Depression, Anxiety, Stress, and Coping Mechanisms among Parents of Children with Autism Spectrum Disorder

ABSTRACT

The purpose of the present study was to determine the level of stress, anxiety, and depression among Slovenian parents of children with autism spectrum disorder and their coping mechanisms. The study included 42 parents of children with ASD who were enrolled at a specialised clinic for children with hearing and speech difficulties. We used the Depression Anxiety Stress Scales (DASS), the Coping Orientation to Problems Experienced (COPE) inventory, and a demographic questionnaire which included questions on satisfaction with life and social support received. The respondents reported no clinically elevated levels of stress, depression or anxiety. However, the mothers reported more stress and anxiety related symptoms then did the fathers. The results showed that coping strategies of positive reinterpretation and growth were positively correlated to higher perceived social support and greater satisfaction with life, and were negatively correlated with depression and anxiety. Perceived social support was highly negatively correlated with anxiety. Strategies of acceptance were used significantly more often by individuals with a higher level of education.

KEYWORDS:

• Anxiety
• autism spectrum disorders
• coping mechanisms
• depression
• parents
• social support

Introduction

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is classified as a developmental neurological disorder. Since there are no reliable biomarkers, diagnosis is made on the basis of behaviour (Lord, Baird, & Veenstra-Vanderweele, 2018). The World Health Organization (2018) defined ASD as a permanent deficit in initiating and maintaining mutual social interaction and social communication, and a series of limited, repetitive, and inflexible behaviours and interests. Individual signs of ASD are usually present at an early age but may fully manifest later when social demands exceed an individual’s capacity. According to the International Classification of Diseases (ICD-11), deficits must be sufficiently serious to cause problems in a private, familial, social, educational, professional or other relevant area. They are a pervasive feature of individual activity that can be observed in all settings, but may differ according to the context. Children with ASD show a very high rate of comorbidity with other disorders, the most common being developmental retardation or intellectual disabilities and language and motoric problems (Lord, Elsabbagh, Baird, & Veenstra-Vanderweele, 2018). Attention deficit hyperactivity disorder (ADHD) is the most common comorbidity in individuals with ASD (28.2%). It has a significant impact on development and outcomes in individuals with average abilities or in those with intellectual disabilities (Lord et al., 2018).

Anxiety is common among those with ASD. It can include social anxiety, generalised anxiety, separation anxiety in young children, and phobias. Depression and anxiety are more commonly observed in verbally fluent individuals, and increase during adolescence in girls and, to a lesser extent, in boys (Lord et al., 2018). Hill et al. (2014) noted irritability and aggression as more common signs of ASD (25%) than other developmental disorders.

Epidemiological studies of ASD have presented a major challenge because the condition has been identified, defined, measured, and evaluated in different ways (Myers, Chavez, Hill, Zuckerman, & Fombonne, 2019). Myers et al. (2019) estimated that 69 in 10,000 children (or 1 in 145) have ASD. They believe that the recent upward trend in rates of prevalence cannot be directly attributed to an increase in the incidence of ASD. The increased possibility and availability of special education and new therapeutic methods, the availability of services, and an increased awareness of ASD on the part of health and medical professionals are also likely to influence the increase in rates of prevalence (Myers et al., 2019). The authors nevertheless pointed out that the possibility of an actual increase (incidence) of ASD has contributed to a trend of increasing prevalence as well, and therefore cannot be excluded on the basis of available data.

The cause of ASD is not yet fully known. However, it is understood to result from a combination of environmental and genetic influences. Studies of monosygotic (identical) twins indicate a 76% chance that both children will develop ASD, confirming a strong genetic basis/heritability and a significant contribution from environmental factors (Ronald & Hoekstra, 2011).

Mental Health of Parents of Children with Autism Spectrum Disorder

Raising a child with special needs, especially one with ASD, is stressful and demanding, and consequently affects the well-being of parents and the wider family. Parents of children with disabilities are at increased risk of developing depression and problems because of psychological distress (Olsson & Hwang, 2001). Higher levels of depression, stress, and anxiety have been consistently observed in parents of children with ASD (Baker, Seltzer, & Greenberg, 2011; Kuusikko-Gauffin et al., 2013), as well as overall reduced psychological well-being (Ekas, Lickenbrock, & Whitman, 2010). The probability of the occurrence of depression is further increased with the child’s age and if a family has more than one child with autism (Cohrs & Leslie, 2017). Olsson and Hwang (2001) reported that mothers of children with ASD experience higher levels of depression (they score higher on self-rated depression questionnaires) than mothers of children with intellectual disabilities but with no ASD. Fathers of children with ASD scored lower than mothers of children with intellectual disabilities with no ASD but higher than the control group. Single mothers of children with special needs were more vulnerable to developing severe depressive symptoms than mothers living with a partner. Taylor and Warren (2012) discovered depressive symptoms in 78.7% of mothers of children with ASD one week after they had received the diagnosis, and 37.3% continued to report symptoms of depression an average of 1.4 years later. This further supports the hypothesis that the increased challenges of parenthood and caregiving heighten the burden on parents/caregivers.

Studies by a number of authors (e.g. Beck, Daley, Hastings, & Stevenson, 2004; Benson, 2006) have found that children’s behavioural problems, rather than the severity of the disorder, contribute to the manifestation of maternal depressive and anxiety symptoms, and the lack of prosocial behaviour in children with ASD increases maternal stress levels. In the current literature, a link between children’s behavioural problems and negative parental psychological well-being has been established; however, few studies have focused on examining the mechanisms underlying this relationship (Rezendes & Scarpa, 2011). The same authors also found that maternal reporting of stress was influenced by the child’s primary diagnosis. Mothers of children diagnosed with autism reported higher levels of stress than mothers of children diagnosed with pervasive developmental but undetermined disorders. Higher levels of stress have been reported by older mothers as well, which may be influenced by the age of the child and increasing social and parental demands rather than the greater independence that might be expected in neurotypical development. The authors concluded that parental self-efficacy influences the strategies of coping with stress and guilt, an area that is addressed in the present study.

Gray and Holden (1992) reported that the older the child at diagnosis, the higher the level of depression in the parents. Parents of older children report higher levels of parental stress than parents of younger children (Holroyd, Brown, Wikler, & Simmons, 1975). Hastings et al. (2005) found significant gender differences in the reported rate of depression; mothers reported a statistically higher rate of depression than fathers. There were no significant differences between reported levels of stress. They concluded that the level of paternal stress was not so much related to the behavioural problems of children with ASD but was more strongly related to the partner’s level of depression. Few studies have focused on the stress and well-being of fathers of children with disabilities. Hartley, Seltzer, Head, and Abbeduto (2012) explored the psychological well-being of the fathers of adolescents and young adults with Down syndrome (DS), fragile X syndrome (FX) and autism. The fathers of adolescents and young adults with autism reported more depressive symptoms than the fathers of adolescents with DS and FX. Likewise, the fathers of adolescents with autism and FX syndrome were more pessimistic about their children’s futures than the fathers of young adults with DS.

Strategies for Coping with Stress among Parents of Children with ASD

Coping mechanisms are the tools that help to deal with stressful situations. One of the most widely cited definitions of coping is that of Folkman and Lazarus (1984). Coping encompasses cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person (Vernhet et al., 2019).

Two major strategies for coping with stress have been proposed in the literature: a problem-focused strategy, which includes stress-related activity, and an emotion-focused strategy, where individuals focus on managing emotional stress related to the problem (Vernhet et al., 2019). Lai and Oei (2014) discovered that parents of children with ASD used both adaptive (e.g. cognitive reframing and seeking social support) and maladaptive (e.g. avoidance and disengagement) coping strategies, with an inclination towards adaptive coping methods such as seeking social support and positive reinterpretation.

However, the results of research in this area have been inconsistent because of the wide scope and diverse methodologies of the studies. Vernhet et al. (2019) noted that parents of children with ASD used more avoidance strategies than parents of neurotypical children and adopted fewer social support-seeking strategies. Pisula and Domasiewicz (2010) came to a similar conclusion; the parents of children with autism used escape-avoidance strategies more often than those in the control group. On the other side, Wang, Michaels, and Day (2011) reported that the parents of children with autism were less likely to use behavioural disengagement, substances, and denial as coping strategies than parents of children with other types of severe disabilities. The parents of children with autism tended to use planning more as a coping strategy than did the parents of children with mental retardation.

The results of some studies (Cappe, Wolff, Bobet, & Adrien, 2011) have indicated that increased use of problem-focused strategies lowers stress levels, and the use of emotionally-focused strategies increases stress levels. Other research (Abbeduto et al., 2004; Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001) has shown that parents who use more emotion-focused strategies, such as withdrawing, running away or distancing themselves, report more depressive symptoms, feel more socially isolated, and experience more problems with their child. Problem-oriented or social support strategies are more effective in reducing the negative effects of stress on quality of life.

Dardas and Ahmad (2015) examined coping strategies as mediators and moderators between stress and quality of life among parents of children with ASD. The results showed that accepting responsibility proved to be the only mediator, and that seeking social support and withdrawal/avoidance were the moderating variables. Folkman and Lazarus (1988) defined taking responsibility as recognising parents’ contribution to the problem and trying to remedy the situation. When parents of children with autism take responsibility for their own life problems, they achieve a greater sense of control. They can then move more quickly towards recovery, rather than remaining in the past or blaming external factors for a given problem.

Summary of the Literature

The current literature is generally consistent in the conclusion that parents of children with ASD experience and report higher levels of stress, depression, and anxiety compared with the parents of neurotypical children. Their psychological well-being is lower and the risk of developing psychological problems is higher. However, findings on the use of coping strategies among parents are inconsistent. Some studies (Pisula & Domasiewicz, 2010; Vernhet et al., 2019) suggest that parents of children with ASD use avoidance strategies more, while others (Wang et al., 2011) state that the parents use planning more.

The purpose of the present study was to determine levels of stress, anxiety, and depression among Slovenian parents of children with ASD, and their coping mechanisms. We were also interested in correlations between all these variables and differences in terms of demographic characteristics.

Method

Participants

The study included 42 parents of children with ASD in kindergarten or in the first three years of primary school who were enrolled at a specialist and therapeutic clinic for children with hearing and speech difficulties or who were attending speech therapy at the same clinic. The mean age of the parents was 38 (SD = 6.52). Twenty-four were mothers and 17 were fathers. One participant choose not to answer this question. Table 1 reports the other demographic characteristics of the sample.

Table 1. Demographic information on parents of children with ASD.

Employment status	N	%
Part time employment – temporary	4	9.5
Full time employment – temporary	4	9.5
Full time employment	24	57.1
Part time employment	1	2.4
Self-employed	2	4.8
Unemployed	2	4.8
No answer	5	11.9
Level of education	N	%
Vocational school and high school	6	14.3
Bachelor’s degree	18	42.9
Master’s degree	14	33.3
PhD	2	4.8
No answer	2	4.8
Relationship status	N	%
Single	1	2.4
Married	18	42.9
Divorced	7	16.7
In a committed relationship	16	38.1

The mean age of the children was 6.29 (SD = 2.04). Boys were the majority (92.9%; N = 39) and there were only 3 girls (7.1%). Most families had one (45.2%) or two (42.9%) children, while a smaller proportion (11.9%) had three. More than half of the children with ASD were first-born (66.7%). Second-born comprised 21.4%, and 11.9% were third born. The prevalent diagnosis of the children was autism (36.6%), followed by a broader category of ASD (34.1%), and 7.1% had a diagnosis of Asperger syndrome. In the other category (9, 8%) we included other diagnostic categories such as PDD-NOS; 12.4% of the parents did not answer this question. Children with ASD have many other comorbidities that influence their behaviour, progress, and overall functioning, and these have a profound effect on the parents. They are presented in Table 2. Parents could choose multiple difficulties.

Table 2. Other difficulties amongst children with ASD.

Other difficulty	N	%
Attention and hyperactivity disorder	8	19
Speech and language difficulties	35	83.3
Behavioural problems	17	40.1
Intellectual disability	2	4,8
Digestive problems	5	11.9
Sensory issues	13	30.9
Other	1	2.4
No answer	4	9.5

Measures

The following self-report questionnaires were administered:

Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995)

This questionnaire consists of 42 items measuring symptoms of depression, anxiety, and stress. Each of the three scales consists of 14 statements. Participants must indicate on a 4-point scale (0 = not at all true of me, 3 = very true of me) the frequency of the symptoms in the previous week. The reliability for the individual scales using Cronbach’s alpha was: depression 0.954 (14 items); anxiety 0.896 (14 items); and stress 0.953 (14 items). Table 3 reports the limit values for the DASS.

Table 3. Limit values for individual subscale in DASS questionnaire.

Level/sublevel	Depression	Anxiety	Stress
Normal	0–9	0–7	0–14
Mild	10–13	8–9	15–18
Moderate	14–20	10–14	19–25
Difficult	21–27	15–19	26–33
Very difficult	28+	20+	34 +

Demographic Questionnaire

Sociodemographic data were collected using an author-developed structured questionnaire. The questionnaire comprised questions on the current age of the mother or father who was completing the questionnaire, their level of education and employment and partner status, the number of children in the family, the order, age, and gender of the child with ASD, the official diagnosis, and associated disorders. The parents rated their current satisfaction with life on a 10-point scale (1 = extremely negative, 10 = best possible) and satisfaction with social support on a 5-point scale (1 = very satisfied, 5 = very unsatisfied). Parents were also asked whether they had received any form of professional assistance in the past, whether they would do so they were given the opportunity, and what type of assistance would be the most appropriate (i.e. individual or group).

The Coping Orientation to Problems Experienced (COPE) inventory (Carver, Scheier, & Weintraub, 1989)

This questionnaire measures different ways of coping with stress, and consists of 15 subscales with 4 items: active coping, planning, suppression of competing activities, spontaneous response retention, search for instrumental social support, search for emotional social support, focus on emotion release, behavioural inactivity, mental inactivity, positive reinterpretation and growth, denial, acceptance, faith orientation, drug and substance abuse, and humour. Participants must indicate on a 4-point scale (1 = I don’t usually do this, 4 = I do this often) how often they use a particular way of coping with stress in their daily lives. Table 4 presents the individual internal reliability coefficients.

Table 4. Internal reliability coefficients on subscales of COPE questionnaire on a sample of parents of children with ASD.

COPE questionnaire scales	α-coefficient	N	No. of items
Religious coping	0.886	41	4
Use of emotional social support	0.853	41	4
Humour	0.809	41	4
Planning	0.803	41	4
Focus on and venting of emotions	0.775	40	4
Positive reinterpretation and growth	0.760	41	4
Suppression of competing activities	0.754	41	4
Use of instrumental social support	0.726	41	4
Acceptance	0.696	41	4
Denial	0.673	41	4
Substance use	0.570	41	4
Restraint	0.463	41	4
Active coping	0.367	41	4
Behavioural disengagement	0.293	41	4
Mental disengagement	0.113	41	4

The internal reliability coefficients for COPE subscales in our sample ranged between 0.57 and 0.87, which is comparable with the coefficients reported by the authors of the inventory. However, the scales of mental disengagement (α = 0.11), active coping (α = 0.37), behavioural disengagement (α = 0.30), and restraint (α = 0.46) were not reliable, and were excluded from further analysis.

Procedures

The questionnaires were given to the parents of the children with ASD by speech and language therapists, kindergarten teachers, and a school counsellor. The speech and language therapists handed them out at the regular speech therapy sessions, the kindergarten teachers at the morning reception, and the school counsellor at the half yearly evaluation meeting. The questionnaires were distributed to both mothers and fathers. They took them home, completed them, then brought them back. The data were collected across two months.

Results

Demographics

The basic demographic characteristics of the sample were described in the Method/ Participants section. The average parental satisfaction with life was 6.98 (SD = 2.04), where 1 was extremely negative and a score of 10 was the best possible.

Table 5 shows how parents evaluated their satisfaction with social support.

Table 5. Perceived level of social support of parents of children with ASD.

Levels of social support	N	%
1_Very satisfied, I have enough support	13	31
2_It’s alright, but I wouldn’t mind more support	14	33.3
3_In between – not bad, but I am not happy about it	9	21.4
4_Not satisfied, I have too little support	3	7.1
5_Very unsatisfied, I feel alone and without any support	1	2.4
No answer	2	4.8

Next, we wanted to know how many of the parents received any kind of professional help; 23.8% had professional help for themselves and 73.8% no professional help. One parent chose not to answer the question. Table 6 presents the results of the question concerning any past professional help and what type of help the parents would like to receive.

Table 6. Frequency of help received and preferred professional help.

Have you ever received any professional help for your mental health?	N	%
Yes	5	11.9
No	36	85.7
No answer	1	2.4
If you had a chance, would you enrol in some type of professional help?	N	%
Yes	23	54.8
No	16	38.1
No answer	3	7.1
If ‘yes’ what format of help would you prefer?	N	%
Individual	12	28.6
Group	13	31.0
Both	2	4.8
No answer	15	35.7

DASS and COPE

Table 7 shows the descriptive statistics for the COPE questionnaires. The results are ordered by the mean, from the highest (the most commonly used coping strategies) to the lowest (the least used).

Table 7. Descriptive statistics of COPE questionnaire.

COPE questionnaire	N	M	SD	Skew.	Kurt.
Planning	41	13.29	2.22	−0.24	−0.90
Active coping	41	12.07	1.54	−0.65	0.48
Positive reinterpretation and growth	41	11.93	2.61	−0.54	−0.15
Suppression of competing activities	41	10.71	2.87	−0.12	−0.91
Use of instrumental social support	41	10.46	2.74	0.53	0.05
Use of emotional social support	41	9.80	3.17	0.24	−0.48
Restraint	41	9.76	2.12	0.22	1.00
Acceptance	41	9.61	2.85	−0.17	−0.48
Focus on and venting of emotions	40	9.42	3.07	−0.005	−0.87
Humour	41	7.00	2.65	1.01	1.05
Mental disengagement	41	6.76	1.74	−0.02	−1.11
Behavioural disengagement	41	6.76	1.65	−0.11	−0.85
Religious coping	41	5.04	1.99	2.24	5.46
Denial	41	4.80	1.58	2.83	10.00
Substance use	41	4.51	1.22	3.00	9.94

Table 8 shows the descriptive statistics for the DASS questionnaires.

Table 8. Descriptive statistics of DASS questionnaire.

DASS questionnaire	N	M	SD	Skew.	Kurt.
Stress	40	10.07	8.44	0.92	0.2
Anxiety	40	4.32	5.96	1.97	3.61
Depression	40	6.22	8.18	1.53	2.14

Data on levels of depression, stress and anxiety in parents, and possible gender differences were analysed.

From Table 9 we can see that statistically significant differences occurred on the subscale of anxiety and stress. According to our sample, the mothers experienced significantly more anxiety symptoms and increased levels of stress compared to fathers.

Table 9. Results of the t-test for independent sample – comparison of scores on subscales of the DASS questionnaire with regard to gender.

	Mothers		Fathers
	M	SD	M	SD
Depression	8.09	7.54	3.94	8.78
Anxiety	6.09	6.90	2.06	3.34
Stress	12.64	8.93	7.24	6.87
	F	Sig.	T	df	Sig. (2-tailed)
Depression	0.32	0.58	1.58	37	0.123
Anxiety	5.10	0.03	2.42	33.69	0.021*
Stress	2.22	0.14	2.06	37	0.046*

Multivariate analysis of variance (MANOVA) was used to analyse whether differences in levels of stress, depression, and anxiety were affected by marital status, child diagnosis, and child age. We found no statistically significant differences. In addition, MANOVA was used to analyse differences in the use of coping mechanisms in parents with regard to the child’s age and diagnosis, their age, level of education or their relationship with a partner. No statistically significant differences in the use of different coping strategies were found, except in the use of acceptance strategy/coping mechanisms (p = 0.029) with regard to level of education. Individuals with higher education used acceptance strategies significantly more often. Data were further analysed to examine correlations between the use of individual coping strategies and stress, depression, and anxiety.

Table 10 shows a significant negative correlation between positive reinterpretation and growth and depression, anxiety, and stress, and a significant positive correlation between strategies focused on the release of emotions and levels of depression, anxiety, and stress. There was also a significant positive correlation between anxiety and faith orientation, and between stress and the strategy of suppression of competing activities.

Table 10. Individual correlation between coping strategies and levels of depression, anxiety, and stress.

	Depression	Anxiety	Stress
Depression	1
Anxiety	0,843**	1
Stress	0.766**	0.765**	1
Positive reinterpretation and growth	−0.536**	−0.321*	−0.290
Focus on and venting of emotions	0.681**	0.634**	0.754**
Use of instrumental social support	−0.208	−0.084	−0.248
Denial	0.104	0.027	0.074
Religious coping	0.217	0.372*	0.138
Humour	−0.262	−0.062	−0.044
Suppression of competing activities	0.313	0.311	0.412**
Use of emotional social support	0.011	0.238	0.020
Substance use	0.189	0.263	0.302
Acceptance	−0.003	0.020	0.014
Planning	−0.103	−0.061	0.055

*p < 0.05. **p < 0.01.

Table 11 shows the correlations between satisfaction with life, level of social support and the DASS.

Table 11. Correlations between self-reported satisfaction with life, perceived level of social support and DASS scales.

	Satisfaction with life	Level of social support
Depression	−0.706**	0.518**
Anxiety	−0.566**	0.457**
Stress	−0.602**	0.516**

**Correlation is significant at the 0.01 level.

As can be seen, all of the correlations between the DASS scales and satisfaction with life are negative and statistically significant. The lower the satisfaction with life, the higher the depressive and anxiety related symptoms and levels of stress. The results also show that all the DASS scales correlated statistically significantly and positively with perceived levels of social support (lower value on this scale means higher satisfaction with social support).

In Table 12 we present correlations between satisfaction with life, level of social support and COPE strategies.

Table 12. Correlations between self-reported satisfaction with life, perceived level of social support and COPE mechanisms.

	Satisfaction with life	Level of social support
Positive reinterpretation and growth	0.597**	−0.375*
Focus on and venting of emotions	−0.687**	0.406*
Use of instrumental social support	0.319*	−0.124
Denial	−0.084	0.245
Religious coping	−0.327*	0.169
Humour	0.243	−0.357
Suppression of competing activities	0.089	0.305
Use of emotional social support	−0.151	−0,143
Substance use	−0.137	0.026
Acceptance	0.015	−0.222
Planning	0.072	0.057

*Correlation is significant at the 0.05 level (2-tailed); **Correlation is significant at the 0.01 level (2-tailed).

We can see that positive reinterpretation and growth and focus on and venting of emotions are significantly related to perceived levels of social support. The parents who perceived higher social support used coping mechanisms oriented more towards positive reinterpretation and growth and the parents with lower levels of perceived social support more often used strategies such as focusing on and venting emotions. Satisfaction with life significantly and positively correlated with positive reinterpretation and growth and use of instrumental social support, and negatively with focus on and venting of emotions and religious coping.

Discussion

Contrary to our expectations and the results reported in the existing literature, the parents of children with ASD in our sample did not report increased levels of depression, anxiety or stress when compared with the cut-off values. A possible explanation for this could be that the children were already actively involved in some form of assistance/intervention, for example, speech and language therapy in kindergarten or a specialised program at a specialist therapeutic clinic. It was assumed that parents had to accept the child’s diagnosis or condition and, subsequently the appropriate form of intervention, before they enrolled them in kindergarten or in speech and language therapy. Of the children in our sample, 83.3% had a comorbid speech and language disorder. For the parents, knowing that a professional was systematically working with their child brought a certain sense of satisfaction and control, and an awareness that the early years, in which new skills are acquired, were not being wasted. The research suggests that behavioural issues in children with ASD are mostly responsible for higher levels of depression and anxiety related symptoms amongst the parents (Hastings et al., 2005). In our sample, 40% of the children were reported by the parents to have behavioural problems. Another important factor is the perceived level of social support. In our sample, the majority of parents (64.3%) reported that they received enough support and were satisfied with it, but that they would not object to more. Benson (2012) stated that social support has been identified as a potent protective factor against the stress experienced while raising a child with ASD, and a prevailing predictor of psychological adjustment. In the present study, one of the reasons why the levels of depression and stress were not higher might have been due to the lack of variety in the sample.

Stoeber and Janssen (2011) claimed that acceptance is one of the more effective mechanisms in coping with stress, and this is associated with increased life satisfaction. The gender analysis or comparison, i.e. between mothers and fathers, showed that mothers of children with ASD reported higher levels of stress and anxiety related symptoms than the fathers. This could be attributed to the higher rate of reporting in women or the lower stigma associated with mental illness among females. However, we are assuming that the children spend most of their time with their mothers, which means that the latter are more exposed to challenging behaviours and other issues related to the child’s diagnosis, and have less time for themselves and their psychological well-being. This is consistent with the findings of Falk, Norris, and Quinn (2014). The fathers in our sample rated their satisfaction with life a little higher than the mothers.

The data also showed a high and statistically significant correlation between depression, anxiety, stress, and self-rated satisfaction with life and perceived social support. Having a child with a lifelong disability disrupts many aspects of caregivers’ lives. Thus, social support seems an important factor that reduces anxiety, stress, and depression in parents of children with ASD.

Mechanisms of Coping with Stress

The results also showed that the parents who used more coping strategies centred on positive reinterpretation and growth experienced significantly less anxiety. This is in line with the findings of Cappe et al. (2011), who found that parents who used more problem-focused strategies perceived their experiences as challenges. In contrast, the use of strategies, which concentrate on emotions and their expression was statistically significantly associated with increased levels of depression, stress, and anxiety. Also Lai, Goh, Oei, and Sung (2015) found that parents of children with ASD were more likely to use less adapted and emotionally focused strategies than parents of neurotypical children. In our sample, increased levels of anxiety were also correlated with religious coping, which could be associated with a low sense of control. In addition, increased levels of stress correlated positively with suppression of competing activities.

The data also showed statistically significant differences in the use of different coping strategies by individuals’ education level. Individuals with higher levels of education used acceptance strategies more. We assumed that people with higher levels of education were able to access more reliable information about the different aspects of special need of their child and possible support, and therefore come to terms with reality. When confronted with data and objective research, they could understand that the child’s diagnosis was not their fault and could therefore concentrate on daily problem solving and less on negative emotions.

We also came across an interesting finding with regard to perceived levels of social support and coping mechanisms, namely, that the parents who were more satisfied with the social support they received used coping mechanisms oriented more towards positive reinterpretation and growth. Support of social networks thus motivates and enables parents to reinterpret their situation in the positive direction. In contrast, the parents with lower levels of perceived social support more often use strategies such as focusing on and venting emotions to reduce their distress.

Limitations of the Research

The main drawback of the present study was its small and relatively specific sample; all participants were involved in some way in activities at the specialist and therapeutic clinic for children with hearing and speech difficulties, so they were already receiving some degree of social and professional support. This certainly helped to reduce their levels of depression, anxiety, and stress. A significant disadvantage was the heterogeneity of the participants in terms of age and comorbidity. Greater representativeness would have been achieved by including a control group instead of using cut-off values. In future studies, it would also make sense to consider offering more anonymity. The participants received questionnaires from their child’s kindergarten educators or speech and language therapists and they returned the questionnaires directly to them.

Conclusion

From the results retrieved from our sample we can conclude that mothers reported higher levels of stress and anxiety than fathers of children with ASD. As hypothesised, satisfaction with life negatively correlated with depression, stress, and anxiety. On this note, mothers in our sample were also the one who reported lower levels of life satisfaction, which negatively correlates with depression, stress, and anxiety. In the present study, perceived level of social support proved as important factor and parents with lower levels of perceived social support more often used strategies oriented mainly towards the reduction of negative emotions, anxious parents with less social support used religious coping more often. Mentioned mechanisms offer a relief but are not oriented towards problem solving or finding a better way to cope with situations, which is crucial in parenting a child with ASD.

Thus, it is of crucial importance to offer different types of social support to parents of children with ASD to help them constructively cope with the situation. In future studies it would be good to research, which types of social support are most effective in helping parents to maintain their well-being.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Slovenian Research Agency [P6-0372].