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Couple Relationships among Parents of Children and Adolescents with Autism Spectrum Disorder: Findings from a Scoping Review of the Literature.

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To explore commonly-held assumptions regarding the risk of couple breakdown in families of children with Autism Spectrum Disorder (ASD), a scoping review of quantitative (n=39), qualitative (n=14), and mixed (n=5) studies was conducted. Findings included themes related to marriage and divorce rates, quality of couple relationships, relationship conflict and communication style, and other significant variables. Parents and service providers of individuals with ASDs will benefit from knowing that divorce risk may not be as high as generally believed in this clinical group, and that strategies such as developing common goals, increasing partner respect, securing social support, reducing stress, and instilling hope are all factors which support the development and maintenance of positive couple and co-parenting relationships.
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... Specifically, the issues of parental stress and guidelines and projects were investigated by the same number of studies, seven studies for stress (Ausderau & Juarez, 2013;Chu, Mohd Normal, McConnell, Tan, & Joginder Singh, 2018;Da Paz & Wallander, 2017;Hayes & Watson, 2013;Rao & Beidel, 2009;Saini, Stoddart, Gibson, Morris, Barrett, Muskat, & Zwaigenbaum, 2015;Zuckerman, Lindly, & Sinche, 2015) and seven studies for guidelines (Cain, Kaboski, & Gilger, 2019;Cridland, Jones, Caputi, & Magee, 2015;DePape, & Lindsay, 2015 In the rest of the review, the features relating to the nationality of the articles, the participants and the methodologies mainly used will be presented in more detail. ...
... In relation to this aspect in two exhibitions (Da Paz & Wallander, 2017;Saini, et al., 2015) the couple's relationship and the interventions carried out to improve the parents' well-being were examined. Specifically, it has been shown (Saini, et al., 2015) that parental stress can cause the interruption of the couple's relationship in families of children with autism spectrum disorder, on which, however, it is possible to intervene through teaching the partners operational strategy, such as developing common goals, increasing respect among partners, ensuring social support and reducing stress. ...
... In relation to this aspect in two exhibitions (Da Paz & Wallander, 2017;Saini, et al., 2015) the couple's relationship and the interventions carried out to improve the parents' well-being were examined. Specifically, it has been shown (Saini, et al., 2015) that parental stress can cause the interruption of the couple's relationship in families of children with autism spectrum disorder, on which, however, it is possible to intervene through teaching the partners operational strategy, such as developing common goals, increasing respect among partners, ensuring social support and reducing stress. All of these are important strategy to maintain couple relationship. ...
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Background: Having a child with Autism Spectrum Disorder can affect family wellbeing and caregiver's parenting skills. The present review aims to explore the main difficulties reported by parents of children with autism and the most used interventions to provide them support to date. Methods: 26 research articles published from 2006 to 2019 were selected and compared, specifically 10 quantitative and 16 qualitative studies, in which the following topics were discussed: parental stress in the presence of autism, presence of guidelines for intervention and relative difficulties to the achievement of the diagnosis. Results: The results of the review analysis indicate that parental stress is one of the difficulties in assuming a primary role. Parents caring for a child with Autism Spectrum Disorder have been shown to experience significantly higher levels of stress than parents of typically developing children. Conclusions: The presence of guidelines and the difficulties in achieving a diagnosis are closely related to the issue of parental stress, increasing or decreasing the perceived stress of parents.
... Using structural equation modeling (SEM), we tested a family process model of psychopathology (Morgan, 1988), hypothesizing that child autistic symptoms would be positively associated with parental depressive and anxiety symptoms, and that these associations would be mediated by future-related worry, parenting stress, marital conflicts, and family economic pressure. Given previous research showing that demographic and clinical factors, such as child and parental age and gender and the presence intellectual disability, may affect parental symptoms as well as the mediators of interest in our analytic model (Bitsika, Sharpley, & Mills, 2017;Buescher, Cidav, Knapp, & Mandell, 2014;Chan & Lam, 2017;Cidav et al., 2012;Hayes & Watson, 2013;Lavelle et al., 2014;Meadan, Halle, & Ebata, 2010;Ogston et al., 2011;Pisula and Porębowicz-Dörsmann, 2017;Saini et al., 2015;Zablotsky, Bradshaw, & Stuart, 2013), we controlled for these factors in the analyses. ...
... Child autistic symptoms were related to more marital conflicts among parents of children with ASD, likely because negative emotions and behaviors might spillover from their parenting experiences to their marital interactions (Hartley, Papp, & Bolt, 2016). This finding is consistent with previous studies reporting impaired relationship qualities among parents of children with ASD (Saini et al., 2015;Sim et al., 2016). It is also in accordance with earlier studies linking child behavior problems to increased marital conflicts and decreased marital satisfaction among parents of children with ASD (Benson & Kersh, 2011;Siman-Tov & Kaniel, 2011). ...
... Increased psychopathology in parents of children with ASD has been associated with poorer parental functioning (Zerach, Greene, Ein-Dor, & Solomon, 2012), greater conflict with children (Ruscio, Weathers, King, & King, 2002), greater severity of child behavioural problems (Baker, Seltzer, & Greenberg, 2011;Ekas & Whitman, 2010;Firat, Diler, Avci, & Seydaoglu, 2002;Machado Junior, Celestino, Serra, Caron, & Pondé, 2016) and the application of more severe discipline regimes (Cohen, Hien, & Batchelder, 2008). Although systematic reviews of the literature on parents of children with ASD have focused on parenting stress (Bonis, 2016;Cachia, Anderson, & Moore, 2016;Corcoran, Berry, & Hill, 2015;Hayes & Watson, 2013;Karst & Van Hecke, 2012), quality of life (Vasilopoulou & Nisbet, 2016) and social impacts ( Saini et al., 2015;Serrata, 2012), there is currently only one meta-analysis that has explored psychological disorders in parents of children with ASD (Yirmiya & Shaked, 2005). ...
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Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.
... These authors reviewed 59 studies-39 quantitative, 15 qualitative, and five mixed methods-and reported that in half the 59 studies included, understanding of couple relationships was not among the primary research questions and further, that none of the qualitative studies included a fulsome exploration of factors that contribute to divorce or separation in couple relationships. Saini et al. (2015) did find reports of relationship strain due to social isolation, limited opportunities for quality couple time, differences in views about how to manage the behaviour and treatment of children, conflicting coping styles, financial burden, concerns with sibling harmony, and lack of access to services, but summarized these factors as inconclusive for narrating how these strains contribute to divorce. ...
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Using media reports of high divorce rates among couples of children with ASD as a point of departure, our purpose in this paper is to examine how married fathers of children with ASD understand their marriages relative to the demands of ASD and in the context of media reports of elevated divorce rates among parents raising children with ASD. We begin with a review of select literature pertaining to the impact of ASD on marriages and we include a brief account of popular media portrayals of the influence of having a child with a developmental disability, and ASD in particular, on marriages. We then describe our qualitative examination of narrative interview data from 26 married fathers raising children with ASD aged 2-13 beginning with our theoretical anchoring in social comparison to focus our attention on how fathers compare themselves with media accounts of elevated divorce rates among parents of children and also with other hypothetical family configurations. Our findings are evidence of fathers' strong and strengthened commitments to marriages and we illustrate a re-purposing of inflated portrayals of divorce rates to shore up fathers' sense of their own effectiveness as husbands and fathers.
... Unfortunately, parents of chil- dren with ASD experience a plethora of stressors within and outside their family. These parents are faced daily with the physical, behavioral, and mental health chal- lenges associated with ASD, 31,32 complex sibling rela- tionships that sometimes involve more than one child with a developmental concern, 33,34 limited time for employment and subsequent increased financial bur- den, 35 marital strain, 36 and stigma and marginalization from the community. 37 There is substantial evidence that having a child with ASD is associated with negative mental health outcomes for parents, 38 including more parenting stress 39 and higher levels of depressive symptoms. ...
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Children with autism spectrum disorder (ASD) present with complex medical problems that are often exacerbated by a range of other intellectual and psychiatric comorbidities. These children receive care for their physical and mental health from a range of providers within numerous child-serving systems, including their primary care clinic, school, and the home and community. Given the longitudinal nature in which care is provided for this chronic disorder, it is particularly necessary for services and providers to coordinate their care to ensure optimal efficiency and effectiveness. There are 2 primary venues that serve as a “home” for coordination of service provision for children with ASD and their families—the “medical home” and the “educational home.” Unfortunately, these venues often function independently from the other. Furthermore, there are limited guidelines demonstrating methods through which pediatricians and other primary care providers (PCPs) can coordinate care with schools and school-based providers. The purpose of this article is 2-fold: (1) we highlight the provision of evidence-based care within the medical home and educational home and (2) we offer practice recommendations for PCPs in integrating these systems to optimally address the complex medical, intellectual, and psychiatric symptomology affected by autism.
... The promotion of resilience in families through an approach that is supportive, encouraging and facilitative of effective coping strategies, enables feelings of hope and can foster familial relationships, mental health and optimal quality of life (Ekas, Pruitt, & McKay, 2016;Hsiao, 2016;Kuhlthau et al., 2014;Saini et al., 2015). Facilitating communication by listening to family members' input and translating this for the healthcare team may be especially important for families of children with autism who face barriers to family-centered care in healthcare settings Owley, 2004;Vaz, 2010;Warfield et al., 2015;Zuckerman et al., 2014). ...
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Social workers with knowledge of autism can be valuable contributors to client- and family-centered healthcare services. This study utilized a qualitative design to explore pediatric hospital social workers’ experiences and perceptions when working with children and youth with autism and their families. Interviews with 14 social workers in a Canadian urban pediatric hospital highlighted perceptions of the needs of families of children with autism in the hospital and challenges and benefits related to the role of social work with these families. Results suggest that pediatric social workers may benefit from opportunities to develop autism-relevant knowledge and skills.
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A high-quality coparenting relationship among families of typically developing children has been shown to be beneficial for both parental and child outcomes. Nevertheless, these results cannot be generalized to parents of a child on the autism spectrum, as they are confronted with very different parenting demands. This systematic review aims to investigate the factors associated with coparenting a child on the autism spectrum. We systematically conducted this review according to the PRISMA statement. Twelve databases were searched and nine articles met the criteria for inclusion after screening. The findings suggested that certain factors such as parenting stress and satisfaction with the division of childcare-related labor are important aspects of coparenting a child on the autism spectrum. There was also some evidence to suggest that autism symptom severity may influence the coparenting relationship. However, the studies were limited by their number and heterogeneous methodologies. Further studies are needed to develop a greater understanding of risk and protective factors, as well as how the coparenting relationship affects the child on the autism spectrum throughout different stages of development. We provide recommendations to guide future research and discuss the implications for clinical practice towards the end of this systematic review.
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Caring for a child with Autism Spectrum Disorder (ASD) has been linked to a range of negative outcomes for parents but less is known about the putative impact upon the parental couple relationship. The relationship satisfaction of parents of children with ASD was investigated using multilevel modeling. Mothers and fathers (146 couples) reported on their relationship satisfaction, their own well-being, and the behavior problems of the child with ASD and a sibling. Results indicated that mothers and fathers reported similar levels of relationship satisfaction and it was significantly and negatively associated with parental depression and the behavior problems of the child with ASD. Relationship satisfaction was unrelated to the behavior problems of a sibling, the number of children in the household, and family socioeconomic position (SEP). Further longitudinal research that captures a broader range of variables is required to build a theoretical understanding of relationship satisfaction in families of children with ASD. Current evidence suggests that early intervention routes targeting either child behavior problems, parental mental health, or the couple relationship have the potential to benefit inter-connected subsystems within the broader family system. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Families with adults with autism spectrum disorders (ASDs) continue to play an instrumental part in the lives of their adult relative with autism throughout the lifespan. This chapter reviews the concerns and roles of families of adults with ASD, and the impact of the stress these responsibilities have on family members. Intervention and support services for families of adults with ASD offered through the TEACCH autism program are described as a framework for the development of future service delivery systems for this growing population. © Springer Science+Business Media New York 2014. All rights are reserved.
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