|Year : 2017 | Volume
| Issue : 2 | Page : 43-53
Social intelligence of parents with autism spectrum disorders impacts their emotional behaviour: A new proposed model for stabilising emotionality of these parents impacting their social intelligence
Vidya Bhagat1, Mainul Haque2, Nordin Bin Simbak1, Kamarudin Jaalam3
1 Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
2 Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of , Kuala Lumpur, Malaysia
3 Universiti Sains Malaysia-Karnatak Lingayat Education (USM-KLE) International Medical Program, Belgaum, Karnataka, India
|Date of Web Publication||28-Apr-2017|
Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
Autism spectrum disorder (ASD) may affect all spheres of a child's life. Indeed, parents and siblings also live with emotional instabilities in the family. The experience of parents with ASD child can be distressing since they need to make more adjustments to the demanding need to cope with their life situations. Perhaps, their life is drastically exaggerated with their complexities of life. Particularly, their social life is radically affected. The presence of pervasive and severe deficits in children with ASD isolates these parents from their social life; demanding adjustments to their social environment of parents in their life situations shove them into distress and unstable emotions. Finally, they culminate being shattered in their interpersonal relationship, their family and social life. Indeed, these aspects of distress mask social intelligence of these parents, thus narrow down their focus more on the treatment rather than holistic management of their child. Thus, the management of ASD with these parents of the deficit children to reach their fullest abilities remains doubtful. Therefore, the objectives of this study are as follows: (a) to examine the impact of emotionality on social intelligence of parents blessed with autistic child, (b) to develop awareness regarding social intelligence and its significance among these parents, (c) to propose a new model stabilising emotionality of these parents through developing social adaption skills and (d) to suggest a new model as a guide in the current intervention regimens to ensure the emotional well-being and better social adoption. This study is made based on the keenly examined past evidence with the correlation of emotionality and its impact on social intelligence of the parents with ASD children. The results reveal that the social intelligence is perceived as lowered evidenced by poor social adjustment reflected in social isolation observed in the parents of children with ASD. A new model proposed for stabilising and developing awareness of social intelligence among the parents of ASD children. Integrating this model with the existing treatment paradigm has been suggested to attain the better result. The conclusion is drawn in this study by analysing the fact that considerable improvement in the diagnosed child may not amend the parent and family distress and drastically affect social intelligence. Indeed, the intervention can be more promising with the healthy personality of parents, where their multiple aspects of intelligence are not affected. The new proposed model of intervention can pave the way for further research in this regard.
Keywords: Autism spectrum disorders, intervention, parent's emotionality, parent's social intelligence
|How to cite this article:|
Bhagat V, Haque M, Simbak NB, Jaalam K. Social intelligence of parents with autism spectrum disorders impacts their emotional behaviour: A new proposed model for stabilising emotionality of these parents impacting their social intelligence. Adv Hum Biol 2017;7:43-53
|How to cite this URL:|
Bhagat V, Haque M, Simbak NB, Jaalam K. Social intelligence of parents with autism spectrum disorders impacts their emotional behaviour: A new proposed model for stabilising emotionality of these parents impacting their social intelligence. Adv Hum Biol [serial online] 2017 [cited 2020 Jan 22];7:43-53. Available from: http://www.aihbonline.com/text.asp?2017/7/2/43/205388
| Introduction|| |
'Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterised, in varying degrees, by difficulties in social interaction, verbal and non-verbal communication and repetitive behaviours'. Autism, or ASD, first described in 1943, 'is a neurodevelopmental disorder characterised by impairments in social interaction and communication, along with repetitive or stereotyped patterns of behaviours and often restricted interests'. The characteristic features of ASD are consistent impairment in social communication, interaction as well as repetitive stereotype behaviours.,, The pervasive and complex deficits often present in children with ASD and related disabilities accompanied have a significant effect on these children., Indeed, this also pushes the parents of autistic kids into an excess of difficulties , such as increased parenting stress, traumatised in their interpersonal relationship, reduced parenting efficacy and increased mental disturbance affecting their multiple intellectual abilities.,,,, One study had reviewed the prevalence of ASDs, which has been observed; there are 6.7 cases per 1000 children, out of which 4 cases per 1000 children had met full diagnostic criteria for ASD. Thereafter, parents' social intellectual domain affected it also paves the way inefficient management. Dr. Howard Gardner, Professor of Education at Harvard University, has developed the theory of multiple intelligences (MIs) in 1983. The traditional concept of astuteness was considered as inadequate and redistricted as founded on an intelligence test, as promoted by the Gardner theory of MI. Dr. Gardner proposes eight different intelligences to account for a broader range of human potential in children and adults. These intelligences are linguistic, logical-mathematical, spatial, bodily-kinaesthetic, musical, interpersonal, intrapersonal, naturalist intelligence. Thereafter, Gardner's theory of MI may yield many possibilities and promises in teaching ASD children. People learn in many and varied ways. Parents and teachers of autistic kids must be aware of Gardner's theory and keep hope and continue their effort for the development of ASD children. The importance of healthy participation of parents in social skill training programme has been studied and revealed that 'manualised parent-assisted social skills intervention' programme progresses relationship quality and societal expertise among young adulthood ASDs. Social intelligences have been redefined to denote to the person's fund of knowledge about the social world. It has been reviewed that the multidimensional nature of the construct of social intelligence is independent of general intelligence. The study examines 188 individuals who were employed in a state-funded mental hospital. Here, the participants were administered a set of questionnaire to assess social interest, social self-efficacy, empathy skills, social skills and intelligence. In this study, through factor-analyses were conducted and identified five domains of social intelligence such as prosocial attitude, social skills, empathy skills, emotionality and social anxiety that were independent of verbal and abstract intelligence. The prosocial attitude domain reflected both social interest and social self-efficacy, and the domains of emotionality and social anxiety were also found unexpectedly. This assemblage of symptoms is disturbing in nature which is present during early childhood in ASD children and conciliates their everyday functioning as well as affecting these children in every phase of their social development. Each stage at which functional impairment differs in their intensity is based on the personal characteristics of each child with ASD. Indeed, these characteristics are shaped by their environmental stimulation. The key diagnostic features in autistic children are noted in the developmental period, but intervention, compensation and current supports and difficulties are ambiguous in some disciplines., The prevalence of ASDs is remarkably innumerable than formerly documented. The high rate of autism may be due to better ascertainment; expanding diagnostic criteria or increased incidence rate remains vaporous. Indeed, it is a need of the day for the health and social welfare organisations to consider the matter earnestly to cater the needs of children with ASD. Multiple studies had observed that the prevalence rate in Asia and globally is remarkably higher than previously stated.,, As depicted in the past evidence, the average prevalence of ASD before 1980 was around 1.9/10,000, which has amplified to 14.8/10,000. The median prevalence of ASD stated in China from 2000 upwards was 10.3/10,000, which shows its headway in Asia than the past evidence stated in one study. It has been also observed that there is a relatively high preponderance of males than females in ASD.,, However, in the recent past, many researchers have shown a keen interest in this area. Their enthusiasm is working with a better understanding of biological mechanisms which cause ASD., However, research on interventions intending to help ASD child and keeping their families with their psychological bounds is found to be limited. Further, there is literature which exhibits that the examined information on the health services, families and researchers in this area could make decisions to develop and adopting more efficient novel models in the holistic management of ASD. In the diagnosis, rate of ASD has also shown a steep increase in the United States in the past three decades., The researchers extended their efforts to understand the biological and genetic markers related to the aetiology manifesting of ASD.,, However, researches on parents' problems and its impact on holistic management are relatively limited. The intervention in ASDs signifies the parental involvement and incorporating their self-efficacy, emotionality and their social skills.,, In the present century, many intervention programmes are running holistic approaches where they give importance to the parental involvement to obtain optimal benefits of the treatment., At present, the intervention programmes for ASD are exhilarated with parental involvement. The parents and family members of ASDs are provided with the information. Their involvement in decision-making is prioritised since this has a vital role in the intervention process. In a parent-advocated intervention, parents use intervention techniques with their child to teach positive skills and reduce undesirable behaviours that disrupt the family stability. Thus, the collaboration of intervention plans the parents' and practitioners' working and heading together toward mutually set goals, further to learn the implementation of intervention with a structured training programme. Thus, the review study proposes that the new interventional model focusing uncovering the mask-blinded social intelligence of parents and thereby social intellect of these parents is better utilised in the holistic approach to the child's treatment and management, thus increase in the treatment effectiveness.
| Parenting Stress and Emotionality|| |
Parenting process is significant in endorsing and fostering the physical, emotional, social, financial and intellectual development of children from infancy to adulthood., A parent of these children shares the biological relationship, and parenting process has significance in raising autistic children. This task is not an easy one; thus, stress is quite common in parenting ASD child.,, The coping pattern varies with the amount of pressure and parental ability to cope with the stressors., Parents of ASD children are facing more complexities in their life since they need to meet demanding situations., It has been evidenced in the literature reviews that the parents' rearing children with ASD are known to experience higher levels of parenting stress than parents of normally developing children. The past evidence found that parents of children with ASD and other neurodevelopmental disorder experienced higher stress levels while adjusting with behavioural problems and cognitive abilities.,,, There are many potential deficits and comorbid diagnoses associated with an ASD diagnosis, meaning that there are many different faces of the disorder that may be related to parenting stress.,,, Further, the factors contributing to parenting stress in caregivers of children with ASD are multi-faced.,, These include the presence of child anxiety, behaviour problems, irritability, dependence, hyperactivity, non-compliance, poor self-care and adaptive functioning., In addition, language deficits, learning disability, enforced limits on family opportunities, need for care across the lifespan, inappropriate eating, toileting and sexual expression and broad social difficulties may also contribute to parenting stress. Further multiple studies observed that there was difference in an impact of individual symptoms of autism on parents.,,, Mothers and fathers of autistic children who work in collaboration with therapists are independently evaluated for their emotional behaviour. The severity of common symptoms of autism in their child and how stressful each of these symptoms impacting parental stress could have been estimated by these therapists., Specifically, the language and cognitive impairment was found to be more severe and stressful. Parents demonstrated a degree of stress, which was associated with symptom severity in their children. It has been observed that the effect of this pressure on these parents made them segregate from their family and friends. The current review examines stress and how the latter changes over the course of the child's development. As well as how the overall stress levels in parents of children with ASD are stabilizes and improve over time. One of the examined reviews reveals the relationship between parenting stress and self-perception of parents' concerning their parenting. Parenting stress closely interacted with self-perception of parents about their limited involvement and poor communication with their children. In parents of younger children, the higher levels of parenting stress impacted the less subsequent self-perceived relationship and poorer communication, with their child. The present study overviews the aspects of stress as depicted in the earlier studies. Here, several researchers have found parenting stress to be significantly impacted by the association between the coping strategies and the extent of social support received by these parents. Therefore, the fact that treatments that boost enhanced parental support and those which heighten hopefulness for parents could be helpful in reducing their stress warrants attention., This can have an impact on parental emotions, intellect and self-efficacy. The current review notes that alleviated stress and active parental role can facilitate the intervention programme to target and to successfully treat subclinical deficits in ASD children. Multiple studies had observed that in broader-line autism, phenotype has sub-threshold characteristics of autism.,,, Here, in these children, parenteral stress paved a way to their impaired social abilities, poor eye contact and narrowed interests in their daily activities. It is understood based on observed evidence that parents get a breathing space with decreased hospitalisations for children with ASD. Thus, intervention is valued in reducing parenting stress and benefit the children with ASD; indeed, it welfares the family. Thus, the current study had focussed on the evident reviews that had affected child's interventional outcome. Moreover, it further examines the supportive literature that evidences the high-level parenting stress resulted in poor interventional outcomes in children with ASD.
| Emotional and Social Intelligence|| |
As emotional intelligence is an important aspect of healthy living. Though majority of population have normal emotional intelligence unless they have some developmental deficits. However, when people get distressed and there is loss of psychological homeostasis this may pave a way to the difficulties in expressing their emotions intellectually. These disturbances not only affect emotional intellect of people but also affect the related realms of emotional intelligence, such as interpersonal relationship and, social intelligence. Social intelligence encompasses our abilities to interpret others' behavior through empathetically understanding their thoughts, intentions, desires and beliefs which promote healthy social networking. Nevertheless, social intelligence is independent from our general intelligence comes from several sources. Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non verbal communication and restricted and repetitive behavior. Parents usually notice signs in the first 2 years of their child's life. Parenting has major impact on child's development. At times parents get distressed this impact their social intellect and their interpersonal relationship with their family members get affected. Thus it also leaves negative impression on the development of their child. Several studies have indicated that the parents' behaviors such as harsh discipline strategies, love withdrawal or guilt induction or limited positive involvement are risk factors for the development and maintenance of externalizing problems in children. The central idea is that in a coercive cycle, aversive child behaviors reciprocally influence parenting behavior, in which negative reinforcement results in maintenance of undesirable behaviors in both child and parent. This study observes that the research evidenced that child social development and parents' temperament-related behavior influences the child's social and emotional development. In addition, it has been observed that the temperament characteristics lead to better or worse outcomes in children depending on their parent's temperament. Thus parent's temperaments found to have an implication on developmental aspect of children. The current study focuses on conceptualizing these temperament and emotionality which mask their social skills its outcome towards child's development.
| Parental Self-efficacy and Social Intelligence|| |
Attaining success in fulfilling parenting responsibilities is a dynamic and qualitative, which in turn increases self-efficacy of parents of children with ASDs., Perhaps, self-efficacies are important competence in performing parenting tasks. Parents' self-efficacy is important in coping with stress and balancing emotions and in intellectual adaptation to the situations encountered in parenting.,, The demanding conditions stressing the parents of children with ASDs are typical in their child rearing which causes emotional disturbances in these parents.,, Perhaps, self-efficacies of these parents can help their child using undisturbed social intelligence regardless of the presence or absence of disability in their children. The past evidence regarding parental self-efficacy which may impact actual parenting behaviours has been reviewed. The study has examined the universality in all the parents regardless to normal or ASDs, in predicting that self-efficacy is a boosting factor in enhancing parenting competence. Indeed, it has been learnt that effective parenting had demonstrated better capabilities in defiant child behaviour. Another study has observed that the association between psychological components of parents of children is ASD and their self-efficacy in their parenting. Here, the reviewed fact demonstrates that the alteration in mental equilibrium leading emotional disturbance reduces their perception of self-efficacy. Although there is a factor mainly parental competency in edge with psychological components such as parental confidence and self-efficacy, may researchers have appreciated the construct simulating self-efficacy? The current review also supports this aspect that parental self-efficacy is a competency in parenting children with ASDs. The current review examines self-efficacy and its significance in determining effective parenting of children with ASD since it has been learnt that self-efficacy is a hallmark general parenting which includes their social and emotional aspect in relation to their parenting outcomes. The current study has reviewed that fathers' anxiety and self-efficacy mediated the effect of child behaviour problems. Evaluating parenting ability and self-efficacy is viewed as a vital point since the possibility that parents of children with ASD experience decreased confidence in self-efficacy and parenting has been allied with increased parenting stress. The parents having a child with ASD lack social network and support system also knotted with social and emotional problems thus make a ground for stress, thereby they lack confidence in their parenting skill.,, Indeed, these parents have probability for developing depression and anxiety about raising their child. The current study tries to review self-efficacy and its impact on various aspects of parent personality such as their self-confidence, social skills and emotional stability. The current review analyses that the standard families have the promising opportunities for personal growth which can be utilised for balancing ones' emotions, and realising its impact on social intelligence is important for parents of children with ASDs. The observed evidence emphasises to parents having considerable distress due to multiple stressors, examined in the family hardiness, perceived social support and parent self-efficacy as predictors of emotionality paving the way to the family distress in mothers of children with ASD. Other observed aspect by the current review study is perceived self-efficacy and social support involvement in building up the stressors, which screens the parents' social intellect and paves the way to the family hardiness. Indeed, the family hardiness was associated with family distress. Investigators and clinicians should escalate the perception of social support and parent self-efficacy paving its role in ascribing family hardiness as psychological components. Parenting abilities and social and emotional behaviours are the common issues noticed with their child's behaviours. The parental perception of their child has led negative emotionality and condensed self-efficacy, thus affected their understanding of their child's need because of poor social communication of ASD children. The children with ASD lack clarity in expressing the needs because of their inability in verbal and non-verbal communication. Parents of these children doubt their own abilities in fulfilling the emotional needs of their children. The current reviews have observed the significance of social intelligence of parents of these children. The current study much importance in parents' self-efficacy because of its role in management of their children. Thus, training programmes also focus on parent's self-efficacy for its optimal benefit. Literature evidence has been observed in the cases of maternal caregivers attending individual treatment sessions upheld self-efficacy. Children behavioural problems can be greatly reduced with intervention programmes focussed on improving parental self-efficacy. Parents of children with ASD child suffer from decreased parental self-efficacy buffered with various reasons. However, an increase in parental self-efficacy seen in the interventions has a constructive impact on parents and their children with ASD. Thus, advancing intervention methods focussing on these issues would pave a way for better outcome. The scrutinising the evidence-based reviews determines that the parent-focussed intervention is more beneficial and that the parents are motivated and self-directed in the intervention programme. Indeed, the evidence reviewed by the current study revealed that the positive parenting paves a way for promising intervention and management of ASD. The data collected from these parents regarding their child's behaviour presaged that parenting styles has an impact on treatment effectiveness.,,,, On the other hand, it has been observed that parental over reactions and verbalising emotional expression have a negative impact on child's behaviour., Thus, parental satisfaction and efficacy widen the floor improvements in child's behaviour. The current study focuses on studies that deliberate parents' social intelligence and self-efficacy intervention that focuses on parental abilities in the programme. Based on Bandura's self-efficacy theory, many self-efficacy measures have been developed. The level, strength and generality are the three-dimensional measures of the scale. The test items consist of day-to-day infant-care tasks as well as their interactive behaviours which also deliberate their social intellect with their child. The parents' strength, degree of confidence and generality to the modalities for different functions are expressed. This pattern demonstrates parental practice of the affective, cognitive and behavioural skills; thus, their efficacy pins parenting. Thus, the current review finds the significance of self-efficacy in the intervention of child with ASD. The review examination evidences the improved outcomes with early behavioural intervention in the initial phase of treatment in the children with autism. However, the question needs to be answered that whether parents could be trained in the intervening programme. One of the reviewed evidence supports this fact that the parent training is an indispensable in enhancing the communication skills of children with ASDs. The current study examines the effectiveness of parental self-efficacy and their social intelligence in bringing out the better results in intervention of ASD children.
| Emotional Component Affected Social Skills|| |
The current study examines the parenting of children with ASDs which pervade into child's behaviour problems. It focuses on the emotional component of personality parenting child rearing since it has been regarded as an important aspect of an intervention of ASD. The current review examines the parents who potentiate the impact on their health and well-being since raising a child with ASD parents needs to face various challenges. The current study had reviewed that fatigue and its impact on parental welfare specifically mothers of children with ASD had high levels of fatigue with poor rest and sleep; hence loose appropriate parenting skill to manage their special child. The observed fact was that the fatigue has an impact on parents' well-being. Stress, anxiety and depression and lower parenting efficacy have also been observed. Review analysis had observed that the emotional disturbances lead to undue delay in diagnosis and treatment of child with ASD. The study examines and explores the parental unstable emotional behaviour and feelings expression to their children. Since the emotional expressions are the part of social behaviour, the negative emotion and their expressions will do affect the social skill of parents. The evidence observed ASD aetiology in conjunction with a surfeit of different interventions available for ASD. However, the various aspects of emotionality and social skills in parents need extensive research. The current study reviewed the evidence that the feeling of insecurity in parents affects the effective parenting and resulted in a delay in ASD diagnosis. Emotional and social components of parents of ASD children affect their wholesome involvement in effective parenting and their participation in the intervention programme. Disturbances in these areas of their personality may reduce their efficiency with this regard. The current study had reviewed lowered self-contentment in these parents. The interventions targeting fatigue in parents who impacting on the families with ASD children has also focussed. Stress in individuals affects their socio-functional level in their occupational life.,, The current study evidenced that parents of children with ASDs have higher levels of parenting stress and their affective symptoms are much greater than the parents of typically developing children. The emotional stress in African-American mothers of children with ASDs had found higher negative impact having ASD child; these mothers were found with less perceived social support. This predicts the greater negative impact on designing interventions with family support in targeting parents who are vulnerable to high levels of stress. The current study had reviewed that the comparison made of parental characteristics among the children with developmental disorder revealed that the autistic children play a crucial role in the genesis of autism. The environmental stressors in the middle-class families of autistic group evidenced larger proportion. There is no supportive evidence observed regarding parental warmth, emotional responsiveness, sociability and any other stresses among the per class of ASD group. Another analyses that it is unlikely to develop ASD because of personality traits of parents. One more study evidenced performance on an emotional labelling task in response to schematic facial patterns representing in parents of children with ASD and evidenced that father's performance was worse than mothers they decoded with expression of disgust. The significance of such research on an emotional expression and the interactions between parents and their children with autism, through play, promotes the social competency in these children. This study also finds emotionality affecting personality trait of parents of a child with ASD also its significance in promoting social competence in these children. Current-reviewed research has explored that mothers' anxiety and depression showed greater than fathers' evidence, which showed clear-cut gender differences with this regard. The current review had also evidenced substance addiction, because of stress and emotionality, it is a coping option to the stress. Evidence also found that alcoholism is in large number among the parents of children with ASD. Scrutinising and examining the past evidence have polished the understanding of coping strategies in parents of children with ASD., The significant differences between the emotional and social cognitive gradient had found that the mothers' level of coping was much higher for the cognitive gradient than that from the emotional angle. The gender difference in the emotional gradient was here in the observed fact that the reviewer finds that the presence of emotional and social cognition gradients in the parents of a child with ASD can be made more suitable for intervention is to be researched.
| Social Cognition|| |
The current review examines the association between cognition and emotion; further, the role of cognition and emotion observed focussed on the treatment of ASD. Parents with the distress of children with ASDs are at risk. The cognitive component of the personality of parents with ASDs child can affect the perspectives of parents of children with ASD. The findings suggest that the possibility of broader autism phenotype and their cognitive flair supporting information-processing and the siblings of ASD children found lower intelligence quotient scores and their performances were poor in reading and spelling. The cognitive profile warrants the need for further research to operationalise this area to get more clarity. The current review observes that the parent's involvement in the therapeutic programme their intellectual in decision-making needs to be focussed to get benefited from the intervention planned. This study had also tried to analyse the past evidence on the therapeutic schedules established for an autistic child and found the need for continued revision, consistency and education for the parents. Thus, the decision-making is structured for the smooth processing of therapies, to bring out the modified interventional programmes. The current study had examined the issues such as parents who still have unsettled issues of their marital discord; parents compromise on their autistic child and development concerning their personal issues. Thereby parental decision-making process regarding treatment plan is affected. The current study had evidenced that parent's cognitive strength also affects their sociability having insight to these aspects which help the intervention of their child with ASD. Parents' perceptions are the cognition that has its relation with the ASD child's emotions. The current study evidences that the parents' perceptions of their children emotion is found to be more negative than positive emotion in their children with ASD. Parental attitudes impacted children's attention and responsiveness to others were evidenced in children's emotion though this evidence is contradicted the view that absence of emotional reaction in autism. The current review examines parent perception and their satisfaction regarding the education of children of their children, effective management of their ASD child's behaviour by the school personnel. However, training for teachers and effective communication between parents and teachers and the teamwork has its own advantage. The present study had reviewed that the children with high functioning autism were asked to consider the outcome priorities of friendship, social skills, physical development, motor development, intellectual ability, academic skills, creativity and emotional capacity. Among these, the friendship would be highly prioritised by parents. However, with this regard, difficulties were experienced by children with autism. Parents-rated outcomes involving social skills, emotional skills and friendship were closely rated. The autistic symptomatology was not influenced by this parent rating. This review study analyses the significance of various fact and learns that the parent rating influencing autistic symptomatology and parenting style. The current study has examined that the parent's perception of child behaviours and its significance in therapeutic benefits has been explored. ASDs children show impairment in communication, abnormal social interactions and abnormal responses to sensory stimuli, restricted, repetitive and stereotyped behaviours. Active interventions with family involvement are needed to predict prognosis of the disorder that could bring positive changes in ASD child. The analytical results of reviewed studies reveal that the significance of music therapy and parents' perceptions of music therapy unveils the positive responses of them. Articulating these new insights may ground the way for effective treatment for children with ASDs children. Therefore, music therapy would have a potential gain in advancing the intervention strategy. The current review reveals that the parental engagement and their communication with teachers help them ground the expected boundaries for the child. The evidence also reveals the mother's desire to contribute with this regard with their child's schooling. The current review evidences that the cognitive strength helps the child communicate well with teachers and paves a way for overall development.
| Conclusion and Integration|| |
In the recent years, the treatment of ASDs is seen with an implausible advancement because of its growing prevalence rate. The advancements with this regard focus more on holistic approaches in the intervention programmes. The psychological interventions refined through parental involvement to their fullest and viewing ASD and related problems in its management in different perspective. Planning these interventions becomes more challenging. Although the parent training and balancing their psychological well-being pave incredible support to the treatment programme, making this option feasible is difficult. Since it demands a lot of time and cost, all the parents may not opt for this option. However, with all the pros and cons, many types of research are still going on this area, so the external agencies such as government and other health agencies can make the parents way easy with this regard. Although the parental training can go with the different perspective, the current study emphasises on conceptualising emotionality masking social intelligence of parents with ASD children. Perhaps, this study focuses on accounting the evidence concerning the existing methods of training the parents of children with ASD and further involving them in therapeutic intervention managing their emotional well-being and opening their eyes regarding their social intellect. This proposed intervention method may be useful in setting up new guidelines though the area is still debated. The studies and researches in these areas to bring the advancement in planning and standardising holistic approach, which appreciates the active participation of the parents in the management of ASD children found to be prolific. Eventually, to support better understanding and conceptualising the importance of parental psychosocial well-being in formulating and modifying existing interventions may pave a way to the enrichment of treatment and extending the scope for more research in this area. A new proposed model for intervening methods for ASD recommends considering emotional and social intelligence of parents with autistic children.
The current inquiry had reviewed the evidence from the above studies and suggested sockets for the programmers listed below:
- Severity and persistency of ASD are dynamic throughout life of affected children
- These deficits are associated with parent's emotional and social intelligence and self-efficacy
- The impact parenting has a reciprocal effect on children with ASD
- The interventions for ASD are still open to fill up the loop holes; parenting style has an impact on effective therapy
- Evaluation of ASD therapy limits to the assessment of the child. It is also needed for the day considering parent's emotional and social intelligence and self-efficacy
Reviewing various hitches in the existing interventions for ASD, the current study had suggested new measures to frame the goals and enrich the effects of treatment. The highlighted area in this study has been extended to personality factors of parents and appraising them as a part of the newly recorded model. The current review examines that the problem encountered in parenting is not only in the biological relationship but also in raising them to independent unique personalities. The coping pattern differs with the amount of pressure and parental ability to cope with the stressors affecting their emotional and social intellectual behaviour. Thus, this study recommends appraisal of this area in parents of ASD children to bring out the efficacy of the treatment programme. Thus, it can be useful for the parents of ASD in facing daily challenges of their life. A thematic analysis of the data identified three essential core categories concerning the appraisal of parent emotional and social intellectual behaviour since their involvement in the intervention programme to the optimal level is vital. Knowing more about how various ASD treatments impact parents and families is important. The proposed model makes sure that the treatment modality for the ASD is not only being applied to the treatment of these children but also includes parents and their involvement with evaluation and conceptualising emotional and social intellectual behaviour. Furthermore, educating them regarding psychological interventions this can help them maintain their psychological well-being. In fact, many therapy models such as parent training models have evaluated parental involvement with different perspective and its outcomes regarding treatment benefits of ASD. It is also important to know that the ASD interventions need to have better understanding of the mechanisms of treatment. Thus, current proposed model facilitates the understanding regarding the significance of conceptualising parents' emotional and social intellectual expressions and its impact on their child's improvement. However, long-term treatment is often restricted by inadequate understanding of therapeutic benefits. This fact has been stated that related research had conceptualised in the present study and recommends to bringing out the understanding regarding structural changes that benefit the treatment of ASD. Thus, the proposed model pays a way in the enrichment in parenting style and their participation in the management of their children. The suggested intervention programme focuses on evaluating and conceptualizing emotional and social intelligence of parents. The appraisal is done in this area to know the disturbances in this field, further to be verified by related research. In addition, this model has been provided to develop an insight in the parents thus mend them in per increase their contribution to the intervention programme.
| the Proposed Model for the Intervention for Autism Spectrum Disorder Children|| |
The current study proposed model focuses on two areas, first one psycho-educational programme part of intervention for the parents with ASD children [Figure 1]. Here, the focus is on evaluation and understanding the emotional stability and its impact on their social intelligence of parents and helping them to conceptualise this aspect through psycho-education. The second area focuses on therapeutic intervention part of an intervention to stabilise emotionality of the parents' with ASD children of enrichment and psychological well-being [Figure 2]. Here, the focus on various psychotherapies such as hypnotherapy, cognitive therapy, individual therapies and supportive programmes by government and other agencies is beneficial as a holistic approach.
|Figure 1: Psycho-educational programme part of intervention for the parents' with autism spectrum disorder children.|
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|Figure 2: Proposed therapeutic intervention part of intervention to stabilise emotionality of the parents' with autism spectrum disorder children of enrichment and psychological well-being.|
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The proposed model helps overcome contributing to the long-term maintenance of sustained growth following treatment. Incorporation of parental factors in therapy outcome in this research study would help fill the areas passed over with ignorance. It is also vital in structuring the environment belonging to the ASD child. The current research support and advocacy have been gained with the help of parents and supporting governmental and non-governmental health organisations. The current review study proposes and recommends parental appraisal emotional and social intelligence and managing these two components with psycho-education and psycho-therapeutic intervention though it is not very feasible for all the parents; it has its own benefits in the treatment and widening the scope for further research. Further, the variables recommended in this model should be evaluated with regard to interacting effects to refine captivity and to conceptualise the multidimensional and the synergetic relationship between the models. These variables can and should be added if they contribute to the therapeutic benefits. These strategic practices eventually allow more comprehensive comparison between ASD treatment developing healthy parental personalities regarding emotional and social well-being. Although this task is herculean, it should deal with the treatment of ASD child. Overall, the evaluation and implication of these variables spelled in the model would explore the further benefits of the intervention and pave the way for future research in this regard. The approaches are not free from the limitation; however, the clinician's work opens the gate for future research and practice based on these findings which have favourable grounds in the interventions of ASD.
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Conflicts of Interest
There are no conflicts of interest.
| References|| |
Kanner L. Autistic disturbances of affective contact. Nerv Child 1943;2:217-50.
Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; the National Academies of Sciences, Engineering, and Medicine; Boat TF, Wu JT, editors. Mental Disorders and Disabilities among Low-Income Children. Washington, DC: National Academies Press (US); 2015. p. 8. Clinical Characteristics of Autism Spectrum Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK332891/
. [Last accessed on 2017 Feb 14].
Martínez-Pedraza Fde L, Carter AS. Autism spectrum disorders in young children. Child Adolesc Psychiatr Clin N
Schriber RA, Robins RW, Solomon M. Personality and self-insight in individuals with autism spectrum disorder. J Pers Soc Psychol 2014;106:112-30.
Brentani H, Paula CS, Bordini D, Rolim D, Sato F, Portolese J, et al.
Autism spectrum disorders: An overview on diagnosis and treatment. Rev Bras Psiquiatr 2013;35 Suppl 1:S62-72.
Howlin P. Living with impairment: The effects on children of having an autistic sibling. Child Care Health Dev 1988;14:395-408.
Schneiderman N, Ironson G, Siegel SD. Stress and health: Psychological, behavioral, and biological determinants. Annu Rev Clin Psychol 2005;1:607-28.
National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children; England MJ, Sim LJ, editors. Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: National Academies Press (US); 2009. p. 4. Associations between Depression in Parents and Parenting, Child Health, and Child Psychological Functioning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215128/
. [Last accessed on 2017 Feb 14].
Stepp SD, Whalen DJ, Pilkonis PA, Hipwell AE, Levine MD. Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personal Disord 2012;3:76-91.
Cheng FK. Is meditation conducive to mental well-being for adolescents? An integrative review for mental health nursing. Int J Afr Nurs Sci 2016;4:7-19.
Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population: The Brick Township, New Jersey, investigation. Pediatrics 2001;108:1155-61.
Laugeson EA, Frankel F, Mogil C, Dillon AR. Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. J Autism Dev Disord 2009;39:596-606.
Cantor N, Kihlstrom JF. Personality and Social Intelligence. Englewood Cliffs, NJ.: Prentice Hall; 1987.
Marlowe HA Jr. Social intelligence: Evidence for multidimensionality and construct independence. J Educ Psychol 1986;78:52-8.
Hixson MD, Wilson JL, Doty SJ, Vladescu JC. A review of the behavioral theories of autism and evidence for an environmental etiology. J Speech Lang Pathol Appl Behav Anal 2008;3:46-59.
Bishop DV. Ten questions about terminology for children with unexplained language problems. Int J Lang Commun Disord 2014;49:381-415.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Arlington, VA: American Psychiatric Publishing; 2013.
Christensen DL, Baio J, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, et al.
Prevalence and characteristics of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ 2016;65:1-23.
Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, et al.
Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). Lancet 2006;368:210-5.
Neggers YH. Increasing prevalence, changes in diagnostic criteria, and nutritional risk factors for autism spectrum disorders. ISRN Nutr 2014;2014:514026.
Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcín C, et al.
Global prevalence of autism and other pervasive developmental disorders. Autism Res 2012;5:160-79.
Wan Y, Hu Q, Li T, Jiang L, Du Y, Feng L, et al.
Prevalence of autism spectrum disorders among children in China: A systematic review. Shanghai Arch Psychiatry 2013;25:70-80.
Sun X, Allison C. A review of the prevalence of autism spectrum disorder in Asia. Res Autism Spectr Disord 2010;4:156-67.
Werling DM, Geschwind DH. Sex differences in autism spectrum disorders. Curr Opin Neurol 2013;26:146-53.
Halladay AK, Bishop S, Constantino JN, Daniels AM, Koenig K, Palmer K, et al.
Sex and gender differences in autism spectrum disorder: Summarizing evidence gaps and identifying emerging areas of priority. Mol Autism 2015;6:36.
Lenroot RK, Yeung PK. Heterogeneity within autism spectrum disorders: What have we learned from neuroimaging studies? Front Hum Neurosci 2013;7:733.
Szpir M. Tracing the origins of autism: A spectrum of new studies. Environ Health Perspect 2006;114:A412-8.
Chaste P, Leboyer M. Autism risk factors: Genes, environment, and gene-environment interactions. Dialogues Clin Neurosci 2012;14:281-92.
Odom SL, Boyd BA, Hall LJ, Hume K. Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. J Autism Dev Disord 2010;40:425-36.
Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; the National Academies of Sciences, Engineering, and Medicine; Boat TF, Wu JT, editors. Mental Disorders and Disabilities among Low-Income Children. Washington, DC: National Academies Press (US); 2015. p. 14. Prevalence of Autism Spectrum Disorder. Available from: https://www.ncbi.nlm.nih.gov/books/NBK332896/
. [Last accessed on 2017 Feb 15].
Nevison CD. A comparison of temporal trends in United States autism prevalence to trends in suspected environmental factors. Environ Health 2014;13:73.
Miles JH. Autism spectrum disorders – A genetics review. Genet Med 2011;13:278-94.
Karst JS, Van Hecke AV. Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clin Child Fam Psychol Rev 2012;15:247-77.
Bhagat V, Mat HK, Husain R, Haque M. Parent's negative emotionality impacting parenting and involvement in the intervention of their child with autism spectrum disorder: A review proposed the new model for intervention. Int J Pharm Sci Rev Res 2016;36:54-62.
DeRosier ME, Swick DC, Davis NO, McMillen JS, Matthews R. The efficacy of a Social Skills Group Intervention for improving social behaviors in children with high functioning autism spectrum disorders. J Autism Dev Disord 2011;41:1033-43.
Dekker V, Nauta MH, Mulder EJ, Timmerman ME, de Bildt A. A randomized controlled study of a social skills training for preadolescent children with autism spectrum disorders: Generalization of skills by training parents and teachers? BMC Psychiatry 2014;14:189.
King G, Strachan D, Tucker M, Duwyn B, Desserud S, Shillington M. The application of a transdisciplinary model for early intervention services. Infants Young Child 2009;22:211-23.
Bhagat V, Jayaraj J, Haque M. Parent's self-efficacy, emotionality, and intellectual ability impacting the intervention of autism spectrum disorders: A review proposed model for appraisal of intervention. Int J Pharm Pharm Sci 2015;7:7-12.
Mackay R. The impact of family structure and family change on child outcomes: A personal reading of the research literature. Soc Policy J N
Aldwin CM, Sutton KJ, Chiara G, Spiro A 3rd
. Age differences in stress, coping, and appraisal: Findings from the Normative Aging Study. J Gerontol B Psychol Sci Soc Sci 1996;51:P179-88.
Nurullah AS. It's really a roller coaster: Experience of parenting children with developmental disabilities. Marriage Fam Rev 2013;49:412-45.
Gomes PT, Lima LH, Bueno MK, Araújo LA, Souza NM. Autism in Brazil: A systematic review of family challenges and coping strategies. J Pediatr (Rio J) 2015;91:111-21.
Estes A, Munson J, Dawson G, Koehler E, Zhou XH, Abbott R. Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism 2009;13:375-87.
Bluth K, Roberson PN, Billen RM, Sams JM. A stress model for couples parenting children with autism spectrum disorders and the introduction of a mindfulness intervention. J Fam Theory Rev 2013;5:194-213.
De Bellis MD, Spratt EG, Hooper SR. Neurodevelopmental biology associated with childhood sexual abuse. J Child Sex Abus 2011;20:548-87.
Spratt EG, Friedenberg SL, Swenson CC, Larosa A, De Bellis MD, Macias MM, et al.
The effects of early neglect on cognitive, language, and behavioral functioning in childhood. Psychology (Irvine) 2012;3:175-82.
Leitner Y. The co-occurrence of autism and attention deficit hyperactivity disorder in children – What do we know? Front Hum Neurosci 2014;8:268.
Rao PA, Landa RJ. Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism 2014;18:272-80.
Romero M, Aguilar JM, Del-Rey-Mejías A, Mayoral F, Rapado M, Peciña M, et al
. Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis. Int J Clin Health Psychol 2016;16:266-75.
McKee L, Colletti C, Rakow A, Jones DJ, Forehand R. Parenting and child externalizing behaviors: Are the associations specific or diffuse? Aggress Violent Behav 2008;13:201-15.
Bebko JM, Konstantareas MM, Springer J. Parent and professional evaluations of family stress associated with characteristics of autism. J Autism Dev Disord 1987;17:565-76.
Tripathi N. Parenting style and parents' level of stress having children with autistic spectrum disorder (CWASD): A study based on Northern India. J Neuropsychiatry 2015;1:1-8.
Wolf LC, Noh S, Fisman SN, Speechlay M. Brief report: Psychological effects of parenting stress on parents of autistic children. J Autism Child Schizophr 1989;19:157-66.
Lecavalier L, Leone S, Wiltz J. The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. J Intellect Disabil Res 2006;50(Pt 3):172-83.
Bishop SL, Richler J, Cain AC, Lord C. Predictors of perceived negative impact in mothers of children with autism spectrum disorder. Am J Ment Retard 2007;112:450-61.
National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children; England MJ, Sim LJ, editors. Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: National Academies Press (US); 2009. p. 7. Prevention of Adverse Effects. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215125/
. [Last accessed on 2017 Feb 20].
Mandy W, Charman T, Puura K, Skuse D. Investigating the cross-cultural validity of DSM-5 autism spectrum disorder: Evidence from Finnish and UK samples. Autism 2014;18:45-54.
Losh M, Childress D, Lam K, Piven J. Defining key features of the broad autism phenotype: A comparison across parents of multiple- and single-incidence autism families. Am J Med Genet B Neuropsychiatr Genet 2008;147B: 424-33.
Pisula E, Ziegart-Sadowska K. Broader autism phenotype in siblings of children with ASD – A review. Int J Mol Sci 2015;16:13217-58.
Gökçen E, Petrides KV, Hudry K, Frederickson N, Smillie LD. Sub-threshold autism traits: The role of trait emotional intelligence and cognitive flexibility. Br J Psychol 2014;105:187-99.
Osborne LA, McHugh L, Saunders J, Reed P. Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. J Autism Dev Disord 2008;38:1092-103.
Rahgozar S, Motahari AA, Zolali A. Assessing Bar-On's emotional intelligence components among normal subjects and those of having suicide trial record. Indian J Sci Technol 2011;4:1391-5.
Baron-Cohen S, Ring HA, Wheelwright S, Bullmore ET, Brammer MJ, Simmons A, et al.
Social intelligence in the normal and autistic brain: An fMRI study. Eur J Neurosci 1999;11:1891-8.
Myers SM, Johnson CP; American Academy of Pediatrics Council on Children with Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007;120:1162-82.
Maljaars J, Boonen H, Lambrechts G, Van Leeuwen K, Noens I. Maternal parenting behavior and child behavior problems in families of children and adolescents with autism spectrum disorder. J Autism Dev Disord 2014;44:501-12.
Festen H, Schipper K, de Vries SO, Reichart CG, Abma TA, Nauta MH. Parents' perceptions on offspring risk and prevention of anxiety and depression: A qualitative study. BMC Psychol 2014;2:17.
Huang M, Zhou Z. Perceived self-efficacy, cultural values, and coping styles among Chinese families of children with autism. Int J Sch Educ Psychol 2016;4:61-70.
Troutman B, Moran TE, Arndt S, Johnson RF, Chmielewski M. Development of parenting self-efficacy in mothers of infants with high negative emotionality. Infant Ment Health J 2012;33:45-54.
Coleman PK, Karraker KH. Self-efficacy and parenting quality: Findings and future applications. Dev Rev 1998;18:47-85.
Weiss JA, Wingsiong A, Lunsky Y. Defining crisis in families of individuals with autism spectrum disorders. Autism 2014;18:985-95.
Hastings RP, Brown T. Behavior problems of children with autism, parental self-efficacy, and mental health. Am J Ment Retard 2002;107:222-32.
Boyd BA. Examining the relationship between stress and lack of social support in mothers of children with autism. Focus Autism Other Dev Disabil 2002;17:208-15.
Sofronoff K, Farbotko M. The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome. Autism 2002;6:271-86.
Petrenko CL. A review of intervention programs to prevent and treat behavioral problems in young children with developmental disabilities. J Dev Phys Disabil 2013;25:1391-5.
Keena D, Couzens D, Muspratt S, Rodger S. The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence. Res Autism Spectr Disord 2010;4:229-41.
Weisner TS, Martin JC. Learning environments for infants. Alternative Lifestyles 1979;2:201-42.
Weisner TS, Gamier H. Nonconventional family life-styles and school achievement: A 12-year longitudinal study. Am Educ Res J 1992;29:605-32.
Eaves LJ, Prom EC, Silberg JL. The mediating effect of parental neglect on adolescent and young adult anti-sociality: A longitudinal study of twins and their parents. Behav Genet 2010;40:425-37.
Paul R. Interventions to improve communication in autism. Child Adolesc Psychiatr Clin N
Am 2008;17:835-56, ix-x.
Whittingham K, Sofronoff K, Sheffield J, Sanders MR. Stepping Stones Triple P: An RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. J Abnorm Child Psychol 2009;37:469-80.
Coolican J, Smith IM, Bryson SE. Brief parent training in pivotal response treatment for preschoolers with autism. J Child Psychol Psychiatry 2010;51:1321-30.
Giallo R, Wood CE, Jellett R, Porter R. Fatigue, wellbeing and parental self-efficacy in mothers of children with an autism spectrum disorder. Autism 2013;17:465-80.
Samios C, Pakenham KI, Sofronoff K. The nature of benefit finding in parents of a child with Asperger syndrome. Res Autism Spectr Disord 2009;3:358-74.
Hill C, Rose J. Parenting stress in mothers of adults with an intellectual disability: Parental cognitions in relation to child characteristics and family support. J Intellect Disabil Res 2009;53:969-80.
Nikolova RI. Novel contemporary guidelines and dimensions of occupational psycho-social stress, psychological risk factors and patterns of the XXI century. Psychol Behav Sci Int J 2017;2:555577.
Law M, Steinwender S, Leclair L. Occupation, health and well-being. Can J Occup Ther 1998;65:81-91.
Michie S. Causes and management of stress at work. Occup Environ Med 2002;59:67-72.
Davis NO, Carter AS. Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics. J Autism Dev Disord 2008;38:1278-91.
Rezendes DL, Scarpa A. Associations between parental anxiety/depression and child behavior problems related to autism spectrum disorders: The roles of parenting stress and parenting self-efficacy. Autism Res Treat 2011;2011:395190.
Cox A, Rutter M, Newman S, Bartak L. A comparative study of infantile autism and specific developmental receptive language disorder. II. Parental characteristics. Br J Psychiatry 1975;126:146-59.
Palermo MT, Pasqualetti P, Barbati G, Intelligente F, Rossini PM. Recognition of schematic facial displays of emotion in parents of children with autism. Autism 2006;10:353-64.
Twoy R, Connolly PM, Novak JM. Coping strategies used by parents of children with autism. J Am Acad Nurse Pract 2007;19:251-60.
Gona JK, Newton CR, Rimba KK, Mapenzi R, Kihara M, Vijver FV, et al.
Challenges and coping strategies of parents of children with autism on the Kenyan coast. Rural Remote Health 2016;16:3517.
Sivberg B. Coping strategies and parental attitudes, a comparison of parents with children with autistic spectrum disorders and parents with non-autistic children. Int J Circumpolar Health 2002;61 Suppl 2:36-50.
Happé F, Briskman J, Frith U. Exploring the cognitive phenotype of autism: Weak “central coherence” in parents and siblings of children with autism: I. Experimental tests. J Child Psychol Psychiatry 2001;42:299-307.
Capps L, Kasari C, Yirmiya N, Sigman M. Parental perception of emotional expressiveness in children with autism. J Consult Clin Psychol 1993;61:475-84.
Starr EM, Foy JB. In parents' voices: The education of children with autism spectrum disorders. Remedial Spec Educ 2012;33:207-16.
Petrinaa N, Cartera M, Stephensona J. Parental perception of the importance of friendship and other outcome priorities in children with autism spectrum disorder. Eur J Spec Needs Educ 2015;30:61-74.
Allgood N. Parents' perceptions of family-based group music therapy for children with autism spectrum disorders. Music Ther Perspect 2005;23:92-9.
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