavior problems across a 1-year period, using three time points. There was remarkable stability in variables over time. Baseline perceived social support significantly predicted changes in child behavior and parent stress at the 6-month time point, but neither of those variables significantly predicted social support. This study adds to our understanding of social support and clarifies how perceived social support relates to other factors longitudinally.

The V-5 provides quick, accurate and cross-culturally valid measures of psychiatric symptoms

This study was designed to cross-validate the V-5, a quick psychiatric screener, across administration formats and levels of examinee acculturation. The V-5 was administered twice (once at the beginning and once at the end of the testing session) to three samples (N = 277) with varying levels of symptom severity and English language proficiency, varying type of administration, alongside traditional self-reported symptom inventories as criterion measures. The highest rest-retest reliability was observed on the Depression (.84) and Pain scales (.85). The V-5 was sensitive to the variability in symptom severity. Classification accuracy was driven by the base rate of the target construct, and was invariant across administration format (in-person or online) or level of English proficiency. The V-5 demonstrated promise as a cross-culturally robust screening instrument that is sensitive to change over time, lends itself to online administration, and is suitable for examinees with limited English proficiency.

High Depression Symptoms and Burnout Levels Among Parents of Children with Autism Spectrum Disorders: A Multi-Center, Cross-Sectional, Case-Control Study

The diagnosis of autism spectrum disorder (ASD) in a child affects family processes, increases parenting stress and marital conflicts, and may lead to parental psychopathology. It may also affect the prognosis for their children. The aim of this study is to determine depression and burnout levels as well as their predictors among parents of children with ASD compared with those of healthy children. We also sought to evaluate rate of complementary and alternative medicine (CAM) interventions among parents and explore the associations of this phenomenon in an exploratory fashion. 145 children with ASD and 127 control children were enrolled along with their mothers and fathers. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate parents' depression symptoms and burnout levels. Symptoms of children with ASDs were evaluated according to the Childhood Autism Rating Scale by the clinicians. Family, child and CAM variables were screened by means of a sociodemographic data form. Descriptive, bivariate and correlation analyses were used in statistical evaluations. Predictors of burnout were evaluated with multiple regression analysis. Burnout and depression levels among parents of children with ASD were significantly elevated compared to controls. Burnout levels of mothers were significantly elevated compared to fathers while depression scores of fathers were significantly elevated compared to mothers. Maternal burnout was significantly predicted by presence of functional speech in child while paternal burnout was significantly predicted by paternal vocation. Maternal depression was associated with paternal depression, lack of speech in child and attendance of child to special education services. Paternal depression was associated with autistic symptom severity and maternal depression. More than half the parents sought CAM interventions. Education level did not affect search for CAM interventions while both maternal and paternal psychopathology and presence of epilepsy among children increased use of CAM methods. Psychological support should be provided to both mothers and fathers of a child receiving a diagnosis of ASD. Addressing parents' burnout and stress levels and facilitating their negotiation of knowledge on etiology and treatments for ASD may be beneficial for the family unit as a whole.

The Mediating Role of Social Support in the Relationship Between Parenting Stress and Resilience Among Chinese Parents of Children with Disability

Few studies have examined the relationships among parents' resilience, parenting stress, and social support. This study surveyed 486 parents of children with disability in China to understand the role of social support between parenting stress and parents' resilience. The results indicated that the resilience of Chinese parents of children with disabilities was at a high level. Additionally, parenting stress, social support and resilience were significantly associated, and the mediating effect of social support between parenting stress and parents' resilience were proved by mediation analyses. The findings suggested that reducing parental stress and improving social support may predict (or be associated with) improved parent resilience. The authors discussed the implications for the improvement the resilience of Chinese parents of children with disabilities.

Examining Effectiveness and Predictors of Treatment Response of Pivotal Response Treatment in Autism: An Umbrella Review and a Meta-Analysis

The current study aimed to provide a comprehensive appraisal of the current evidence on the effectiveness of Pivotal Response Training (PRT) for individuals with autism spectrum disorder (ASD) and to explore predictors of treatment response. We conducted a systematic review of the following electronic databases and registers: PsycINFO, Medline, Embase, Cochrane Central Register of Controlled Trials, ERIC, Linguistics and Language Behavior Abstracts. Six systematic reviews were identified, two with meta-analytic component. Identified reviews varied widely in terms of their aims, outcomes, and designs which precluded a unified and consistent set of conclusions and recommendations. Ten RCTs were identified. Eight of identified RCTs reported at least one language and communication-related outcome. Statistically significant effects of PRT were identified across a majority of identified RCTs for a range of language and communication skills. However, evidence for positive treatment effects of PRT on outcome measures assessing other domains was less robust and/or specific. Overall, both previous systematic reviews and new meta-analysis of the RCTs suggest that PRT shows promise for improving language and communication. Only four RCTs examined the association between baseline child characteristics and treatment outcomes, however, no consistent pattern emerged. This review has identified several key methodological and design improvements that are needed to enable our field to fully capitalize on the potential of RCT designs and characterize detailed profiles of treatment responders. These findings are essential for informing the development of evidence-based guidelines for clinicians on what works for whom and why.

Predicting the Outcomes of Parents of Transition-Age Youth or Young Adults with ASD

The transition outcomes for individuals with autism spectrum disorder (ASD) and their families are less than desirable. A survey of parent stressors, resources, coping/appraisals, and adaptation to transition was completed by 226 parents. The mediating mechanisms between stressors and parent outcomes were identified. At the indicator level, three stressors (i.e., autism severity, mental health crisis/challenging behaviors, and filial obligation), four resources (i.e., general social support, transition planning quality, parent-teacher alliance, and parenting efficacy), and three coping styles (i.e., problem-focused coping, avoidance-focused coping, and optimism) predicted parents' outcomes (i.e., burden, transition experience, subjective health, and quality of life). At the structural level, optimism, emotion-coping strategies, and resources mediated the relationships between stressors and parental outcomes. Research and practical applications are discussed.

Predicting Mental Health and Psychological Wellbeing in Mothers of Children with Autism Spectrum Disorder: Roles of Intolerance of Uncertainty and Coping

Research has consistently shown that parents of children with autism spectrum disorder (ASD) are more likely to report chronic stress and symptoms of psychopathology when compared to parents of typically developing children and children with other psychological or physical conditions. Certain individual characteristics might either put parents at risk or allow them to cope more effectively under the strenuous conditions of raising children with neurodevelopmental conditions. Previous research has suggested that higher levels of intolerance of uncertainty and certain coping styles are associated with higher parental levels of anxiety and depression. The aim of this study is to characterize the way in which intolerance of uncertainty and coping (avoidant and problem-focused coping) predict mental health and psychological wellbeing in parents of children with ASD. Only mothers participated in this study. Fifty mothers (M_age = 44.28 years, SD_age = 6.58) of children with ASD completed questionnaires assessing anxiety and depression, psychological wellbeing, intolerance of uncertainty, and avoidant and problem-focused coping. The results from this study provide preliminary evidence that higher use of problem-focused coping but not avoidant coping and intolerance of uncertainty predicts psychological wellbeing. Furthermore, our observation of greater intolerance of uncertainty and higher use of avoidant coping predicting anxiety and depression supports previous research. The findings from this study have implications for the development of intervention programs to help improve the mental health and psychological wellbeing of parents. LAY SUMMARY: This research studied the factors that impact the mental health of parents of children on the autism spectrum. We found that mothers, who are not comfortable with uncertainty, use more avoidant coping, and less problem-focused coping have poorer mental health. Identifying these factors is a crucial first step in developing intervention programs to help improve the mental health of parents. Autism Res 2020, 13: 1797-1801. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

The Role of Negative Affectivity in Concurrent Relations Between Caregiver Psychological Distress and Social-Emotional Difficulties in Infants With Early Signs of Autism

Recent evidence suggests the link between caregiver psychological distress and offspring social-emotional difficulties may be accounted for by offspring temperament characteristics. However, existing studies have only focused on neurotypical children; thus, the current study sought to provide an initial examination of this process among children with varying levels of early autism features. Participants included 103 infants aged 9-16 months (M = 12.39, SD = 1.97; 68% male) and their primary caregiver (96% mothers) referred to a larger study by community healthcare professionals. We utilized caregiver-reported measures of psychological distress (Depression Anxiety Stress Scales), infant temperament (Infant Behavior Questionnaire-Revised) and internalizing and externalizing symptoms (Infant-Toddler Social and Emotional Assessment) and administered the Autism Observation Schedule for Infants (AOSI) at an assessment visit to quantify autism features. Infant negative affectivity was found to mediate positive concurrent relations between caregiver psychological distress and infant internalizing and externalizing symptoms, irrespective of the infants' AOSI score. While preliminary and cross-sectional, these results replicate and extend previous findings suggesting that the pathway from caregiver psychological distress to negative affectivity to social-emotional difficulties might also be apparent among infants with varying levels of autism features. More rigorous tests of causal effects await future longitudinal investigation. LAY SUMMARY: Offspring of caregivers experiencing psychological distress (i.e., symptoms of depression, anxiety, and/or stress) may themselves be at increased risk of poor mental health outcomes. Several previous studies conducted with neurotypical children suggest that this link from caregiver-to-child may be facilitated by children's temperament qualities. This study was a preliminary cross-sectional exploration of these relationships in infants with features of autism. We found that infants' elevated negative emotions were involved in the relation between caregiver heightened psychological distress and children's mental health difficulties, consistent with neurotypical development. Autism Res 2020, 13: 1349-1357. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder

AIMS

Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies.

METHODS

A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input.

RESULTS

Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies.

CONCLUSIONS

Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.

Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT

BACKGROUND AND OBJECTIVES

Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up.

METHODS

Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time.

RESULTS

Both groups improved during active treatment in all subdomains of parent stress (β = -1.42, -1.25, -0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = -0.62 and -0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = -1.91 and -1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems.

CONCLUSIONS

Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.

Identifying long-term psychological distress from single measures: evidence from a nationally representative longitudinal survey of the Australian population

BACKGROUND

Single time-point assessments of psychological distress are often used to indicate chronic mental health problems, but the validity of this approach is unclear. The aims of this study were to investigate how a single assessment of distress relates to longer-term assessment and quantify misclassification from using single measures to indicate chronic distress.

METHODS

Data came from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative study of Australian adults. Psychological distress, measured with the Kessler10 and categorised into low (scores:10- < 12), mild (12- < 16), moderate (16- < 22) and high (22-50), has been assessed in the Survey biennially since wave 7. Among respondents who were aged ≥25 years and participated in all waves in which distress was measured, we describe agreement in distress categories, and using a mixed linear model adjusting for age and sex we estimate change in scores, over a two-, four-, six- and eight-year follow-up period. We applied weights, benchmarked to the Australian population, to all analyses.

RESULTS

Two-years following initial assessment, proportions within identical categories of distress were 66.0% for low, 54.5% for mild, 44.0% for moderate and 50.3% for high, while 94.1% of those with low distress initially had low/mild distress and 81.4% with high distress initially had moderate/high distress. These patterns did not change materially as follow-up time increased. Over the full eight-year period, 77.3% of individuals with high distress initially reported high distress on ≥1 follow-up occasion. Age-and sex- adjusted change in K10 scores over a two-year period was 1.1, 0.5, - 0.7 and - 4.9 for low, mild, moderate and high distress, respectively, and also did not change materially as follow-up time increased.

CONCLUSION

In the absence of repeated measures, single assessments are useful proxies for chronic distress. Our estimates could be used in bias analyses to quantify the magnitude of the bias resulting from use of single assessments to indicate chronic distress.

Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh

This cross-sectional study examined the burden of depression and quality of life (QoL) among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. All consenting mothers were 18 years of age and older and met criteria for major depressive disorder (MDD) on the Structured Interview for DSM-V-TR Research Version-non patient edition administered by trained raters. QoL was assessed by the EuroQol five-dimensional standardized questionnaire. MDD was diagnosed in 45% of mothers and was proportionally higher among those who did not work outside the home, had no childcare support at home, expressed low level of satisfaction with the quality of providers when they had sought care for their children with ASD, and reported being recipient of negative attitudes from neighbors toward their children with ASD. QoL was negatively associated with MDD, mothers' illness, and low satisfaction with the health care providers for children with ASD, as well as experiencing a negative attitude by neighbors toward their children. QoL was positively associated with the reported family monthly income and improvement of the children with ASD on school attendance. The prevalence of MDD among mothers of children with ASD was high and associated with poor QoL. Integrating mental health services and supports for mothers in the ASD care of children is likely to address the high burden of depression they face, and improve their overall quality of life. Autism Res 2020, 13: 284-297. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The levels of depression were assessed among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. Almost one in two mothers was found to have major depression. The quality of life of these mothers was generally poor. Integrating mental health services for mothers with ASD care in children is likely to address the burden of depression among the mothers of children with ASD and improve overall quality of life.

Preliminary Efficacy of Family Implemented TEACCH for Toddlers: Effects on Parents and Their Toddlers with Autism Spectrum Disorder

This study examined the effects of an intervention to support parents and promote skill development in newly diagnosed toddlers with ASD. Participants included 50 children with ASD under 3 and their parents who were randomly assigned to participate in a 6-month intervention, Family Implemented TEACCH for Toddlers (FITT) or 6 months of community services as usual. FITT included 90-min in-home sessions (n = 20) and parent group sessions (n = 4). Results revealed significant treatment effects on parent stress and well-being, with families in the FITT group showing decreased stress and improved well-being over time. While no treatment effects were found for global child measures, there were significant treatment effects on social communication skills.

Risk factors underlying depressive symptoms among parents/primary care providers of kids with autism spectrum disorder: A study from Muscat, Oman

AIM

To explore the prevalence and correlates of depressive symptoms among parents/primary care providers of children with autism spectrum disorder (ASD).

DESIGN AND METHODS

A cross-sectional analytical study was conducted among a systematic random sample of parents/caregivers of children with diagnosis of ASD in Muscat, Oman. Depressive symptoms were quantified using the Patient Health Questionnaire-9.

FINDINGS

The response rate was at 86% (n = 80) and the prevalence of depressive symptoms, at 71.3% (95% confidence interval, 60.5-80.1). Logistic regression analyses indicated that unemployment and being the sole parent/caregiver in the family were both significant correlates of depressive symptoms.

PRACTICE IMPLICATIONS

With an increase in the number of children being diagnosed with ASD, multidimensional preventive and remedial service programs for parents/caregivers will be essential.

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M-ASD, n = 15) and mothers of typically developing children (n = 15). M-ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M-ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M-ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.

Mental Health and Coping in Parents of Children with Autism Spectrum Disorder (ASD) in Singapore: An Examination of Gender Role in Caring

Research has supported the notion that gender plays a significant role in coping and mental health outcome among parents of children with ASD. The current study aims to examine gender role in the relationship between mental health outcome and coping in parents of children with ASD in Singapore. This study involved 97 fathers and 106 mothers of children with ASD completing self-report questionnaires. MANOVA revealed mothers experienced significantly higher stress levels than fathers. Stress was a significant predictor of depression for fathers but not for mothers. Regression analyses found use of active avoidance coping moderated the relationship between stress and depression in both parents. Implications of these findings on intervention are discussed.

Coping strategies of parents of children with autism spectrum disorder: a systematic review

To deal with stress, parents of children with ASD use coping strategies that help to tackle the challenging situations of raising their child. This systematic review examines parental coping strategy's questionnaires, factors which influence these coping strategies, interactions between these strategies and perceived stress and their impact on parental quality of life. According to PRISMA guidelines, an electronic search was conducted on Medline, PsycInfo and Eric: 156 articles were identified and 11 studies were selected. Many types of self-reported questionnaires were used to assess parental coping strategies. Studies highlighted that parents of a child with ASD used more avoidance strategies and less social support-seeking strategies than those of typical children. Furthermore, problem-focused coping protects parental stress and quality of life, that on the contrary, emotion-focused coping is a risk factor for alteration. Our systematic review illustrates the need to adapt psychoeducational interventions for parents of children with ASD.

A Model of Family and Child Functioning in Siblings of Youth with Autism Spectrum Disorder

The potential clinical needs of typically developing (TD) siblings of youth with autism spectrum disorder (ASD) remain disputed. A total of 239 mothers of youth aged 6-17, including one youth with ASD (M = 11.14 years; simplex families) and at least one other youth (M = 11.74 years) completed online standardized measures of various familial factors and TD youth outcomes. Overall, only 6-23% of siblings were identified within the clinical range of emotional, behavioral, or social functioning. Both maternal depression and sibling relationship were identified as key pathways in predicting siblings' functioning within a good-fitting path analysis model. The current model is presented as a novel base for the development of future research and services for this unique population of children.

Brief Report: Mapping Systems of Support and Psychological Well-Being of Mothers of Adolescents with Autism Spectrum Disorders

Parents of children with autism spectrum disorders are generally known to experience elevated levels of stress and poorer psychological well-being. To provide treatments and resources that most effectively support parent mental health, it is critical to understand how parents' connections with various networks and systems impact their well-being. This study examined the relationship between the psychological well-being of mothers of adolescents with ASD (n = 20) and their systems of support from an ecological systems theoretical framework. Findings indicated that most connections across mothers' ecosystems were strong in nature. However, the presence of strong connections was not significantly related to psychological well-being. In contrast, stressful/weak connections were significantly related to elevated levels of depressive symptoms, perceived stress, and sense of burden.

Longitudinal effects of caregiving on parental well-being: the example of Rett syndrome, a severe neurological disorder

Little longitudinal research has examined parental well-being in those with a child with specific genetic developmental disorder although the associated severe neurological impairments and multiple physical comorbidities likely place substantial burden of caregiving on the parent. We aimed to examine longitudinally the well-being of parents of individuals included in the Australian Rett Syndrome Database over the period from 2002 to 2011 using the Short Form 12 Health Survey. Residential remoteness, the child being a teenager at baseline, having frequent sleep disturbances or behavioural problems, and the type of MECP2 gene mutation were each associated with later poorer parental physical well-being scores. Being a single parent or on a low income was also associated with later poorer physical well-being, while the child having enteral feeding was associated with later poorer emotional well-being. Both the physical and emotional well-being of the parent improved if the child was living in out-of-home care. Our findings suggest that some opportunities do exist for clinicians to help optimise parental well-being. Being alert to the possibility and need for management of a child's sleep or emotional disturbance is important as is awareness of the additional likely parental burden as the child moves through adolescence into early adulthood and their need for additional support at that time. However, the findings also highlight the complex nature of parental well-being over time in parents of children with a severe neurological disorder and how they may be affected by a range of inter-related family and child factors.

Parents’ perceptions of raising children with autism spectrum disorders in the United States and Arab countries: A comparative review

Four databases were searched to identify studies published by Arab researchers on parents’ perceptions of autism spectrum disorder and studies conducted by US researchers and published in systematic reviews of this topic. The electronic search resulted in 14 studies published by Arab researchers and 55 studies published by US researchers. The results showed that autism spectrum disorder has many of the same effects on Arab and American families. Six major areas were identified in the results. Financial difficulties associated with raising children with autism spectrum disorder were mentioned more in Arab studies than in US studies. Arab studies had more emphasis on gender than US studies. The results related to quality of life of parents of children with autism spectrum disorder in Arab studies were equivocal. US studies included comparisons with families without a child with autism spectrum disorder, and addressed factors that were associated with quality of life indicators. More health, educational, and social services were available in United States than in Arab countries, but some frustration was reported by US parents in obtaining appropriate services in some studies. A higher percentage of Arab studies mentioned the role of religious faith than US studies. Finally, social stigma was evidenced in both cultures, but not much research was available.

An Examination of the Relations Between Symptom Distributions in Children Diagnosed with Autism and Caregiver Burden, Anxiety and Depression Levels

High stress levels and impairment of physical/mental health in parents can delay early and effective intervention in autism. The purpose of this study was to examine relations between the clinical characteristics of children diagnosed with autism spectrum disorder (ASD) and caregiver burden, and anxiety and depression levels. Seventy cases under monitoring at the Namık Kemal University Medical Faculty Child and Adolescent Psychiatric Polyclinic with a diagnosis of ASD, and their principal caregivers, were included in the study. The Autism Behavior Checklist (ABC), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and the Zarit Caregiver Burden Scale were completed. At multiple regression analysis, autism symptom severity and caregiver depressive symptom levels emerged as significant predictors of total caregiver burden scores. Only the ABC language subscale score had a determining effect on caregiver burden (r = 0.51, r² = 0.26, p = 0.04). ABC body and object use subscale scores were identified as the symptom cluster affecting depression and anxiety scores (r = 0.25, r² = 0.06, p = 0.03 and r = 0.28, r² = 0.08, p = 0.01). Our findings show that ASD symptom severity and depressive symptoms in the caregiver are the most important factors giving rise to the caregiver burden, and that the main ASD symptom cluster affecting the caregiver burden was problems associated with language development. Better understanding of variables impacting on the caregiver burden will increase the quality of psychosocial services for caregivers.

"I'm not in this alone" the perspective of parents mediating a physical activity intervention for their children with autism spectrum disorder

BACKGROUND AND AIMS

Web-based, parent-mediated interventions have shown to be beneficial for children with autism spectrum disorder (ASD) in a variety of domains. We aimed to examine how parents of children with ASD perceive mediating a physical activity intervention delivered via a private Facebook group.

METHODS

Thirteen families participated in a four-week trial of Project CHASE. Inductive thematic analysis of semi-structured interviews and interactions within the Facebook group were conducted to elicit the perspective of the parents.

OUTCOMES AND RESULTS

Thematic analysis resulted in three themes emerging: (1) 'Remembering to Act' encompassed the participants' perspectives of Project CHASE as being an intervention that reminded them of the importance of physical activity, and served as a prompt for them to take action; (2) 'A sharing community' included the subthemes of 'sharing success and struggles' and 'sharing ideas'; and, (3) 'Taking control: possibilities and problems' encapsulates the dichotomy between participants who spoke of embracing and rising to the challenge of taking control, with the parents who spoke of the need for more support, direction, and guidance.

CONCLUSION AND IMPLICATION

The current study suggests parent-mediated, web-based interventions may have the potential for improving the effectiveness of physical activity interventions for children with ASD.

Perceptions of Stress and Enrichment in Caregivers of Children with Autism Spectrum Disorder: Implications for Community Support

Compared to negative experiences associated with parenting a child with Autism Spectrum Disorder (ASD), research has paid much less attention to positive aspects of experiences. This study examined both experiences of stress and enrichment in parenting a child with ASD to provide insights for practical community support services. Eighty-seven caregivers responded to the Effects of the Situation Questionnaire, a modified version of the Childhood Autism Rating Scale (2nd Ed.), and the Parental Sense of Competence Scale. Stress and enrichment were examined in their relations to child symptom severity, number of child-focused services, and parenting self-efficacy. Parenting self-efficacy and perceived level of stress, but not child symptom severity or number of child-focused services, were correlated with parental experiences of enrichment. The link between parenting self-efficacy and enrichment was mitigated by reported levels of stress. The findings revealed the paradoxical existence of enrichment experiences despite challenges in parenting a child with ASD. Notably, a higher number of community supports was associated with higher levels of stress, suggesting quality of support may be more important than involvement in numerous services. Moreover, enrichment occurs disregarding child’s symptoms and entails properly managing stress and a sense of parenting efficacy.

Parental Burden and its Correlates in Families of Children with Autism Spectrum Disorder: A Multicentre Study with Two Comparison Groups

BACKGROUND

The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions.

OBJECTIVE

This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child's characteristics, and parents' coping resources and strategies.

METHODS

The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child's clinical characteristics and parents' caregiving burden, psychological distress, coping resources and strategies were assessed.

RESULTS

The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies.

CONCLUSION

This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.

Parenting stress and depressive symptoms in Taiwanese mothers of young children with autism spectrum disorder: Association with children's behavioural problems

BACKGROUND

This study examined the severity of parenting stress and depressive symptoms in Taiwanese mothers of young children with autism spectrum disorder (ASD) compared to mothers of young children with developmental delay (DD). The associations between parenting stress, depressive symptoms, and children's behavioural problems were also tested.

METHODS

The study sample included 51 young children with ASD (mean age = 31 months), 51 young children with DD (mean age = 30 months) and their mothers.

RESULTS

The results confirmed that mothers of young children with ASD experienced higher levels of parenting stress and depressive symptoms than mothers of young children with DD. In addition, children's behavioural problems were robust predictors of parenting stress and depressive symptoms in mothers of young children with ASD, but not in mothers of young children with DD.

CONCLUSION

The findings indicated that one of the critical goals in early intervention for young children with ASD and their families is to reduce children's behavioural problems.

Mental health care needs and preferences for mothers of children with a disability

BACKGROUND

Mothers of children with a disability are at increased risk of poor mental health compared with mothers of typically developing children. The aim of the study was to describe the mental health care needs and preferences for support of mothers of children and young people aged 0-25 years with a disability.

METHODS

A cross-sectional study was used, using an online survey with 294 mothers of children with a disability. Questions were asked about mental health, perceived need for support, barriers to accessing mental health care, and preferences for support. Descriptive and chi-squared analyses were performed.

RESULTS

High rates of mental ill health were self-identified in the previous 12 months, with reported clinically significant depression (44%), anxiety (42%), and suicidality (22%). Nearly half (48%) of the mothers reported high to very high psychological distress. Although 75% of mothers perceived a need for professional support, only 58% attempted to access this. Key barriers to accessing support were caregiving duties making it difficult to schedule appointments (45%) and not perceiving the mental health problem as serious enough to require help (36%). Individual counselling was the preferred type of support (66%) followed by professionally guided relaxation (49%) and education about mental health (47%). Support was considered most critical at the time of diagnosis and during medical intervention for their child.

CONCLUSIONS

Although mental health problems were common and mothers perceived the need for professional help, several key barriers were preventing mothers from accessing help. Our study suggests that improving mothers' knowledge of when and where to seek help (mental health literacy) may encourage their access to support. There also needs to be more accessible treatment to mothers given the high care demands that are placed upon them.

Enhancing interactions during daily routines: A randomized controlled trial of a web-based tutorial for parents of young children with ASD

Children with Autism Spectrum Disorder (ASD) often experience difficulty participating in everyday home routines, such as bed time or bath time. This randomized controlled trial examined the efficacy of an interactive, web-based parenting tutorial for improving children's engagement in daily routines (i.e., proximal outcomes) as well improving children's social communication and parenting efficacy and stress (i.e., broad outcomes). Parents of children with ASD between 18 and 60 months were randomly assigned to the Tutorial group (n = 52) or the Control group (n = 52). All parents completed questionnaires at baseline (T1), 1 month after T1 (T2; post-tutorial completion), and 2 months after T1 (T3). Relative to the Control group, parents in the Tutorial group reported significantly higher use of evidence-based instructional strategies and higher levels of child engagement during routines at T2 and T3. In addition, parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3, as well as higher ratings of child social communication at T2 and T3, compared to the Control group. Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial. These improvements in both proximal and broad parent-child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent-child interactions. Autism Res 2018, 11: 667-678. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

This web-based tutorial helped parents of children with ASD use proven strategies to improve their child's participation in daily routines at home. Parents who used the tutorial reported less parenting stress, felt better about their parenting skills, and reported better child social interactions compared to parents who did not use the tutorial. This tutorial may be especially helpful for families who have limited access to services, as it can be completed at home.

Predicting Internalizing and Externalizing Symptoms in Children with ASD: Evaluation of a Contextual Model of Parental Factors

Parental adjustment, parenting behaviors, and child routines have been linked to internalizing and externalizing child behavior. The purpose of the present study was to evaluate a comprehensive model examining relations among these variables in children with ASD and their parents. Based on Sameroff's Transactional Model of Development (Sameroff in: The transactional model of development: How children and contexts shape each other, American Psychological Association, Washington, DC, 2009), researchers hypothesized that these factors would collectively predict child behavior. Parents (n = 67) completed measures of parental adjustment, parenting behaviors, child routines, and child behavior using the Hopkins Symptom Checklist, Alabama Parenting Questionnaire, Child Routines Inventory, and Child Behavior Checklist, respectively. Results indicated that parental adjustment predicted harsh/disengaged parenting (B = 0.17, p < .01) and internalizing behavior (B = 0.32, p < .01). Harsh/disengaged parenting and warm/supportive parenting predicted externalizing behavior (B = 0.59, p < .01) and internalizing behavior (B = - 0.49 p < .01), respectively.

The Effectiveness of a Psychoeducation Intervention delivered via WhatsApp for mothers of children with Autism Spectrum Disorder (ASD) in the Kingdom of Saudi Arabia: A randomized controlled trial

BACKGROUND

Mothers of children with autism spectrum disorder (ASD) report high levels of stress and lower levels of well-being than parents of typically developing children. Current interventions for ASD typically focus on working with the child rather than delivering strategies to help support parents.

OBJECTIVE

To evaluate the effectiveness of a psychoeducation intervention developed to support mothers of children with ASD in Saudi Arabia.

METHOD

Sixty-two mothers (23-52 years) of children (26-78 months) were recruited to a multisite randomized controlled trials of the intervention. The intervention consisted of one face-to-face session (60 min) and four virtual sessions (30 min each) delivered using WhatsApp. Parenting stress was the primary outcome, with secondary outcomes focusing on maternal depression, anxiety, and happiness, and child behaviour problems and ASD symptoms. Data were collected at baseline T1, immediately postintervention T2 and 8-week follow-up T3.

RESULTS

One-way analysis of covariance was used at T2 and T3 with T1 scores entered as a covariate. Improvements were found at T2 for stress (F = 234.34, p = .00, and d = -1.52) and depression (F = 195.70, p = .00, and d = -2.14) but not anxiety, and these results were maintained at T3. Changes in child behaviour problems were limited to improvements in hyperactivity at T2 (F = 133.66, p = .00, and d = -1.54). Although changes in stress and depression were statistically significant, change to clinically normal levels was limited to depression. None of the participants had recovered after the intervention (Parent Stress Index Short Form stress scores), whereas 23 mothers (71.87%) in the intervention group had recovered at T2 and 22 (68.75%) at T3 (Hospital Anxiety and Depression Scale depression scores).

CONCLUSION

This intervention with WhatsApp support is beneficial but may need to be augmented with other forms of support for mothers of children with ASD including more condensed sessions on stress and interventions targeting anxiety.

Depression in Parents of Children Diagnosed with Autism Spectrum Disorder: A Claims-Based Analysis

Previous studies showing that Autism Spectrum Disorder (ASD) in children can have secondary effects on the child's parents are limited by small sample sizes and parent self-report. We examined the odds of depression in parents of children with ASD compared to parents of children without ASD using a large national claims database. Mothers (OR 2.95, 95% CI 2.81-3.09) and fathers (OR 2.41, 95% CI 2.25-2.58) of children with ASD were more likely to have a diagnosis of depression than parents of children without ASD. Odds of depression also increased when there was more than one child with ASD in the family and with child age. Study results reinforce the benefits of support and education for parents of children with ASD.

Longitudinal Correlates of Maternal Depression Among Mothers of Children With or Without Intellectual Disability

This study identified trajectories of depressive symptoms among mothers of children with or without intellectual disability longitudinally across eight time points. Results of fitting a linear growth model to the data from child ages 3-9 indicated that child behavior problems, negative financial impact, and low dispositional optimism all significantly related to initial maternal depressive symptoms. Child behavior problems were significantly associated with changes in depressive symptoms over time, relating above and beyond child disability status. When looking from late childhood into early adolescence, hierarchical linear regression analysis revealed that maternal depressive symptoms at child age 9 and perceived financial impact significantly related to maternal depressive symptoms at child age 13. Implications for practice and future research directions are discussed.

Impacts of caring for a child with the CDKL5 disorder on parental wellbeing and family quality of life

Background

Although research in this area remains sparse, raising a child with some genetic disorders has been shown to adversely impact maternal health and family quality of life. The aim of this study was to investigate such impacts in families with a child with the CDKL5 disorder, a newly recognised genetic disorder causing severe neurodevelopmental impairments and refractory epilepsy.

Methods

Data were sourced from the International CDKL5 Disorder Database to which 192 families with a child with a pathogenic CDKL5 mutation had provided data by January 2016. The Short Form 12 Health Survey Version 2, yielding a Physical Component Summary and a Mental Component Summary score, was used to measure primary caregiver’s wellbeing. The Beach Center Family Quality of Life Scale was used to measure family quality of life. Linear regression analyses were used to investigate relationships between child and family factors and the various subscale scores.

Results

The median (range) age of the primary caregivers was 37.0 (24.6–63.7) years and of the children was 5.2 (0.2–34.1) years. The mean (SD) physical and mental component scores were 53.7 (8.6) and 41.9 (11.6), respectively. In mothers aged 25–54 years the mean mental but not the physical component score was lower than population norms. After covariate adjustment, caregivers with a tube-fed child had lower mean physical but higher mean mental component scores than those whose child fed orally (coefficient = −4.80 and 6.79; p = 0.009 and 0.012, respectively). Child sleep disturbances and financial hardship were negatively associated with the mental component score. The mean (SD) Beach Center Family Quality of Life score was 4.06 (0.66) and those who had used respite services had lower scores than those who had not across the subscales.

Conclusions

Emotional wellbeing was considerably impaired in this caregiver population, and was particularly associated with increased severity of child sleep problems and family financial difficulties. Family quality of life was generally rated lowest in those using respite care extensively, suggesting that these families may be more burdened by daily caregiving.

Executive Functioning Mediates the Effect of Behavioral Problems on Depression in Mothers of Children With Developmental Disabilities

The present investigation explored long-term relationships of behavioral symptoms of adolescents and adults with developmental disabilities with the mental health of their mothers. Fragile X premutation carrier mothers of an adolescent or adult child with fragile X syndrome (n = 95), and mothers of a grown child with autism (n = 213) were included. Behavioral symptoms at Time 1 were hypothesized to predict maternal depressive symptoms at Time 3 via maternal executive dysfunction at Time 2. Results provided support for the mediating pathway of executive dysfunction. Additionally, the association of behavioral symptoms with executive dysfunction differed across the two groups, suggesting that premutation carriers may be more susceptible to caregiving stress due to their genotype.

How Are Child Restricted and Repetitive Behaviors Associated with Caregiver Stress Over Time? A Parallel Process Multilevel Growth Model

The impact of raising a child with autism spectrum disorder (ASD) is frequently accompanied by elevated caregiver stress. Examining the variables that predict these elevated rates will help us understand how caregiver stress is impacted by and impacts child behaviors. This study explored how restricted and repetitive behaviors (RRBs) contributed concurrently and longitudinally to caregiver stress in a large sample of preschoolers with ASD using parallel process multilevel growth models. Results indicated that initial rates of and change in RRBs predicted fluctuations in caregiver stress over time. When caregivers reported increased child RRBs, this was mirrored by increases in caregiver stress. Our data support the importance of targeted treatments for RRBs as change in this domain may lead to improvements in caregiver wellbeing.

Risks and Protective Factors for Stress Self-Management in Parents of Children With Autism Spectrum Disorder: An Integrated Review of the Literature

PROBLEM

Stress in parents of children with autism spectrum disorder (ASD) has been reported to be very high. However, little is known about what risk and protective factors influence parental stress self-management in this population. Accordingly, this manuscript is a synthesis of the risk and protective factors that impact self-management of stress in these parents. The concepts in the individual and family self-management theory context domain were used as a framework to guide data collection and analysis.

ELIGIBILITY CRITERIA

Searches were conducted using CINAHL, MedLine and PsychInfo. Studies were included if they addressed context factors in parents of children with ASD and were written in English.

SAMPLE

Ninety-eight studies met review criteria.

RESULTS

This review highlighted risk factors to parental stress self-management within the context of condition-specific factors, physical and social environment, and individual and family. The most concerning of these findings is that parents struggle accessing a diagnosis and services for their child and are frustrated with health care providers' knowledge of ASD and lack of communication.

CONCLUSIONS

The risks parents experience as they care for their child with ASD far outweigh the protective factors for self-management of parental stress.

IMPLICATIONS

Nurses who are aware of these issues can make important changes to their practice and have a significant impact on parental stress self-management and the care of children with ASD.

Respite Care for Single Mothers of Children with Autism Spectrum Disorders

Single mothers of children with autism spectrum disorders are rarely studied, yet they may experience unique stressors. Researchers asked 122 single mothers to complete questionnaires concerning respite care, daily hassles/uplifts, depression, and caregiver burden. More than half (59.8%) accessed respite care, which was provided for 1 h per day, often by multiple sources (41%), such as grandparents and community agencies; most were satisfied with this care. Most mothers (77%) were at risk for clinical depression. While uplifts were negatively correlated with depression, hassles and caregiver burden were positively correlated with depression. Respite care was positively related to daily uplifts, and uplifts mediated the relationship between respite care and depression. Recommendations for researchers, policymakers, and school personnel are offered.

Sibling sleep-What can it tell us about parental sleep reports in the context of autism?

Sleep problems are common in families raising children with Autism Spectrum Disorder (ASD). Clinicians often depend on parent reports of child sleep but minimal research exists to address the accuracy or biases in these reports. To isolate parent-report accuracy (from differences in sleep behaviors), the sleep of younger siblings were assessed within a two-group design. The present study compared parent diary reports of infant sibling sleep to videosomnography and actigraphy. In the high-risk group, families had at least one child with ASD and a younger sibling (n = 33). The low-risk comparison group had no family history of ASD (n = 42). We confirmed comparable sleep behaviors between the groups and used paired t tests, two-one-sided-tests (TOST), and Bland-Altman plots to assess parent report accuracy. The parameters of sleep onset, nighttime sleep duration, awakenings, morning rise time, and daytime sleep duration were evaluated. Diary and videosomnography estimates were comparable for nighttime sleep duration, morning rise time, and awakenings for both groups. Diary and actigraph estimates were less comparable for both groups. Daytime sleep duration estimates had the largest discrepancy with both groups reporting (on average) 40 additional minutes of sleep when compared to actigraphy estimates. In the present study, families raising children with ASD were just as accurate as other families when reporting infant sleep behaviors. Our findings have direct clinical implications and support the use of parent nighttime sleep reports.

Understanding fragile X syndrome from a mother's perspective: Challenges and resilience

The purpose of this study is to communicate findings from a case study on a South African mother with three children diagnosed with full mutation fragile X syndrome (FXS). The participant is an unaffected carrier of FXS. Research has shown that mothers of children with FXS often experience high levels of parenting stress and low levels of psychological well-being. However, observations made have piqued curiosity about their positivity and determination to carry on each day raising children diagnosed with FXS. The aim is to develop a better understanding of the manner in which a mother of children with FXS make sense of her situation, to gain further insight into the specific resilience processes she acquired. A qualitative case study approach was followed, gathering data through semi-structured interviews based on open-ended questions. The findings offer new insights into a South African mother's life raising children with FXS. Even though there is very limited support and little awareness of FXS in South Africa, she still found ways to seek help, and find solutions to every day challenges. The study conclusions discourage blind stereotyping of mothers of children with FXS as vulnerable only. Future research should concentrate on promoting awareness, education, advocacy, and support for individuals with FXS in South Africa.

Stress and Parents of Children with Autism: A Review of Literature

The purpose of this review is twofold. The first is to synthesize factors that impact parents' experiences of caring for a child with autism spectrum disorder (ASD); the second is to identify factors that impact parental stress and parental decision-making to use autism services or not. Parents of children with ASD score higher on levels of stress than other groups of parents. The daily challenges of caring for the child are endless and effect all aspects of the child's care as well as the parent's mental health and ability to manage the needs of the child and family. Understanding more about the challenges parents face will provide direction for research, intervention development, and practice. Accordingly, a search was conducted using CINAHL and Medline. Inclusion criteria included articles available in full text, published in English, and focused on children with ASD distinct from other diagnoses, as well as parental experiences of caring for a child with ASD. Articles (N = 132) that met the inclusion criteria were summarized. Challenging aspects of the child's diagnosis and care are discussed, as well as the factors that impact parental stress and decision-making to use autism services. Recommendations for research and practice include interventional development related to early diagnosis, disparity, access to care, parental decision-making to use autism services, and parental stress management.