Family Relationships and Parental Stress in Only Child Versus Multiple Children Families in the Context of Autism Spectrum Disorders: A Pilot Study

Background: Parenting stresses have consistently been found to be higher in parents of children with autism spectrum disorders (ASD; Yamada et al., 2007; Cassidy et al., 2008;   Hamlyn-Wright,  Draghi-Lorenz,  Ellis, 2007; Herring et al., 2006; Hastings et al., 2005; Osborne, 2008; Siman-Tov, Kaniel, 2011; Johnson et al., 2011); yet, some families are able to be resilient and thrive in the face of these challenges, positively impacting on their child’s developmental outcome (Milshtein et al., 2010; Oppenheim, 2011; Aitken, Trevarthen, 2001; Gerstein, Crnic, Blacher, Baker, 2009).

Objectives: In the present work we consider family structure and dynamics as a crucial component of such resilience. Within such perspective, our aim is to assess the quality of family interactions comparing three subgroups: ASD only child families, two children families with both siblings diagnosed with ASD, and two children families, with one ASD diagnosed child and one typically developing child.

Methods: In order to assess family interactions, we administered to 15 families (children’s mean age= 6.76, s.d.= 2.8; mothers’ mean age= 38.9, s.d.= 5.4; fathers’ mean age= 42.48, s.d.= 1.07) the Italian adaptation of the Lausanne Trialogue Play - LTP (Fivaz-Depeursinge, Corboz-Warnery, 1999; Malagoli Togliatti, Mazzoni, 2006). Degree of coordination partners achieve in seeking playful affective contact defines a 'family alliance', ranging from functional (Cooperative alliance and Stressed alliance)  to problematic (Collusive Alliance and Disordered alliance). To evaluate the potential for parental behaviour problems and child adjustment difficulties within the family system, we applied the Parenting Stress Index – PSI (Abidin, 1995).

Results: Overall, no family showed a collaborative alliance. However, 42.9% showed a functional, yet stressed alliance. Within dysfunctional alliances, 38.1% were collusive and 19% disordered. Student's t-tests showed significant differences between the quality of family relationships (LTP) and levels of parental stress  (PSI) with respect to the number of ASD diagnosed children  in the family. The less coordinated families were among families with both siblings diagnosed with ASD (p= 0.001). Nevertheless, the child’s worst score on LTP was among the ASD only child families (p=0.001), whose parents also showed the highest level of stress (p= 0.008).

Conclusions: Results highlight the impact of Autism Spectrum Disorders on family ability to cooperate and on parental levels of stress and point out the relevance to include the whole system within the intervention program in order to enhance a positive environment and improve mental health and wellness of the family.