Thankful thinking: A thematic analysis of gratitude letters by mothers of children with autism spectrum disorder
Introduction
Parents of children with autism spectrum disorder (ASD) are likely faced with unique challenges and stresses associated specifically with the disorder. Previous research suggests that parents of children with ASD experience increased parenting stress, depression, and anxiety compared to parents of typically developing children (Estes et al., 2013, Weiss, 2002). Although some parents of children with ASD exhibit such negative outcomes, research indicates that others are more resilient, potentially due to positive attributes, such as acceptance, optimism, and a sense of coherence (Bekhet, Johnson, & Zauszniewski, 2012; Ekas, Lickenbrock, & Whitman, 2010; Ekas, Timmons, Pruitt, Ghilain, & Alessandri, 2015). Another such quality, which has yet to be investigated with parents of children with ASD, is gratitude. Therefore, this study sought to qualitatively examine gratitude themes from letters written by mothers of children with ASD.
Although parenting may be generally stressful and life-changing for some, raising a child with a developmental disability may be even more so. Mothers of children with ASD exhibited poorer well-being than mothers of typically developing children, as indicated by a higher level of depressive symptoms (Olsson & Hwang, 2001). Additionally, parents of children with ASD reported higher stress levels and greater levels of depressive symptoms compared to parents of children with other developmental disabilities, including Down syndrome (Abbeduto et al., 2004, Hayes and Watson, 2013). Indeed, approximately 25% of parents exhibited clinical levels of depressive symptoms in one study of parents of young children with ASD (Davis & Carter, 2008).
Parents’ feelings of competence and efficacy related to their parenting (i.e., parent-related well-being) may also be negatively impacted by raising a child with ASD. For example, mothers of children with ASD reported lower levels of parental competence and knowledge compared to mothers of typically developing children and mothers of children with Down syndrome (Rodrigue, Morgan, & Geffken, 1990). Indeed, for mothers of children with ASD, greater parenting stress was a significant predictor of lower maternal self-efficacy (Kuhn & Carter, 2006). That is, mothers under more stress felt less competent at being a mother. Given the aforementioned studies showing decreased well-being of mothers of children with ASD, it is especially imperative to examine factors that promote positive adaptation.
While some parents of children with ASD experience negative outcomes, many report positive changes after their child’s diagnosis, such as adopting a more positive outlook on life and feeling stronger as an individual (Bayat, 2007, Taylor and Warren, 2012). Indeed, some parents of children with ASD specifically expressed that the child made positive contributions to their life, such as being kind and loving or a source of happiness (e.g., Hastings et al., 2005; Kayfitz, Gragg, & Orr, 2010). More recently, research has begun to shift focus from examination of detrimental factors to factors that influence maternal well-being positively, such as optimism (Ekas et al., 2010). These positive psychological factors, such as optimism and hope, are considered personal strengths of character. Character strengths are positive traits which may offer protective benefits to an individual (Duckworth, Steen, & Seligman, 2005). One strength, yet to be examined with parents of children with ASD, is gratitude. Gratitude has been defined in various ways, typically as a positive emotion, practice, or dispositional tendency of being thankful for something or someone in one’s life (Watkins, Woodward, Stone, & Kolts, 2003).
Previous research found connections between dispositional gratitude (i.e., a tendency toward showing gratitude) and overall well-being of individuals (e.g., Emmons and McCullough, 2003, Watkins et al., 2003). More grateful people reported experiencing higher levels of life satisfaction and a greater number of positive emotions than comparatively less grateful people (McCullough, Emmons, & Tsang, 2002). Gratitude has also been shown to buffer against negative effects on well-being in special populations, such as female breast cancer patients, for whom having high levels of gratitude predicted greater post-traumatic growth, as well as lower levels of depression and anxiety compared to those with little gratitude (Ruini & Vescovelli, 2013). Furthermore, gratitude affects other domains of well-being, beyond psychological well-being. For instance, partners’ greater expressed and felt gratitude towards their spouses were both associated with increased marital satisfaction (Gordon, Arnette, & Smith, 2011).
Gratitude served as a mechanism to increase well-being in previous intervention research. Typically, these interventions involved having an individual write about things they are grateful for, either in a list format or in letters to others across varying periods of time. In the general population, participation in these writing activities predicted increased well-being (Emmons & McCullough, 2003). A weekly diary gratitude intervention with undergraduate students showed that those who wrote gratitude lists experienced significantly greater subjective happiness compared to those who listed weekly hassles or neutral weekly events (Emmons & McCullough, 2003). Furthermore, those who wrote letters of gratitude showed increased life satisfaction, greater subjective happiness, and decreased levels of depressive symptoms (Toepfer, Cichy, & Peters, 2012). Gratitude interventions had positive effects on well-being as many as six months later (Lyubomirsky, Dickerhoof, Boehm, & Sheldon, 2011). Finally, in a special population of chronically stressed health practitioners, a weekly diary gratitude intervention led to decreased levels of stress and depressive symptoms compared to both a control and daily hassles group (Cheng, Tsui, & Lam, 2014). While previously examined in some special populations, gratitude has not yet been studied in parents of children with ASD. Moreover, research with gratitude in other populations focused primarily on young, unmarried individuals such as college students, rather than parents (e.g., Emmons and McCullough, 2003, Toepfer et al., 2012).
Although the benefits of grateful thinking are well established, only two previous studies have examined the content of open-ended gratitude responses for prevalent themes, to the knowledge of the researcher. One of those studies focused exclusively on gratitude to God and perceptions of God among the elderly (Krause, Evans, Powers, & Hayward, 2012). The findings revealed four primary themes: (1) the experience of stressful life events and whether or not stress makes individuals less grateful to God; (2) whether or not it is necessary to express feelings of gratitude to God and in what way; (3) beliefs about the way God responds to expressed gratitude; and (4) possible benefits of expressing gratitude to God (Krause et al., 2012). The second study focused on adults with congenital heart failure who listed things for which they were grateful (Krause et al., 2012). Findings from that study included themes of social support, life appreciation (e.g., each day is a gift), participation in leisurely activities, religious and faith-based resources, medical resources, financial security, and current health or physical abilities (Sacco, Park, Suresh, & Bliss, 2014). Further, results from that study indicated that greater gratitude scores, based on qualitative gratitude responses, were related to more life meaning and lower levels of depressive symptoms at a later time point (Sacco et al., 2014). However, the nature of gratitude may differ significantly between adults coping with their own health issues as compared to adults caring for children with a developmental disability, such as ASD. Given that some mothers of children with ASD reported positive contributions the child has made to their life, we wanted to extend that to examine whether mothers could consistently express the positive emotion of gratitude in relation to their child and the reasons they provided.
The purpose of the current study was to examine the personal strength of gratitude in mothers of children with ASD. Specifically, the study aimed to identify the general and child-specific components of gratitude most frequently mentioned by parents. While some qualitative analyses have been conducted with parents of children with ASD (e.g., Huws, Jones, & Ingledew, 2001), this is the first known study to examine written statements of gratitude qualitatively in this population.
Section snippets
Participants
A sample of mothers (n = 53) of children with ASD (M = 8.52 years, SD = 3.41) was taken from participants of a larger study. Child diagnoses of ASD were confirmed through parent report. Mothers participating in the study (M = 38.92 years, SD = 6.76) were predominantly Caucasian, middle to upper-middle class, and college-educated (see Table 1 for further demographic information).
Procedure
Data for the current qualitative study was collected as part of a larger study, an intervention utilizing gratitude, which was
Results
Several overarching gratitude-related themes emerged for mothers in both the general and child-specific gratitude groups. Within the general gratitude responses, the prominent themes were as follows: individuals that provided social support to the parent, characteristics of close personal friendships or relationships, generally kind-hearted people that helped the family, and inspirational individuals. The four emergent themes of gratitude for mothers who wrote to their child with ASD were as
Discussion
This exploratory qualitative study examined the positive personal strength of gratitude in mothers of children with ASD. Although the benefits of expressing gratitude were established in the general population (e.g., Emmons and McCullough, 2003, Toepfer et al., 2012), this personal strength had not previously been studied in this population. Moreover, there are a limited number of studies examining the content of gratitude narratives (e.g., Krause et al., 2012, Sacco et al., 2014). Given the
Conflict of interest statement
There are no known conflicts of interest for any of the authors of this manuscript which would interfere with the integrity of this research.
References (40)
The health care experiences of the preschool child with autism
Journal of Pediatric Nursing
(2012)- et al.
Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorder
Brain and Development
(2013) - et al.
Have you thanked your spouse today?: Felt and expressed gratitude among married couples
Personality and Individual Differences
(2011) - et al.
Living with heart failure: Psychosocial resources, meaning, gratitude and well-being
Heart & Lung: Journal of Acute and Critical Care
(2014) - et al.
Psychological well-being and coping in mothers of youths with autism, Down syndrome, or fragile X syndrome
American Journal on Mental Retardation
(2004) Evidence of resilience in families of children with autism
Journal of Intellectual Disability Research
(2007)- et al.
Resilience in family members of persons with autism spectrum disorder: A review of the literature
Issues in Mental Health Nursing
(2012) - et al.
Using thematic analysis in psychology
Qualitative Research in Psychology
(2006) - (2014)
- et al.
Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention
Journal of Consulting and Clinical Psychology
(2014)
Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics
Journal of Autism and Developmental Disorders
Positive psychology in clinical practice
Annual Review of Clinical Psychology
Optimism, social support, and well-being in mothers of children with autism spectrum disorder
Journal of Autism and Developmental Disorders
The power of positivity: Predictors of relationship satisfaction for parents of children with autism spectrum disorder
Journal of Autism and Developmental Disorders
Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life
Journal of Personality and Social Psychology
Qualitative data analysis with ATLAS.ti
Respite care, marital quality, and stress in parents of children with autism spectrum disorders
Journal of Autism and Developmental Disorders
Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism
Journal of Autism and Developmental Disorders
The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder
Journal of Autism and Development Disorders
Parents of children with autism using an email group: A grounded theory study
Journal of Health Psychology
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