Understanding Autism Spectrum Disorder (ASD): Challenges & Contributing Factors - Research Paper

Introduction

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopment condition, it affects boys more than girls. (ASD) is a neurological disorder affecting 1 in 150 children according to (Croen et al., 2002; Fombonne, 1999). Some challenges associated with (ASD) include social communication impairments and behavioral challenges. Furthermore, (ASD) has been linked to contributing factors such as destructive, repetitive and aggressive behavior to parents and those attending the needs of children with (ASD). Existing evidence confirms parents raising a child with (ASD) are predisposed for developing anxiety and depression when compared to parents of other developmental disabilities (Whitehead, Dorstyn & Ward, 2015; Garcia-Lopez, Sarria & Pozo, 2016; Padden & James, 2017). However, short literature has been found on parents' training on coping with frustration, sense of helplessness, stress, anxiety & depression. The motivating factors of this hypothesis seeks to find alternative approaches for parents through methodological training to reduce the risks on their psychological well-being.

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Although several studies have been dedicated to investigating the adverse indicators of parental outcomes among parents of children with (ASD), Whitehead, Dorstyn and Ward (2015) attribute parents' stress to the maladjusted, involuntary and temperamental behaviors that affects children with (ASD). Moreover, the authors suggested daily caregiving responsibilities such as a doctor's visits, interventions, and therapy appointments can increase their predisposition to depression (Whitehead et al., 2015). A study by Padden and James (2017) reported poor mental health outcomes for parents with a child with ASD. The study compared psychological and physiological measures of health between parents of children with ASD and those without (n=76). Furthermore, the researchers collected saliva and blood pressure to monitor the physiological condition of the patients. Finding show that parents who had kids with ASD reported poorer outcomes, including elevated levels of depression, anxiety, and distress, as compared to children who were developing normally.

Mount and Dillon (2014), in their study of 9 parents with ASD children, reported that parents often face a number of difficulties. All the nine participants in the study reported facing problems related to communication, inflexibility, lack of spontaneity, delayed outburst, social perception issues, impulsive behaviors, as well as, food related behaviors. The study also reported that such constant pressures and stress takes toll on the lives of parents. Direct relationship between distress and poor mental health outcomes is supported by the findings of a study by Kayfitz, Gragg and Orr (2010) involving 23 mother and father dyads raising children with autism. According to the finding parents who did not experience high stressful situations when raising a child with autism reported higher level of positive experiences as compared to those who experienced distress or problems.

A study by Sawyer et al., (2010) on the demands of caring for ASD children found that time pressure associated with caring for children with ASD was linked to maternal health problems. The study involved 216 mothers of children with ASD. Sawyer et al., (2010) found higher level of mental health problems in the sample of the mothers with children with autism as compared to normal population. The authors also reported that the mothers spent a lot of time with their children, often spending more than six hours a day with their kids. After controlling for other variables such age of child, behavioral problems of the child and maternal social support, the researchers found that there was a positive and significant relationship between time pressure and poor maternal mental health.

On the other hand, Montaque et al., (2018) reported the findings of a qualitative study involving women who have experienced the meltdown of their children with autism in the past. Using semi-structured interviews the scholars collected data from nine parents. The women reported that during meltdowns they would fell highly anxious. However, parenting knowledge allowed them to cope with the problem and correct it. Summarily, these studies provide evidence that parents of children of with autism often face a lot of challenges which can lead to poor mental health outcomes, including parental anxiety, depression, and stress.

Coping Mechanisms

There are multiple studies that have examined how parents with children with autism cope with everyday stresses. Coping responses determine the mental health outcomes of care giver. A national wide survey by Whitehead, Dorstyn and Ward (2015) involving 438 female caregivers reported that those care givers who employed action-oriented strategies reported better outcomes as compared to those who used avoidant strategies. Avoidant strategies such as emotional venting, denial, self-blame and disengagement resulted depressed mood and stress symptomatology, while positive reframing, planning and acceptance was associated with better coping and good mental health.

Kuhaneck et al., (2015) noted that there are those parents who successful cope with ASD effectively and develop resilience. Success in coping and building resilience seems to be affected by multiple factors, including income, nature of event, family resources and how the parent reframe the problem. Garcia-Lopez, Sarria and Pozo (2016) reported a strong relationship between family income and their psychological wellbeing. Competency and self-efficacy in dealing with behaviors that are considered problematic also affects coping outcomes, with increased self-efficacy being associated with better outcomes (Ozkurt, Vivanti, Uljarevic, & Dissanayake, 2016). Strategies that may promote self-efficacy may have to provide knowledge and skills required to build up self-efficacy so that it can aid in coping and building resilience.

Parents of children with autism rely on a number of coping strategies including professional support, social and family support. Hall et al., (2017), in his study of experiences of parents with children with ASD, reported that coping strategies can differ. The participants reported relying on spiritual, family and community support to support the coping process. However, specific interventions were required to address the behaviors that caused problems to care givers. In one of the cases, medication had to be used to manage the problematic behaviors of the child and reduce stress on care givers. Other participants reported using other means to cope such as through counselling or engaging in therapy. Ozturk et al., (2016) reported a reduction in psychological stress in a sample of women after their children received treatment for communication problems, suggesting interventions that target the child could reduce psychological distress.

Padden and James (2017) conducted an experiment to compare coping strategies and social support among two groups in a study that measured the stress among parents of children with (ASD). Additionally, for anxiety and depression, further analyses were conducted with parents in the (ASD) group showing higher levels of anxiety and depression than parents in the control group. When comparing alternative approaches among both groups, many main effects for spiritual support and positive growth, yielded positive results on how parents of children with (ASD) reported increased use of social support and positive reevaluation as coping mechanisms than parents of children with normal development.

Similarly, Leaf et al., 2016 did a study on an educational model consisting of instructing parents on the principles, fundamentals and implement the educational methodology on their children with (ASD) and application on their personal use. The results of the study revealed how the parents of children with (ASD) adopted alternative approaches such as comprehending the principles of Applied Behavior Analysis (ABA), how to adjust teaching, more efficient assessments, and decision making.

Potential Interventions

A review of the literature shows that there are multiple interventions that have been developed to reduce or treat psychological distress among parents who have children with autism. The first group of interventions are those that focus on the child or those that seek to address some aspect of behavior that is leading to parental distress. Ozturk et al., (2016) reported positive psychological outcomes for parents whose children received communication treatment. According to the scholar, parents of children who improve after treatment benefit are more likely to experience higher levels of parenting satisfaction. Communication may have allowed the parent to deal with behavioral problems more effectively.

Hall, Fruh and Zlomke, Swingle (2017) reported the use children-directed interventions to reduce stress and improve care giver outcomes. In their qualitative study, they reported a case of a care giver who was too hard to manage due to difficult behavior. The child would throw tantrums or run towards the street. Eventually, the caregiver was able to manage the behavior of the child through medication. Another participant in the study reported using counselling and leveraging the interests of the child to manage problematic behaviors and reduce stress.

Children with autism could also benefit from therapy and specific coping strategies to reduce problematic behavior and reduce parental distress or reduce demand for parental attention. Chin et al., (2016), in a study of Taiwanese school aged children, reported that the students employ different strategies to cope with the daily social living challenges that are can cause stress. To enhance problem solving skills, the children reported that they relied on cognitive rehearsal, active communication, taking medication and use of reminders to address daily problems that may affect their functioning. The children also reported that acting put was common when faced with problems. According to the findings, the children used avoidance or seek help when faced with difficult situations in order to avoid acting out. Teaching children with autism these skills could reduce the workload of care givers and therefore improve parental mental health outcomes.

Another potential intervention is the use of cognitive behavioral therapy to address problematic behavioral issues associated with autism. According to Rotheram-Fuller and MacMullen (2011) cognitive behavioral theory (CBT) can be used to treat a wide range of problematic behaviors associated with autism. For example, psycho-education can be used to treat anxiety in children with autism. However, empirical evidence on the use of CBT in treating behavioral problems associated with ASD is lacking. Majority of the evidence is based on private transcripts of personal sessions with children with autism. Rotheram-Fuller and MacMullen (2011) argue that the practice can be brought into the mainstream by educating parents on how to implement some of the strategies that are employed in CBT. For example, the parents may be engaged in psycho-education sessions where they are taught to assess the risk of potential problematic behaviors and how they can deal with them without escalating the problem.

The second type of interventions are those that target parents. Multiple interventions have been recommended. These include mindfulness, as well as, other behavioral interventions (Kuhaneck, Madonna, Novak, & Pearson, 2015). A systematic review of various interventions for children with autism by Kuhaneck et al., (2015) did not find sufficient eviden...