**2. Method**

#### **2.1. Participants**

The sample used this research was composed of 217 parents of children diagnosed with ASD (127 mothers and 90 fathers). All of the parents spoke Spanish as their primary language. Participation was voluntary and kept confidential. The data presented in Table 1 indicate that mothers and fathers were similar in age, marital status and educational level.

Coping Strategies and Parents' Positive Perceptions of Raising a Child with Autism Spectrum Disorders http://dx.doi.org/10.5772/58966 57


**Table 1.** Demographic information for parents

orientation guidelines for the different professionals involved in the care of the child. Parents themselves are worthy of the best and most effective psychological support that professionals can provide to promote parents' quality of life and well-being. Research has shown that parents can obtain significant benefit from psychological support to face the challenge of caring for their child with special needs [65-70]. It is also important to remember that the psychological well-being of parents affects the exercise of their paren‐ tal role and, therefore, contributes to conditions that support the child's development and

This review allows us to justify the pertinence of a study with the primary aim of analysing the relationship between parents' perceived positive contributions of raising a child with ASD and their psychological well-being and perception of family quality of life. The complexity of parents' psychological adaptation processes leads us to propose a complex design that include other variables to obtain the most comprehensive information about possible intervening factors, the relationship among these factors, and the relative position that positive contribu‐ tions could have on predictive models of parental well-being. An *ex post facto* design was applied with a wide sample of parents of children diagnosed with ASD (127 mothers and 90

**•** Predictor variables: age of the child with ASD, behaviour problems, family income, parents'

Considering the results of the research reviewed above, the following hypotheses are formu‐

**1.** We expect some differences between mothers and fathers. Mothers will have higher levels

**2.** The perception of positive contributions will be related to psychological well-being and perceived family quality of life among the parents in the study. Higher levels of perceived positive contributions would correspond with higher levels of psychological well-being

**3.** The perception of positive contributions will be a relevant predictor of the two criterion

The sample used this research was composed of 217 parents of children diagnosed with ASD (127 mothers and 90 fathers). All of the parents spoke Spanish as their primary language. Participation was voluntary and kept confidential. The data presented in Table 1 indicate that

coping strategies, social support and perception of positive contributions

**•** Criterion variables: parents' psychological well-being and family quality of life.

welfare [71, 72].

56 Autism Spectrum Disorder - Recent Advances

lated:

**2. Method**

**2.1. Participants**

fathers) and the following study variables:

and family quality of life.

of perceived positive contributions than fathers.

variables: psychological well-being and family quality of life.

mothers and fathers were similar in age, marital status and educational level.

A significant difference appeared in employment (*chi square*=54.89, *p*=0.01), with 54% of the mothers and 89% of the fathers gainfully employed. Data on family composition with the frequency distribution according to number of members and household income are presented in Table 2.


#### **Table 2.** Family composition and family income


*Note.* SD=Standard Deviation; ASD=Autism Spectrum Disorders

PDD-NOS=Pervasive Developmental Disorder – Not Otherwise Specified

With regard to the characteristics of the individuals with ASD (N=137), it is important to note (see Table 3) the wide age range (3-37 years); the average of age was *M*=11.7 years, *SD=*8.36; 109 of the individuals with ASD were male and 28 were female. The main category of ASD among participants was Autistic Disorder (82), followed by PDD-NOS (38), Rett's Syndrome (8), Asperger's Syndrome (6) and Disintegrative Disorder (2). The criteria diagnoses corre‐ spond to the categories of DSM-IV-TR because the diagnoses were made before publication DSM-V (APA, 2013).

#### **2.2. Procedure**

**Families (n = 137) % (n)**

**Individuals with ASD (n = 137) % (n) Mean (SD)** *Age* (years) range 3-37 11.72 (8.36)

> 79.6 (109) 20.4 (28)

59.9 (82) 4.4 (6) 5.8 (8) 1.5 (2) 27.7 (38)

43.0 (59) 5.1 (7) 38.0 (52) 13.9 (19)

4.4 (6) 25.5 (35) 51.8 (71) 15.6 (20) 3.7 (5)

10.9 (15) 30.7 (42) 29.2 (40) 18.2 (25) 2.9 (4) 8.0 (11)

*Family composition* 2 members 3 members 4 members 5 members 6 members or more

*Family incomes* < 500 euros 500-850 euros 850-1200 euros 1200-1800 euros 1800-2000 euros > 2000 euros

**Table 2.** Family composition and family income

58 Autism Spectrum Disorder - Recent Advances

*Gender* Men Female

*Type ASD*

Autistic disorder Asperger's syndrome Rett's syndrome Disintegrative disorder

PDD-NOS

*Education centre*

Day centre

Ordinary school Special-education school Autism-specific school

**Table 3.** Demographic information for individuals with ASD

*Note.* SD=Standard Deviation; ASD=Autism Spectrum Disorders

PDD-NOS=Pervasive Developmental Disorder – Not Otherwise Specified

Initially, the heads of schools were contacted and informed of the aims of the research through the psychologist responsible for the school counselling in the case of ordinary schools and through the Spanish Professional Association of Autism in the case of specific centres. Parents received a letter inviting them to participate in the study. Further instructions were sent with the questionnaires to the voluntary participants. Instructions highlighted the confidential nature of the data, the participants' right to abandon the research if desired and the require‐ ment that questionnaires be completed individually, without discussion with their spouse. We relied on a non-probability sampling based on schools' accessibility to the researcher and individuals´ availability for participation (convenience sample). Parents participated by individually completing a set of questionnaires that they received either through the school or by e-mail, depending on their preference. A total of 217 parents (127 mothers and 90 fathers) completed the questionnaires.

#### **2.3. Measures**

Demographic information describing the parents, individuals with ASD and families was obtained through a brief questionnaire designed by the research team. Six questionnaires administered in Spanish evaluated the study variables. Two questionnaires—the *Brief Psychological Well-being* and the *Family Quality of Life Scale*—were previously adapted for Spanish by other authors. We translated the following measures into Spanish: the *Behaviour Problems Inventory,* the *Checklist of Support for Parents of the Handicapped,* the *Positive Contribu‐ tions Scale* and the *Brief Coping Orientation of Problems Experienced.* We adopted the backtrans‐ lation technique to ensure translation accuracy. Two bilingual experts were invited to translate the Spanish versions back to English to correct differences between the two versions.

The *Behaviour Problems Inventory* (BPI; [73]), a 52-item scale, was used to assess the behaviour problems of individuals with ASD. Each item is scored on a 4-point severity scale ranging from 0 (no problem) to 3 (a severe problem). The BPI has three subscales: self-injurious, stereotyped and aggressive/destructive behaviour. The BPI has been found to be a reliable and valid rating instrument for behaviour problems in individuals with mental retardation and developmental disabilities [73]. The reliability in the original scale is high, with a Cronbach's alpha of.83 for the total scale. The internal consistency of the total scale in the present study was also high, with α=.89.

The *Checklist of Supports for Parents of the Handicapped* (CSPH; [74]) was used to evaluate the social support available to parents caring for a child with ASD. It is a 23-item rating scale that uses a 5-point item scale ranging from 0 (nothing useful) to 4 (very useful). The total score of the measure was used in this study. There is no information regarding the internal consistency of the original scale, but in the present study, Cronbach's alpha was.82.

The *Positive Contribution Scale of the Kansas Inventory of Parental Perceptions* (KIPP; [51]) was chosen to evaluate the positive feelings of parents towards the child with ASD. The KIPP is a 50-item rating scale that ranges from 1 (strongly disagree) to 4 (strongly agree). Higher scores are associated with greater awareness of the positive perceptions. We also used measures of three subscales: a) source of happiness and fulfilment subscale (six items) to represent positive feelings towards the child; b) source of personal growth and maturity subscale (seven items) to indicate positive impact upon the respondent; and c) source of strength and family closeness (seven items) to represent the positive impact upon the family. The alpha reliability for the original Positive Contribution Scale was.80. For the subscales, the alpha reliability ranged from.84 and.86, indicating good psychometric characteristics. In the present study, Cronbach's alpha for the total scale was.91, and for the subscales, the alpha ranged from.68 to.81.

The *Brief Coping Orientation of Problems Experienced* (Brief-COPE; [75]; adapted to Spanish by [76]) was used to obtain information on coping strategies used by parents raising an individual with ASD. The Brief-COPE has 14 two-item subscales. Each item is rated in terms of how often the responder utilises a particular coping strategy as measured on a 4-point scale, where 0 represents "I have not been doing this at all" and 3 represents "I've been doing this a lot".

To reduce the number of strategies, we performed a principal component factor analysis following the methodology used by Hastings et al. [30]. The results showed that two factors explained 28% of the variance; the two factors included items from the original Brief-COPE sub-scales. Factor 1, which is named "positive and problem-focused coping strategies", includes thirteen items for active coping, planning, seeking instrumental and emotional social support, positive reframing, and humour (items 2, 5, 7, 10, 12, 14, 15, 17, 18, 19, 21, 23 and 28). Factor 2, which is named "active avoidance coping strategies", includes nine items (items 1, 3, 6, 8, 9, 16, 20(-), 24(-) and 26). Only the scores for these two factors were used in the current study. Reliability was good for the total scale (α=.77), positive and problem-focused coping strategies (α=.79), and active avoidance coping strategies (α=.71).

The *Brief Psychological Well-being Spanish Version* [77] is a brief version of the original Psycho‐ logical Well-being Scale [78]. It is a 29-item scale with a 4-point item scale ranging from 1 (completely disagree) to 4 (completely agree). The 29 items are organised into six dimensions (self-acceptance, positive relations, autonomy, environmental mastery, purpose in life and personal growth). The measure of psychological well-being used in this study was the total score. The internal consistency of the brief version of the scale in the original study was good (α=.84). In the present study, Cronbach's alpha was.91.

The *Family Quality of Life Scale* (FQOL [79]; adapted for Spanish by [80] was used to assess parents' satisfaction with their family quality of life. This is a 25-item scale with five sub-scales (family interaction, emotional well-being, parenting, physical/material well-being and disability-related support). This scale has two different response formats: satisfaction and importance. We used the total score of satisfaction format in this study. The items are rated on a 5-point scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Cronbach's alpha for the FQOL subscale rating of satisfaction was.94 in the original study and.95 in this study.

There were no missing values for the total scores of any of the scales. Missing values were limited to specific items of the questionnaires and were not always the same. The rates for all missing data were less than 1%. We applied average values derived from the existing values to fill in missing items. Comparative analysis between mothers and fathers were applied. Bivariate correlations and multiple regression analysis were performed separately for mothers and fathers. Data analysis was conducted using the SPSS 15 Program. The G\* Power 3.1 program [81] was used to calculate the effect size.
