Abstract
Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.
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References
Abbeduto, L., Seltzer, M. M., Shattuck, P., Krauss, M. W., Orsmond, G., & Murphy, M. M. (2004). Psychological well-being and co** in mothers of youths with autism, Down syndrome, or fragile X syndrome. American Journal on Mental Retardation, 109(3), 237–254
Aubé, B., Follenfant, A., Goudeau, S., & Derguy, C. (2021). Public stigma of autism spectrum disorder at school: Implicit attitudes matter. Journal of Autism and Developmental Disorders, 51(5), 1584–1597
Arzeen, N., Irshad, E., Arzeen, S., & Shah, S. M. (2020). Stress, depression, anxiety, and co** strategies of parents of intellectually disabled and non-disabled children. Journal of Medical Sciences, 28(4), 380–383
Bader, S. H., & Barry, T. D. (2014). A longitudinal examination of the relation between parental expressed emotion and externalizing behaviors in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(11), 2820–2831
Bader, S. H., Barry, T. D., & Hann, J. A. (2015). The relation between parental expressed emotion and externalizing behaviors in children and adolescents with an autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 30(1), 23–34
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., & Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2014. Centers for Disease Control Morbidity and Mortality Weekly Report Surveillance Summaries, 67(6), 1–23
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(2), 551–561
Bourke-Taylor, H. M., Joyce, K. S., Grzegorczyn, S., & Tirlea, L. (2021). Mental health and health behaviour changes for mothers of children with a disability: Effectiveness of a health and wellbeing workshop.Journal of Autism and Developmental Disorders,1–14
Carr, T., & Lord, C. (2013). Longitudinal study of perceived negative impact in African American and Caucasian mothers of children with autism spectrum disorder. Autism, 17(4), 405–417
Chan, K. K. S., & Lam, C. B. (2018). Self-stigma among parents of children with autism spectrum disorder. Research in Autism Spectrum Disorders, 48, 44–52
Chan, K. K. S., Yip, C. C. H., & Leung, D. C. K. (2022). Longitudinal impact of self-stigma content and process on parental warmth and hostility among parents of children with autism spectrum disorder.Journal of Autism and Developmental Disorders,1–9(e-publication ahead of print).
Cheung, R. Y., Leung, S. S., & Mak, W. W. (2019). Role of mindful parenting, affiliate stigma, and parents’ well-being in the behavioral adjustment of children with autism spectrum disorder: Testing parenting stress as a mediator. Mindfulness, 10, 2352–2362
Chien, W. T., Yeung, F. K., & Chan, A. H. (2014). Perceived stigma of patients with severe mental illness in Hong Kong: Relationships with patients’ psychosocial conditions and attitudes of family caregivers and health professionals. Administration and Policy in Mental Health and Mental Health Services Research, 41, 237–251
Chu, S. Y., Park, H., Lee, J., Shaharuddin, K. K. B., & Gan, C. H. (2020). Self-stigma and its associations with stress and quality of life among Malaysian parents of children with autism. Child: Care Health and Development, 46(4), 485–494
Cotton, S. M., McCann, T. V., Gleeson, J. F., Crisp, K., Murphy, B. P., & Lubman, D. I. (2013). Co** strategies in careers of young people with a first episode of psychosis. Schizophrenia Research, 146(1–3), 118–124
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70
Corrigan, P. W., & Miller, F. E. (2004). Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. Journal of Mental Health, 13(6), 537–548
Delvecchio, E., Di Riso, D., Chessa, D., Salcuni, S., Mazzeschi, C., & Laghezza, L. (2014). Expressed emotion, parental stress, and family dysfunction among parents of nonclinical Italian children. Journal of Child and Family Studies, 23(6), 989–999
Falk, N. H., Norris, K., & Quinn, M. G. (2014). The factors predicting stress, anxiety and depression in the parents of children with autism. Journal of Autism and Developmental Disorders, 44(12), 3185–3203
Feinberg, M. E., Solmeyer, A. R., & McHale, S. M. (2012). The third rail of family systems: Sibling relationships, mental and behavioral health, and preventive intervention in childhood and adolescence. Clinical Child and Family Psychology Review, 15(1), 43–57
Georgiades, S., Tait, P. A., McNicholas, P. D., Duku, E., Zwaigenbaum, L., Smith, I. M., & Szatmari, P. (2022). Trajectories of symptom severity in children with autism: Variability and turning points through the transition to school. Journal of Autism and Developmental Disorders, 52(1), 392–401
Goddard, E., Macdonald, P., Sepulveda, A. R., Naumann, U., Landau, S., Schmidt, U., & Treasure, J. (2011). Cognitive interpersonal maintenance model of eating disorders: Intervention for careers. The British Journal of Psychiatry, 199(3), 225–231
Greenberg, J. S., Seltzer, M. M., Hong, J., & Orsmond, G. I. (2006). Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism. American Journal on Mental Retardation, 111(4), 229–249
Griffith, G. M., Hastings, R. P., Petalas, M. A., & Lloyd, T. J. (2015). Mothers’ expressed emotion towards children with autism spectrum disorder and their siblings. Journal of Intellectual Disability Research, 59(6), 580–587
Hale, W. W., Crocetti, E., Nelemans, S. A., Branje, S. J., van Lier, P. A., Koot, H. M., & Meeus, W. H. (2016). Mother and adolescent expressed emotion and adolescent internalizing and externalizing symptom development: A six-year longitudinal study. European Child & Adolescent Psychiatry, 25(6), 615–624
Hartman, C. A., De Bildt, A., & Minderaa, R. B. (2013). CSBQ: Children’s Social Behavior Questionnaire. In F. R. Volkmar (Ed.), Encyclopedia of Autism Spectrum Disorders (829 vol., p. 825). New York: Springer
Hartman, C. A., Luteijn, E., Serra, M., & Minderaa, R. (2006). Refinement of the Children’s Social Behavior Questionnaire (CSBQ): An instrument that describes the diverse problems seen in milder forms of PDD. Journal of Autism and Developmental Disorders, 36(3), 325–342
Hastings, R. P., Kovshoff, H., Ward, N. J., Espinosa, D., Brown, F., T., & Remington, B. (2005). Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism. Journal of Autism and Developmental Disorders, 35(5), 635–644
Higgins, D. J., Bailey, S. R., & Pearce, J. C. (2005). Factors associated with functioning style and co** strategies of families with a child with an autism spectrum disorder. Autism, 9(2), 125–137
Jones, E. A., Fiani, T., Stewart, J. L., Neil, N., McHugh, S., & Fienup, D. M. (2020). Randomized controlled trial of a sibling support group: Mental health outcomes for siblings of children with autism. Autism, 24(6), 1468–1481
Jones, E. A., Fiani, T., Stewart, J. L., Sheikh, R., Neil, N., & Fienup, D. M. (2019). When one sibling has autism: Adjustment and sibling relationship. Journal of Child and Family Studies, 28(5), 1272–1282
Kanter, J., Lamb, H. R., & Loeper, C. (1987). Expressed emotion in families: A critical review. Psychiatric Services, 38(4), 374–380
Lindsey, R. A., Saltness, S. R., Lau, A. F., & Barry, T. D. (2020). A longitudinal examination of interactions between autism symptom severity and parenting behaviors in predicting change in child behavior problems. Research in Autism Spectrum Disorders, 70, 1–12
Lovell, B., & Wetherell, M. A. (2016). The psychophysiological impact of childhood autism spectrum disorder on siblings. Research in Developmental Disabilities, 49–50, 226–234
Lovell, B., & Wetherell, M. A. (2019). Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study. Archives of Psychiatric Nursing, 33(5), 31–35
Lovell, B., & Wetherell, M. A. (2020). Exploring the moderating role of benefit finding on the relationship between child problematic behaviours and psychological distress in caregivers of children with ASD. Journal of Autism and Developmental Disorders, 50(2), 617–624
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343
Luteijn, E., Luteijn, F., Jackson, S., Volkmar, F., & Minderaa, R. (2000). The Children’s Social Behavior Questionnaire for milder variants of PDD problems: Evaluation of the psychometric characteristics. Journal of Autism and Developmental Disorders, 30(4), 317–330
Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., & Cogswell, M. E. (2018). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States. Centers for Disease Control Morbidity and Mortality Weekly Report Surveillance Summaries, 70(11),1–16
Mak, W. W. S., & Cheung, R. Y. M. (2008). Affiliate stigma among caregivers of people with intellectual disability or mental illness. Journal of Applied Research in Intellectual Disabilities, 21(6), 532–545
Mak, W. W., & Kwok, Y. T. (2010). Internalization of stigma for parents of children with autism spectrum disorder in Hong Kong. Social Science & Medicine, 70(12), 2045–2051
Mazumder, R., & Thompson-Hodgetts, S. (2019). Stigmatization of children and adolescents with autism spectrum disorders and their families: A sco** study. Review Journal of Autism and Developmental Disorders, 6(1), 96–107
McCann, T. V., Songprakun, W., & Stephenson, J. (2015). Effectiveness of guided self-help in decreasing expressed emotion in family caregivers of people diagnosed with depression in Thailand: A randomized controlled trial. Bmc Psychiatry, 15, 258
Mello, Rivard, M., Morin, D., Patel, S., & Morin, M. (2021). Symptom severity, internalized and externalized behavioral and emotional problems: Links with parenting stress in mothers of children recently diagnosed with autism. Journal of Autism and Developmental Disorders, 52(6), 2400–2413
Mikami, A. Y., Chong, G. K., Saporito, J. M., & Na, J. J. (2015). Implications of parental affiliate stigma in families of children with ADHD. Journal of Clinical Child and Adolescent Psychology, 44(4), 595–603
Mohammadi, M., & Zarafshan, H. (2014). Family function, parenting style and broader autism phenotype as predicting factors of psychological adjustment in typically develo** siblings of children with autism spectrum disorders. Iranian Journal of Psychiatry, 9(2), 55–63
Muralidharan, A., Kotwicki, R. J., Cowperthwait, C., & Craighead, W. E. (2015). Parental relationships and behavioral approach system dysregulation in young adults with bipolar disorder. Journal of Clinical Psychology, 71(4), 387–401
Noordhof, A., Krueger, R. F., Ormel, J., Oldehinkel, A. J., & Hartman, C. A. (2015). Integrating autism-related symptoms into the dimensional internalizing and externalizing model of psychopathology. The TRAILS Study. Journal of Abnormal Child Psychology, 43(3), 577–587
Parkitny, L., & McAuley, J. (2010). The depression anxiety stress scale (DASS). Journal of Physiotherapy, 56(3), 204
Phillips, M. R., Pearson, V., Li, F., Xu, M., & Yang, L. (2002). Stigma and expressed emotion: A study of people with schizophrenia and their family members in China. The British Journal of Psychiatry, 181, 488–493
Reynolds, C. R., & Kamphaus, R. W. (2015). Behavior assessment system for children, third edition. San Antonio, TX: Pearson
Rivard, M., Terroux, A., Parent-Boursier, C., & Mercier, C. (2014). Determinants of stress in parents of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(7), 1609–1620
Romero-Gonzalez, M., Chandler, S., & Simonoff, E. (2018). The relationship of parental expressed emotion to co-occurring psychopathology in individuals with autism spectrum disorder: A systematic review. Research in Developmental Disabilities, 72, 152–165
Salleh, N. S., Abdullah, K. L., Yoong, T. L., Jayanath, S., & Husain, M. (2020). Parents’ experiences of affiliate stigma when caring for a child with autism spectrum disorder (ASD): A meta-synthesis of qualitative studies. Journal of Pediatric Nursing, 55, 174–183
Samadi, S. A., & McConkey, R. (2014). The impact on Iranian mothers and fathers who have children with an autism spectrum disorder. Journal of Intellectual Disability Research, 58(3), 243–254
Selvakumar, N., & Panicker, A. S. (2020). Stress and co** styles in mothers of children with autism spectrum disorder. Indian Journal of Psychological Medicine, 42(3), 225–232
Shivers, C. M., Jackson, J. B., & McGregor, C. M. (2019). Functioning among typically develo** siblings of individuals with autism spectrum disorder: A meta-analysis. Clinical Child and Family Psychology Review, 22, 172–196
Tomeny, T. S., Barry, T. D., & Bader, S. H. (2012). Are typically-develo** siblings of children with an autism spectrum disorder at risk for behavioral, emotional, and social maladjustment? Research in Autism Spectrum Disorders, 6(1), 508–518
Tomeny, T. S., Baker, L. K., Barry, T. D., Eldred, S. W., & Rankin, J. A. (2016). Emotional and behavioral functioning of typically-develo** sisters of children with autism spectrum disorder: The roles of ASD severity, parental stress, and marital status. Research in Autism Spectrum Disorders, 32, 130–142
Torbet, S., Proeve, M., & Roberts, R. M. (2019). Self-compassion: A protective factor for parents of children with autism spectrum disorder. Mindfulness, 10, 2492–2506
Tudor, M. E., Rankin, J., & Lerner, M. D. (2018). A model of family and child functioning in siblings of youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(4), 1210–1227
de Weisman, A., Weintraub, M. J., Maura, J., Martinez de Andino, A., & Brown, C. A. (2018). Stigma, expressed emotion, and quality of life in caregivers of individuals with dementia. Family Process, 57(3), 694–706
Werner, S., & Shulman, C. (2013). Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables. Research in Developmental Disabilities, 34(11), 4103–4114
Werner, S., & Shulman, C. (2015). Does type of disability make a difference in affiliate stigma among family caregivers of individuals with autism, intellectual disability or physical disability? Journal of Intellectual Disability Research, 59(3), 272–283
Wiedemann, G., Rayki, O., Feinstein, E., & Hahlweg, K. (2002). The Family Questionnaire: Development and validation of a new self-report scale for assessing expressed emotion.Psychiatry Research, 109(3),265–279
Zhou, T., Wang, Y., & Yi, C. (2018). Affiliate stigma and depression in caregivers of children with Autism Spectrum Disorders in China: Effects of self-esteem, shame and family functioning. Psychiatry Research, 264, 260–265
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Funding for this study was supported by the Anthony Marchionne Foundation for the Scientific Study of Human Relations and Psychological Processes Endowed Graduate Summer Research Program at Washington State University to the third author.
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Brinkman, A.H., Barry, T.D. & Lindsey, R.A. The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-develo** Sibling Internalizing Behavior in Families with a Child with ASD. J Autism Dev Disord 53, 4591–4603 (2023). https://doi.org/10.1007/s10803-022-05760-3
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DOI: https://doi.org/10.1007/s10803-022-05760-3