Expressed Emotion Among Indian Mothers and Fathers of Children with Autism: Cultural Variations in Parenting Approaches

Background: Parents’ degree of expressed emotion (EE) has been associated with psychiatric outcomes in a wide range of psychiatric disorders. Recently, EE also has been measured in parents of children and adults with autism (Benson et al., 2011; Baker et al., 2011), and shown to mediate increased behavior problems over time. At the same time, cross-cultural research has shown that EE varies widely across cultural contexts, and that Western parental expectations may not hold universally. For instance, a previous study of EE in India has shown that Indian parents of persons with schizophrenia have lower degrees of EE, which may lead to better outcomes (Wig et al., 1987). Finally, most cross-cultural and cross-diagnostic research on EE has focused on mothers’ approach to their child, while relatively little is known about the self-perceived role of fathers in parenting their child. The present study presents the first cross-cultural examination of EE in Indian parents of children with autism, and also includes both mothers’ and fathers’ views of their child.

Objectives: The current study aims to establish: (a) whether Indian parents of a child with autism had lower rates of expressed emotion, as compared to US and European parents; (b) whether Indian mothers and fathers differ in their degrees of expressed emotion; and (c) whether Indian parents of children raise unique themes when discussing their children, that point to challenges and strategies that are less common in the West.

Methods: Mothers and fathers of 30 children with autism (aged 2-10) were interviewed as part of a larger study on the Parent-Child Training Program at Action for Autism, India, before they entered the training program. Parents were instructed to speak for five uninterrupted minutes about their child with autism, and about their relationship with their child. The five-minute speech samples were recorded and translated from Hindi to English.  The speech samples were coded according to standard Western criteria (Magana et al., 1986), for Warmth, Emotional Over-Involvement, Relationship, Critical and Positive comments. In addition, qualitative analysis of the speech samples identified and coded unique themes in what parents said.

Results: Preliminary analyses indicate that Indian parents of children with autism describe their children with a combination of criticism and positive comments, while their relationship with their child may be characterized as less warm using Western coding schemes.  Using Indian thematic coding, and in the context of Indian family circumstances, however, these comments fit with training, respect, and family roles relevant in those contexts.  

Conclusions: Examining the spontaneous descriptions of Indian mothers and fathers of children with autism using both standard EE coding, as well as culturally-relevant coding for the Indian family context, captures the meaning and relevance of EE more broadly than either alone. As awareness of autism expands globally, understanding the variety of parenting approaches to children with autism is crucial for developing culturally-appropriate treatments that take local environment and family context more fully into account. Future research will examine how parent support and training programs can incorporate contextual understanding and parent EE.