Studies
indicate that the demands placed on parents caring for an autistic child contribute
to a higher overall incidence of parental stress, depression, and anxiety which
adversely affects family functioning and marital relationships compared with
parents of children with other disabilities. It is well
established that social support is protective of optimal parent well-being and,
therefore, a key element of intervention and treatment. Supporting and ensuring
the family system’s emotional and physical health is a critical component of best
practice.
School professionals working with families
of children with autism should be aware of the negative effects of stress and
anxiety and assist in offering services that directly address parental needs
and support mental health. Negative outcomes include: (a) increased risk of
marital problems; (b) decrease in father’s involvement; (c) greater parenting
and psychological distress; (d) higher levels of anxiety and depression; (f)
added pressure on the family system; (g) more physical and health related
issues; (h) decrease in adaptive coping skills; and (i) greater stress on
mothers than fathers. Parents often experience stress as they decide how to
allocate their attention and energy across family members. For example, they
may feel guilty about the limited time they spend with their spouse and other
children, when so much of their attention is focused on the child with autism.
Understanding
parent perspectives and targeting parental stress is critical in enhancing
well-being and the parent-child relationship. School professionals who have
knowledge and understanding of the stressors parents face are able to provide
more effective assistance and support to the family. When families receive a
diagnosis of autism, a period of anxiety, insecurity, and confusion often
follow. Some autism specialists have suggested that parents go through stages
of grief and mourning similar to the stages experienced with a loss of a loved
one (e.g., fear, denial, anger, bargaining/guilt, depression and acceptance). Sensitivity
to this process can help school professionals provide support to families
during the critical period following the child’s autism diagnosis when parents
are learning to navigate the complex system of autism services.
Mothers,
in particular, may experience high levels of psychological distress, depressive
symptoms, and social isolation. Research has found that nearly 40% of mothers
reported clinically significant levels of parenting stress and between 33% and
59% experienced significant depressive symptoms following their child’s
diagnosis of autism. Challenges in obtaining a timely ASD diagnosis and lack of
appropriate treatment services and education were contributors to parental
stress and dissatisfaction. Frequently reported important unmet needs include
(1) financial support; (2) break from responsibilities; (3) rest/sleep; and (4)
help remaining hopeful about the future.
Support, Educate, Advocate
School
professionals can support parents by educating them about autism; provide guidance
and training; assist them in obtaining access to resources; offer emotional
support by listening and talking through problems; and help advocate for their
child’s needs. It is especially important to acknowledge the value of parents’
unique and important perspective, validate their observations and concerns, and
reinforce their roles as important contributors to the educational process.
Professionals should also help the family understand what the identification or
diagnosis of autism means and what the next steps are in addressing the issues of
support and educational planning. This includes helping parents achieve a
better understanding of how their child thinks and learns differently and
become familiar with strategies that might help both at home and school. For
example, parents can be taught evidence-based strategies that successfully
support their children. Parent-implemented interventions have the
potential to improve the child’s communication skills and reduce aggression and
disruptive behaviors, as well as increase the functioning of the family system.
Parents can learn to implement story-based interventions, visual
supports/schedules, and Pivotal Response Treatment (PRT) strategies in their home and/or community through
individual or group training formats. Professionals can also assist families by
offering parent training in behavior management, which has been shown to
increase parents’ self-efficacy and decrease their child’s problematic
behaviors. Establishing a school-based parent support group may also be
consideration.
Another major
strategy for helping families with autistic children is providing information
on the access to ongoing supports and services. This includes publicly funded,
state-administrated programs such as early intervention, special education,
vocational and residential/living services, and respite services. Professionals
and family advocates need to be aware of the various programs and their
respective eligibility requirements and help parents to access these
services. Parents will also need timely and appropriate information regarding
their children’s programs and services and may have questions about long-term
educational planning. It is important to openly communicate the student’s
strengths and weaknesses and encourage parents to play an active role in
developing and implementing intervention plans and IEPs. Professionals should
also remember that parents have a life-long role in their child’s development
and realize that the family’s needs will change over time, and that they have
other family responsibilities in addition to their child with autism. When
schools use a family-centered approach and work to increase parental
involvement and support, not only do the parents and children benefit, but
school personnel do as well.
Adapted from Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London and
Philadelphia: Jessica Kingsley Publishers.
Key References & Further Reading
Barnhill, G. P. (2014). Collaboration between
families and schools. In L. A. Wilkinson (Ed.), Autism spectrum disorder in
children and adolescents: Evidence-based assessment and intervention in
schools (pp. 219-241). Washington, DC: American Psychological Association.
Estes, A., Munson, J., Dawson, G., Koehler, E.,
Zhou, X., & Abbott, R. (2009). Parenting stress and psychological
functioning among mothers of preschool children with autism and developmental
delay. Autism, 13, 375-387.
Feinberg, E., Augustyn, M., Fitzgerald, E.,
Sandler, J., Ferreira-Cesar Suarez, Z., Chen, N…Silverstein, M. (2014).
Improving maternal mental health after a child’s diagnosis of autism spectrum
disorder: Results from a randomized clinical trial. JAMA Pediatrics, 168(1),
40-46. doi:10.1001/jamapediatrics.2013.3445.
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.
Hardan, A. Y., Gengoux, G. W., Berquist, K. L.,
Libove, R. A., Ardel, C. M., Phillips, J…Minjarez, M. B. (2015), A randomized
controlled trial of Pivotal Response Treatment Group for parents of children
with autism. Journal of Child Psychology and Psychiatry, 56,
884-892. doi: 10.1111/jcpp.12354
Hoffman,
C. D., Sweeney, D. P., Hodge, D., Lopez-Wagner, M. C., & Looney, L. (2009)
Parenting stress and closeness: Mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24, 178-187.
Parenting stress and closeness: Mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24, 178-187.
Kiami, S. R., &
Goodgold, S. (2017). Support Needs and Coping Strategies as
Predictors of Stress Level among
Mothers of Children with Autism Spectrum Disorder. Autism Research and Treatment Volume 2017,
Article ID 8685950, https://doi.org/10.1155/2017/8685950
Myers,
S. M., & Johnson, C. P. (2007). Management of children with autism spectrum
disorders. Pediatrics, 120, 1162-1182. doi: 10.1542/peds.2007-2362
National Autism Center. (2015). Evidence-based
practice and autism in the schools: An educator’s guide to providing
appropriate interventions to students with autism spectrum disorder (2nd
ed.). Randolph, MA: Author
Rogers,
S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for
early autism. Journal of Clinical Child & Adolescent Psychology, 37,
8-38.
Wagner, S. (2014). Continuum of services and
individualized education plan process. In L. A.
Wilkinson (Ed.). Autism spectrum disorder in
children and adolescents: Evidence-based assessment and intervention in
schools (pp. 173-193). Washington, DC: American Psychological Association.
Wilkinson, L.A. (2017). A best practice guide to assessment and intervention for autism
spectrum disorder in schools (2nd Edition). London and
Philadelphia: Jessica Kingsley Publishers.
Weiss, J. A., Cappadocia, M. C., MacMullin, J. A.,
Viecili, M., & Lunsky, Y. (2012). The impact of child problem behaviors of
children with ASD on parent mental health: The mediating role of acceptance and
empowerment. Autism, 16, 261-274. doi: 10.1177/1362361311422708
Lee A. Wilkinson, PhD, is a licensed and nationally certified school 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 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).
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