Stress in mothers of children with autism: Trait mindfulness as a protective factor
Introduction
Decades of research support the popular opinion that parenting is extremely stressful (Abidin, 1992, Crnic and Low, 2002). Parental stress is defined as an aversive or negative reaction to parenting, influenced by parenting-specific demands, parental well-being, the parent–child relationship, and child characteristics (Deater-Deckard, 1998, Deater-Deckard, 2004). In addition, parenting stress has been theorized to have a bidirectional relationship with the child's behavior, such that increased parental stress contributes to poorer parenting and potentially more child behavior problems, and child behavior problems contribute to increased parenting stress (Abidin, 1992, Deater-Deckard, 2004). The purpose of the present study was to examine the relationship between trait mindfulness and stress, in mothers of children with or without ASD, taking into account the severity of child behavior problems.
Research suggests that parents of children with disabilities are more likely to experience elevated levels of parenting stress. A recent meta-analysis of parenting stress among parents of children with ASD found that such parents have higher levels of parenting stress than parents of typically developing children as well as parents of children with other developmental disabilities, with large effect sizes (Hayes & Watson, 2013). Additionally, prior research has also shown that mothers of children with ASD typically take on much of the additional strain associated with raising a child with special treatment needs, and thus have been observed to have higher levels of parental stress than fathers (Johnson, Frenn, Feetham, & Simpson, 2011). Parental, child, and environmental factors such as increased child symptom severity, high levels of maladaptive child behaviors, lack of parental social support, and parental maladaptive coping skills have all been shown to effect the level of stress parents of children with ASD face (Benson, 2010, Dunn et al., 2001, Lyons et al., 2009).
There is growing evidence to indicate that increasing mindfulness, or a person's focused awareness in the here and now, may be a worthwhile therapeutic goal in order to reduce stress. The use of techniques to increase mindfulness has become somewhat mainstream in the clinical literature (Hayes, Strosahl, & Wilson, 2012) as a way to increase awareness of emotions and reframe emotions in a more adaptive fashion (Bishop et al., 2004), with a growing research base to support applicability and utility. Mindfulness originates from Buddhist meditation practices and has been defined as the ability to stay cognizant of the present moment and assess actions and emotions in an accepting, non-judgemental manner (Herbert and Forman, 2011, Kabat-Zinn et al., 1985). Higher levels of trait mindfulness are associated with increased life satisfaction, decreased depression and anxiety, improved emotion regulation, and decreased experiential avoidance (Keng, Smoski, & Robins, 2011).
Mindfulness building techniques have also been utilized in several parenting interventions (Bluth and and Wahler, 2011, Bögels et al., 2010, Duncan et al., 2009, Van der Oord et al., 2012). Mindfulness is often used in parenting interventions because it effects intrapersonal skills, such as attributions and parental attitudes, as well as interpersonal skills (e.g., how parents respond to their children's behavior) (Coatsworth, Duncan, Greenberg, & Nix, 2009). Mindfulness has been shown to reduce parents’ stress, as well as improve parenting satisfaction among parents of typically developing adults (see Duncan et al., 2009, for review). Mindfulness could have particular utility in parenting interventions in the ASD population, as raising children with ASD has been found to be associated with higher levels of stress, anxiety, and worry (Dunn et al., 2001, Johnson et al., 2011). In addition, the utilization of mindfulness techniques, especially acceptance, could be viewed as a promising means to address the chronicity inherent in ASD, which often results in parents’ increased involvement in their adult child's life (Barker et al., 2011).
Several preliminary studies have contributed emerging support to mindfulness interventions among parents of children with ASD. Singh et al., 2006, Singh et al., 2007 utilized mindfulness meditation and mindfulness exercises (e.g., teaching to reconsider before reacting, monitoring one's self-talk during the day) in a 12-week program with seven mothers of children with ASD aged 3–6 years in two separate studies. They found that mothers reported increased satisfaction with their parenting skills and their parent–child interactions, in addition to fewer behavior problems (e.g., aggression, non-compliance, and self-injury observed in interactions with parents and siblings) in their children with ASD. Gika and colleagues (2012) found that training in progressive muscle relaxation and controlled breathing were significantly lowered scores on measures of parenting stress and overall stress in 11 mothers of children with ASD, as well as lowered parental report of child behavioral problems. These results provide preliminary evidence that mindfulness-based parent interventions can be useful for the ASD population. However, these initial treatment studies were preliminary, non-randomized, and they did not directly measure mindfulness among parents, nor did they establish a direct relationship between mindfulness and parenting stress. Only one previous study has assessed this relationship between trait mindfulness and stress among parents of children with ASD, and found that parental mindfulness was significantly negatively correlated with their child's behavioral problems, as well as lower levels of parental stress and depressive symptoms (Beer, Ward, & Moar, 2013).
For mothers of children with ASD in particular, it is imperative that we explore the relationship between maternal mindfulness and stress, as people with ASD are more likely to have behavioral difficulties and require prolonged and more intensive care well into adulthood. Additionally, an improved understanding of the relationship between mindfulness and stress among this group of mothers should inform the development of effective supportive services and treatments. Although studies have begun to evaluate treatments utilizing mindfulness- and acceptance-based methods with this population (Bazzano et al., 2013, Bögels et al., 2008, Kowalkowski, 2012, Singh et al., 2007), the relationship between targeted outcomes (stress) and mechanisms (mindfulness) has not been established. This preliminary examination of the role of trait mindfulness on the experience of stress was conducted to determine if trait mindfulness functions similarly among mothers of typically-developing children and in mothers of children with ASD. It was hypothesized that, for both groups, higher levels of maternal trait mindfulness would significantly predict lower levels of stress, above and beyond child behavioral difficulties, such as tantrums and screaming, aggressive and self-injurious behavior, and irritability. A measure of behavioral difficulties that is widely used with individuals with ASD was included, as opposed to a measure of specific behavioral concerns that may present among many different psychological diagnoses in children (e.g., hyperactivity, inattention). ASD and non-ASD groups were then analyzed separately to determine whether the relationship between maternal stress and mindfulness differed based on child diagnosis.
Section snippets
Participants
Study procedures were approved by the university's Institutional Review Board. A secure, cross-sectional online survey, which took approximately 25 min to complete, was used to collect data. Recruitment targeted mothers of children via flyers and online sources across two states. Group (ASD, non-ASD) determination based on participants’ responses to a question on whether or not their child had an ASD diagnosis; thus, a child's ASD diagnosis was not confirmed through testing or prior records.
Results
An independent-samples t-test was conducted in order to compare the group with missing data from the participants who completed the entire survey. The participants with missing data did not differ from those with complete data on mother's age, racial or ethnic minority status, marital status, employment status, the SES risk composite, number of children in the family, or child ASD diagnostic status. Descriptive statistics were computed for all demographic variables (i.e., age, ethnicity, race,
Discussion
This study was the first to investigate the relationship of maternal mindfulness and stress among a sample of both mothers with children with ASD and a comparison sample of mothers whose children do not have ASD. Results supported the primary hypothesis that maternal mindfulness is associated with maternal stress, above and beyond child behavioral problems, for both groups. Overall, these findings are consistent with a smaller prior study demonstrating the association between increased levels
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