Parents are often
overwhelmed by the challenges presented by a child with an autism spectrum
disorder (ASD). Studies indicate that the demands placed on parents caring
for a child with autism contribute to a higher overall incidence of parental
stress, depression, and anxiety and adversely affects family functioning and
marital relationships compared with parents of children with other
intellectual, developmental, or physical conditions. Mothers of children with
ASD, in particular, appear to face unique challenges that potentially have an
impact on their health and wellbeing.
Parents of children with ASD are increasingly involved in the provision of early intervention and
learning activities to promote positive outcomes for their children. However,
several studies have documented that parental stress as well as a lack of time
and energy are barriers to providing early intervention activities. Because
autism impairs social relatedness and adaptive functioning, parent stress
can decrease helpful psychological processes and directly influence
the parent or caregiver’s ability to support the child with disabilities. Consequently,
understanding factors, such as lack of energy or fatigue that may limit the
capacity of the parent to assist in promoting their child’s development is
critical for this group.
Research
A study published in the
journal Autism examined
the extent to which parents experience fatigue and its relationship to other
aspects of wellbeing and parenting. Fifty mothers of children ages 2-5 years
with ASD participated in the study and completed questionnaires assessing level
of fatigue, parenting self-efficacy (belief about the ability to parent
successfully), children’s behavioral and emotional problems, sleep quality,
parent support needs, and overall physical activity. The study found that
compared with mothers of typically developing children, mothers of children
with ASD reported significantly higher fatigue, with overall scores in the
moderate range. Factors associated with high levels of fatigue were poor
maternal sleep quality, a high need for social support and poor quality of
physical activity. Fatigue was also significantly related to other aspects of
wellbeing, including stress, anxiety and depression, and lower parenting
efficacy and satisfaction.
These findings were somewhat
expected given the additional caregiving demands, parenting challenges and
pressures of managing family life when raising a child with an ASD. Likewise,
It is also probable that symptoms of depression, anxiety, stress and worry
(body tension, increased heart rate and rumination) can be mentally taxing and contribute
to, or exacerbate fatigue. The researchers also note that it was not surprising
that poor sleep quality was associated with higher levels of fatigue given the
large amount of research indicating that inadequate sleep and poor sleep
quality is associated with a range of physical health and wellbeing
difficulties. Parents of children with ASD are at particular risk of sleep
disruption and poor sleep quality owing to the high rate of sleep problems in
their children. Parents reported that their child waking was the primary reason
for sleep disruption. For other parents in the study, stress, anxiety and not
being able to wind down were stated reasons for sleep disruption.
Implications
What are the implications
of this study? The findings clearly indicate the need for interventions to
specifically target parental fatigue and its impact on families affected by ASD
both in the present and longer term. In addition to interventions targeting
child sleep problems, parents are likely to benefit from psycho-education about
fatigue and its potential effects on wellbeing, parenting and caregiving. This
includes information about strategies to minimize and/or cope with the effects
of sleep disruption, increase health and self-care behaviors, and strengthen
opportunities for social support. It is well established that social support is
protective of optimal parent wellbeing and, therefore, is an important
component of any intervention to address fatigue and wellbeing of parents of
children with an ASD. Parents with limited assistance to share the daily
demands of caregiving and family life are likely to be at greater risk of
fatigue than parents with more support. For parents with limited support, there
might also be fewer opportunities to engage in self-care behaviors that are likely
to alleviate or protect them from fatigue.
From a clinical
perspective, professionals working with families of children with an ASD should
be aware of negative effects of fatigue in addition to other wellbeing
difficulties, such as stress and anxiety. An assessment of the presence and
severity of the physical, cognitive and emotional symptoms of fatigue, as well
as the perceived impact on daily functioning, mood, relationships, parenting
and other aspects of caregiving is important. Lastly, future work in this area
should involve the development and evaluation of information resources and
intervention approaches to assist parents of children with an ASD to manage
fatigue and promote their overall wellbeing. The longer-term benefits for
parents in terms of strengthening their overall health, wellbeing and parenting
should also be a focus of research.
Giallo, R., Wood, C. E., Jellett,
R., & Porter, R. (2013). Fatigue, wellbeing and parental self-efficacy in
mothers of children with an Autism Spectrum Disorder. Autism, 17, 465-480.
DOI:
10.1177/1362361311416830
Lee
A. Wilkinson, PhD, NCSP is a licensed and nationally certified school
psychologist, chartered psychologist, and certified cognitive-behavioral
therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and
Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the
Autism Spectrum: A Self-Help Guide Using CBT. He is also
editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and
Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and
Intervention for Autism Spectrum Disorder in Schools (2nd Edition).
