Abstract
High depression rates for adolescents with autism indicate a need for a comprehensive prevention approach. Parents can promote parent–child factors that buffer adolescents from depression. However, parenting adolescents with autism presents challenges which can diminish parental self-efficacy and mental wellbeing with potential negative sequelae for their adolescents. This proof-of-concept study investigated the value of adding a strength-focused parenting intervention to a depression-prevention intervention for adolescents with autism. A Consensual Qualitative Research framework analysed 15 parents’ intervention experience. Parents reported that feeling isolated and unsupported by existing services motivated their participation, and they valued interacting with other parent participants. They also reported that the program enhanced wellbeing and parenting efficacy, reduced isolation, increased ability to parent calmly, and improved parent-adolescent relationships.
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References
Allen, J. (2008). The attachment system in adolescence. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 419–435). New York: The Guilford Press.
Allen, J., Mcelhaney, K., Land, D., Kuperminc, G., Moore, C., Beirne–Kelly, O.H., & Kilmer, S. (2003). A secure base in adolescence: Markers of attachment security in the mother–adolescent relationship. Child Development, 74, 292–307. https://doi.org/10.1111/1467-8624.t01-1-00536.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.,. text revision ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13, 288–295. https://doi.org/10.1002/wps.20151.
Barker, E. T., Hartley, S. L., Seltzer, M. M., Floyd, F. J., Greenberg, J. S., & Orsmond, G. I. (2011). Trajectories of emotional well-being in mothers of adolescents and adults with autism. Developmental Psychology, 47, 551–561. https://doi.org/10.1037/a0021268.
Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36, 863–870. https://doi.org/10.1007/s10803-006-0125-y.
Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report: Surveillance Summaries, 63(2), 1–22.
Chen, M. H., Pan, T. L., Lan, W. H., Hsu, J. W., Huang, K. L., Su, T. P., … Bai, Y. M. (2017). Risk of suicide attempts among adolescents and young adults with autism spectrum disorder: A nationwide longitudinal follow-up study. Journal of Clinical Psychiatry, 78, e117–e1179. https://doi.org/10.4088/JCP.16m11100.
Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.
Corrieri, S., Heider, D., Conrad, I., Blume, A., König, H., & Riedel-Heller, S. G. (2014). School-based prevention programs for depression and anxiety in adolescence: A systematic review. Health Promotion International, 29, 427–441. https://doi.org/10.1093/heapro/dat001.
Cortina, M., & Liotti, G. (2010). Attachment is about safety and protection, intersubjectivity is about sharing and social understanding: The relationships between attachment and intersubjectivity. Psychoanalytic Psychology, 27, 410–441. https://doi.org/10.1037/a0019510.
Côté, S., Tremblay, R., Boivin, M., Liu, X., Nagin, D., & Zoccolillo, M. (2009). Depression and anxiety symptoms: Onset, developmental course and risk factors during early childhood. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50, 1201–1208. https://doi.org/10.1111/j.1469-7610.2009.02099.x.
Culpin, I., Mars, B., Pearson, R., Golding, J., Heron, J., Bubak, I., … Rai, D. (2018). Autistic traits and suicidal thoughts, plans, and self-harm in late adolescence: Population-based cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 57, 313–320. https://doi.org/10.1016/j.jaac.2018.01.023.
Derguy, C., Michel, G., M’Bailara, K., Roux, S., & Bouvard, M. (2015). Assessing needs in parents of children with autism spectrum disorder: A crucial preliminary step to target relevant issues for support programs. Journal of Intellectual & Developmental Disability, 40, 156–166. https://doi.org/10.3109/13668250.2015.1023707.
Divan, G., Vajaratkar, V., Desai, M. U., Strik-Lievers, L., & Patel, V. (2012). Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in Goa, India. Autism Research, 5, 190–200. https://doi.org/10.1002/aur.1225.
Duarte, C. S., Bordin, I. A., Yazigi, L., & Mooney, J. (2005). Factors associated with stress in mothers of children with autism. Autism, 9, 416–427. https://doi.org/10.1177/1362361305056081.
Francis, K. (2005). Autism interventions: A critical update. Developmental Medicine & Child Neurology, 47, 493–499. https://doi.org/10.1111/j.1469-8749.2005.tb01178.x.
Gau, S. S., Chou, M., Chiang, H., Lee, J., Wong, C., Chou, W., & Wu, Y. (2012). Parental adjustment, marital relationship, and family function in families of children with autism. Research in Autism Spectrum Disorders, 6, 263–270. https://doi.org/10.1016/j.rasd.2011.05.007.
Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism & Developmental Disorders, 32, 299–306.
Gladstone, T. R. G., Beardslee, W. R., & O’Connor, E. E. (2011). The prevention of adolescent depression. Psychiatric Clinics of North America, 34, 35–52. https://doi.org/10.1016/j.psc.2010.11.015.
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.
Gray, D. E. (2001). Accommodation, resistance and transcendence: Three narratives of autism. Social Science & Medicine, 53, 1247–1257. https://doi.org/10.1016/S0277-9536(00)00424-X.
Gross, J. J. (2015). The extended process model of emotion regulation: Elaborations, applications, and future directions. Psychological Inquiry, 26, 130–137. https://doi.org/10.1080/1047840X.2015.989751.
Hale, W., van der Valk, I., Akse, J., & Meeus, W. (2008). The interplay of early adolescents’ depressive symptoms, aggression and perceived parental rejection: A four-year community study. Journal of Youth and Adolescence, 37, 928–940. https://doi.org/10.1007/s10964-008-9280-0.
Hannon, G., & Taylor, E. (2013). Suicidal behaviour in adolescents and young adults with ASD: Findings from a systematic review. Clinical Psychology Review, 33, 1197–1204. https://doi.org/10.1016/j.cpr.2013.10.003.
Hartley, S. L., & Schultz, H. M. (2015). Support needs of fathers and mothers of children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 1636–1648. https://doi.org/10.1007/s10803-014-2318-0.
Hayes, S. A., & Watson, S. L. (2012). 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 Developmental Disorders, 43, 629–642. https://doi.org/10.1007/s10803-012-1604-y.
Hill, C., Knox, S., Thompson, B., Williams, E., Hess, S., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196–205. https://doi.org/10.1037/0022-0167.52.2.196.
Hill, C., Thompson, B., & Williams, E. (1997). A guide to conducting consensual qualitative research. Counselling Psychologist, 25, 517–572. https://doi.org/10.1177/0011000097254001.
Hill, C. E. (2012). Consensual qualitative research: A practical resource for investigating social science phenomena. Washington, DC: American Psychological Association.
Hoffman, C. D., Sweeney, D. P., Hodge, D., Lopez-Wagner, M. C., & Looney, L. (2009). Parenting stress and closeness: Mothers of typically developing children and mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 24, 178–187. https://doi.org/10.1177/1088357609338715.
Jones, T. L., & Prinz, R. J. (2005). Potential roles of parental self-efficacy in parent and child adjustment: A review. Clinical Psychology Review, 25, 341–363. https://doi.org/10.1016/j.cpr.2004.12.004.
Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of Autism Spectrum Disorders: A review and proposed model of intervention evaluation. Clinical Child and Family Psychology Review, 15, 247–277. https://doi.org/10.1007/s01567-012-0119-6.
Kelly, A. B., Garnett, M. S., Attwood, T., & Peterson, C. (2008). Autism spectrum symptomatology in children: The impact of family and peer relationships. Journal of Abnormal Child Psychology, 36, 1069–1081. https://doi.org/10.1007/s10802-008-9234-8.
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen Theory. New York: Norton.
Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of Autism Spectrum Disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158. https://doi.org/10.1542/peds.2008-1057.
Kovacs, M. (2003). Children’s Depression Inventory (CDI). Toronto: Multi–Health Systems (MHS).
Kuhn, J. C., & Carter, A. S. (2006). Maternal self-efficacy and associated parenting cognitions among mothers of children with autism. American Journal of Orthopsychiatry, 76(4), 564–575. https://doi.org/10.1037/0002-9432.76.4.564.
Laursen, B., & Collins, W. (2009). Parent–child relationships during adolescence. In R. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology: Vol. 2. Contextual influences on adolescent development (3rd ed., pp. 3–42). New York: Wiley.
Losh, M., Childress, D., Lam, K., & Piven, J. (2008). Defining key features of the broad autism phenotype: A comparison across parents of multiple- and single-incidence autism families. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 147B(4), 424–433. https://doi.org/10.1002/ajmg.b.30612.
Mackay, B. A., Shochet, I. M., & Orr, J. A. (2017). A pilot randomised controlled trial of a school-based resilience intervention to prevent depressive symptoms for young adolescents with autism spectrum disorder: A mixed methods analysis. Journal of Autism and Developmental Disorders, 47, 3458–3478. https://doi.org/10.1007/s10803-017-3263-5.
Mayes, S. D., Calhoun, S. L., Murray, M. J., & Zahid, J. (2011). Variables associated with anxiety and depression in children with autism. Journal of Developmental and Physical Disabilities, 23, 325–337. https://doi.org/10.1007/s10882-011-9231-7.
McPheeters, M. L., Davis, A., Navarre, J. R., & Scott, T. A. (2011). Family report of ASD concomitant with depression or anxiety among US children. Journal of Autism and Developmental Disorders, 41, 646–653. https://doi.org/10.1007/s10803-010-1085-9.
Merry, S., McDowell, H., Wild, C. J., Bir, J., & Cunliffe, R. (2004). A randomized placebo-controlled trial of a school-based depression prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 538–547. https://doi.org/10.1097/00004583-200405000-00007.
Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2011). Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database Systematic Reviews. https://doi.org/10.1002/14651858.CD003380.pub3.
Orsmond, G., Seltzer, M., Greenberg, J., & Krauss, M. (2006). Mother-child relationship quality among adolescents and adults with autism. American Journal on Mental Retardation, 111, 121–137. https://doi.org/10.1352/0895-8017.
Pineda, J., & Dadds, M. R. (2013). Family intervention for adolescents with suicidal behavior: A randomized controlled trial and mediation analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 851–862. https://doi.org/10.1016/j.jaac.2013.05.015.
Piven, J., & Palmer, P. (1999). Psychiatric disorder and the broad autism phenotype: Evidence from a family study of multiple incidence autism families. The American Journal of Psychiatry, 156, 557–563.
Pottie, C. G., & Ingram, K. M. (2008). Daily stress, coping, and wellbeing in parents of children with autism: A multilevel modelling approach. Journal of Family Psychology, 22, 855–864. https://doi.org/10.1037/a0013604.
Restifo, K., & Bögels, S. (2009). Family processes in the development of youth depression: Translating the evidence to treatment. Clinical Psychology Review, 29, 294–316. https://doi.org/10.1016/j.cpr.2009.02.005.
Rueter, M., Scaramella, L., Wallace, L., & Conger, R. (1999). First onset of depressive or anxiety disorders predicted by the longitudinal course of internalizing symptoms and parent-adolescent disagreements. Archives of General Psychiatry, 56, 726–732. https://doi.org/10.1001/archpsyc.56.8.726.
Seltzer, M. M., Greenberg, J. S., Hong, J., Smith, L. E., Almeida, D. M., Coe, C., & Stawski, R. S. (2010). Maternal cortisol levels and child behavior problems in families of adolescents and adults with ASD. Journal of Autism and Developmental Disorders, 40, 457–469. https://doi.org/10.1007/s10803-009-0887-0.
Sheeber, L., Allen, N., Davis, B., & Sorensen, E. (2000). Regulation of negative affect during mother–child problem-solving interactions: Adolescent depressive status and family processes. Journal of Abnormal Child Psychology, 28, 467–479. https://doi.org/10.1023/A:1005135706799.
Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H., & Osgarby, S. M. (2001). The efficacy of a universal school-based program to prevent adolescent depression. Journal of Clinical Child Psychology, 30, 303–315. https://doi.org/10.1207/s15374424jccp3003_3.
Shochet, I. M., & Ham, D. (2004). Universal school-based approaches to preventing adolescent depression: Past findings and future directions of the resourceful adolescent program. International Journal of Mental Health Promotion, 6, 17–25. https://doi.org/10.1080/14623730.2004.9721935.
Shochet, I. M., Holland, D., Osgarby, S. M., & Whitefield, K. (1998). The resourceful family project: Parent program. Brisbane: Griffith University.
Shochet, I. M., Mackay, B., & Wurfl, A. (2011). Resourceful Adolescent Program: Autism spectrum disorders supplement. Brisbane: School of Psychology and Counselling, Queensland University of Technology.
Shochet, I. M., Saggers, B. R., Carrington, S. B., Orr, J. A., Wurfl, A. M., Duncan, B. M., & Smith, C. L. (2016). The Cooperative Research Centre for Living with Autism (Autism CRC) conceptual model to promote mental health for adolescents with ASD. Clinical Child and Family Psychology Review, 19, 94–116. https://doi.org/10.1007/s10567-016-0203-4.
Shochet, I. M., & Wurfl, A. (2015a). Resourceful Adolescent Program: Group leader’s manual. Brisbane: School of Psychology and Counselling, Queensland University of Technology.
Shochet, I. M., & Wurfl, A. (2015b). Resourceful Adolescent Program: Participant’s workbook. Brisbane: School of Psychology and Counselling, Queensland University of Technology.
Shochet, I. M., & Wurfl, A. (2016a). Resourceful Adolescent Parent Program: Group Leader’s manual. Brisbane: School of Psychology and Counselling, Queensland University of Technology.
Shochet, I. M., & Wurfl, A. (2016b). Resourceful Adolescent Parent Program: Participant’s workbook. Brisbane: School of Psychology and Counselling, Queensland University of Technology.
Short, M., & Rosenthal, S. (2008). Psychosocial development and puberty. Annals of the New York Academy of Sciences, 1135, 36–42. https://doi.org/10.1196/annals.1429.011.
Siklos, S., & Kerns, K. A. (2006). Assessing need for social support in parents of children with autism and down syndrome. Journal of Autism and Developmental Disorders, 36, 921–933. https://doi.org/10.1007/s10803-006-0129-7.
Smetana, J. G. (2011). Adolescents’ social reasoning and relationships with parents: Conflicts and coordinations within and across domains. In E. Amsel & J. Smetana (Eds.), Adolescent vulnerabilities and opportunities: Constructivist and developmental perspectives (pp. 139–158). New York: Cambridge University Press.
Smith, L., Greenberg, J., Seltzer, M., & Hong, J. (2008). Symptoms and behavior problems of adolescents and adults with autism: Effects of mother-child relationship quality, warmth, and praise. American Journal on Mental Retardation, 113, 387–402. https://doi.org/10.1352/2008.113.
Steca, P., Bassi, M., Caprara, G., & Fave, A. (2011). Parents’ self-efficacy beliefs and their children’s psychosocial adaptation during adolescence. Journal of Youth and Adolescence, 40, 320–331. https://doi.org/10.1007/s10964-010-9514-9.
Steinberg, L., & Morris, A. (2001). Adolescent development. Annual Review of Psychology, 52, 83–110. https://doi.org/10.1146/annurev.psych.52.1.83.
Stern, D. N. (2004). The present moment in psychotherapy and everyday life (Norton series on interpersonal neurobiology). New York: Norton.
Stice, E., Shaw, H., Bohon, C., Marti, N., C., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486–503. https://doi.org/10.1037/A0015168.
Stockings, E. A., Degenhardt, L., Dobbins, T., Lee, Y. Y., Erskine, H. E., Whiteford, H. A., & Patton, G. (2016). Preventing depression and anxiety in young people: A review of the joint efficacy of universal, selective and indicated prevention. Psychological Medicine, 46, 11–26. https://doi.org/10.1017/S0033291715001725.
Taylor, J. L., Henninger, N. A., & Mailick, M. R. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19, 785–793. https://doi.org/10.1177/1362361315585643.
Teague, S., Gray, K., Tonge, B., & Newman, L. (2017). Attachment in children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 35, 35–50. https://doi.org/10.1016/j.rasd.2016.12.002.
Titelman, P. (Ed.). (2014). Differentiation of self: Bowen family systems theory. New York: Routledge.
Tucker, C. J., McHale, S. M., & Crouter, A. C. (2003). Conflict resolution: Links with adolescents’ family relationships and individual well-being. Journal of Family Issues, 24, 715–736.
Weiss, J. A., Cappadocia, M. C., MacMullin, J. A., Viecili, M., & Lunsky, Y. (2012). The impact of child problem behaviors of children with ASD on parent mental health: The mediating role of acceptance and empowerment. Autism, 16, 261–274. https://doi.org/10.1177/1362361311422708.
Weiss, J. A., Robinson, S., Fung, S., Tint, A., Chalmers, P., & Lunsky, Y. (2013). Family hardiness, social support, and self-efficacy in mothers of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 1310–1317. https://doi.org/10.1016/j.rasd.2013.07.016.
Weiss, J. A., Tint, A., Paquette-Smith, M., & Lunsky, Y. (2016). Perceived self-efficacy in parents of adolescents and adults with autism spectrum disorder. Autism, 20, 425–434. https://doi.org/10.1177/1362361315586292.
Woodman, A., Smith, L., Greenberg, J., & Mailick, M. (2015). Change in autism symptoms and maladaptive behaviors in adolescence and adulthood: The role of positive family processes. Journal of Autism and Developmental Disorders, 45, 111–126. https://doi.org/10.1007/s10803-014-2199-2.
Yap, M., Pilkington, P., Ryan, S., & Jorm, A. (2014). Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis. Journal of Affective Disorders, 156, 8–23. https://doi.org/10.1016/j.jad.2013.11.007.
Zablotsky, B., Bradshaw, C., & Stuart, E. (2013). The association between mental health, stress, and coping supports in mothers of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 1380–1393. https://doi.org/10.1007/s10803-012-1693-7.
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The authors are grateful to Rachel Aberdeen for transcribing the interviews, and to Kate McLisky for conducting the audit of the CQR process.
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This research is supported by the Australian Cooperative Research Centre for Living with Autism (Autism CRC) under Grant No. 2.029, awarded to Professor Ian Shochet and Associate Professor Beth Saggers. The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Project.
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All authors conceived of the study and participated in its design. JO and BD coordinated the study and conducted the recruitment of participants. BD interviewed the participants. JO, BD, AW, and IS participated in the interpretation of the data. JO and IS drafted the manuscript. All authors read and approved the final manuscript.
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Shochet, I.M., Saggers, B.R., Carrington, S.B. et al. A Strength-Focused Parenting Intervention May Be a Valuable Augmentation to a Depression Prevention Focus for Adolescents with Autism. J Autism Dev Disord 49, 2080–2100 (2019). https://doi.org/10.1007/s10803-019-03893-6
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DOI: https://doi.org/10.1007/s10803-019-03893-6