contribute to parental mental health problems. However, by being as inclusive as possible (and by ensuring the selection of predictors is based on empirical findings), this study aimed to provide a holistic view of not only the key predictors of mental health problems in the parents of children with autism, but also the relationship between those predictors.
Section 8.1 – Thesis Conclusions - The Study Population
Some of the existing studies assessing the predictors of mental health
problems in the parents of children with autism have recruited participants presenting to support services (Duarte et al., 2005; Hastings & Johnson, 2001), creating a
potential skew in the study population. Many parents will not present to support services, irrespective of whether or not they would benefit from support. Thus the present study aimed to recruit parents direct from the community, and as such recruited via Facebook, a widely used social media network. As of April 2010, when recruitment to this study was initiated, an estimated 41.6% of the US population had a Facebook account (Wells, 2010). The current study recruited internationally, and limited its participants solely based on whether or not they had one or more children of school age (4 to 17 years 11 months) with a diagnosis of autism.
However, even using this inclusive approach to recruitment, there remains a notable bias in participant selection. Recruitment via Facebook occurred through promotion of study-specific Facebook Web-pages (one for mothers and one for fathers) by autism advocacy and community groups with a Facebook presence (such as Autism Tasmania (www.autismtas.org.au); Autism Victoria
(www.autismvictoria.org.au); the Olga Tennison Autism Research Centre at La Trobe University, Melbourne (http://www.latrobe.edu.au/otarc/centre.html); the National Autistic Society, UK (www.autism.org.uk); the National Autism
Association, US (www.nationalautismassociation.org); the Autism File magazine (www.autismfile.com) and Carers UK (www.carersuk.org).) Thus parents recruited to the study were primarily those with an active awareness of one or more of these Facebook-based information or advocacy groups, and thus, arguably, had an active interest in either learning about autism or interacting with other families or
professionals with experience of autism. Evidence of this potential ‘skew’ can be found in the percentage of participants who reported being a primary carer for their child with autism – 99% of mothers and 43% of fathers. The study population therefore reflects those parents taking an active role in the care of their children, and is not as representative of parents who are less actively involved with their child with autism. The predictors of mental health problems in parents less actively involved with their child may be different to the predictors of mental health problems in those closely involved in childcare. When drawing conclusions from the study results, this needs to be taken into account.
The study demographic data reveals some other interesting features of the study population. Sixty-six percent of mothers reported a past or present mental health diagnosis for themselves, compared to only forty percent of fathers. However,
according to the cut-offs for depression and anxiety provided for the Depression, Anxiety and Stress Scales (DASS; Lovibond & Lovibond, 1995) of 10 or above for depression and 8 or above for anxiety, seventy-four percent of participating mothers and sixty-five percent of fathers reported mild or greater levels of depression, and sixty-seven percent of mothers and fifty-three percent of fathers reported mild or
greater levels of anxiety. It is arguable that this indicates that there is a comparative underdiagnosis of mental health problems in fathers, and that fathers are therefore potentially receiving less support from mental health professionals than mothers. As both depression and anxiety can be associated with negative cognitions related to the self and perceptions of isolation from others, this may contribute to the finding reported by Altiere and von Kluge (2009) that fathers report lower levels of social support, and greater levels of social isolation, than their partners.
Another interesting finding from the demographic data is that both fathers and mothers report a comparatively high proportion of children with autism being the oldest child (40% in participating mothers; 41% in participating fathers). To provide a comparison, only 28% were reported by mothers as being the youngest child (24% by fathers). Although not a statistically significant difference, a possible conclusion that can be drawn from this is that when parents have a child with autism, they will often choose to have additional children. The qualitative feedback collected as part of this study indicates that parents experience a sense of grief or loss after having a child with autism. Based on comments submitted by participants, this sense of grief relates to the expectations they had prior to becoming a parent, and the belief that those expectations will never be fulfilled. In order to cope with this, parents may try for additional children to ‘make up’ for what they perceive they have lost. . As one mother commented on the Facebook Website for this study. ‘I am glad to find this site because I was feeling alone myself. Having to block the world out because they don't understand why my kid is happily screaming. Knowing that other mothers do not accept my children or me in their happy friendship circle and play group activities. I have gotten used to (being) hurt and excluded, but it is still painful. Sometimes I think
I should have another child, just so I can be a normal Mum and be accepted. But then I hate myself for thinking that.’
Section 8.2 – Thesis Conclusions - Study One Results
The results of the linear regressions conducted as part of Study One indicated that stress, anxiety and depression in the mothers of children with autism are
significantly predicted by conduct problems (Gray, 2003; Lecavelier et al., 2005), social support (Gray & Holden, 1992; Lamminen, 2008) and autism symptom severity (Duarte et al., 2005; Hastings & Johnson, 2001), when these predictors are regressed individually against each mental health variable. The results also showed that parental locus of control, a factor shown to predict mental health problems in the parents of children with an intellectual disability (Hassall, Rose & McDonald, 2005), is a predictor of stress, anxiety and depression in the mothers of children with autism.
The results of the stepwise regression analysis for mothers, however, indicated a clear difference in the predictors for anxiety and depression. Whereas anxiety was predicted by maternal age, the mother’s perceived ability to set behavioural limits for their child and autism symptom severity, depression was predicted by the child’s aggression towards adults, a perceived lack of social support and an externalized parental locus of control. The observed result has arguably significant implications for parental support services. When a mother of a child with autism presents with
depression, the underlying contributors to the problem will not necessarily be the same as a mother of a child with autism presenting with anxiety. However, although the pattern of predictors between depression and anxiety is clearly different, there is