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Best Things”: Parents Describe Their Children with Autism Spectrum Disorder Over Time

A Correction to this article was published on 20 July 2021

This article has been updated

Abstract

This study examined parental perceptions of the character traits of children with autism from early childhood to age 11. Parents (n = 153) provided descriptions of the “best things” about their children on the Child Behavior Checklist (CBCL) at ages 3–4, 7–8, and 10–11 years. Descriptions were coded using the framework of the Values in Action Classification of Strengths, with additional traits added as needed. Parent-endorsed traits included love, kindness, happiness, and humor in children across all ages and traits such as perseverance as children entered school. Higher CBCL scores were associated with a lower likelihood of endorsement for Humanity traits. Results are congruent with a contemporary neurodiversity perspective that emphasizes strengths and resilience.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder that affects the way individuals communicate and relate to the people and the world around them. ASD is often diagnosed in early childhood and, in most cases, persists throughout the lifespan. Despite ongoing efforts to identify biomarkers, ASD remains a behaviorally defined disorder characterized by two core symptom dimensions – social communication deficits and restricted, repetitive behavior, interests, or activities (American Psychiatric Association 2013). In 2018, the National Autism Spectrum Disorder Surveillance System Report estimated a prevalence of 1 in 66 children in Canada (Ofner et al. 2018).

The past two decades have seen a paradigm shift in the conceptualization of ASD, from a focus on unusual behavior, deficits, and remediation to an increasing appreciation of strengths, assets, and accommodations. This is reflected in literature written from a neurodiversity perspective that views the strengths, differences, and challenges associated with autism as central to identity (e.g., Kapp et al. 2013; Robertson 2010). Similarly, it is reflected in the growing literature on resilience that emphasizes the positive attributes and strengths of people with autism that can counterbalance factors that may place them at risk (McCrimmon and Montgomery 2014; Szatmari et al. 2016). Finally, the paradigm shift can be seen in the use of innovative methodologies that capture the lived experiences of people across the autism spectrum, with an emphasis on identifying strengths that enhance well-being (Lam et al. 2020; Nicholas et al. 2019; Tesfaye et al. 2019; Teti et al. 2016). All of these endeavors are congruent with the positive psychology movement that seeks to understand and foster the factors that allow individuals, communities, and societies to flourish (Seligman and Csikszentmihalyi 2000). Positive psychology involves the study of positive human qualities at the subjective, individual, and group (i.e., societal) levels. At the subjective level, the focus is on understanding experiences that contribute to well-being, satisfaction, hope, optimism, and happiness. At the individual level, it is the study of positive character traits and how those traits allow individuals to flourish. And, at the group level, it is about understanding the civic virtues and institutions that promote better citizenship, such as responsibility, altruism, tolerance, and compassion.

At the level of the individual, Rashid et al. (2013) offered the following observation:

“For more than a century, psychology has been fascinated with the clichéd question.

‘What is wrong with you, Johnny?’ Since the dawn of this millennium, positive psychology has seriously urged psychologists to also probe into a much deeper and a loftier question, ‘what are you good at, Johnny?’” (p. 81).

Understanding ‘what Johnny is good at,’ necessitates a way to measure, among other things, character traits that are “morally desirable” (Rashid et al. 2013, p. 85) and that contribute to one’s capacities of cognition, affect, volition, and behavior. Character traits have been defined as “positive capacities for thinking, feeling, and behaving in ways that benefit oneself and others” (Niemiec et al. 2017, p. 14) and also as “a family of positive characteristics each of which exists in degrees” (Park and Peterson 2009, p. 3).

One of the best-known classification models in this regard is the Values in Action (VIA) Classification of Strengths that was developed by two prominent leaders of the positive psychology movement (Peterson and Seligman 2004). The VIA consists of 24 character traits that are subsumed under six broad categories: Wisdom and Knowledge, Courage, Humanity, Justice, Temperance, and Transcendence. A VIA study in a sample of 117,676 adults found that the most frequently self-endorsed traits (kindness, fairness, honesty, gratitude, and judgment) were highly similar across 54 nations and all 50 US states (Park et al. 2006). Other studies have found that character traits are developmental; for example, the most common traits in a sample of neurotypical 3 to 9-year-olds were love, kindness, creativity, and humor (Park and Peterson 2006a), while the most common traits among children aged 10 to 13 years were humor, creativity, gratitude, and teamwork (Park and Peterson 2006b). Among neurotypical young children and adolescents, the least common traits are those that require some level of cognitive and social maturation, such as open-mindedness, integrity, leadership, forgiveness/mercy, humility/modesty, appreciation of beauty and excellence, gratitude, and spirituality (Park and Peterson 2006a, 2006b). However, some traits appear to be advantageous regardless of age; for example, hope, zest, gratitude, and love have been robustly associated with higher life satisfaction in children aged 3 to 9 (Park and Peterson 2006a), youth aged 10 to 17 (Ruch et al. 2014), and adults aged 35 to 40 (Park et al. 2004). In neurotypical children and adolescents, associations have also been found between specific VIA character traits and outcomes such as self-efficacy (Ruch et al. 2014), peer acceptance and friendship quality (Wagner 2019), and subjective well-being and school adjustment (Shoshani and Aviv 2012; Shoshani and Slone 2013).

Various assessment approaches, including the VIA classification, have been used to identify character strengths in individuals with ASD from both first-person and parental perspectives. In one such study, 33 adults with ASD (without intellectual impairment) and 33 neurotypical controls (matched by sex, age, and education) self-assessed character strengths using the VIA classification (Samson and Antonelli 2013). The five most highly endorsed traits for both groups were open-mindedness, love of learning, curiosity, fairness, and authenticity, although the rank order varied across groups. In a similar study, 32 pairs of adults with ASD and matched neurotypical controls also completed the VIA classification as well as a measure of life satisfaction (Kirchner et al. 2016). Results indicated that open-mindedness emerged as one of the five most frequently endorsed strengths in both groups, along with (for the ASD group) authenticity, love of learning, creativity, and fairness. With the exception of creativity/curiosity, these were the same traits found for adults with ASD by Samson and Antonelli. In contrast, the neurotypical group in this study endorsed fairness, humor, kindness, and love among their top five traits. For both groups, hope, zest, humor, social intelligence, and teamwork had the strongest positive associations with life satisfaction.

Positive character traits have also been identified in people with ASD using approaches other than the VIA classification. For example, Russell et al. (2019) conducted semi-structured interviews with 24 adults with autism, asking them questions such as “Are there any aspects of your autism that may have been advantageous or beneficial to you?” and “Has your autism meant that you are particularly good at something?” The study was unique with regard to participant diversity; it included those who lived independently (33.3%), those who lived with a caregiver (37.5%) and those who lived in residential care (29.2%). Responses fell into two broad categories: cognitive/perceptual strengths (e.g., the abilities to “hyperfocus” on a specific task and attend to details, excellent memory) and social skills (e.g., compassion, honesty). Several participants acknowledged that their positive traits had a “flip side” that could be problematic; for example, one participant noted that her attention to detail, taken to an extreme, became perfectionism that interfered with her ability to complete work on time.

Various strategies have also been used to identify character strengths in people with ASD based on parental or sibling input. Carter et al. (2020) administered the Assessment Scale for Positive Character Traits-Developmental Disabilities (ASPeCT-DD; Woodard 2009) to 163 siblings (aged 18–30) of individuals with ASD (51.5%) or intellectual disability between the ages of 1 and 46 (M = 20.6). Of the 26 character traits on this measure, kindness, caring for others, and having a sense of humor were the most highly rated traits by siblings when thinking about their brother or sister with ASD. As part of a larger study, Carter et al. (2015) interviewed 28 parents of youth with ASD or intellectual disability (ages 13–21) and asked, “What comes to mind when you think about [youth’s name] strengths?” with follow-up probes as needed. Results of a four-stage transcript coding process indicated that the most frequently mentioned traits were compassion, sociability, being loving, being good with children, and kindness. Hastie and Stephens (2019) asked parents of eight adolescents with ASD (aged 14–19 years) to provide five photographs that depicted one or more strengths of their child, and then used the photographs to guide semi-structured interviews with the parents and with two of the adolescents themselves. Participants identified strengths that included social skills, fluency with technology, good memory, artistic ability, bravery, perseverance, humor, and autonomy. In the only study of positive character traits that was restricted to fathers of children with ASD up to age 19, Potter (2016) asked (among other questions), “What kinds of things do you find satisfying about being the father of your child with autism?” One of the major themes that emerged from participants’ responses involved descriptions of positive child characteristics, which included interpersonal traits (e.g., kindness, sensitivity, caring, loyalty), having a sense of humor, and various “intellectual” abilities (e.g., persistence, intelligence, creativity, the ability to problem-solve). Most recently, parents of 41 adolescents with ASD (aged 12–19 years) mentioned children’s strengths and skills during interviews exploring their expectations for life after high school (Warren et al. 2020). The most frequently mentioned strengths included intelligence, rule following, independence, and self-determination.

Only one study to date has been conducted with parents of young children with ASD (Sabapathy et al. 2017). As part of a multidisciplinary diagnostic assessment, parents were asked to “Describe your child’s strengths.” Charts of 98 children (aged 3–8 years) who were diagnosed with ASD following the assessment were reviewed retrospectively to extract parents’ responses, which were then coded by two independent raters based on a thematic framework developed in a previous study of children with developmental disabilities (Colavita et al. 2014). On average, parents reported four strengths for their child, of which the five most frequently mentioned were loving/caring/affectionate, various academic skills (e.g., good reader, good at math), good memory, intelligent/smart, and various recreational skills (e.g., loves music and dancing, plays musical instrument).

Study Purpose

The purpose of this study was twofold: to add to the literature on character strengths of children with ASD and to address some of the gaps in this emerging area of research. With the exception of Sabapathy et al. (2017), researchers have not examined character traits in pre-adolescent children with ASD nor have they coded open-ended parental responses using VIA traits as a basic framework. In addition, character traits in neurotypical children and adolescents are known to be developmental in nature. However, all of the trait research in ASD that we have identified has been cross-sectional, so nothing is known about the stability of traits, how they evolve and develop over time, or variables that are associated with trait endorsement in this population. This information may act as a reminder to parents and professionals about the importance of recognizing individual strengths, appreciating the changing nature of positive trait development over time, and implementing strength-based assessments for educational planning. Furthermore, research aimed at identifying how character traits develop over time can serve to highlight the fact that children’s strengths are malleable and can be promoted to enhance both developmental health and resilience (Lerner and Schmid Callina 2014; Szatmari et al. 2016). Thus, our primary aims in this study were to examine (a) character traits identified by parents of children with ASD at ages 3–4 (Time 1, T1), 7–8 (Time 2, T2), and 10–11 (Time 3, T3); (b) the stability and evolution of parental trait endorsement over time; and (c) associations between trait endorsement and autism symptom severity or behavior problems.

Method

This qualitative study used a subset of data that were drawn from Pathways in ASD, a longitudinal study examining the developmental trajectories of children with ASD in an inception cohort recruited across five Canadian provinces in urban centres. The study was approved by the Research Ethics Boards at participating sites and families provided informed consent.

Participants

Children in the Pathways study met the following inclusion criteria: (a) age 2;0 to 4;11 (years; months) at the time of diagnosis; (b) met criteria for ASD on the Autism Diagnostic Observation Schedule (ADOS; Lord et al. 2000) and in the social and one other domain of the Autism Diagnostic Interview – Revised (Rutter et al. 2003); and (c) met DSM-IV-TR criteria for ASD (American Psychiatric Association 2000) according to judgment by clinicians with diagnostic expertise. Exclusion criteria included known genetic or chromosomal abnormalities, neuromotor disorders (e.g., cerebral palsy), and/or severe hearing and/or vision impairments. In total, 402 families met the study inclusion criteria, participated in direct child assessments within 4 months of an ASD diagnosis (T1), and participated in additional assessments at one or more time points following T1.

Inclusion criteria for this study were parental completion of an open-ended request (“Please describe the best things about your child”) on the Child Behaviour Checklist (CBCL) at T1 and at either one or two additional time points. Completion of all or part of the CBCL at each time point was optional and the open-ended request was identical on both versions. At T1, the version of the CBCL that was designed for children between ages 1.5 to 5 (Achenbach and Rescorla 2000) was completed by 153 parents (M child age = 3.4 years; 129 boys and 24 girls). This time point was selected to reflect parental impressions of their child’s character traits within 4 months of ASD diagnosis. Subsequently, we elected to use data that were collected when children were toward the beginning and end of the elementary school period in Canada. Hence, the version designed for children ages 6 to 18 (Achenbach and Rescorla 2001) was completed by 112 parents at T2 (M child age = 7.8 years, 92 boys and 20 girls) and by 129 parents at T3 (M child age = 10.6 years, 108 boys and 21 girls). Key characteristics of the included participants at all three time points are summarized in Table 1.

Table 1 Participant demographic variables

Measurement

Character Traits

As per the inclusion criteria, the primary data used in this analysis were drawn from two versions of the CBCL, a parent report measure that is typically used to assess children’s externalizing and internalizing behavior. Both versions include a qualitative section that asks parents to “Please describe the best things about your child,” with no limits to the length or content of the response. Responses to this request formed the basis of the analysis.

Predictors of Character Endorsement

The quantitative section of both versions of CBCL consists of 99 items that describe various types of behaviors; informants rate each item on a 3-point scale (0 = not true, 1 = somewhat/sometimes true, and 2 = very/often true). The behavior problems total score was used in the analysis as a predictor variable, to examine associations between behavior problems and trait endorsement. We also used the total calibrated severity score (CSS) of the ADOS at all three time points to examine whether autism symptom severity affected parental descriptions of children’s character traits; scores range from 1 to 10, with higher scores indicating more severe symptoms (Gotham et al. 2009). The ADOS is a semi-structured, standardized assessment that was administered in this study by research-reliable clinicians with ASD experience.

Missingness

In order to determine the extent to which participants who met the CBCL inclusion criteria were representative of the all Pathways families, we examined data missingness in several ways. First, at each time point, we used the ADOS CSS score to determine whether parents of children with more severe ASD symptomatology were less likely to complete the “best things” section. Second, we used the depression symptoms dimension score from the Symptom Checklist-90-R (SCL-90-R; (Derogatis 1994) at all three time points to examine whether completion of the “best things” section was influenced by the presence of parental depressive symptomatology (see Bennett et al. 2012). On this measure, parents rate their responses to symptom descriptions on a 5-point scale ranging from 0 = not at all to 4 = extremely, such that higher scores indicate more severe depressive symptoms. Finally, to assess missingness related to family socio-economic risk (SER), we created a risk index from four indicators that were drawn from a Family Background Information Questionnaire developed for the Pathways study and administered at T1. The indicators have been used in previous Pathways studies (e.g., Zaidman-Zait et al. 2020) and were selected based on Canadian statistics suggesting their relevance to SER (Campaign 2000, 2015); each indicator was assigned a value of 1 (risk) or 0 (no risk). The four indicators were: (a) lone-parent household (1 = yes; 0 = no); (b) primary caregiver’s educational level (attended secondary school but not completed = 1; completed secondary school or higher education = 0); (c) immigration status (both parents born outside of Canada = 1; not so = 0); and (d) annual household income (1 =  ≤ $40,000; 0 =  > $40,000). The lattermost indicator was dichotomized at a cut-point that was as close as possible to the most extreme 15% of the distribution at the adverse end of the income range available (Browne et al. 2016). The mean of all four indicators was calculated, yielding a composite score that reflected family socio-economic risk at T1.

Procedure

Parents were provided with a paper copy of the CBCL, completed it at home, and returned it either by mail or in person, depending on where they lived. All parental responses to the request to “Please describe the best things about your child” on the CBCL were transcribed verbatim into an Excel spreadsheet and were coded using the VIA framework of 24 character traits (Peterson and Seligman 2004). At the outset, we included two additional traits – attractiveness and intelligence – that were examined in a VIA study of young children in a similar age range as our sample (Park and Peterson 2006a). In addition, the coding scheme was elaborated iteratively to include unique words that were not provided in the original VIA definitions; for example, no parent described their child as vital or vigorous (words that are listed as synonyms for the VIA trait “zest”), but several parents did describe their children as “full of life” or “high energy,” so these (and others) were add to the “zest” synonyms. Finally, we added several traits that did not fit the VIA framework; for example, “friendliness” was added as a Humanity trait because many parents described their child using words such as “friendly,” “social/sociable,” and “charming.” We also added several categories that did not fit into the VIA framework, including Happiness and Specific Skills, which included several subskills (e.g., memory, gross motor skills) that were mentioned frequently. Table 2 summarizes the final coding framework.

Table 2 Final coding system of categories and traits

Data Analytic Plan

Data Coding

Using the framework in Table 2, the first three authors independently coded approximately 50 response sets at a time, such that a response set included all descriptors provided by a parent at a time point. All T1 response sets were coded first, followed by the sets for T2 and T3 without reference to a child’s previous codes. When all three authors agreed on a code, it was accepted without additional discussion; when any one author disagreed, a final decision was made after discussion. When all response sets were coded, each code was reviewed for consistent application of the definitions across time points and was re-coded as needed. In the end, the three authors agreed on all codes at all three time points.

Character Traits and Categories

The number and frequency of individual character traits were computed using R Statistical Programming Language, version 4.0.2 (R Core Team 2020). At each time point, we scored every individual trait in the coding framework (Table 2) as either endorsed (1) or not endorsed (0) for each child, with the latter indicating parental non-endorsement of a trait as a “best thing” about their child. The frequency of individual traits was also examined by estimating the percentage of children for whom each trait was endorsed. We then summed the number of traits endorsed for each child and calculated the overall mean and standard deviation for the number of endorsed traits at each time point.

Next, we examined aggregate trait endorsement within each of the character categories (e.g., Wisdom and Knowledge, Courage, Humanity; see Table 2). Because parents could endorse multiple traits within a category (i.e., a child could be endorsed for both love/intimacy and also for kindness within the Humanity category) a category was scored as endorsed if any individual trait within that category was endorsed for a child within that time point. Finally, McNemar chi-square tests were calculated to examine the stability of within-child category endorsements over time, using the R stats package (R Core Team 2019). Specifically, we analyzed the level of agreement between parents’ endorsement of a category at T1 and T2, T2 and T3, and T1 and T3.

Analysis of Missingness

We conducted multivariable regression analyses to determine whether autism symptom severity (ADOS CSS), parental depression scores (SCL-90-R), and/or SER were associated with non-completion of the “best things” section of the CBCL at each time point, with three groups: (a) parents who completed the both the quantitative section and the “best things” section, (b) parents who completed the quantitative section but not the “best things” section, and (c) parents at each time point who did not complete the CBCL. Within the (a) and (b) groups, we also examined the rate of missingness in completion of the “best things” section of the CBCL relative to completion of the “concerns” section, to determine whether completion of the former was skewed in favour of parents who reported fewer concerns. At all three time points, neither autism symptom severity (ADOS CSS) nor parental depression scores (SCL-90-R) was significantly associated with non-completion of the “best things” section of the CBCL, both for Pathways parents who completed the quantitative section alone and for those who did not complete the CBCL at all (p > 0.40 for all analyses). However, socio-economic risk was significantly associated with group differences in non-completion of the entire CBCL only: T1: p < 0.0003, adjusted R2 = 0.04; T2: p = 0.014, adjusted R2 = 0.02; T3: p < 0.0003, adjusted R2 = 0.04. Taken together, these analyses suggest that the sample was not skewed in favour of parents who were less depressed nor those who were less concerned about their child or had children with less severe autism symptoms. However, it did favour parents who were at lower socio-economic risk.

Category Predictors

In exploratory analyses, we conducted a series of logistic regression models used the R stats package in order to examine whether autism symptom severity and/or CBCL behavior problems total score were associated with category endorsement at each time point. We set an a priori threshold of  > 10% endorsement using the within-time-point ADOS CSS and the CBCL total score. Because there were very few girls in the sample (n = 24), we were unable to include sex as either a covariate or predictor. However, we examined the frequency of both categories and traits with stratification by sex assigned at birth (male, female; Cost et al. 2020) using the R tidyverse package (Wickham et al. 2019) and base R.

Results

Traits and Categories

Parental responses ranged from 1 to 50 words in length, with means of 16 words at T1 (SD = 11.8), 13 words at T2 (SD = 9.6), and 12 words at T3 (SD = 10.8). Parents endorsed a mean of 3.54 traits (SD = 1.58) per child at T1, a mean of 3.38 traits (SD = 1.53) at T2, and a mean of 3.19 traits (SD = 1.59) at T3. Ninety-eight percent of parents completed both the “concerns” and “best things” sections of the CBCL at T1, and 93.8% completed both sections at T2 and T3. At T1, the four most prevalent traits endorsed were love (68.6%), happiness (51.6%), kindness (28.1%), and humor (26.8%). The pattern was similar at T2, when parents most frequently endorsed love (52.7%), happiness (38.4%), kindness (34.8%), and intelligence (28.6%). The pattern persisted at T3, when the four most prevalent traits were kindness (45.7%), love (43.4%), humor (35.7%), and happiness (31.0%). Traits that were endorsed by 0–1% of parents at all three time points included perspective (Wisdom and Knowledge); teamwork and leadership (Justice); forgiveness/mercy, humility/modesty, and prudence (Temperance); and appreciation of beauty, gratitude, hope, and spirituality (Transcendence). With regard to endorsement by category, consistency over time was also considerable. At all time-points, the largest proportion of endorsements (70.5–78.4%) was in the Humanity category and the second largest proportion (31.0–51.6%) was in the Happiness category. Table 3 and Fig. 1 summarize these results.

Table 3 Number and frequency of endorsed traits by category over three time points
Fig. 1
figure1

Percent of children endorsed for a trait at Time 1, Time 2, and Time 3, by category. Traits with zero endorsements at all three time points are not included

Finally, regarding within-child stability of category endorsements over time, some cell sizes were too small to support McNemar Chi-square analyses. However, when cell sizes were adequate, endorsement was stable across three out of nine categories from T1 to T2; two out of nine categories from T2 to T3; and three out of nine categories from T1 to T3. The categories of Wisdom and Knowledge, Happiness, and Interests were each stable across two of three comparisons. Table 4 summarizes these results.

Table 4 Within-child stability of category endorsement across time points (McNemar χ2)

Variables Associated with Category Endorsement

We ran 26 logistic regressions, one for each category with sufficient endorsement at each of the three time points. Because these analyses were exploratory, and as we were not adequately powered for multiple predictors and did not correct for multiple testing, we report odds ratios and associated 95% CIs. At both T1 and T2, higher CBCL total scores (indicating more externalizing and internalizing behavior) were associated with decreased likelihood of being endorsed for Humanity traits (T1 OR = 0.96, 95% CI = 0.92–1.00, p = 0.045; T2 OR = 0.93, 95% CI = 0.88–0.98, p = 0.01). At T2, higher ADOS CSS scores were associated with increased likelihood of being endorsed for Specific Skills (OR = 1.87, 95% CI = 1.35–2.73, p < 0.001). Neither CBCL total scores nor ADOS CSS scores were associated with any category endorsement at T3.

Regarding sex assigned at birth, most categories were equally prevalent (i.e., < 10% difference) in males (m) and females (f), with a few exceptions. Two categories favoured girls: Specific Skills at T2 (25%f and 11.6%m) and Courage at T3 (33.3%f and 18.6%m). Four categories favoured boys: Wisdom and Knowledge at T1 (34.9%m and 16.7%f), Humanity at T1 (82.9%m and 54.2%f), Happiness at T1 (54.3%m and 37.5%f), and Temperance at T3 (18.6%m and 4.6%f). Categories and specific traits with > 10% difference between boys and girls are summarized in Supplementary Table 1.

Discussion

Love. Happiness. Kindness. Humor. Most likely, these are not words that readily come to mind for most people when they think about individuals with ASD. Yet, these were among the traits that parents mentioned most often when describing their children with autism during the preschool years, early school years, and up to age 11. They are also similar to the traits identified most often in previous ASD studies with parent or sibling informants. For example, in Sabapathy et al. (2017), parents described their children with ASD as “loving/caring/affectionate” and “happy/having zest for life.” In Carter et al. (2020), kindness, caring for others, and having a sense of humor were the top three descriptions used by siblings of individuals with ASD; and in Carter et al. (2015), youth with ASD were described by their parents as kind and loving, among other attributes.

On average, across all three time points, parents mentioned three traits in response to the “best things” item on the CBCL. This is the same number of traits provided by 680 parents of neurotypical children in the same age range (Park and Peterson 2006a). In addition, three of the four traits endorsed in this study – love, kindness, and humor – are among the top four traits reported by Park and Peterson. The exception – happiness – is not included in the VIA taxonomy, as it is usually considered to be synonymous with subjective well-being or life satisfaction, constructs that reflect the cumulative impact of both intra- and interpersonal environmental variables on an individual (Park 2004). However, parents who used this word to describe a “best thing” most likely did so with reference to their child’s affect and general mood, rather than as a comment on their overall well-being or life satisfaction. For example, in addition to various comments that included the word “happy” (e.g., “very happy,” “always wakes up happy”) descriptors that were coded for this trait included “always in a good mood,” “smiles a lot,” and “cheerful.” Thus, we included Happiness as a separate category in the current coding scheme to reflect parents’ perceptions of this as a positive affective characteristic in their child.

Several of the least endorsed traits in this study are also congruent with those reported by Park and Peterson (2006a). Traits endorsed by 0–1% of Pathways parents at all three time points and by  < 20% of parents in the reference study included gratitude, humility/modesty, forgiveness/mercy, hope, appreciation of beauty and excellence, and perspective. Because all of these traits require some level of cognitive and/or social maturation, it is perhaps not surprising that they were less likely to be endorsed in children aged 3 to 11 in both studies. Similarly, traits such as open-mindedness, love of learning, fairness, and authenticity – four of the most frequently identified traits in two self-report studies of adults both with and without ASD (Kirchner et al. 2016; Samson and Antonelli 2013) – were rarely endorsed at any time point for the children in the present study.

The developmental nature of trait endorsement is also suggested in the results presented in Table 3. For example, 32% of parents endorsed the Wisdom/Knowledge category at T1 (when children were preschoolers), while 45.5% endorsed this category at T2 (after the children had entered school). It is likely that traits in this category – in particular, creativity and curiosity – became more evident to parents as children matured and were exposed to educational contexts that elicited them. Similarly, parents increasingly endorsed traits in the Courage category from T1 (15.7%) to T2 (21.4%) to T3 (24.8%), perhaps because they increasingly recognized traits in this category, especially perseverance, as their children encountered the social and academic challenges of school. In contrast, the Interests and Specific Skills categories saw a decrease over time, suggesting that, as children matured, their parents were less focused on children’s interests (e.g., enjoyment of dancing, music, sports) and special talents (e.g., exceptional memory) as a “best thing” and were more focused on character traits.

The results of Table 4 offer a different perspective than those in Table 3. Whereas Table 3 presents the between-child frequency of endorsements across categories (and traits) at each time point, Table 4 presents the results of McNemar chi-square analyses of within-child category endorsements. Specifically, we examined the extent to which parental descriptions of a child’s “best things” remained stable and/or evolved over time, within categories. Wisdom and Knowledge traits were stable from T1-T2 (M ages 3.4 to 7.8) and T2-T3 (M ages 7.8 to 10.6) but not from T1-T3 (M ages 3.4 to 10.6). This suggests that parents’ perceptions of the predominant traits in this category – intelligence, curiosity, and creativity – evolved over time as their children aged and were exposed to different experiences that might have been available to them in school. In contrast, Happiness, one of the four most highly endorsed traits by parents in this study, was stable from all time periods except T2-T3; the same pattern was seen for Interests (i.e., active/sports or passive/arts-based activities that the child enjoys). In the T2-T3 time period, most children begin to spend more time away from their family and more time in school and other activities. As they experience more of the world around them, children also begin to develop their own identities, become increasingly independent, and develop foundational skills for building healthy social relationships. Thus, during this time period, children may be exploring new interests and activities (e.g., taking piano or dance lessons, learning to play a new sport) and may be experiencing novel stressors that affect their overall happiness or their parents’ perceptions thereof.

It is also interesting to note that parents who endorsed Happiness and Interest traits during the time of preschool and early school entry (T1-T2) endorsed them again when their children were older (T1-T3), despite the fact that the developmental experiences and societal expectations of 3-year-olds are very different than those of 10-year-olds. This occurred for humour as well, the primary trait in the Transcendence category which was also stable from T1-T3. Such longitudinal stability suggests that traits such as happiness and humour may be related to temperament, which is shaped by genetic predispositions and environmental input and remains relatively stable within individuals across the lifespan (Lee et al. 2020; Rothbart and Posner 2006). Lee et al. (2020) empirically classified children with ASD in the Pathways cohort into “even” and “reactive” temperament profiles and hypothesized that children with an even temperament (i.e., those who are more focused and easily soothed) might experience a higher frequency and duration of positive engagements with caregivers. If this is the case, character traits such as happiness and (good) humour might be outward manifestations of an even temperament.

In exploratory analyses, we examined autism symptom severity and total problem behavior scores as potential predictors of category endorsements in a logistic regression. At T1 and T2, children who had higher scores for problem behavior were less likely to be endorsed for Humanity traits. This suggests that parents whose children regularly engage in high levels of challenging behavior might be less likely to ascribe positive Humanity traits such as kindness, love, social intelligence, and friendliness to them. In addition, children with more severe autism symptoms at T2 were more likely to be endorsed for Specific Skills. Parents might have mentioned such skills – which included memory, gross motor, and a wide range of “academic” and early learning abilities – to acknowledge that, despite severe autism, their children also had these strengths.

Using a criterion of  > 10% difference between assigned sex, a higher proportion of males was endorsed at one or two time points for Wisdom and Knowledge traits (especially creativity), Humanity traits (especially kindness and love), Temperance traits (especially self-regulation), and Happiness. In contrast, a higher proportion of females was endorsed at one time point for Courage traits (especially perseverance) and for Specific Skills. Few studies have examined assigned sex differences among traits and none have done so in child samples, so it is not possible to compare these results to previous work. Furthermore, cultural norms are known to affect such ratings, as are prior expectations when parents act as informants (Shoshani and Shwartz 2018). So, for example, parents who mentioned kindness, love, and self-regulation in their sons might have done so because they did not expect boys to show these traits in light of an ASD diagnosis; the same could be said of perseverance for daughters. Conversely, there is no reason to suspect that parents did not simply describe their children as they saw them, regardless of assigned sex and diagnosis.

Strengths and Limitations

A primary strength of this study was in the care that was taken to examine some of the factors that might limit generality to the present sample. We included data only from Pathways parents who responded to the CBCL “best things” request at a minimum of two of three time points, which resulted in a relatively small sample of 153 families. However, we analyzed data missingness in detail, to determine whether the sample was skewed in favor of Pathways parents whose children had less severe autism symptoms and/or behavioral concerns or who themselves had fewer depressive symptoms and/or experienced less socio-economic risk (SER). Results indicated that only the latter was the case; parents at lower levels of SER were more likely to complete the “best things” section of the CBCL from which the data were coded. This suggests that there was not a halo effect related to autism symptom severity, child problem behavior severity, or parental depression, and that the results can be generalized to the larger sample of 402 low-SER parents who in the Pathways inception cohort across five Canadian provinces.

We also acknowledge several limitations to the results. First, the results reflect parental perceptions of their children rather than children’s perceptions of their own strengths, which might be quite different (see De et al. 2005). Second, because of the small sample, we were unable to assess within-child category stability in some categories over time. Third, except for comparisons with the findings of Park and Peterson (2006a), we were unable to compare our results with those of neurotypical children in the same age range. Finally, we examined sex assigned at birth in an exploratory analysis because of the small number of girls in the sample (Supplemental Table 1); thus, caution should be used when interpreting these results. Furthermore, child gender was determined at T1 by the clinician based on the pronouns used by parent(s) to refer to their child; however, we recognise that gender identity is an evolving area of study, particularly in individuals with ASD (Kallitsounaki and Williams 2020).

Future Research

Additional research is needed to clarify the character straits endorsed by parents of children with ASD who are at high socio-economic risk. Future research is also needed to explore longitudinal stability in a more robust fashion, using larger sample sizes. It would also be useful to identify associations between traits/categories and additional variables such as school adjustment (Shoshani and Aviv 2012; Shoshani and Slone 2013), school functioning (Zaidman-Zait et al. 2020), and peer relationships and friendships (Wagner 2019). Finally, as discussed previously, research is also needed to explore relationships between character traits/categories and temperament profiles, sex assigned at birth, and child gender.

Implications for Practice

A diagnosis of ASD requires identification of a child’s “persistent deficits” and “clinically significant symptoms” in two domains (American Psychiatric Association 2013). Hence, at the time of parents’ first experience with ASD, they encounter a deficit-oriented framework that is aimed at identifying traits that their child does not have and behaviors that their child is lacking. Following diagnosis, they enter an early intervention system that seeks to further assess their child’s skill deficits in order to develop a plan for remediation. Rarely are parents formally asked by professionals to identify their child’s strengths and positive character traits, either during the early childhood period or as their child with ASD enters school. This occurs despite the fact that, as Rashid et al. (2013) noted, “Good character is what parents look for in their children, what teachers look for in their students, what siblings look for in their brothers and sisters, and what friends look for in their peers… Good character is not simply the absence of deficits, problems, and pathology but rather a well-developed cluster of positive personality traits” (p. 87).

Research on the positive character traits of individuals with ASD is congruent with both a contemporary neurodiversity perspective that emphasizes strengths, resilience, and lived experiences (Kapp et al. 2013; Szatmari et al. 2016; Tesfaye et al. 2019) and a strength-based approach to assessment and intervention (Cosden et al. 2006). Cosden and colleagues described several ways that a strength-based approach can contribute to educational planning. First, such an approach can assist in the development of intervention plans that capitalize on a child’s strengths and motivations. Second, by placing an emphasis on the positive aspects of a child’s personality, the outcomes of a strength-based approach may change the attitudes of both parents and educators and result in the development of more fruitful working relationships (Steiner 2011). Third, a strength-based approach encourages educators and other interventionists to establish goals that go beyond “fixing” a child’s deficits to include those aimed at improving overall quality of life. Finally, and perhaps most importantly, a focus on the strengths of children with ASD by parents and professionals may have a lasting impact on children’s self-esteem, developmental health, and resilience (Szatmari et al. 2016).

Conclusion

This study adds to the growing body of research in this area by examining parental perspectives of the “best things” about their children with ASD from early childhood to age 11. On average, parents identified three “best things,” irrespective of children’s autism symptom severity and/or externalizing and internalizing behavioral challenges. They recognized traits such as love, kindness, happiness, and humor in their children regardless of age, while also recognizing traits such as perseverance increasingly as their children matured and entered school. What was perhaps most striking was the tone of many of the parental responses to the “best things” request, with many parents offering comments such as “a bundle of joy and a ball of energy,” “[a best thing is] his mind and heart,” “a true gift in my life,” and “he has a super great heart!” One gets the impression that, for the most part, these parents did not have to think hard in order to identify positive traits in their children; rather, they readily recognized these assets and were both proud of and eager to share them. Their comments are a reminder of the importance of looking past diagnostic labels, test scores, and behavioral challenges to focus on individual strengths, toward the goal of supporting people with ASD to live the lives that they define as both meaningful and fulfilling.

Change history

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KTC, AZ-Z, and PM conceived of the study and its design, coded all of the data, and participated in the design and interpretation of the data. KTC and AZ-Z performed the statistical analyses. PM drafted the manuscript and acted as corresponding author during the review process. PS coordinated the larger study from which the data were drawn. ED, LZ, IMS, WJU, CK, TB, PS, SG, CW, ME, and TV provided oversight for data collection, participated in interpretation of the data, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Katherine T. Cost or Pat Mirenda.

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Cost, K.T., Zaidman-Zait, A., Mirenda, P. et al.Best Things”: Parents Describe Their Children with Autism Spectrum Disorder Over Time. J Autism Dev Disord 51, 4560–4574 (2021). https://doi.org/10.1007/s10803-021-04890-4

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Keywords

  • Autism spectrum disorder
  • Children
  • Character traits
  • Strengths
  • Positive psychology