Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers.

Parenting is a rewarding experience but is not without its challenges. Parents of Autistic children face additional challenges, and as a result can experience lower levels of wellbeing and more mental health problems (i.e., depression, anxiety, stress). Previous studies have identified concurrent correlates of wellbeing and mental health. However, few have investigated predictors of subsequent wellbeing and mental health, or of change over time, among parents of pre-school aged autistic children. We examined child-, parent-, and family/sociodemographic factors associated with change in parents' mental health and wellbeing across three timepoints (spanning approximately one year) among 53 parents of Autistic pre-schoolers (M = 35.48, SD = 6.36 months. At each timepoint, parents reported lower wellbeing and greater mental health difficulties compared to normative data. There was no significant group-level change over time in parent outcomes. However, individual variability in short-term (~ 5 months) wellbeing and mental health change was predicted by a combination of child- and parent-related factors, while variability in medium-term (~ 10 months) change was predicted by parent factors alone. Parents' description of their child and their relationship predicted change in both wellbeing and mental health. Furthermore, participating in a parent-mediated intervention (available to a subgroup) was a significant predictor of change in wellbeing. Our findings highlight potentially modifiable factors (e.g., learning healthier coping strategies) that may positively impact both short- and medium-term change in parental outcomes.

Relative predictive utility of the original and Autism-Specific Five-Minute Speech Samples for child behaviour problems in autistic preschoolers: A preliminary study.

LAY ABSTRACT: Parental Expressed Emotion refers to the intensity and nature of emotion shown when a parent talks about their child, and has been linked to child behaviour outcomes. Parental Expressed Emotion has typically been measured using the Five-Minute Speech Sample; however, the Autism-Specific Five-Minute Speech Sample was developed to better capture Expressed Emotion for parents of children on the autism spectrum. In each case, parents are asked to talk for 5 min about their child and how they get along with their child. Parents' statements are then coded for features such as number of positive and critical comments, or statements reflecting strong emotional involvement. While both the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample have been used with parents of autistic school-aged children, their relative usefulness for measuring Expressed Emotion in parents of preschool-aged children - including their links to child behaviour problems in this group - is unclear. We collected speech samples from 51 parents of newly diagnosed autistic preschoolers to investigate similarities and differences in results from the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample coding schemes. This included exploring the extent to which the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample, separately, or together, predicted current and future child behaviour problems. While the two measures were related, we found only the Autism-Specific Five-Minute Speech Sample - but not the Five-Minute Speech Sample - was related to child behavioural challenges. This adds support to the suggestion that the Autism-Specific Five-Minute Speech Sample may be a more useful measure of parental Expressed Emotion in this group, and provides a first step towards understanding how autistic children might be better supported by targeting parental Expressed Emotion.

Examining the Links Between Received Network Support and Marital Quality Among Mothers of Children with ASD: A Longitudinal Mediation Analysis.

Employing a cohort sequential design and multilevel modeling, the direct and indirect effects (via depressed mood, emotional wellbeing, and perceived support) of received network support on marital quality were assessed over a 7-year period (child age 7-14) on 96 married or cohabiting mothers of children with ASD. Findings indicated several significant direct and indirect effects affecting change within mothers over time, with effects varying by whether the support source was a spouse or partner, family members, or friends. In addition, one moderated mediation effect was noted, with the indirect effect of received spousal support on marital quality via perceived spousal support retaining significance only at low and moderate levels of child problem behavior severity. Study strengths, limitations, and clinical implications are discussed.

The impact of child and family stressors on the self-rated health of mothers of children with autism spectrum disorder: Associations with depressed mood over a 12-year period.

Employing a cohort sequential design and multilevel modeling, the effects of child and family stressors and maternal depressed mood on the self-rated health of 110 mothers of children with autism spectrum disorder were assessed over a 12-year period when children in the study were 7-19 years old. Findings indicate a significant decline in self-rated health over time. In addition, child and family stressors, as well as maternal depressed mood, exerted significant between-persons effects on self-rated health such that mothers who reported more stressors and depressed mood across the study period were less likely to rate themselves in better health across that period. In addition, a significant within-person relationship between maternal depressed mood and self-rated health was found, indicating that at times when mothers reported higher levels of depressed mood than usual (their personal average across the study), they were significantly less likely to report better self-rated health. Finally, maternal depressed mood partially mediated the between-persons effects of child and family stressors on self-rated health such that increased stressors led to increased maternal depressed mood which, in turn, led to poorer maternal self-rated health. Findings suggest that chronic stressors erode maternal health over time and that depression may be an important mechanism linking stressors to decreased maternal health.

The Longitudinal Effects of Network Characteristics on the Mental Health of Mothers of Children with ASD: The Mediating Role of Parent Cognitions.

Employing a cohort sequential design, the effects of network characteristics on maternal cognitions (perceived social support and parenting self-efficacy) and mental health (depression and well-being) were assessed over 7 years when children with ASD of mothers in the study were age 7-14. Findings indicated that network size, network emotional support, and network instrumental support were positively related to perceived support, while network availability and emotional support were positively linked to self-efficacy. In addition, network support exerted direct and indirect effects on maternal depression and well-being, with cognitive resources mediating the social network-mental health relationship. Finally, consistent with the support-efficacy model, parenting efficacy partially mediated the effects of perceived support on maternal mental health outcomes. Study findings and implications are discussed.

Coping and psychological adjustment among mothers of children with ASD: an accelerated longitudinal study.

Utilizing a cohort sequential design and multilevel modeling on a sample of 113 mothers, the effects of four coping strategies (engagement, disengagement, distraction, and cognitive reframing) on multiple measures of maternal adjustment were assessed over a 7 years period when children with autism spectrum disorders in the study were approximately 7-14 years old. Findings indicated increased use of disengagement and distraction to be related to increased maternal maladjustment over time, while increased use of cognitive reframing was linked to improved maternal outcomes (findings regarding engagement's effects on adjustment measures were mixed). In addition, results indicated that use of different coping strategies at times moderated the effects of child behavior on maternal adjustment. Study findings are discussed in light of prior research and study limitations and clinical implications are highlighted.

Network characteristics, perceived social support, and psychological adjustment in mothers of children with autism spectrum disorder.

This study examined the characteristics of the support networks of 106 mothers of children with ASD and their relationship to perceived social support, depressed mood, and subjective well-being. Using structural equation modeling, two competing sets of hypotheses were assessed: (1) that network characteristics would impact psychological adjustment directly, and (2) that network effects on adjustment would be indirect, mediated by perceived social support. Results primarily lent support to the latter hypotheses, with measures of network structure (network size) and function (proportion of network members providing emotional support) predicting increased levels of perceived social support which, in turn, predicted decreased depressed mood and increased well-being. Results also indicated that increased interpersonal strain in the maternal network was directly and indirectly associated with increased maternal depression, while being indirectly linked to reduced well-being. Study limitations and implications are discussed.

Marital quality and psychological adjustment among mothers of children with ASD: cross-sectional and longitudinal relationships.

Using data drawn from a longitudinal study of families of children with ASD, the current study examined the impact of marital quality on three indicators of maternal psychological adjustment: depressed mood, parenting efficacy, and subjective well-being. Multiple regression analyses indicated marital quality to be a significant cross-sectional and longitudinal predictor of maternal adjustment. In the cross-sectional regressions, marital quality negatively predicted maternal depression and positively predicted parenting efficacy, and well-being, while in the longitudinal regressions, initial levels of marital quality negatively predicted maternal depressed mood and positively predicted well-being at follow-up. Longitudinal regression results also revealed that marital quality mediated the relationship between family SES and maternal well-being. Study limitations and implications are discussed.

Assessing expressed emotion in mothers of children with autism: the Autism-Specific Five Minute Speech Sample.

BACKGROUND: Expressed emotion (EE) is a measure of family emotional climate found to be predictive of symptom levels in a range of psychiatric, medical, and developmental disorders, including autism. METHOD: Employing data from 104 mothers of children with autism, this study examines the Autism-Specific Five Minute Speech Sample (AFMSS), a modified EE coding system based on the widely used Five Minute Speech Sample (Magana et al., 1986). FINDINGS: With the exception of one EE component, emotional over-involvement, the revised coding system demonstrated adequate internal consistency and good to excellent inter-rater and code-recode reliability. It also demonstrated acceptable validity, based on its significant correlations with factors linked to EE in previous research. Regression analyses also indicated AFMSS-EE to be a significant predictor of child social competence, but not child problem behaviors. DISCUSSION: While further testing is required, the AFMSS appears to be a useful method of assessing EE within the context of parenting children with autism and related disorders.

Anger, stress proliferation, and depressed mood among parents of children with ASD: a longitudinal replication.

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

The impact of child symptom severity on depressed mood among parents of children with ASD: the mediating role of stress proliferation.

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