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Neighborhoods, Family Functioning, and Mothers’ Mental Health for Families with a Child with an Autism Spectrum Disorder

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Abstract

Mothers of children with autism spectrum disorders (ASD) typically report lower overall family functioning and worse mental health. Neighborhood conditions are found to positively influence family functioning and mental health in the general population. Employing a process-person-context model, this study extends these literatures to examine whether various neighborhood conditions – both positive and negative – affect mothers’ mental health and the overall functioning of families with a child with an ASD. Simultaneous equation path analysis of a nationally representative sample of children in the US finds neighborhood support to be positively and significantly associated with mothers’ mental health and the overall functioning of families with a child with an ASD. However, neighborhood amenities and neighborhood deficiencies were not significantly associated with either mothers’ mental health or family functioning. Neighborhood support can play a vital role in improved subjective quality of life for mothers with a child on the autism spectrum.

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Notes

  1. The lower response rate for the 2011/2012 wave of the NSCH was primarily due to the inclusion of cell-phone interviews which “provided better coverage of the population of children at the expense of lower response rates” (Blumberg et al. 2013:10). The lower response rates for the cell-phone interviews were due to higher non-resolution rates for those interviews. Also, there is a higher risk of uncorrected coverage bias in the 2007 NSCH due to the lack of use of cell phones when collecting that sample. See Blumberg et al. 2013 for more information on response rates and analysis of nonresponse for the 2011/2012 NSCH.

  2. It is important to note that the NSCH relies on the parent/guardian reporting whether their child has ever been diagnosed with an autism spectrum disorder. It does not verify each child’s diagnosis with medical professionals. As will be discussed later, the rates of the disorders found in the 2007 and 2011/2012 waves of the NSCH using parental reporting of diagnoses are found to be reliable compared to studies that utilize clinical validation (Kogan et al. 2009).

  3. Concerning ASD specifically, diagnosis at age 2 or later is shown to be reliable, valid, and stable (Lord et al. 2006). Furthermore, research shows parents of children with ASD notice a developmental problem before the child’s first birthday, with some differences in communication, social, and fine motor skills evident at 6 months (Bolton et al. 2012; Kozlowski et al. 2011). By limiting the sample to those children aged 2 to 17, the NSCH increases the probability that parents have noticed signs of ASD and sought out professional help.

  4. It is important to note that both waves of the National Survey of Children’s Health (NSCH) utilize a complex sampling design. Creating subsamples using listwise deletion for surveys that employ a complex sampling design can be problematic and thus subpopulation analysis is generally discouraged. However, as Bell et al. (2009) show, there is little to no difference in the standard errors generated using listwise deletion and subpopulation techniques on surveys with complex sampling designs. They conclude that it is reasonable to perform analyses on subgroups created using listwise deletion on a survey that utilized a complex sampling design.

  5. Ancillary analyses demonstrate that there are statistically significant differences in the ratings of the mother’s mental and emotional health depending on whether the mother answered about herself or a father or other relative answered about the mother. Respondents who were not the mother consistently rated the mother as having a higher mental and emotional health than mothers rated themselves. Results available upon request.

  6. The score for mental/emotional health for mothers with a child with an ASD is 10 % lower than mothers who do not have a child with an ASD (3.58/3.99 = 0.897; 1–0.897 = 0.103; 0.103 × 100 = 10.3 %).

  7. Families of children with an ASD report a score of −3.02; families without a child with an ASD report a score of −0.04. The mean value for family functioning in the overall sample is 0 and ranges from −15 to 4. See the Data section for more on this particular measure.

  8. The perceived neighborhood support scores for mothers of children with an ASD are 18 % lower than for mothers without a child with an ASD (1.99/2.43 = 0.819; .1–.0819 = 0.181; 0.181 × 100 = 18.1 %).

  9. Zhao et al. (2010) provide a corrective to Baron and Kenny (1986) much-cited procedure for establishing mediation. In their decision tree for establishing and understanding types of mediation and nonmediation, complementary mediation exists when a significant indirect effect (X → M → Y) and a significant direct effect (X → Y) are both present and are of the same sign. Zhao and colleagues argue that the persistence of a direct effect signals the possibility of an omitted mediator which serves to further the advancement of the theoretical framework. I return to this in the discussion section below.

  10. Following Zhao et al. (2010), the relationship between neighborhood threats and neighborhood resources, family functioning, and mothers’ mental and emotional health can be classified as no-effect non mediation. The implications of this finding are discussed further in the discussion section below.

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Acknowledgments

The author would like to thank the editor and the anonymous reviewers for their constructive feedback on an earlier version of this manuscript. Any errors or omissions remain the author’s alone. Special thanks as well to Kelly, Joel, and Theodore Whitehead for embodying hope and strength in the face of countless obstacles.

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  1. Department of Sociology & Anthropology, Clemson University, 132 Brackett Hall, Clemson, SC, 29634, USA

    Andrew L. Whitehead

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Whitehead, A.L. Neighborhoods, Family Functioning, and Mothers’ Mental Health for Families with a Child with an Autism Spectrum Disorder. Applied Research Quality Life 12, 633–651 (2017). https://doi.org/10.1007/s11482-016-9480-9

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