According to a recent survey conducted over a period of 18 months, approximately 50% of all mothers of children with autism spectrum disorder (ASD) had elevated levels of depressive symptoms, while rates for mothers with neurotypical children were much lower (6% to 13.6%), according to UCSF researchers in a new study published August 26 in Family Process.
Furthermore, while previous research has suggested that having a depressed parent increases the risk of children developing mental health and behavioural issues, this study found the opposite.
"We discovered that mothers' higher levels of depression did not predict increases in children's behaviour problems over time, even in families with a child with autism who are under a lot of stress," said Danielle Roubinov, PhD, UCSF assistant professor in the Department of Psychiatry and Behavioral Sciences and the study's first author. "That was both surprising and welcome news."
"Being a parent of a child with special needs is inherently difficult every day," said Elissa Epel, PhD, a UCSF professor in the Department of Psychiatry and Behavioral Science and the study's senior author. "It is a classic example of chronic stress, which is why we have focused on caregiving mothers in our studies on the effects of stress on health."
"We already know from this sample that mothers who have more depression have signs of faster biological ageing, such as lower levels of the anti-ageing hormone klotho and older immune cells," Epel added. We wanted to know how their depression affected their child and vice versa."
A One-Way Street
Regardless of ASD status, the researchers discovered that child behaviour problems predicted higher levels of maternal depression in the future. However, they did not observe an inverse effect; prior maternal depression did not predict later child behaviour problems.
"The finding that maternal depression does not worsen child symptoms is especially important for mothers of children with ASD because it helps alleviate the guilt that many mothers feel about their children's diagnosis and behaviour problems," Roubinov said. "We hope that these findings will reassure mothers that it's normal to experience some depression while caring for a child and that their depression isn't exacerbating their child's behavioural issues."
Previous research by the team shows that self-blame and guilt are common among parents of ASD children and predict worsening depression and lower life satisfaction over time.
In the current study, researchers measured maternal depression and behavioural problems in 86 mother-child dyads over the course of 18 months. Half of the mothers had autistic children, while the other half had neurotypical children. The children in the study ranged in age from two to sixteen years old, with the majority (75%) being elementary school age or younger.
The Inventory of Depressive Symptoms, a self-report scale completed by mothers, was used to assess maternal depression. The Child's Challenging Behavior Scale, which focuses on externalising behaviours such as tantrums, aggression, and defiance, was used to assess child's behaviour. Future research should look into the links between maternal depression and children's internalising symptoms, according to the researchers (e.g., withdrawal, anxiety, emotional reactivity).
Few studies on maternal depression, child behaviour in the ASD context
Previous research has found bidirectional links between maternal depression and child behaviour problems. However, few studies have looked into these relationships in autistic families.
According to Roubinov, families with autism face more marital conflict, lower relationship satisfaction, and a variety of other challenges.
"A stressful family environment may spill over onto family members and change the ways mothers and children relate to one another," she explained. "We wanted to see if the relationship between maternal and child mental health differed in a high-stress family system, such as when a child has autism."
Although the study acknowledged that families with autistic child experience high levels of stress, the authors were careful to point out that stress is not their only distinguishing feature.
"Many mothers of autistic children report high levels of emotional closeness and positive interactions with their children," said Roubinov. "These are valuable experiences on which supportive programmes can build."
Following the study, the researchers offered mindfulness classes to all parents to help them cope with the stress of parenting. "The parents were grateful for the opportunity to share common challenges and learn inner coping strategies," Epel said. "Many studies have shown that mindfulness training can help with parenting stress, and we also discovered that our parents' mental health improved."
Despite a more difficult life situation, it is critical to experience and notices positive emotions and joy, according to Epel.
"Given the effects of chronic stress on health and mood, caregiving parents require extraordinary emotional support in addition to their child's special services," she said. "It is just as important to support parents' mental health as it is to support children's mental health."
She believes that physicians should be on the lookout for parental distress and be prepared to offer resources to parents, particularly parents of special needs children. Support groups are available in the Bay Area through the National Alliance on Mental Illness California chapter, Support for Families of Children with Disabilities, and some health insurers.
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