Indian Journal of Health Social Work
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MEDIATING ROLE OF ACCEPTANCE ON PARENTAL STRESS AND
COPING AMONG PARENTS HAVING CHILDREN WITH AUTISM
SPECTRUM DISORDER
Kalaivani. P1 & Laxmi Narayan Rathore2
1PhD Scholar & 2Associate Professor, Department of Clinical psychology, School of Medical &
Paramedical Sciences, Mizoram University, Aizawl, Mizoram, India
Correspondence: Laxmi Narayan Rathore, E-mail: laxminarayan21@rediffmail.com
ABSTRACT
Background: Autism Spectrum Disorder (ASD) is a lifelong heterogeneous neurodevelopmental
condition which includes social and communication impairments and restricted stereotypical
patterns of behavior and interests. This is considered as chronic condition and it requires multiple
therapy procedures and Rehabilitation for improvement of the condition. Parental acceptance of
children with disability is very significant as it effects the perception of the problem, and the way
they adopt coping strategies to deal effectively with the problem of the child. Parents especially
of children with ASD undergo lot of stress as it is a chronic condition associated with poor
adaptive skills and behavioural problems which makes them feel more stressed.Objectives: To
study the level of distress and coping strategies among parents of children with Autism Spectrum
Disorder. Methods: Sampling method included purposive sampling. About 50 parents aged
between 25 years to 50 years old, who is the primary care giver of children with Autism Spectrum
Disorder, attending OP services from NIEPMD, Chennai were included in the study. Parents who
are single and having any other chronic physical or mental illness were excluded from the study.
The participants were approached individually and after obtaining informed consent, General
Health Questionnaire (GHQ-12), Parental Acceptance Questionnaire (PAR-Q), and Coping Health
Inventory for parents (CHIP) were administered. The data obtained were statistically analyzed
to assess the level of distress of parents with disability, different coping strategies they adopt,
and mediating effect of Acceptance on relationship between coping strategies and stress. Results:
The results showed that the majority of the parents are found to have psychological distress and
the rejection level was found to be mildly high than the acceptance level of the parents. There is
negative relationship between coping strategies and level of distress among these parents having
children with ASD. Further, it was also found that level of acceptance plays a significant mediating
role and it affects the relationship between coping strategies and level of distress among the
parents. Conclusion: The study highlighted the importance of identifying mental health issues
among parents having children with ASD and it also signifies the importance of adopting strategies
to enhance the Acceptance level and coping strategies while delivering intervention programs
for parents having children with ASD.
Keywords: Autism Spectrum Disorder, Psychological distress, and Parental acceptance.
INTRODUCTION
Parents having child with disability undergo
lot of stressors due to multiple challenges
while rearing the child like facing stigma from
the society, long term therapy procedures,
and difficulty in accessibility of services. While
the Parental stress among parents having
children with disability has been well
established, the stress among Parents having
children with Autism Spectrum Disorder (ASD)
has been more when compared to than those
of with typical children and other disability. It
has been reported that Parents of children
with ASD have more stress compared to those
with typical children and also than having
children with Down Syndrome (A. dwska & E.
Pisula., 2010, L. Abbeduto et al.., 2004).
Parents of children with Autism face many
challenges as Autism remains undiagnosed
late or until preschool years (Beauchesne &
Kelley, 2004) and due to the associated
symptoms such as impairment in social
communication skills and restricted or
repetitive behaviors (Gabriels, R. L.,2005). In
a very recent study done by Dijkstra-de Neijs,
L (2024), he has reported that Parents of
children with ASD have more psychological
distress and poor quality of life. Although
there is no proven cure for autism, the
treatment of Autism includes long term
multiple therapy procedures to improve the
overall functional status of the child by
promoting development of communication,
social, adaptive, behavioral, and academic
skills as well as lessening maladaptive and
repetitive behaviors. Troster H. and Lange
S. (2019) have described the various demands
of parents having children with ASD such as
cooperating with the partner, strengthening
parent child relationship, difficulty in
maintaining social life, facing stigmatizing
social reactions, managing problem behavior
of the child, and fulfilling one’s own need. Due
to multiple challenges, they are prone to
develop psychological disorders such as
depression and anxiety (Al-Farsi, O. A 2016.,
Cai, R. Y., 2020). In a review of study done
by Bailey et al., (2007) on mothers of children
with disability, higher ratings of depressive
symptoms were attributed to children with
autism or behavioral problems. Although the
stress is overwhelming, it is not likely that all
parents were not able to handle the stress,
some of them were able to cope up well the
situation in a positive optimal way. It depends
upon the individual and the coping strategies
they adopt to deal with the situation. Coping
involves specific coping strategies and
psychological resources to manage a stressful
event or situation. It depends upon the wide
variety of factors such as perception and
interpretation of the event, individual
personality characteristics, financial status,
education etc. The other factors such as
marital relationship and social support also
determines the adjustment of mother having
individuals with disability (Emerson, 2003 &
Fazil, Wallace & Singh, 2004). It is reported
in a study that social support was associated
with better coping strategy such as mobilizing
family to acquire social support (Vassiliki
Ntre., et al., 2021) Coping strategies to deal
with the situation can be active and passive.
Active coping strategies is more action
oriented such as approaching the problem and
resolution while passive coping strategies
were such as avoiding the problem, can be a
mechanism to reduce stress on short term.
Many studies have revealed the relationship
between coping strategies and stress among
parents with disability. Problem focused
coping has been associated with more positive
well-being including relationship adjustment
with one’s partner (Stoneman & Gavidia-Payne
2006), whereas avoidant coping strategies
have been associated with psychological
distress (Hastings et al., 2005). According to
the systematic review by Vernhet and
colleagues (2019), parents of children with
ASD use less support and are more likely to
OBJECTIVES
Hence, this current study aimed to study the
level of distress and level of acceptance and
rejection among Parents of children with
Autism Spectrum Disorder. The study also
intended to study the mediating effect of
Acceptance on relationship between coping
strategies and level of distress.
HYPOTHESES
1. There will be significant level of distress among Parents of Children with ASD
2. There will be high level of Rejection compared to level of Acceptance among the Parents towards their children with Autism
3. There will be significant relationship between different types of coping strategies and the level of distress among the parents
4. The level of Acceptance and Rejection will mediate the relationship between Coping strategies and level of distress among Parents of Children with ASD.
METHODOLOGY
The present study included parents, both male
and female aged between 25 years to 60 years
old, who is the primary care giver of children
with ASD, attending OP services from NIEPMD,
Chennai. Parents of children with any
comorbid disability other than intellectual
disability and parents having more than one
child with disability were excluded from the
study. Parents having history of any other
chronic mental illness or physical illness were
also excluded from the study. After getting
ethical clearance from the institution, the
participants were approached individually and
after obtaining informed consent, General
Health Questionnaire (GHQ-12), Parental
Acceptance Questionnaire (PAR-Q), and Coping Health Inventory for parents (CHIP)
were administered. The data obtained were
statistically analyzed to assess the level of
distress of parents with disability, different
coping strategies they adopt, and mediating
effect of Acceptance on relationship between
coping strategies and stress.
STATISTICAL ANALYSIS & STUDY DESIGN
Data was analysed using Statistical Package
for Social Sciences (SPSS 20). Descriptive
statistics was done to find the frequency
percentage of level of distress and level of
Acceptance. Pearson Correlation was used
to find the relationship between coping
strategies and psychological distress. The
mediation analysis was done to assess the
mediating effect of Acceptance on the
relationship between coping and
psychological distress.
RESULTS
DISCUSSION
The results have revealed that there is
significant level of distress among parents of
Children with ASD which is in line with the
previous literature that Parents of children
with ASD have more distress due to reasons
such as difficulty especially in handling the
behaviour pattern of the child which has been
reported in a recent study done by Miranda,
A., Mira., et al., (2019) and deficits in social
and communication domain. In a study done
by Omar Al-Farsi (2016), caregivers of
children with Autism have high levels of stress,
anxiety, and depression compared to parents
with intellectual disability and typically
developing children. It also has been reported
in a study done by Ciara Padden ( 2017) that
Parents of children with ASD not only
experience higher level of stress but also
poorer health than parents of typically
developing children. In a very recent study
done by Taleha Shahbaz et al., (2023), stress
level of 144 parents of children with ASD were
assessed and it reported that especially
Mothers experienced higher level of stress
and it correlated with symptoms of autism.
The current study also revealed similar
findings in line with the previous findings that
majority of them had higher level of
psychological distress. Even though, the
person experience stress, the way an individual cope is significantly important for
the person to overcome the stress and
maintain their wellbeing. Hence, as the study
intended to study the coping mechanism
adopted by the parents, CHIP inventory was
used to study the coping mechanisms of
parents having children with ASD as the
condition of Autism is considered as a chronic
condition. In this study, most of the Parents
had better coping mechanism which might be
due to the reason that most of them included
in our study were literates and belongs to
middle socio-economic status. They are also
aware of the condition of the child since they
are seeking services already for their children
and hence these factors might have amplified
the coping mechanism in a better way in the
current study.
The current study showed that relationship
between different coping domains such as
family integration (r = -.546), social support
(r = -.572), and understanding the medical
situation (r = -.s508) have significant
negative correlation with psychological
distress (Joseph Awwad Bawalsah 2016; Ana
Miranda et al., (2019). In a study done by
Sharabi, A., and Marom-Golan, D. (2018), it
was reported that different sources of
informal social support from the family,
friends, and partner reduce stress, foster
engagement, and mediate and moderate
wellbeing. This finding well corroborates with
finding of the current study which revealed
that social support and family integration was
negatively correlated with distress level of the
parents. The findings corroborated with the
study done by Joseph Awwad Bawalsah (2016)
in which he concluded significant and positive
correlation between levels of stress and
coping strategies. Our study also have found
that the acceptance level mediates the
relationship between coping strategies and
stress. The similar findings were highlighted
in other similar previous studies. In a study
done by Lloyd, T., & Hastings, R. P. (2008),
acceptance was negatively associated with
maternal anxiety, depression and stress such
that mothers who were generally more
accepting reported fewer psychological
adjustment problem. In a study done by
Elaine E. MacDonald et al., (2009), his findings
have revealed that Acceptance level mediates
the impact of behavioural problems on
parental stress, anxiety, and depression and
it also serves as positive predictor of parent’s
perceptions associated with raising their child
with disability. This finding clearly proves the
effect of parental acceptance on mental wellbeing of the parents. In another study done
by Heiman T. (2002), he conducted interview
with the parents and majority of them have
expressed the need for optimistic outlook,
realistic view and acceptance of the disability.
These findings highlighted the importance of
knowing the parent’s insight and acceptance
level towards their child which would help us
to implement intervention programs to
improve the parent’s attunement towards
their child’s condition which indeed will also
help to maintain their mental well being.
CONCLUSION
The study have concluded that Parents of
Children with ASD have significant level of
distress which had significant negative
relationship with coping strategies they adopt.
The study also highlighted the significance of
Acceptance level of the parents towards their
children with ASD that mediated the
relationship between coping strategy and
distress. This study gave the understanding
that while planning interventions for the
children, the focus should also be aimed to
improve the mental well being of the parents,
decrease their stress by using appropriate
strategies and also to improve the level of
acceptance. The factors such as increasing
their social support and family integration,
and making them to understand the condition
of the child would serve a lot in the programs of rehabilitation and intervention.
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Conflict of interest: None
Role of funding source: None
ISSN: 2582-1393 (Online)