Effects of Autism on Interpersonal Family Relationships - Literature review Example

Review of Major Research Studies on the Effects of Autism on Interpersonal Family Relationships Introduction This essay is a review of current research studies designed to assess the primary ways in which autism, a disorder that affects a child’s capacity to communicate with others, changes the dynamics of family interactions. The relationships to be evaluated include the primary relationship between parent and child and the ways in which autism may affect this most critical relationship. In addition, the study will address the effects of autism on relationships between the autistic child and his/her siblings. Finally, the research review will evaluate studies designed to address the more generalised effects of an autistic child on other family relationships: between parents and between parents and the siblings of the autistic child. Effects of autism on the Parent-child relationship Several major research studies have explored the ways in which autism, as compared to other types of disorders, affects interpersonal relationships between parents and the affected child. A recent clinical study of the effects of autism on the parents of children with high-functioning autism (High Functioning Austism Spectrum Disorders) HFASDs, assessed a cohort of 48 parents of children with HFASD and 26 parents of children without the disorder with respect to a number of important psychosocial and adjustment parameters ( Lee, 2009). The results of this research study indicated that, as a group, the parents of children with autism experienced levels of depression and anxiety that were significantly higher than the control group. Moreover, the study indicated that these parents exhibited somewhat higher levels of marital stress and fewer coping skills than parents whose children were not affected with this disorder. The coping skills of mothers of autistic children were somewhat greater than fathers, based on the responses obtained to psychological testing parameters. Research has identified that parents of autistic children have a higher incidence of depression, anxiety and poor social adjustment in comparison to parents of children with other types of disabilities (Bouma and Schweitzer, 1990; Nissenbaum et al, 2009). This may result from the fact that children with autism often engage in disruptive behaviours that create a highly stress family dynamic. These behaviours include aggression, self-injury, hyperactivitty, rage, tantrums and obsessional behaviours (Dewey, 2002; Sharpley, Bitsika and Efremidis,1997; and Gray,1993). The effects of dealing with autism have been reported to be associated with feelings of extreme stress in more than 80% of parents on a regular basis in dealing with their autistic children. Moreover, there is very frequently little support for parents of autistic children. (Sharpley, Bitsika and Efremidis, 1997; Loynes, 2000). Another clinical research study by Mori et al (2008) examined the stress levels in parents raising children with Asperger’s Syndrome, a mild form of Autism, compared to parents of children with autism in Japan. Stress levels were assessed in both groups of parents using Parenting Stress Index/Short Form. The study enrolled 193 families. Although significant levels of stress were identified in both groups of parents, significantly higher stress levels were measured in the parental group whose children were affected with Asperger’s Syndrome (AS). The elevated stress levels in this group were associated with basic behvioural patterns identified in the children with Asperger’s Syndrome. Yet another study comparing stress levels in parents whose children were diagnosed with Asperger’s Syndrome compared to those whose children were autistic produced similar findings. Higher levels of stress were observed in parents of children with Asperger’s Syndrome (Epstein, 2008). Children with AS may have sensory sensitivities and problems in executing functions and activities that may contribute to the increased stress experienced by this group of parents. This study highlighted the association of child behaviours associated with psychological syndromes directly to levels of parental stress. A critical question relating to the effects of autism on parent child interactions involves potential effects on primary attachment bond formation between mother and child that is so essential to psychological development. Research relevant to this important question suggests that high levels of stress are experienced by mothers caring for young children with autism, and that these elevated stress levels are also exhibited in this group of children. The stress responses may affect primary attachment mechanisms between mother and child. Bromley et al (2004) showed that 50% of mothers with autistic children tested positive for emotional disorders and suggested that a significant component of this high level of emotional distress was associated with the difficulties involved in raising a child with autism. This effect was especially prominent in families in which mothers experienced low levels of emotional support from other family members. A study by Ornstein and Davis, and Carter (2008) indicated that elevated stress levels are observed even in parents of very young children diagnosed with autism. Grief is a typical reaction among parents whose child is diagnosed with autism, particularly immediately after diagnosis. A clincial study by Corbett et al (2009) explored cortisol levels, a primary indicator of physiological stress, in children with autism. This physiological parameter was compared to measures of psychological stress in this group of childre, including the Stress survey schedule (SSS), the Short sensory profile (SSP), and the Parenting Stress index (PSI). In this study, higher levels of psychological stress were correlated with low am cortisol levels. Lower morning cortisol is observed as a symptom of chronic stress. SSPs displayed a more complex association with measured cortisol levels. The authors suggested that the increased sensory sensitivity profile exhibited by autistic children may cause rapid changes in cortisol production. High evening cortisol levels were associated with SSS. There was a positive correlation between parent reported stress and child evening cortisol levels (Bouma and schweitzer, 1998). This study demonstrated the important relationship between physiological mediators of stress and psychological parameters of stress in children with autism. Clinical research by Osborne et al (2007) assessed the early childhood teaching interventions in children with autism spectrum disorders specifically with respect to the effects of intervention on parental stress levels as well as child behavioural and psychological parameters. A comparative assessment of multiple groups of children who received differing amounts of intervention educational therapy demonstrated a positive correlation between the amount of intervention therapy and measures of intellectual and social developmental skills. It was noted however, that parents displaying high levels of stress appeared to exert a negative effect on these positive outcomes associated with intervention. This study highliughted the importance of parent child interrelationships on the intellectual and psychological developmental gains in children with autism. Research studies by Futagi and Yamamoto (2002) suggest that early diagnosis of autism is associated with greater parental acceptance of this difficult diagnosis. Another study by Gray (2003) demonstrated that the average age of diagnosis of Asperger’s Syndrome in children is 9 years, and frequently involved a protracted course of consultation and evaluations before a conclusive diagnosis was reached. This long, uncertain path to diagnosis has been observed to be very stressful for all family members, particularly parents ( mothers, especially) searching for a conclusive and definitive assessment of their child’s psychological problems (Barson, 1998). This burden is associated with elevated stress among all family members striving to cope with an undiagnosed psychological disorder (Sharpley, Bitsika and Efremidis,1997; Seltzer, 2001). Effects of autism on parents’ relationship to each other Relationships between parents may be negatively affected by the stresses of coping with an autistic child. The mother may be burdened as primary caregiver and husbands have been observed to place blame on their wives for behavioural issues associated with the condition over which they often have no control. Siegal (2001 has provided evidence that, despite these difficult issues, the divorce rate in the USA for parents of autistic children is not greater than that of the population average. Another study by Bromley (202), indicated that one third of autistic children are raised in single-parent families. In general, the effects of raising a child with autism appear to create greater emotional distress in mothers than in fathers (Bromley, 2002; Gray, 2003). The lesser emotional effect experienced by fathers of autistic children was attributed in part to gender roles and the male identification with occupational roles versus care-giving, traditionally the domain of the mother (Tonmanil, Harris and Hawkins, 2004). Moreover, for mothers with occupations outside the home, there was an observed negative effect on career development attributed to the extraordinary responsibilities associated with parenting an autistic child (Bromley, 2004). Fathers of autistic children were observed to engage in information seeking and wishful thinking as primary coping mechanisms in dealing with parenting an autistic child, consistent with behaviour characteristic in general of fathers whose children are disabled (Rodrigue, Morgan and Geffken,1992). Religion has been viewed as a positive coping strategy by many parents (Krauss and Seltzer, 1999). Effects on Siblings of Autistic Children The effects of profound psychological disorders such as autism are experienced by all members of affected families, both individually and in the context of inter-familial relationships extending beyond the autistic child (Lobato, 1985). The siblings of autistic children frequently receive little attention in terms of their reactions and coping mechanisms, but these family must be considered as well. Research studies suggest that children are generally aware from the earliest stages of diagnosis that their sibling is different, based on their own observations and the behaviour and reactions of relatives, parents and friends (Miller, 2001). The siblings of an autistic child may be reluctant to ask questions or express their fears and concerns and must be approached directly by their parents to discuss relevant issues, according to psychologists (Hare, 2004; Hastings, 2003). Siblings of autistic children may require emotional support or therapy to deal with conflicting emotions of love and disdain, fear anger, guilt over-protectiveness and embarrassment (Anon, 1998). Howlin and Teats (1990) reported that there are also positive effects on siblings that are associated with increased interpersonal skills, self-reliance altruism, particularly in girls. With respect to the interactions between parents and the siblings of children with autism, higher parental expectations have frequently been noted by researchers, perhaps as a compensatory mechanism in dealing with feelings of loss of expections for their affected child (Miller, 2001; Sharpley et al, 1997). This may have a negative effect on the normal–function children in a family who may experience great stress in attempting to compensate for their parents’ loss (Kaminsky and Dewey, 2002). Bågenholm and Gillberg (1991) conducted research on the siblings of children with autism and found an increase in loneliness and peer problems. A positive correlation was observed between family size and motional adjustment among siblings of autistic children (Broach, 2003; Rivers and Stoneman, 2003). Miller (2001) also reported that additional factors such as gender, birth order and the severity of the disability of the affected child are critical factors that play an important role in determining the overall psychosocial adjustment of siblings of autistic children. Conclusion A review of the current literature provides extensive evidence that autism affects the dynamic of all interpersonal relationships with in the family that are associated with high levels of stress and may ultimately damage the ties that bond the family together. Ample evidence suggests the need for family support services, which, unfortunately, are often difficult to obtain due to limited mental health resources (Osborne, 2007). Research studies have repeatedly shown that families with strong support mechanisms are more stable and less negatively affected by the challenges of raising an autistic child. It is important that research studies continue to address the best approaches to developing strong interpersonal familial relationships within families affected by autism that will promote the well-being of all members of the family unit. A clinical study by Solomon et al (2008) documenting the effects of evidence-based treat ment utilising Parent-Child Interaction therapy (PCIT) was conducted in a small group of families with young boys between the ages of 5-12 with high functioning autism spectrum disorder. The study measured parameters of shared positive affect and parental outcomes post-therapy. 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