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DOI 10.1007/s10803-010-1105-9
ORIGINAL PAPER
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Autism spectrum disorders (ASDs) are a group of developmental disorders that are defined by social interaction
deficiencies, communication delays, and restricted, repetitive behavior patterns (American Psychiatric Association
2000). According to Kogan et al. (2009), ASD may occur
as frequently as 1 in 91 children. Because of the pervasive
features of the disorder, raising a child with an ASD often
exerts considerable pressure on the family (Whitman,
2004). For example, families must cope with the initial
diagnosis, search for treatment and intervention services,
modify their parenting practices, and manage the substantial financial burden of paying for services. These
challenges, although not unique to this disorder, are often
more severe than those confronted by families of children
with other disabilities (Koegel et al. 1992).
The socioemotional impact of raising a child with an
ASD on the family is extensive, affecting all of its
members (e.g., Higgins et al. 2005; Pottie et al. 2009).
For example, siblings of children with an ASD have been
reported as having more extensive behavioral and emotional problems than siblings of typically developing
children and siblings of children with other developmental
disorders (Bishop et al. 2007; Fisman et al. 2000). Most
research on the family, however, has focused on the
impact of an ASD on parent well-being (e.g., Pottie et al.
2009); of particular note is research indicating that fathers
of children with an ASD experience less stress than
Effects on Mothers
Considerable research has been conducted examining the
adverse effects of raising a child with an ASD (e.g., Bishop
et al. 2007; Hastings and Brown 2002). For example, Ekas
and Whitman (2010) found that greater severity of ASD
symptoms was directly related to increased maternal stress.
Research has also indicated that the behavioral problems of
children with an ASD are associated with elevated psychological distress in mothers (e.g., Abbeduto et al. 2004;
Fisman and Wolf 1991; Olsson and Hwang 2001), which
can also affect parenting behaviors. For example, Osborne
and Reed (2010) found that increased parenting stress
among parents of children with an ASD was associated
with less parental involvement, communication, and limit
setting for the child. Moreover, mothers of children with an
ASD have been found to display increased rates of
depression (e.g., Ekas et al. 2009).
Although many studies suggest that raising a child with
an ASD can be a stressful experience for mothers; other
research reports that some mothers experience positive
psychological benefits. For example, mothers have reported
that their children have brought their family closer together
(Towbin et al. 2002) and helped them become more
resilient (Bristol 1987). A number of studies indicate that
the specific socioemotional impact on mothers well-being
varies and depends upon other factors, such as how they
perceive their child and the quality of their marital relationship. For example, several studies suggest that the
impact on mothers of children with an ASD may vary
depending upon whether they emphasize more the negative
attributes and deficiencies of the child (e.g., behavior
problems, symptom severity; Ekas and Whitman 2010;
Phelps et al. 2009; Pottie et al. 2009) or their positive
attributes and accomplishments (Hastings and Taunt 2002).
The current study examined both the influence of negative
and positive maternal perceptions in mothers of children
with an ASD.
849
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850
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Method
Participants
Participants were part of a larger longitudinal study
examining stress and well-being in mothers of children
with an ASD. Participants were recruited through both a
regional autism service center and local autism support
groups. Mothers had to have at least one child younger than
18 years of age who had been diagnosed with an ASD in
order to participate. This study took place in two phases:
the first a cross-sectional phase and the second a longitudinal, daily diary phase. During the cross-sectional phase,
mothers completed questionnaires (e.g., demographic
information, life satisfaction, self-control, social support,
etc.) at one time-point. The 122 mothers, who completed
phase 1 of the study, were contacted through a letter
seeking their permission to participate in phase 2, the daily
diary portion. Mothers who chose not to take part in phase
2 returned a prepaid postcard indicating their decision.
Fifty mothers expressed interest in phase 2, resulting in a
42% response rate. Forty-nine mothers from phase 2 were
included in the present study; one mother was removed
from the study because she did not have data pertaining to
the marital relationship. Therefore, only data from phase 2
(n = 49) was used in the present study because we were
interested in assessing daily relationships. Participants
received no compensation for study participation.
The marital status of the mothers was as follows: married (87.8%), divorced (6.1%), widowed (2.0%), and single
(4.1%). Mothers were predominately Caucasian (93.9%).
Socioeconomically, 36.8% of the mothers had annual
household incomes greater than $75,000, 42.9% earned
$74,999 to $25,000, and 16.3% earned less than $24,999.
The majority of mothers either completed college or had
some college training (69.3%) or completed postgraduate
training (20.4%); and the remainder had a high school
degree or less (10.2%). Mothers ranged in age from 29 to
61 (M = 41.19, SD = 7.01). Children were between the
ages of 2 and 18 (M = 10.18, SD = 4.31), and were predominately male (77.6%). Four families had at least one
other child who was also diagnosed with an ASD. Test of
differences between the individuals who participated in the
current daily diary study (n = 49) compared to the
remainder of the total sample (n = 73) revealed no significant differences between groups with regard to marital
status, household income, race, age (mother or child), or
child gender.
Procedure
The daily diary data was collected over 30 consecutive
days. Participants were randomly assigned to receive an
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Marital Adjustment
The Small Life Events Scale (Zatura et al. 1986) was used
to evaluate how mothers perceived their daily relationship
with their spouse. For this study, 12 events (positive and
negative) were chosen for this evaluation. Sample questions include I argued with my spouse and I kissed and/
or had pleasing contact with my spouse. Participants were
asked to indicate if the event had occurred that day. If the
event did occur, participants used a 7-point Likert-type
scale to indicate how stressful (negative events) or how
enjoyable (positive events) were (1 = not at all to
7 = extremely). An average marital well-being score was
computed with a high score indicating high marital wellbeing. In order to create the average score negative items
were reverse coded and then averaged with the positive
items. This was done in order to obtain a marital well-being
score that captured both positive and negative events.
Possible scores ranged from 1 to 7. Being that not all
events occur on the same day, Cronbach alphas could not
be calculated for this measure.
Maternal Well-Being
The Positive and Negative Affect Schedule (PANAS;
Watson et al. 1988) is a 20-item self-report measure
designed to measure two dimensions of mood: positive
mood (10 items) and negative mood (10 items). Participants indicated the extent to which they experienced each
affective state, such as distressed or inspired, on a
daily basis by using a 7-point Likert-type scale ranging
from 1 (not at all) to 7 (extremely). Total scores were
created separately for positive and negative mood. A high
score indicated high levels of that affective state with
possible scores ranging from 10 to 70 each mood. On
Day 1, Cronbachs alphas were .93 for positive affect and
.92 for negative affect. Watson et al. (1988) reported
high internal consistency, adequate testretest reliability,
and external validity with measures of distress and
psychopathology.
Data Analysis Plan
Hierarchical Linear Modeling (HLM; Raundenbush and
Bryk 2002) was used to test all research questions in the
current study. HLM is used when the data possesses a
hierarchical structure, and is appropriate for this study
because there are 30 daily diaries nested within each participant. HLM allows for simultaneous estimation of two
models: the Level 1 model and the Level 2 model. The
Level 1 model, the day-level model, addresses questions
pertaining to intraindividual change (e.g. within-person
change). The Level 2 model, the person-level model,
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852
Results
Results are presented in four parts. First, descriptive analyses and zero-order correlations were conducted between
all variables. Second, analyses were conducted to determine whether possible covariates should be included in the
models. Third, lower-level mediation models that were
used to test our first research questions are presented.
Fourth, moderation models were used to test our second
research question.
Preliminary Analyses
Descriptive statistics are presented in Table 1. The skewness and kurtosis suggested that all of the variables were
normally distributed, except for negative maternal affect,
which revealed a peaked distribution but still had an
acceptable kurtosis value (close to 10). Therefore, there
were no severe violations of normality. Overall, mothers
reported higher daily negative perceptions of the child than
daily positive perceptions of the child. Secondly, mothers
mean marital adjustment (M = 4.32) is slightly above the
average on the 7-point Likert scale. Lastly, mothers
reported higher daily positive affect than daily negative
affect.
.24a
3. Marital adjustment
-.04
.23a
.43** -.10
-.40
-.38*
.46** .47**
-.27a
Correlation analyses were conducted to examine associations between the variables of interest. The correlations
were mean-level, thus the variables were averaged across
the 30-days. In Table 2, negative maternal perceptions of
the child and positive maternal perceptions of the child
were found to be unrelated, however, there was a nonsignificant trend suggesting that the higher the positive
maternal perceptions of the child, the higher the negative
maternal perceptions of the child. Negative maternal perceptions of the child were positively associated with negative maternal affect and not related to positive maternal
affect. Marital adjustment was not significantly related to
negative affect, however, there was a non-significant trend
suggesting that it was positively associated with positive
maternal affect. Similarly that positive and negative
maternal affect were negatively, but non-significantly,
correlated with one another.
Lower-Level Mediation Models
The first model examined whether marital adjustment
mediated the relationship between negative maternal perceptions of the child and negative maternal affect. As
shown in Fig. 1, the direct path from negative perceptions
of the child to negative maternal affect was found to be
significant such that mothers who reported higher negative
perceptions of their children also reported increased daily
negative affect. Additionally, the path from marital
adjustment to daily negative affect was significant such that
mothers who reported as higher marital adjustment also
Mean
SD
49
12.30
7.73
1.00 to 32.60
.74
-.19
49
11.45
4.54
3.70 to 23.07
.60
-.16
Marital adjustment
49
4.32
1.16
1.00 to 6.55
-.80
1.45
47
48
18.20
39.00
8.25
10.60
10.30 to 58.50
11.17 to 57.06
2.82
-.49
11.61
.08
Note: Variables were averaged across the 30-days to report the descriptive statistics
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Range
Skewness
Kurtosis
853
.34 (SE=.05)***
Negative
Maternal Affect
Negative Maternal
Perceptions
-1.57 (SE=.46)**
.02 (SE=.004)**
-1.20 (SE=.41)**
Marital
Adjustment
Marital
Adjustment
B
Negative Maternal
Perceptions
Negative
Maternal Affect
Positive Maternal
Perceptions
Positive
Maternal Affect
2.35 (SE=.42)***
Positive Maternal
Perceptions
.26 (SE=.05)***
.01 (SE=.004)**
Positive
Maternal Affect
2.03 (SE=.43)***
Marital
Adjustment
Marital
Adjustment
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854
Intercept
Day
Negative perceptions of the child
Marital adjustment
Negative perceptions of the child X
19.12 (1.43)
.01 (.08)
.36(.06)
-1.36 (.41)
-.06 (.03)
df
13.33***
42
.13
42
5.85***
-3.27**
42
42
-2.02*
42
Marital adjustment
* p \ .05; ** p \ .01; *** p \ .001
effect was .30 (SE = .13) and the 95% confidence interval
did not contain zero (.03 to .56). Being that both the random indirect effect and the random total effect 95% confidence intervals were found to not contain zero, it could be
concluded that partial mediation existed in this model,
more specifically, that there was evidence that positive
perceptions of the child had both a direct effect as well as
an effect mediated through the marital relationship.
The final set of 4 models tested the extent to which
marital adjustment moderated the associations between: (a)
negative maternal perceptions of the child and negative
maternal affect; (b) negative maternal perceptions of the
child and positive maternal affect; (c) positive maternal
perceptions of the child and negative maternal affect; and
(d) positive maternal perceptions of the child and positive
maternal affect. As shown in Table 3, the only moderation
model that was found to be significant was the model in
which marital adjustment moderated the relationship
between negative maternal perceptions of the child and
negative maternal affect. Using Aiken and Wests (1991)
procedures for examining significant interaction effects, we
used a computer program by Dawson and Richter (2006) to
graph the significant moderator interaction (see Fig. 3).
Separate negative affect and negative perceptions of the
child regression lines were generated for days of high
marital adjustment (1 standard deviation above the mean)
and low marital adjustment (1 standard deviation below the
mean). Specifically, it was found that for mothers high in
marital adjustment there was no apparent association
between negative perceptions of their children and negative
affect. However for mothers low in marital adjustment,
there was a positive association between negative perceptions of their children and negative affect. All of the other
moderation models were found to be non-significant.
Discussion
Past research examining how children with an ASD influence their mothers well-being has emphasized the impact
123
B (SE)
18
16
14
12
10
8
6
855
123
856
mothers negative experiences with her children are considered. Moreover, the meditational analyses indicate that
marital adjustment can further exacerbate mothers negative well-being when she views her child in a more negative fashion.
These results underline the importance of examining
both positive and negative maternal outcomes in one study.
Correlational results revealed that positive maternal affect
and negative maternal affect were not significantly related.
As indicated, the direct effects of positive and negative
maternal perceptions varied depending on which maternal
outcome was examined. Moreover, marital adjustment
played different meditational and moderational roles
depending whether maternal positive or negative outcomes
were considered. These findings support previous research
suggesting that positive and negative dimensions of
parental outcomes are relatively independent of one
another (e.g., Hastings and Taunt 2002), and that these two
dimensions are predicted by different factors (e.g., Trute
and Hierbert-Murphy 2002; Watson and Clark1997; Zatura
and Reich 1983).
Limitations, Future Directions, and Conclusions
There are several limitations to the present study. First,
mothers in this sample were mostly better educated, married, Caucasian, and living above the poverty line.
Research needs to examine whether findings from this
study generalize to less advantaged and racially diverse
populations. Second, it is not clear how relationships found
in this study change over a longer period of time. Future
studies should consider utilizing a broader longitudinal
time-line, for example, extending from the time when the
child is first diagnosed to when the child enters to school to
the time the child enters adolescence.
Third, our measure of marital adjustment, taken from the
Small Life Events Questionnaire (Zatura et al. 1986), was
not a commonly used measure of marital adjustment.
Future studies should consider replicating these results with
an established and more commonly used measure of marital satisfaction. Fourth, the present study used only
maternal self-report measures. By having solely maternal
report, we have potentially obtained a more limited view of
mothers day-to-day lives, for this reason it would be
helpful to have multiple measures of child characteristics,
marital adjustment, maternal well-being, including reports
from the father and siblings. Lastly, the present study only
examined the daily effects of raising a child with an ASD
on mothers, and not on the other members of the family
system such as fathers and siblings. Therefore, future
studies need to consider the impact of on all members of
the family in order to obtain a more complete picture of the
day-to-day events in families of children with an ASD, and,
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