A Systematic Review of Family Functioning in Families of Children on the Autism Spectrum

Relational Patterns of Support and Communication in Families with a Child Diagnosed with Autism: an Interpretive Phenomenological Study

BACKGROUND

The impact of autism spectrum disorder (ASD) can be far-reaching for families. Research has shown that neurotypical (NT) siblings can experience negative and positive implications of ASD in their lives. However, researchers have not fully captured the factors associated with successful adaptation to the range of experiences, particularly regarding NT siblings and the relational support from and communication with their parents.

METHODS

We utilized an interpretive phenomenological analysis to illuminate and better understand NT siblings' experiences of parental support and communication.

RESULTS

Analysis of qualitative semi-structured interviews with seven families of parents with at least one sibling over the age of 10 (N = 22) yielded four significant themes: (a) targeted NT sibling time, (b) targeted NT sibling communication, (c) sibling expectations, and (d) understanding autism.

CONCLUSION

The findings regarding relational support patterns suggest that NT siblings' experience with autism is positively influenced by parents who dedicate time to the NT siblings, communicate openly with them, and educate them about autism.

Correlates of Impairment and Growth in Families of Young Autistic Children

The purpose of this project was to investigate potential correlates of family life impairment in families of young autistic children. This project incorporated measures of specific child and parent challenges in addition to a commonly used unidimensional measure of autism characteristics. In this way, we could assess whether such challenges explain variance in family life impairment, and whether their inclusion diminish associations between autism characteristics and family life impairment. Cross-sectional data were collected from 564 parents of autistic children aged 2 to 5 years who participated in a larger online study. Participants completed measures on child characteristics (autism characteristics, emotion dysregulation, speaking ability, flexibility, and sleep problems), parent depression, and family life impairment, using the Family Life Impairment Scale (FLIS). Multiple linear regression models were generated to examine whether any of the independent variables were associated with the four domains of the FLIS. Models controlled for child age and sex, parent education, and single-parent homes. All independent variables were associated with impairment in one or more FLIS domains. None of the primary independent variables were significantly associated with positive growth. More overt characteristics and behaviors (e.g., autism characteristics, reactivity, speaking ability, and flexibility) were associated with impairment in domains that reflected a family's ability to navigate the community. However, sleep challenges and parent and child emotional difficulties were most strongly associated with parent impairment. Findings suggests that families may have different needs across contexts and provide new avenues through which they might be better supported.

Relationship between caregiver burden and family resilience among Chinese parents of children with autism spectrum disorder: The mediating role of social support and positive cognition

PURPOSE

This study was designed to assess the impact of caregiver burden on family resilience and explore the potential mediating role of social support and positive cognition in this association among Chinese families of children with autism spectrum disorder (ASD).

DESIGN AND METHODS

A total of 254 parents of children with ASD were recruited using convenience sampling from five ASD rehabilitation institutions in Wenzhou and Ningbo, Zhejiang Province from June to August 2021. The Zarit Burden Scale, Social Support Rate Scale, Illness Cognition Questionnaire-Parent Version, and Family Resilience Assessment Scale were employed to investigate the mediating mechanisms of social support and illness cognition between caregiver burden and family resilience. Structural equation models were conducted to evaluate the relationships among the variables.

RESULTS

This study revealed that caregiver burden negatively associated with family resilience, with social support partially mediating this relationship (accounting for 17.86 % of the total effect), and both factors being indirectly linked through social support and positive cognition (accounting for 3.76 % of the total effect).

CONCLUSIONS

The findings emphasize the need for interventions aimed at enhancing social support and positive cognition to alleviate the negative effects of caregiver burden on family resilience among parents of children with ASD.

Screening for Depression in Caregivers of Children with Developmental Disabilities: A Quality Improvement Initiative

INTRODUCTION

Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support.

METHOD

A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology.

RESULTS

Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers.

DISCUSSION

Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.

Disorder Type and Severity as Predictors of Mental Health in Siblings of Children with Chronic Disorders

Siblings of children with chronic disorders are at risk of developing mental health problems. Studies are inconclusive about whether sibling mental health is best predicted by the specific diagnoses of the child with disorder or by transdiagnostic factors. The aims of the present study were (1) to examine if specific diagnoses predicted sibling mental health, and (2) to examine if disorder severity in the child with the chronic disorder predicted sibling mental health. Baseline data from a randomized controlled trial were used. Siblings (aged 8 - 16 years) of children with chronic disorders and their parents were recruited from eight municipality and hospital clinics (N = 288). The children with chronic disorders were placed in ICD-10 diagnostic categories based on combined parent report and clinical records. Regression analyses with the most frequent primary diagnoses (ADHD, Asperger syndrome, autism, down syndrome, rare disorders) and a measure of disorder severity as predictors of sibling mental health were run. Father-reported disorder severity predicted sibling-reported internalizing problems and father-reported internalizing and externalizing problems in siblings. Mother-reported disorder severity predicted mother-reported sibling internalizing problems. No single primary diagnosis predicted sibling internalizing or externalizing problems. Disorder severity does to an extent predict sibling mental health, whereas single diagnostic categories do not. Disorder severity may be used to identify siblings at risk and/or in need of interventions. Fathers should be included in assessment and health care for siblings as their reports seem to predict sibling mental health better than the mothers.

Quality of life of primary caregivers of autistic children: Structural equation modeling

PURPOSE

Because autistic children may face difficulties living independently, considering their caregivers' quality of life (QoL) is crucial. However, few studies have examined the pathways through which the severity of autism spectrum disorder (ASD) affects caregivers. Based on the stress process model, this study examined a hypothesized model of how ASD severity affects caregivers' QoL, both directly and indirectly, through coping strategies, family functioning, and perceived social support.

DESIGN AND METHODS

This cross-sectional study included 392 caregivers of autistic children in Saudi Arabia. Structured interviews were conducted between April and July 2023. The data were collected from caregivers who visited the developmental and behavioral disorders clinic, daycare centers, and schools. Descriptive and correlational analyses were conducted to describe the study variables and their association with caregivers' QoL. Structural equation modeling was used to test the hypothesized model.

RESULTS

The results showed that the hypothesized model fit the data. Maladaptive coping strategies (β = -0.039, P < 0.05), family functioning (β = -0.110, P < 0.05), and perceived social support (β = -0.182, P < 0.05) partially mediated the association between ASD severity and caregivers' QoL.

CONCLUSION AND IMPLICATIONS

Our findings underscore the importance of tailoring interventions that focus on QoL for caregivers of autistic children, encouraging adaptive coping strategies, improving family functioning, and enhancing perceptions of social support.