Predictors of Well-Being Among Mothers of Children with Autism in Lebanon

Background:

This study extends upon our work demonstrating that heightened child behavioral problems were associated with poorer well-being among mothers of children with ASD in Lebanon (Obeid & Daou, 2015). Mothers’ coping styles (Benson, 2010) were also associated with well-being; distraction and disengagement were associated with poorer well-being, while cognitive reframing predicted enhanced well-being. Unlike Benson’s (2010) finding in the U.S., engagement was not associated with maternal well-being in Lebanon. Lebanese mothers reported using more problem-focused than emotion-focused coping, which we believed might be due to the social desirability bias.

We controlled for social desirability; compared benefits of formal and informal social support; and examined the impact of additional factors on well-being: (i) knowledge, given that trainings about ASD enhance knowledge (Gillespie-Lynch et al., 2015) and that Kuhn and Carter (2006) suggested knowledge could facilitate maternal self-efficacy and well-being despite limitations they noted in their knowledge measure; (ii) empowerment, given that parents’ understanding of ASD empowers them to improve their children’s quality of life (Murray et al., 2011); and (iii) locus of control (LoC), given that prior research (Siman-Tov & Kaniel, 2011) showed that parents with internal LoC cope better with stress than those with external LoC.

Objectives:

(1) To examine if baseline child behavioral problems and maternal coping styles, LoC, autism knowledge, empowerment, and formal and informal social support impacted maternal well-being after controlling for social desirability. (2) To examine if participating in an in-person training about ASD was associated with increased ASD knowledge and maternal well-being.

Methods:

A within-subject quasi-experimental design assessed whether the training was associated with changes in well-being. Participants completed a pre-test, an hour-long lecture-based training about ASD, and a post-test. The training, a 63-slide presentation adapted from Gillespie-Lynch et al. (2015), described ASD and effective tools/interventions, during group sessions. Fifty-four mothers completed the pretest, 33 also completed the training and post-test. Measures assessed behavioral problems, coping styles, ASD knowledge, social support, empowerment, LoC, social-desirability bias, and well-being. The reliability of the ASD knowledge scale (α= .47) was lower than in our work with students and teachers in Lebanon (αs> .61).

Results:

LoC and distraction were significant predictors of maternal well-being, F(2,49)= 6.72, p= .003. The model explained 21.5% (R²= .215) of the variance in maternal well-being. We found no evidence that the training enhanced ASD knowledge, empowerment, and maternal well-being from pretest to posttest.

Conclusions: Distraction coping and LoC predicted maternal well-being. However, the ASD knowledge measure had lower reliability than in other samples and the intervention was not impactful. Mothers were more knowledgeable about autism than teachers in Lebanon in our concurrent work, likely due to their lived experiences with their children. Deeply rooted experiences may have contributed to low reliability and to difficulty shifting conceptions. It is critical to attune assessments and interventions to the needs of mothers, particularly where resources are scarce (e.g., Harrison et al., 2014). Adopting a bottom-up approach by conducting needs assessments and developing trainings/instruments that address them may be more effective.