benson 2010

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Coping, distress, and well-being in mothers of children with autism

Paul R. Benson *

Department of Sociology and Center for Social Development and Education, University of Massachusetts Boston, 100 Morrissey Boulevard,

Boston, MA 02125, United States

1. Introduction

Prior research clearly indicates that the demands of raising a child with autismcan resultin marked psychological distress

for many parents (see Glasberg, Martins, & Harris, 2007; Hastings, 2008 for recent reviews). However, it is also clear that

parents vary substantially in their ability to successfully respond to the challenges linked to their child’s autism, with some

parents experiencing significant mental health problems, while other parents experience relatively few of these difficulties

(Benson, 2006; Benson & Karlof, 2009). It is also noteworthy that research has shown that many parents experience positivegains as a result of raising a child with autism or other disability, including personal growth, improved relationships with

others, and increased patience and empathy (Hastings & Taunt, 2002; Pakenham, Sofronoff, & Samios, 2005; Scorgie &

Sobsey, 2000).

Coping strategies have been posited as one mechanism by which individuals respond to threats of stress, including

stressors associated with parenting a child with autism. Based on the stress and coping model of Lazarus and Folkman

(1984), researchers have often grouped coping methods into two general types, problem-based coping (strategies aimed at

solving the problem or doing something to change the source of stress) and emotion-based coping (strategies aimed at

Research in Autism Spectrum Disorders 4 (2010) 217–228

A R T I C L E I N F O

Article history:Received 24 June 2009

Received in revised form 10 August 2009

Accepted 11 September 2009

Keywords:

Autism

Coping

Distress

Well-being

Mothers

A B S T R A C T

As is the case in stress research generally, studies examining the relationship betweencoping and mental health outcomes in parents of children with autism frequently classify

parental coping methods as being either problem- or emotion-focused. We argue that this

dichotomization of coping strategies oversimplifies the way parents respond to their

child’s autism. In the present study, the coping methods employed by 113 mothers of

children with autism were investigated using the Brief COPE (Carver et al., 1989).

Exploratory factor analysis of Brief COPE subscales identified four reliable coping

dimensions: engagement coping, distraction coping, disengagement coping, and cognitive

reframing coping. In addition, using multiple regression, we examined the relationship of

coping strategies to negative and positive maternal outcomes (depression, anger, and

well-being). In general, maternal use of avoidant coping (distraction and disengagement)

was found to be associated with increased levels of maternal depression and anger, while

use of cognitive reframing was associated with higher levels of maternal well-being. In

several instances, child characteristics, particularly severity of child maladaptive behavior,

moderated the effect of copingon maternal outcomes. Study findings are discussed in lightof previous research in the area; in addition, study limitations and clinical implications are

highlighted.

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E-mail address: [email protected].

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reducing or managing feelings of distress associated with the stressor). In studies of family caregivers, including parents of

individuals with autism and intellectual disability, use of emotion-focused coping strategies (e.g., denial, venting) have

generally been found to be associated with higher levels of psychological distress, while use of problem-focused coping

methods (e.g., planning, taking action to address the problem) have often, but not always, been associated with improved

mental health outcomes (Abbeduto et al., 2004; Aldwin & Revenson, 1987; Seltzer, Greenberg, & Krauss, 1995). In addition,

problem- and emotion-focused coping have sometimes been found to moderate the effects of stressors on caregiver distress.

For example, in a recent study comparing the coping strategies used by mothers of preschool and adolescent children with

ASD, Smith, Seltzer, Tager-Flusberg, Greenberg, and Carter (2008) found that for mothers of preschoolers, lower levels of emotion-focused coping and higher levels of problem-focused coping were associated with improved maternal well-being,

regardless of child symptom severity. For mothers of adolescents, however, coping was often related to maternal well-being

only when child symptoms were severe.

While the distinction between problem-focused and emotion-focused coping has served an important heuristic purpose

in stress research, evidence suggests that it oversimplifies how people deal with adversity ( Carver, Schneier, & Weintraub,

1989; Lazarus, 1996; Skinner, Edge, Altman, & Sherwood, 2003). Many important coping methods, such as use of social

support, fail to fit clearly into either the problem- and emotion-focused coping category. In addition, many coping methods

serve both instrumental and affective functions. For example, while taking direct action against a source of stress clearly

involves problem-solving, it may also reduce negative emotions associated with the stressor, such as anxiety (Skinner et al.,

2003; Folkman & Moskowitz, 2004). For this reason, studies examiningthe factor structure of widely used coping scales, such

as the Way of Coping-Revised (Folkman & Lazarus, 1985), typically identify multiple coping dimensions rather than just two

(e.g., Aldwin & Revenson, 1987; Dunkel-Schetter, Feinstein, Taylor, & Falke, 1992; Folkman & Lazarus, 1985 ). Similarly,

Carver et al. (1989) included 14 conceptually distinct types of coping in their theoretically derived COPE inventory. Whilesome of the coping strategies identified by Carver et al. (1989) map closely onto the problem- vs. emotional-focused coping

classificatory schema (e.g., active coping, planning), others did not fit clearly into either coping type.

To our knowledge, only one study to date has examined the structure of coping by parents with children with autism. In

that study, Hastings, Kovshoff, Brown, et al. (2005) used exploratory factor analysis to classify the coping methods used by

135 parents of children with autism in the UK. Based on their analysis of parent responses on the Brief COPE (Carver, 1997),

four reliable coping dimensions were extracted, which they termed active avoidance coping , problem-focused coping , positive

coping , and religious/denial coping . While the first two of these dimensions corresponded closely to the emotion- and

problem-focused coping categories commonly used in stress research (cf. Folkman & Lazarus, 1985), the latter two were

viewed as being more specific to the unique circumstances associated with parenting a child with autism or other disability.

In bivariate analyses, Hastings, Kovshoff, Brown, et al. (2005) found passive avoidant and religious/denial coping to be

significantly related to increased parent stress, anxiety, and depression, while problem-focused coping was unrelated to any

of these distress measures (positive coping was negatively correlated with depression only). Potential interactions between

parental coping strategies and child characteristics were not examined in this study.As can be gleaned from the above review, the existing literature on coping by parents of children with autism is limited

and leaves many key issues unresolved. Aside from the one study by Hastings, Kovshoff, Brown, et al. (2005), very little is

known about the underlying structure of coping strategies used by parents of children with autism. In addition, very few

studies of families of children with disabilities have examined how different coping methods are associated with parent

distress and well-being, and, in particular, whether the effects of different coping strategies on parent outcomes are

moderated by child characteristics such as the severity of child autism symptomatology or maladaptive behavior. Although

coping has been found to buffer the effects of high levels of stress on caregiver distress in some studies of parents of persons

with autism and intellectual disability (Essex, Seltzer, & Krauss, 1999; Seltzer et al., 1995; Smith et al., 2008 ), other studies

have failed to replicate this finding(Abbeduto et al., 2004). Finally, as noted by Smith et al. (2008), there continuesto be some

debate in the literature regarding the extent to which the relationship between autism and maternal psychological

functioning is primarily driven by deficits specific to autismor, alternatively, by child maladaptive behaviors more generally,

with some studies indicating that maternal distress is primarily associated with child problem behaviors (Hastings,

Kovshoff, Ward, et al., 2005; Herring et al., 2006), while others have emphasized the pivotal role played by core autismsymptoms (Eisenhower, Baker, & Blancher, 2005; Ello & Donovan, 2005; Lecavlier, Leone, & Wiltz, 2006). Clearly, additional

research is needed that directly assesses the relative impact of these two child-related stressors on maternal distress and

well-being.

The aim of the present study was to contribute to the literature on autism and the family by investigating the structure of

coping used by mothers of children with autism and by examining how these empirically derived coping categories are

linked to maternal psychological functioning. In so doing, the study sought to replicate key aspects of Hastings, Kovshoff,

Brown, et al.’s (2005) factor analysis of coping among British parents of children with autism and Smith et al.’s (2008)

comparative study of the impact of coping strategies on maternal distress and well-being. In addition, the present study

extended the work of Smith and colleagues by comparing the effects of two child-related stressors, autism symptoms and

maladaptive behaviors, on maternal outcomes. Finally, as did Smith et al. (2008), the effects of maternal coping and child

characteristics on negative and positive maternal outcomes were examined, specifically depressed mood, anger, and

psychological well-being.While a good deal of past research has examined the impact of child disability and parentingstress

on maternal depression (Singer, 2006), much less attention has been given to examining anger as an outcome, particularlywithin the context of parenting children with ASD (however, see Benson & Karlof, 2009). In addition, relatively little

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attention has been given to the potential effects of coping on positive parent outcomes (cf. Folkman & Moskowitz, 2000,

2004). Research involving both disabled and non-disabled populations, however, has indicated that a variety of beneficial

outcomes, including the acquisition of new skills and relationships (e.g., Hastings & Taunt, 2002; Schafer & Coleman, 1992),

personal growth (e.g., Nolen-Hoeksema, Larson, & Grayson, 1999; Park, Cohen, & Murch, 1996), and spiritual or religious

transformation (e.g., Pargament, 1997; Pearce, 2005), can result from confronting stressful situations, even when the

situation is chronic and unable to be successfully resolved. In this study attention was focused on one specific potential

benefit of effective coping, feelings of personal happiness and well-being.

In summary, the present study sought to investigate the coping strategies used by mothers of children with autism andthe relationship of these strategies to negative and positive parent outcomes. Specifically, three research questions were

addressed: (1) What is the underlying structure of coping strategies used by mothers of children with autism; (2) To what

extent are different coping methods and child-related stressors (i.e., autism symptoms and maladaptive behaviors)

associated with maternal distress and well-being; and (3) Under what circumstances, if any, is the interaction of coping

strategies and child stressors linked to maternal outcomes?

2. Methods

2.1. Participants

The current study was undertaken as part of an ongoing longitudinal study of children with ASD and their families

(Benson & Karlof, 2008, 2009; Benson, Karlof, & Siperstein, 2008). The full study sample (142 children, aged 6–9, and 136

parents) was recruited into the study in 2002 and 2005 from a variety of public and private schools, multi-system specialneeds programs, and autism service organizations located in eastern and central Massachusetts. The present paper utilizes

information collected in 2005 from a subsample of 113 mothers of children whose autism diagnosis had been confirmed

through the use of the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994).

In terms of child characteristics, most were male (87%) and Caucasian (83%), with a mean age of 8.6 years (S.D. = 1.5).

According to parent report, the primary mode of communication for 19% of children was through non-verbal means.

Seventy-six percent of the children in the sample attended a typical or inclusive classroom for at least part of the school day,

while 24% attended a fully self-contained special needs classroom.

In terms of parent and family characteristics, family income averaged between $70,000 and $80,000 a year, but varied

substantially within the sample, ranging from under $30,000 (14%) to over $140,000 a year (15%). Parent educational level

was also generally high, with 64% of mothers identifying themselves as college graduates.

2.2. Procedure

Data on participating parents were gathered through in-home interviews and self-administered questionnaires. Parent

questionnaires included items on child, parent, and family characteristics, school services, and other issues, while parent

interviews were used to collect information on a variety of other issues, including the impact of the child with autism on the

family and the ways that parent activities may have been altered to accommodate to the needs of the child with autism

(Benson & Karlof, 2008; Benson et al., 2008). Data on variables included the present study were collected though the use of

parent questionnaires only.

2.3. Measures

2.3.1. Coping measures

As did Hastings, Kovshoff, Brown, et al. (2005), we assessed mother’s copingstrategies using the Brief COPE (Carver, 1997),

an abbreviated version of the COPE inventory developed by Carver et al. (1989). In its situational format, the Brief COPE uses a

4-point Likert scale (1 = I haven’t been doing this at all to 4 = I’ve been doing this a lot ) to query respondents on how frequentlythey employ 28 different behaviors and cognitions when coping with a specific stressful situation (in the present study,

parenting a child with autism). Following Carver (1997), maternal responses were initially grouped into 14 theoretically

derived subscales consisting of two items each (acceptance, active coping , planning , behavioral disengagement , denial,

substance use, humor , positive reframing , religious coping , self-distraction, use of emotional support , use of instrumental support ,

and venting emotions). In the present investigation, Cronbach’s alpha reliabilities across the 14 subscales averaged .72 (range:

.54–.93). These reliabilities are similar to those reported in Carver (1997) and indicate acceptable to excellent internal

consistency for the abbreviated subscales.

2.3.2. Maternal depressed mood

Mothers’ level of depressed mood was measured using a short form of the Center for Epidemiologic Studies-Depression Scale

(CES-D; Radoff,1977;Ross & Mirowsky, 1984). Using theCES-D short form, respondentswere asked, ‘‘On howmanydays during

the past week did you. . . (a) feel you couldn’t get going, (b) feel sad, (c) have trouble going to sleep or staying asleep, (d) feel

everything was an effort, (e) feel lonely, (f) feel you couldn’t shake the blues, (g) have trouble keeping your mind on what youwere doing?’’ Responses on the seven items were added to produce an index score ranging from of 0–49 (mean = 15.2,

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S.D. = 12.2; Cronbach’s alpha = .86). As is common with count variables, the distribution of responses on the CES-D short form

were highly positively skewed. For this reason, in the analyses below, we utilized a square-root transformation of CES-D short

form scores in order to correct for variable non-normality ( Cohen, Cohen, Aiken, & West, 2003).

2.3.3. Maternal anger

Parent anger was assessed using a three-item measure developed by Ross (1996). Using this measure, respondents were

asked, ‘‘On how many days during the past week did you. . . (a) feel annoyed with things or people, (b) feel angry, (c) yell at

someone?’’ These items are intended to represent escalating forms of anger, with the first two indicating feelings of angerand the last a behavioral expression of anger (Ross & Van Willigen, 1996). Responses were summed to create an index

ranging from 0 to 21 (mean = 7.8, S.D. = 5.3). Like the CES-D, the distribution of responses on the anger index was highly

positively skewed and a square-root transformation was utilized in order to correct for non-normality. In this study,

Cronbach’s alpha for the anger measure was .78.

2.3.4. Maternal well-being

Maternal well-being was also assessed using a three-item measure developed by Ross (1996). Using this measure,

respondents were asked, ‘‘On how many days during the past week did you. . . (a) enjoy life, (b) feel happy, (c) feel hopeful

about the future?’’ Responses were summed to create an index of 0 to 21 (mean = 12.1, S.D. = 6.6). In this study, Cronbach’s

alpha for the well-being measure was .92.

2.3.5. Child autism symptoms

Severity of child autism symptoms was assessed using the parent-report version of the Social Responsiveness Scale (SRS;Constantino, 2000). Using a 4-point Likert scale (1 = never true to 4 = almost always true), the SRS is a 65-item scale that

ascertains quantitative data on the frequency of a wide array of autistic traits, including social awareness (e.g., ‘‘Knows when

he/she is too close to someone or invading someone’s space’’), social information processing (e.g., ‘‘Concentrates too much on

part of things rather than seeing the whole picture’’ [reverse coded], capacity for reciprocal social response (e.g., ‘Is able to

imitate others’ actions’), social use of language (e.g., ‘‘Gets frustrates when trying to get ideas across in conversations’’), and

stereotypic/repetitive behaviors/preoccupations (e.g., ‘‘Has repetitive odd behaviors, such as hand flapping or rocking’’).

Responses are summed across SRS items to generate a total score that serves as an index of autism symptom severity, with

higher scores indicating more severe impairment. Prior psychometric studies on the SRS indicate good reliability and

validity, with SRS scores being significantly correlated with symptom scores generated by the ADI-R (Constantino et al.,

2003). Because a substantial minority (19%) of children with autism in the present study were non-verbal, 12 SRS items

specifically requiring verbal language on the part of the child were excluded from the measure used in the present analysis,

resulting in a 53-item autism symptom scale (mean = 148.1, S.D. = 22.9). Cronbach’s alpha for the modified SRS was .93,

indicating excellent internal consistency.

2.3.6. Child maladaptive behavior

Severity of child maladaptive behavior was assessed using the problem behavior scale of the Nisonger Child Behavior

Rating Form – Parent Version (NCBRF; Aman, Tasse, Rojahn, & Hammer, 1996). The 66-item NCBRF problem behavior scale

utilizes a 4-point Likert scale (1 = Did not occur or was not a problem to 4 = Occurred a lot or was a serious problem) and taps

several dimensions of maladaptive behavior commonly seen in children with autism, including non-compliance,

hyperactivity, self-injury, aggression, ritualism, and irritability (Lecavlier, Aman, Hammer, Stoica, & Matthews, 2004).

Cronbach’s alpha for the NCBRF problem behavior scale was .93 in the current study (mean = 51.9, S.D. = 24.3).

2.3.7. Family socioeconomic status

Based on prior research indicating that coping responses differ by socioeconomic status ( Pearlin, 2000), family SES was

included as a control variable in the present analysis. Family SES was assessed using an additive index composed of each

parents’ standardized education and income scores (in one-parent families, only the mother’s education and income scoreswere utilized, with the final SES score weighted to adjust for number of parents).

3. Results

3.1. Factor structure of coping strategies

Exploratory factor analysis was used to identify the underlying structure of coping strategies used by our sample of

mothers of children with autism. However, in contrast to Hastings, Kovshoff, Brown, et al. (2005), in the present analysis,

factor analysis was performed on the 14 theoretically derived subscales of the Brief COPE rather than on the measure’s 28

individual items. The rationale for utilizing this analytical strategy is two-fold. First, as several investigators have noted

(Bernstein & Teng, 1989; Briggs & Cheek, 1986; Gorsuch, 1983), because many factor analytic techniques (including

exploratory factor analysis) assume interval-level data, use of multi-category scales, including the Brief COPE, can exaggerate

thenumber of factors needed when criteria applicable to continuous data is used. One proposed solution to this problem is tocombine items into subscales and then factor analyze the subscales, assuming that they have been shown to have acceptable


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levels of inter-item reliability (Bernstein & Teng, 1989; Briggs & Cheek, 1986; Hudek-Knezevic, Kardum, & Vukmirovic,

1999). A second reason for factor analyzing the Brief COPE on the scale (rather than the item) level stems from concerns

regarding the adequacy of the sample size (N = 113), which was deemed to be too small to allow for item-level analysis (cf.

Gorsuch, 1983).

To explore the factor structure of Brief COPE subscales, a principal components factor analysis with varimax rotation was

used, employing the Scree-test as a criterion for the extraction of the optimal number of factors. Following Hastings, Kovshoff,

Brown, et al. (2005), subscales were retained if they mettwo criteria: (1) they loaded>0.40 on one of the factors and<0.40 on

the other factors; and(2)their loadingon the main factor waspositive. Based on these criteria, all items were retained, with fourfactors being extracted (first seven eigenvalues: 3.63, 2.48, 1.44, 1.02, 0.96, 0.86, 0.71), explaining 61.2% of the common

variance. As shown in Table 1, Factor 1 (termed engagement ) included four Brief COPE subscales (use of instrument support,

activecoping, planning, anduse of emotional support), allof which reflectedactive involvement bythemotherin addressingthe

stressful situation posed by their child’s autism. Factor 2 (termed distraction) also included four subscales (self-distraction,

humor, self-blame, and venting), each of which reflected attempts by the mother to distract herself from the stressor, while

Factor 3 (termed disengagement ) included three Brief COPE subscales (substance use, behavioral disengagement, and denial),

each of with involved attempts by the mother to deny or distance herself from the situation. Lastly, Factor 4 (cognitive

reframing ), includedthree scales (acceptance, use of religion, and positive reframing),all of which described maternal efforts to

positively restructure or reframe their beliefs about the stresses related to their child’s autism.

Table 1 also displays Cronbach’s alpha reliabilities for each of the four coping dimensions extracted from the factor

analysis. As shown, these values ranged from .73 (distraction) to .86 (engagement), indicating good internal consistency for

all four empirically derived coping dimensions.

3.2. Predicting maternal distress and well-being

For each respondent, a score on each coping dimension (engagement, distraction, disengagement, and cognitive

reframing) was obtained by summing maternal scores on the relevant Brief COPE subscales. The resulting four coping scales

were then used to address our two remaining research questions regarding the effects of different forms of coping and child-

related stressors on maternal psychological distress and well-being. In order to address these questions, we conducted a

series of multiple regressions, with separate regressions being performed for each of the four coping strategies extracted

from our prior factor analysis as well as for each of the two child-related stressors examined (autism symptoms and

maladaptive behavior). In each regression, a stressor variable, a coping variable, and a multiplicative term denoting the

interaction of the stressor and copingvariables (stressor x coping) were entered simultaneously into theregression equation.

We also included family SES as a control variable in each regression.1

Tables 2–4 present the regression results for the three dependent variables, maternal depressed mood, anger, and well-

being, respectively. Each table also presents twomodels, one for each child-related stressor, autismsymptoms(Model 1) andmaladaptive behavior (Model 2), with each column representing the standardized coefficients (betas) associated with a

separate regression examining the effect of a specific coping strategy on a specific maternal outcome.

As shown in Table 2, distraction and disengagement coping were significant predictors of maternal depressed mood,

with higher levels of each form of coping linked to higher levels of depression. In contrast, coping via engagement and

cognitive reframing were each unrelated to maternal depressed mood. In addition, child maladaptive behavior severity

was found to be positively associated withmaternal depression, regardless of the type of coping examined, while symptom

severity was not a significant predictor of depressed mood in any of the regressions. Lastly, two significant interactions

between coping and maladaptive behavior were uncovered. As illustrated by the data plot presented in Fig. 1, when

severity of child maladaptive behavior was high, distraction coping was unrelatedto maternal depressed mood.2 However,

when maladaptive behavior severity was low, mothers who used higher levels of distraction to cope with their child’s

autism reported significantly higher levels of depressed mood compared to mothers who used lower levels of distraction.

Similarly, higher use of disengagement coping was significantly related to higher levels of depression only in mothers of

children with lower levels of maladaptive behavior, not in mothers whose children displayed higher levels of problembehavior.

Next, we examined predictors of maternal anger. As shown in Table 3, higher use of distraction as a coping strategy was

associated with higher levels of maternal anger, while engagement and cognitive reframing were unrelated to this outcome.

In addition, as in the regressions predicting depression, child maladaptive behavior was positively associated with maternal

anger, regardless of the type of coping examined, while autism symptomology was significantly linked to anger only in the

regressions assessing the impact of engagement and cognitive reframing. Finally, one significant interaction between coping

1 As suggested by Cohen et al. (2003), in all regressions, predictor variables were ‘‘centered’’ over their means in order to control for multi-collinearity

between first-order and interaction terms.2 The data plot displayed in Fig. 1 graphically illustrates the relationship between distraction coping and depressed mood for mothers reporting ‘‘low’’ (1

S.D. below themean)and ‘‘high’’ (1 S.D. above themean)scores forchildmaladaptivebehavior(see Cohen et al., 2003). Two additional dataplots illustrating

the significant interaction of (1) maternal disengagement and child maladaptive behavior on maternal depressed mood, and (2) maternal disengagement

and child maladaptive behavior on maternal anger revealed a similar pattern of effects as found in Fig. 1. Data plots of these interactions are available fromthe author upon request.


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and child maladaptive behavior was found. Similar to the interaction noted above for maternal depressed mood, when child

maladaptive behavior severity was more severe, there was no association between disengagement coping and anger.

However, when child problem behaviors were less severe, mothers who used higher levels of disengagement to cope with

their child’s difficulties reported significantly higher levels of anger compared to those who used lower levels of

disengagement.

Finally, we examined the predictors of maternal well-being (see Table 4). As shown, disengagement and cognitive

reframing each exerted a significant main effect on maternal well-being, with lower levels of disengagement and higher

levels of cognitive reframing, linked to higher levels of well-being among mothers of children with autism. In addition, two

significant interactions were uncovered in the regressions predicting maternal well-being: one between engagement copingand child autism symptoms and a second between engagement coping and child maladaptive behavior. As illustrated by the

Table 1

Second-order factor analysis of Brief COPE subscales.

Factor 1

Engagement

Factor 2

Distraction

Factor 3

Disengagement

Factor 4

Cognitive reframing

Percent of total variance 25.9 17.8 10.3 7.3

Cronbach’s alpha 0.86 0.73 0.78 0.74

Brief COPE subscale and items (original item number in parenthesis)

Use of instrumental support .803 .224 .021 .164(10) Help and advise from others

(23) Advise/help from others about what to do

Active coping .789 .084 .166 .175

(2) Concentrate on doing something about situation

(7) Take action to make situation better

Planning .789 .063 .009 .254

(14) Come up with strategy about what to do

(25) Think about what steps to take

Use of emotional support .744 .319 .123 .030

(5) Get emotional support from others

(15) Get comfort and understanding from someone

Self-distraction .060 .733 .199 .134

(1) Turn to work or other activities to distract

(19) Do something to think about it less

Humor .046 .685 .192 .275

(18) Make jokes about the situation

(28) Make fun of the situation

Self-blame .008 .647 .391 .230

(13) Criticize myself

(16) Blame myself for things that happen

Venting .362 .579 .272 .046

(9) Say things to let feelings escape

(21) Express negative feelings

Substance use .040 .007 .776 .134

(4) Use alcohol/drugs to get through

(11) Use alcohol/drugs to feel better

Behavioral disengagement .062 .303 .665 .028

(6) Give up trying to deal with it

(16) Give up attempts to cope

Denial .200 .140 .575 .334

(3) Say to myself, ‘‘This isn’t real’’

(8) Refuse to believe what has happened

Acceptance .164 .046 .089 .724

(20) Accept reality of what has happened

(24) Learn to live with the situation

Religion .202 .066 .183 .679

(22) Find comfort in religious beliefs

(27) Pray or meditate

Positive reframing .321 .273 .332 .477

(12) See in a different light to make seem more positive

(17) Look for something good in situation

Significant loadings are italicized in bold type.

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data plot presented in Fig. 2, when child autism symptoms were less severe, engagement was unrelated to well-being;

however, when symptoms were more severe, engagement exerted a significant positive effect on maternal well-being.

Similarly, when child maladaptive behavior was less severe, engagement was unrelated to well-being; however, when

maladaptive behavior was more severe, mothers who reported high use of engagement as a way of coping with their child’s

autismhad significantly higher levels of well-being compared to mothers who reported lower use of engagement as a coping

strategy.

3

4. Discussion

The purpose of the present study was to investigate the structure of coping strategies used by mothers of children with

autism and to assess the relationship of those empirically derived coping dimensions to maternal mental health. Expanding

upon previous research, both positive and negative maternal outcomes were examined. In addition, the present study also

compared the role played by two child-related stressors, autism symptoms and. maladaptive, behaviors, in the prediction of

maternal distress and well-being. Finally, partially, replicating prior analysis by Smith et al. (2008), the moderating effects of

different coping strategies on the relationship between child-related stressors and maternal outcomes were also

investigated.

Table 2

Regressions predicting maternal depressed mood.

Variable Coping strategy

Engagement Distraction Disengagement Cognitive reframing

Model 1

Family SES .317*** .345***.271** .295***

Autism symptom severity .121 .012 .013 .109

Coping .059 .358

***

.401

***

.001Coping Symptom severity .161 .029 .171 .148

R2 .137** .212*** .226*** .127*

Model 2

Family SES .308*** .341***.264*** .299***

Problem behavior .330*** .262** .273*** .337***

Coping .017 .284*** .352*** .017

Coping Problem Behavior .076 .224**.252*** .010

R2 .222*** .327*** .323*** .206***

The coefficients shown are standardized betas. Each coping strategy was entered into a separate regression model.* p< .05.** p< .01.*** p< .001.

Table 3Regressions predicting maternal anger.



Model 1

Family SES .174 .205* .110 .156

Autism symptom severity .198* .103 .102 .212*

Coping .132 .405*** .469*** .053

Coping Symptom severity .030 .041 .139 .089

R2 .083 .219*** .235*** .076

Model 2

Family SES .162 .190* .099 .150

Problem behavior .329*** .248** .261** .361***

Coping .037 .360*** .426*** .047

Coping Problem behavior .099 .091 .183* .060

R2 .158*** .271*** .294*** .153**


3

A data plot illustrating the significant interaction of maternal engagement and child maladaptive behavior on maternal well-being followed the samepattern as shown in Fig. 2 and is available from the author upon request.


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Turning first to our findings regarding the structure of coping, our exploratory factor analysis of maternal responses on

the Brief COPE (Carver, 1997) uncovered four conceptually and empirically distinct coping dimensions which we termed

engagement, distraction, disengagement, and cognitive reframing. The first dimension, engagement coping, included a

variety of ways of coping, such as planning and active problem-solving, which correspond closely to the category of problem-

focused coping as generally conceptualized in the stress literature (cf. Lazarus & Folkman, 1984; see also Hastings, Kovshoff,Brown, et al., 2005). Engagement coping was also found to correspond to the construct of approach-oriented coping (Roth &

Cohen, 1986) in that engagement coping strategies orient the mother into more direct contact with sources of stress related

to their child’s autism. In contrast, disengagement, the second coping dimension uncovered in our factor analysis, entailed

maternal behaviors and cognitions geared generally toward withdrawal from the stressor through substance use, denial, and

giving up attempts to cope. A third broad-based copingstrategy was termed distraction copingand involved maternal efforts

to cope with their child’s autism through the discharge and modulation of emotion (e.g., venting, self-blame, humor, and

orienting attention away from the stressful situation), while a final coping dimension, cognitive reframing, consisted of

efforts by the mother to ‘‘come to terms’’ with their child’s autism in a positive way through acceptance, cognitive

restructuring, and use of religion.

In addition to examining the structure of maternal coping, the present study also examined the impact of different coping

strategies on maternal depressed mood, anger, and well-being. In regard to the prediction of maternal depression and anger,

it is noteworthy that neither engagement nor cognitive reframing was found to be related to these negative parent outcomes

in ourregression analyses. In contrast, greater use of distraction and disengagement coping were generally found to linked tohigher levels of depression and anger. These findings are largely consistent with the findings of both Hastings, Kovshoff,

Table 4

Regressions predicting maternal well-being.



Model 1

Family SES .215* .223* .186 .243**

Autism symptom severity .209* .142 .077 .223**

Coping .225

*

.072

.388

***

.350

***

Coping Symptom severity .225* .109 .185 .137

R2 .189*** .092* .189*** .215***

Model 2

Family SES .215** .226* .175 .244**

Problem behavior .176 .123 .058 .171

Coping .260** .074 .329** .322***

Coping Problem behavior .226* .159 .058 .092

R2 .164*** .094 .154** .182***


Fig. 1. Data plot illustrating the significant interaction of distraction coping and child maladaptive behavior in the prediction of maternal depressed mood.


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Brown, et al. (2005) and Smith et al. (2008) and suggest that use of problem-focused coping strategies have minimal impact

on reducing maternal distress, while use of avoidant strategies (distraction and disengagement) increase parent distress. In

addition, to these main effects, in several instances, child maladaptive behavior was also found to moderate the effects of

distraction and disengagement on maternal distress. In these cases, distraction and disengagement coping exerted a

significant positive effect on distress only when child maladaptive behaviors were less severe, while having no effect on

distress when problem behaviors were more severe. These findings suggest, at least in some instances, that heavy use of

avoidant coping strategies may be particularly problematic for mothers whose children with autism display relatively less

intense behavioral difficulties.

A somewhat different pattern of findings emerged when the relationship of coping to maternal well-being was examined,

with disengagement coping exerting a significant negative effect on well-being, while distraction coping was found to be

unrelated to this outcome. In addition, consistent with the stress-buffering hypothesis ( Cohen & Willis, 1985), engagement

coping was found to be exert a significant positive effect on maternal well-being only in cases where child symptoms weremore, rather than less, severe (the same moderating effect was found between engagement coping and child maladaptive

behavior). Finally, consistent with the findings of Smith et al. (2008), use of cognitive reframing strategies was found to exert

a significant main effect on well-being, with higher use of cognitive reframing (i.e., acceptance, positive restructuring, use of

religious coping) associated with higher levels of maternal well-being. The value of positive cognitions as a coping method

has been well documented in the stress literature (Folkman & Moskowitz, 2004) and appears to be particularly helpful in

stressful situations that are either chronic or largely uncontrollable. Likewise, prior studies have indicated that acceptance

and positive reframing can promote improved mental health among parents of children with autism and other disabilities

(Hastings & Taunt, 2002; Lloyd & Hastings, 2008; Pakenham et al., 2005; Scorgie & Sobsey, 2000) Finally, study findings

highlight the potential positive effects of religiosity on well-being. In recent years, research on religious coping by parents of

children with disabilities has increased (Coulthard & Fitzgerald, 1999; Ekas, Whitman, & Shivers, 2009; Tarakeshwar &

Pargament, 2001). These studies suggest religiosity to be a complex construct, with religious coping affectingparents in both

positive and negative ways. In a recent study of mothers of children with ASD, for example, Ekas et al. (2009) found religious

beliefs and spirituality to be associated with improved parental mental health, while greater involvement in religiousactivities (e.g., frequency of church attendance, engaging in prayer) was related to greater distress. It is noteworthy that in

the present study, our factor analysis classified religious coping (along with acceptance and positive reframing) as a

beneficial coping method, while Hastings, Kovshoff, Brown, et al.’s (2005) factor analysis of the same instrument, the Brief

COPE (Carver, 1997) placed religious coping in the same category as denial.4 Clearly, additional research is needed to better

explicate the multifaceted role played by religion in the coping process, both generally and specifically in terms of parenting

children with autism.

A final issue addressed by present study concerned assessing the relative strength of two different child-related stressors,

autism symptoms and maladaptive behaviors, in the prediction of maternal distress and well-being. In regard to the

prediction of maternal depressed mood and, to a somewhat lesser extent, maternal anger, severity of child maladaptive

behavior was clearly the more powerful predictor of the two, a finding consistent with most studies in the field (cf. Hastings,

Fig. 2. Data plot illustrating the significant interaction of engagement coping and child autism symptoms in the prediction of maternal well-being.

4

It is importantto recall, however, that the Hastings et al.(2005a) studyfactor analyzed the Brief COPE at theitem-level,whilethe present study didso atthe subscale level.


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2008). Interestingly, however, severity of child problem behaviors was not found to be a significant predictor of maternal

well-being in the present study. This finding requires replication, but suggests that the well documented association

between child problem behaviors and parent distress may not hold for positive parent outcomes such as life satisfaction,

happiness, and psychological well-being.

In discussing the findings and implications of the present study, it is important to note it’s limitations as well. First, the

analyses reported here utilized cross-sectional data and thus no causal inferences can be made based on these data.5 Second,

because of the necessarily voluntary nature of the sample, selection biases may have operated among study participants,

which could cause their responses to differ from those who chose not participate. Third, because the measures used in thisstudy were based on self-report, it is possible that some of the associations noted were inflated due to shared-method

variance. Finally, it is important to note that the present study utilized a predominately upper middle-class, Caucasian

sample of mothers, thus limiting the generalization of study findings to non-white and lower socioeconomic populations, as

well as to fathers and other caregivers.

In conclusion, the present study demonstrated how the impact of coping on psychological outcomes among mothers of

children with autism can differ, depending on the specific type of coping strategy used and outcome examined. Consistent

with previous research, study findings generally indicate that over-reliance on avoidant coping methods are likely to

promote rather than reduce, maternal distress, while use of positive coping strategies, such as engagement and cognitive

reframing, are likely to have their greatest impact on improving parents’ sense of happiness and well-being. Thus

interventions that seek to reduce parents’ use of avoidant coping, while facilitating their use of positive behavioral and

cognitive coping strategies are particularly important. In addition, study findings suggest that child maladaptive behaviors,

rather than autism symptoms, per se, are the key driver of the link between autism and maternal distress. For this reason,

professional interventions aimed at enhancing parents’ ability to manage their child’s problem behaviors may be especiallybeneficial since, if successful, they would serve not only to reduce behavior-related parent stress, but also to buttress parent

self-confidence, efficacy, and positive coping skills as well (Marcus, Kunce, & Schopler, 2005; McConachie & Diggle, 2007;

Moes, 1995; Singer, Ethridge, & Aldana, 2007; Sofronoff & Farbotko, 2002 ). Study findings also point to the need for

interventions which assist parents in better managing feelings of depression and anger which are often associated with

parenting a child with autism (Benson & Karlof, 2009; Coon, Thompson, Steffen, Sorocco, & Gallagher-Thompson, 2003).

Finally, interventions aimed at promoting a sense of mindfulness and a positive acceptance on the part of parents of children

with autism also may be useful, especially as parents and their children grow older (Blackledge & Hayes, 2006; Lloyd &

Hastings, 2008; Singh et al., 2006).

Acknowledgements

Special thanks areextended to themothers who participatedin this study and to Kristie Karlof, Dorothy Robison, andZach

Rossetti for their invaluable help in data collection. The research on which this paper is based was supported by the U.S.Department of Education, Grant No. H324C040092 (‘‘A Longitudinal Study of Children with ASD and Their Families During

the Elementary School Years’’).

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