Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

  • Adrian B. Kelly
  • Michelle S. Garnett
  • Tony Attwood
  • Candida Peterson
Article

Abstract

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.

Keywords

Autism spectrum disorder Asperger’s syndrome Autism Family Peers Conflict Support 

Notes

Acknowledgements

The authors thank Beverlee Garnett for invaluable administrative assistance. This research was conducted during an NHMRC Career Development Fellowship awarded to the first author.

References

  1. Achenbach, T. M. (1991). Manual for the child behavior checklist/4–19 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
  2. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association text revision.Google Scholar
  3. Apter, R., Bernhout, E., & Tyano, S. (1984). Severe obsessive compulsive disorder in adolescence: A report of eight cases. Journal of Adolescence, 7(4), 349–358.PubMedCrossRefGoogle Scholar
  4. Asperger, H. (1944). Autistic psychopathy in childhood. In U. Frith (Ed.) Autism and Asperger’s syndrome. Cambridge: Cambridge University Press (1991).Google Scholar
  5. Asperger, H. (1979). Problems of infantile autism. Communication: Journal of the National Autistic Society, London, 13, 45–52.Google Scholar
  6. Attwood, T. (2003). Understanding and managing circumscribed interests. In M. Prior (Ed.) Learning and behavior problems in Asperger syndrome. New York: Guilford.Google Scholar
  7. Attwood, T. (2006). The complete guide to Asperger’s syndrome. London, UK: Kingsley.Google Scholar
  8. Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71(2), 447–456.PubMedCrossRefGoogle Scholar
  9. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of autism and Developmental Disorders, 33(5), 489–506.PubMedCrossRefGoogle Scholar
  10. Benson, P. R. (2006). The impact of child symptom severity on depressed mood among parents of children with ASD: The mediating role of stress proliferation. Journal of Autism and Developmental Disorders, 36, 685–695.PubMedCrossRefGoogle Scholar
  11. Berthoz, S., & Hill, E. (2005). The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. European Psychiatry, 20, 291–298.PubMedCrossRefGoogle Scholar
  12. Biederman, J., Faraone, S., & Monteaux, M. (2002). Differential effect of environment adversity by gender: Rutter’s index of adversity in a boys and girls with and without ADHD. American Journal of Psychiatry, 159, 1556–1562.PubMedCrossRefGoogle Scholar
  13. Biederman, J., Milberger, S., Faraone, S., Kiely, K., Guite, J., Mick, E., et al. (1995). Family-environmental risk factors for attention-deficit hyperactivity disorder. Archives of General Psychiatry, 52, 464–470.PubMedGoogle Scholar
  14. Bollmer, J. M., Milich, R., Harris, M. J., & Maras, M. A. (2005). A friend in need: The role of friendship quality as a protective factor in peer victimization and bullying. Journal of Interpersonal Violence, 20(6), 701–712.PubMedCrossRefGoogle Scholar
  15. Bolton, D., Collins, S., & Steinberg, D. (1983). The treatment of obsessive–compulsive disorder in adolescence: A report of fifteen cases. British Journal of Psychiatry, 142, 456–464.PubMedCrossRefGoogle Scholar
  16. Bradbury, T. N., Fincham, F. D., & Beach, S. R. H. (2000). Research on the nature and determinants of marital satisfaction: A decade in review. Journal of Marriage and the Family, 62, 964–980.CrossRefGoogle Scholar
  17. Bristol, M. (1987). Mothers of children with autism or communication disorders: Successful adaptation and the double ABCX model. Journal of Autism and Developmental Disorders, 17, 469–486.PubMedCrossRefGoogle Scholar
  18. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen, & J. S. Long (Eds.) Testing structural models (pp. 136–162). Newbury Park, CA: Sage.Google Scholar
  19. Bukowski, W. M., Hoza, B., & Boivin, M. (1994). Measuring friendship quality during pre- and early adolescence: The development and psychometric properties of the friendship qualities scale. Journal of Social and Personal Relationships, 11, 471–484.CrossRefGoogle Scholar
  20. Burman, B., & Margolin, G. (1992). Analysis of the association between marital relationships and health problems: An interactional perspective. Psychological Bulletin, 112(1), 39–63.PubMedCrossRefGoogle Scholar
  21. Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic concepts, applications and programming. NJ: Erlbaum.Google Scholar
  22. Cohen, S., & Wills, T. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.PubMedCrossRefGoogle Scholar
  23. Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Scrimshaw, S. C. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243–1258.PubMedCrossRefGoogle Scholar
  24. Congalten, A. A., & Daniel, A. E. (1976). An individual in the making: An introduction to sociology. Sydney: Wiley.Google Scholar
  25. Cutrona, C. E., & Suhr, J. A. (1994). Social support communication in the context of marriage: An analysis of couples’ supportive interactions. In B. R. Burleson, T. L. Albrecht, & I. G. Sarason (Eds.) Communication of social support: Messages, interactions, relationships, and community (pp. 113–135). Thousand Oaks, CA: Sage.Google Scholar
  26. Dunn, W., Myles, B., & Orr, S. (2002). Sensory processing issues in Asperger syndrome: A preliminary investigation. American Journal of Occupational Therapy, 56(1), 97–102.PubMedGoogle Scholar
  27. duPaul, G. J., McGoey, K. E., Eckert, T. L., & Vanbrakle, J. (2001). Preschool children with attention-deficit/hyperactivity disorder: Impairments in behavioral, social, and school functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 40(5), 508–515.CrossRefGoogle Scholar
  28. Dumas, J. E., Wolf, L. C., Fisman, S. N., & Culligan, A. (1991). Parenting stress, child behaviour problems, and dysphoria in parents of children with autism, Down syndrome, behaviour disorders, and normal development. Exceptionality, 2, 97–110.Google Scholar
  29. Ehlers, S., & Gillberg, C. (1993). The epidemiology of Asperger’s Syndrome—a total population study. Journal of Child Psychology and Psychiatry, 34, 1327–1350.PubMedCrossRefGoogle Scholar
  30. Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 29, 129–141.PubMedCrossRefGoogle Scholar
  31. Fincham, F. D. (2003). Marital conflict: Correlates, structure, and context. Current Directions in Psychological Science, 12, 23–27.CrossRefGoogle Scholar
  32. Fombonne, E. (2007). Epidemiology of pervasive developmental disorders. In J. M. Pérez, P. M. González, M. L. Comí, & C. Nieto (Eds.) New developments in autism: The future is today. London: Kingsley.Google Scholar
  33. Gabriels, R., Hill, D., Pierce, R., Rogers, S., & Wehner, B. (2001). Predictors of treatment outcome in children with autism. Autism: An International Journal of Research and Practice, 5(4), 407–429.Google Scholar
  34. Gilchrist, A., Green, J., Cox, A., Rutter, M., & Le Couteur, A. (2001). Development and current functioning in adolescents with Asperger syndrome: A comparative study. Journal of Child Psychology and Psychiatry, 42, 227–240.PubMedCrossRefGoogle Scholar
  35. Gillberg, C., & Gillberg, I. C. (1989). Asperger Syndrome—some epidemiological considerations: a research note. Journal of Child Psychology and Psychiatry, 30, 631–638.PubMedCrossRefGoogle Scholar
  36. Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345.PubMedCrossRefGoogle Scholar
  37. Goodman, R., & Scott, S. (1999). Comparing the strengths and difficulties questionnaire and the child behavior checklist: Is small beautiful? Journal of Abnormal Child Psychology, 27, 17–24.PubMedCrossRefGoogle Scholar
  38. Griffin, D., & Gonzalez, R. (1995). Correlational analysis of dyad-level data in the exchangeable case. Psychological Bulletin, 118, 430–439.CrossRefGoogle Scholar
  39. Halford, W. K., Osgarby, S., & Kelly, A. B. (1996). Brief cognitive behavioural couples therapy: A preliminary investigation. Behavioural and Cognitive Psychotherapy, 24, 263–273.Google Scholar
  40. Happé, F., & Frith, U. (1996). The neuropsychology of autism. Brain, 119, 1377–1400.PubMedCrossRefGoogle Scholar
  41. Harrison, J., & Hare, D. (2004). Brief report: Assessment of sensory abnormalities in people with autistic spectrum disorders. Journal of Autism and Developmental Disorders, 34, 727–730.PubMedCrossRefGoogle Scholar
  42. Hawker, S. J., & Boulton, M. J. (2000). Twenty years of research on peer victimization and psychosocial maladjustment: A meta-analytic review of cross-sectional studies. Journal of Child Psychology and Psychiatry, 41, 441–455.PubMedCrossRefGoogle Scholar
  43. Hay, D., Payne, A., & Chadwick, A. (2004). Peer relations in childhood. Journal of Child Psychology and Psychiatry, 45, 84–108.PubMedCrossRefGoogle Scholar
  44. Hill, E., Berthoz, S., & Frith, U. (2004). Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.PubMedCrossRefGoogle Scholar
  45. Howard, B., Cohn, E., & Orsmond, G. I. (2006). Understanding and negotiating friendships: Perspectives from an adolescent with Asperger syndrome. Autism, 10(6), 619–627.PubMedCrossRefGoogle Scholar
  46. Howlin, P. (2003). Outcome in high-functioning adults with autism with and without early language delays: Implications for the differentiation between autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 33(1), 3–13.PubMedCrossRefGoogle Scholar
  47. Iwanaga, R., Kawasaki, C., & Tsuchida, R. (2000). Brief report: Comparison of sensory-motor and cognitive function between autism and Asperger syndrome in preschool children. Journal of Autism and Developmental Disorders, 30, 169–174.PubMedCrossRefGoogle Scholar
  48. Kadesjo, B., Gillberg, C., & Hagberg, B. (1999). Autism and Asperger syndrome in seven-year-old children: a total population study. Journal of Autism and Developmental Disorders, 29, 327–331.PubMedCrossRefGoogle Scholar
  49. Kamps, D., Royer, J., & Dugan, E. (2002). Peer training to facilitate social interaction for elementary students with autism and their peers. Exceptional Children, 68(2), 173–178.Google Scholar
  50. Kashani, J. H., Allan, W. D., Dahlmeier, J. M., Rezvani, M., & Reid, J. C. (1995). An examination of family functioning utilizing the circumplex model in psychiatrically hospitalized children with depression. Journal of Affective Disorders, 35(1–2), 65–73.PubMedCrossRefGoogle Scholar
  51. Kelly, A. B., Fincham, F. D., & Beach, S. R. H. (2003). Communication skills in couples: A review and discussion of emerging perspectives. In J. O. Greene, & B. R. Burleson (Eds.) The handbook of communication and social interaction skills (pp. 723–752). NJ: Erlbaum.Google Scholar
  52. Kelly, A. B., Masterman, P. M., & Marlatt, G. A. (2006). Tobacco-related associative strength in adolescents: A cross-sectional and contextual analysis. Nicotine and Tobacco Research, 8, 49–55.PubMedCrossRefGoogle Scholar
  53. Kiecolt-Glaser, J. K., Bane, C., Glaser, R., & Malarkey, W. (2003). Love, marriage, and divorce: Newlyweds’ stress hormones foreshadow relationship changes. Journal of Consulting and Clinical Psychology, 71(1), 176–188.PubMedCrossRefGoogle Scholar
  54. Kotler, J. S., & McMahon, R. J. (2005). Child psychopathy: Theories, measurement, and relations with the development and persistence of conduct problems. Clinical Child and Family Psychology Review, 8, 291–325.PubMedCrossRefGoogle Scholar
  55. Leekam, S., Libby, S., Wing, L., Gould, J., & Gillberg, C. (2000). Comparison of ICD-10 and Gillberg’s criteria for Asperger syndrome. Autism, 4, 11–28.CrossRefGoogle Scholar
  56. Little, L. (2002). Middle-class mothers’ perceptions of peer and sibling victimization among children with Asperger’s syndrome and nonverbal learning disorders. Issues in Comprehensive Pediatric Nursing, 24, 43–57.CrossRefGoogle Scholar
  57. Lord, C., Pickles, A., McLennan, M., Rutter, M., Bregman, J., Folstein, S., et al. (1997). Diagnosing autism: Analysis of data from the autism diagnostic interview. Journal of Autism and Developmental Disorders, 27, 501–517.PubMedCrossRefGoogle Scholar
  58. Lovaas, O. (1987). Behavioural treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.PubMedCrossRefGoogle Scholar
  59. Luiselli, J., Cannon, B., Ellis, J., & Sisson, R. (2000). Home-based behavioral intervention for young children with autism/pervasive developmental disorder. Autism: The International Journal of Research and Practice, 4(4), 427–437.Google Scholar
  60. Marshall, M. P., & Chassin, L. (2000). Peer influence on adolescent alcohol use: The moderating role of parental support and discipline. Applied Developmental Science, 4, 80–88.CrossRefGoogle Scholar
  61. Mayes, S., & Calhoun, S. (2001). Nonsignificance of early speech delay in children with autism and normal intelligence and implications for DSM-IV Asperger’s disorder. Autism: International Journal of Research and practice, 5, 81–94.Google Scholar
  62. Moos, R., & Moos, B. S. (1994). The family environment scale (3rd ed.). Palo Alto, CA: Consulting Psychologists.Google Scholar
  63. Myles, B., Bock, S., & Simpson, R. (2001). Asperger syndrome diagnostic scale examiner’s manual. Austin, TX: PRO-ED.Google Scholar
  64. Nieminen-von Wendt, T. (2004). On the origins and diagnosis of Asperger syndrome: a clinical, neuroimaging and genetic study. Academic dissertation, Medical Faculty, University of Helsinki.Google Scholar
  65. Olson, D. H., Portner, J., & Bell, R. Q. (1982). FACES II: Family adaptability and cohesion evaluation scales. St. Paul: University of Minnesota.Google Scholar
  66. Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28(1), 25–32.PubMedCrossRefGoogle Scholar
  67. Ozonoff, S., South, M., & Miller, J. (2000). DSM-IV defined Asperger syndrome: Cognitive, behavioural and early history differentiation from high-functioning autism. Autism, 4, 29–46.Google Scholar
  68. Piacentini, J., Bergman, R. L., Keller, M., & McCracken, J. (2003). Functional impairment in children and adolescents with obsessive–compulsive disorder. Journal of Child and Adolescent Psychopharmacology. Special Issue: Obsessive–compulsive disorder, 13(2,Suppl), S61–S69.CrossRefGoogle Scholar
  69. Pierce, K., & Schreibman, L. (1997). Multiple peer use of pivotal response training to increase social behaviors of classmates with autism: Results from trained and untrained peers. Journal of Applied Behavior Analysis, 30, 157–160.PubMedCrossRefGoogle Scholar
  70. Rastam, M., Gillberg, C., Gillberg, I. C., & Johansson, M. (1997). Alexithymia in anorexia nervosa: a controlled study using the 20-item Toronto alexithymia scale. Acta Psychiatrica Scandinavica, 95, 385–388.PubMedCrossRefGoogle Scholar
  71. Rice, F., Harold, G. T., Shelton, K. H., & Thapar, A. (2006). Family conflict interacts with genetic liability in predicting childhood and adolescent depression. Journal of the American Academy of Child & Adolescent Psychiatry, 45(7), 841–848.CrossRefGoogle Scholar
  72. Rigby, K. (1996). Bullying in schools: And what to do about it. Bristol, PA: Kingsley.Google Scholar
  73. Rodrigue, J. R., Morgan, S. B., & Geffken, G. R. (1990). Families of autistic children: Psychological functioning of mothers. Journal of Clinical Psychology, 19, 371–379.Google Scholar
  74. Rogers, S., & Ozonoff, S. (2005). Annotation: What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry, 46, 1255–1268.PubMedCrossRefGoogle Scholar
  75. Rutgers, A. H., Bakermans-Kranenburg, M. J., van Ijzendoorn, M. H., & van Berckelaer-Onnes, I. A. (2004). Autism and attachment: A meta-analytic review. Journal of Child Psychology and Psychiatry, 45(6), 1123–1134.PubMedCrossRefGoogle Scholar
  76. Sanders, J. L., & Morgan, S. B. (1997). Family stress and management as perceived by parents of children with autism or Down Syndrome: Implications for intervention. Child and Family Behavior Therapy, 19, 15–32.CrossRefGoogle Scholar
  77. Sanford, K., Bingham, C. R., & Zucker, R. A. (1999). Validity issues with the family environment scale: Psychometric resolution and research application with alcoholic families. Psychological Assessment, 11, 315–325.CrossRefGoogle Scholar
  78. Sasso, G. M., Hughes, M. J., Swanson, M., & Novak, C. G. (1987). A comparison of peer initiation interventions in promoting multiple peer initiators. Education & Training in Mental Retardation, 22(3), 150–155.Google Scholar
  79. Sharpley, C. F., Bitsika, V., & Efremidis, B. (1997). Influence of gender, parental health, and perceived expertise of assistance upon stress, anxiety, and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22(1), 19–28.CrossRefGoogle Scholar
  80. Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152–1160.PubMedCrossRefGoogle Scholar
  81. Solomon, M., Goodlin-Jones, B. L., & Anders, T. F. (2004). A social adjustment enhancement intervention for high functioning autism, Asperger's syndrome, and pervasive developmental disorder NOS. Journal of Autism and Developmental Disorders, 34(6), 649–668.PubMedCrossRefGoogle Scholar
  82. Spence, S. (1995). Social skills training: Enhancing social competence with children and adolescents. Windsor: NFER-Nelson.Google Scholar
  83. SPSS (2005). Statistical package for the social sciences version 14.0 and AMOS version 6.0 [Computer Software]. Chicago, Illinois: SPSS.Google Scholar
  84. Straus, M. (1979). Measuring intrafamily conflict and violence: The conflict tactics scales. Journal of Marriage and the Family, 35, 75–88.CrossRefGoogle Scholar
  85. Szatmari, P., Bremner, R., & Nagy, J. (1989). Asperger’s syndrome: A review of clinical features. Canadian Journal of Psychiatry, 34, 554–560.Google Scholar
  86. Tani, P., Joukamaa, M., Lindberg, N., Nieminen-von Wendt, T., Virkkala, J., Appelberg, B., et al. (2004). Asperger syndrome, alexithymia and sleep. Neuropsychobiology, 49, 64–70.PubMedCrossRefGoogle Scholar
  87. Tantam, D. (1988). Annotation: Asperger’s syndrome. Journal of Child Psychology and Psychiatry, 29, 245–255.PubMedCrossRefGoogle Scholar
  88. Tonge, B. J., Brereton, A. V., Kiomall, M., MacKinnon, A., King, M., & Rinehart, N. (2006). Effects on parental mental health of an education and skills training program for parents of young children with autism: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 561–570.PubMedCrossRefGoogle Scholar
  89. Toro, J., Cervara, M., Osejo, E., & Salamero, M. (1992). Obsessive–compulsive disorder in childhood and adolescence: A clinical study. Journal of Child Psychology and Psychiatry, 33(6), 1025–1037.PubMedCrossRefGoogle Scholar
  90. Verté, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., & Sergeant, J. A. (2006). Executive functioning in children with an autism spectrum disorder: Can we differentiate within the spectrum? Journal of Autism and Developmental Disorders, 36, 351–372.PubMedCrossRefGoogle Scholar
  91. Weidle, B., Bolme, B., & Hoeyland, A. L. (2006). Are peer support groups for adolescents with Asperger's syndrome helpful? Clinical Child Psychology and Psychiatry, 11(1), 45–62.PubMedCrossRefGoogle Scholar
  92. Willey, L. H. (2001). Asperger syndrome in the family: Redefining normal. London: Kingsley.Google Scholar
  93. Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11, 115–129.PubMedCrossRefGoogle Scholar
  94. Wing, L. (1992). Manifestations of social problems in high-functioning autistic people. In E. Schopler, & G. B. Mesibov (Eds.) High-functioning individuals with autism. New York: Plenum.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Adrian B. Kelly
    • 1
    • 3
  • Michelle S. Garnett
    • 2
  • Tony Attwood
    • 2
  • Candida Peterson
    • 2
  1. 1.School of Social ScienceThe University of QueenslandBrisbaneAustralia
  2. 2.School of PsychologyThe University of QueenslandBrisbaneAustralia
  3. 3.School of Social ScienceThe University of QueenslandSt LuciaAustralia

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