Clinical Validation of the Family Life Impairment Scale in Families Raising a Toddler on the Autism Spectrum

Background: Developmental, social-emotional, and other forms of psychological symptoms are not only impairing to young children, but can also negatively impact family functioning. Previous research showed significant associations between the Family Life Impairment Scale (FLIS) and problem behaviors, including externalizing, internalizing and sensory symptoms, in a non-clinical representative sample of toddlers (Briggs-Gowan et al., 2006). Four distinct domains of family functioning were also observed in this non-clinical sample, suggesting that family impairment is a multi-dimensional construct (Soto et al., 2009). Impairment in families with a young child with an autism spectrum disorder (ASD) includes parental stress, disruptions in family routines, and limitations in participation in settings that support family needs, such as childcare.. A multidimensional measure of family impairment is needed to assess the degree of family stress and disruption associated with raising a child with ASD. 

Objectives: (1) To confirm validation of the four-factor structure of the FLIS. (2) To provide further clinical utility of the FLIS.

Methods: As part of a larger study, mothers (n = 168) of young children with ASD (n = 174; mean age = 28 months) completed the Family Life Impairment Scale (FLIS), a multidimensional measure assessing impairment in 1) family activities, 2) parent activities, 3) childcare, and 4) positive growth attributed to the child’s behavior, personality or special needs. Children’s diagnoses were confirmed with the Autism Diagnostic Interview – Revised (ADI-R), Autism Diagnostic Observation Schedule (ADOS), and clinical impression.

Results: Structural equation modeling was used to test the validation of the FLIS in a population of toddlers with ASD. Overall model fit was good (RMSEA = 0.042; CFI = 0.942. Standardized factor loadings were between 0.36 and 0.91, and all loadings were statistically significant (p < 0.001). 

Conclusions: Results provide strong evidence for the validity of the four-factor structure of this multidimensional measure of family impairment in this clinical sample. Three domains of impairment and one domain of positive growth were validated in a sample of families with a toddler with ASD, and appear to be adequately assessed by the FLIS. This study indicates that the FLIS is a valid measure of parental perceptions of the effects of a child's disability and behaviors in the family. The FLIS may be a useful clinical tool to assess the impact of the child in the family and to identify specific targets for intervention.