**Table 5.**

*Descriptive statistics (mean, standard deviation, maximum and minimum scores) of the parental scales (N = 43).*

*Mothers* 39.6 6.9 57 29 *Fathers* 45 5.6 55 32 2. Emotional coping 34.2 6.6 52 20 *Mothers* 40.9 6.5 57 25 *Fathers* 36.6 5.4 50 28


#### **Table 6.**

*The correlations coefficients between parental measures scales.*

emotional style of coping. A similar correlation is seen with adopting the emotional coping style and parental stress, whereas those parents who used rational coping styles had better health and less stress.

Based on McDonald [40], because of the application of a large number of statistical tests in the present study analyses, there is a probability of an increased level of reporting the statistical significance merely on chance. Regression analysis was used not only to reduce this problem but also to control the multivariate relationships among the data. However, this analysis should be considered as exploratory, and for

*Summary of regression analysis for parent and child variables predicting parent's general health.*

**Table 9.**

**117**

*\**p *< 0.05. \*\**p *< 0.01.*

**Table 7.**

**Table 8.**

**Variable B** *SE B* **β** *t p* Parental stress 0.141 0.058 0.306 0.393 .002 Child's gender 7.461 2.136 0.403 3.493 .027 Parents' gender 1.395 0.587 0.266 1.604 .023 Mothers' job 1.721 0.633 0.312 1.940 .010 Emotional coping 0. 119 0.047 0.297 3.457 .015 ASD severity (ABC score) 0.219 0.101 0.587 1.034 .005

*The correlations between the parental measures and indicators of ASD in children (N = 43).*

General health total score 0.37\* 0.01 0.12 Emotional coping s 0.21 0.04 0.06 Rational coping 0.35\* 0.04 0.05 Family functioning 0.04 0.16 0.13 Parental stress 0.47\*\* 0.15 0.25 Parental satisfaction 0.01 0.22 0.06

*Frequencies of the coping style scale based on the scales scoring system.*

*DOI: http://dx.doi.org/10.5772/intechopen.92700*

**Coping style questionnaire Frequencies of the responses Percentage of the responses**

• Rational coping style (total) (26) (60%) *Mothers* 17 39.5% *Fathers* 9 21% • Emotional coping style (total) (12) (28%) *Mothers* 10 23% *Fathers* 2 5% • Avoidant coping style (total) (4) (10%) *Mothers* 4 10% *Fathers* 0 0 • Detached coping style (total) (1) (2%) *Mothers* 1 2% *Fathers* 0 0

*Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran*

**Total ABC scores Total SCQ score Total GARS2 all the subscales**

There was also a significant negative correlation between parental tendencies towards using a rational style of coping style and a child's ABC score (see **Table 8**). This indicated that parents whose children with ASD showed fewer behavioural problems showed more tendencies towards using the rational style of coping style.

*Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran DOI: http://dx.doi.org/10.5772/intechopen.92700*


#### **Table 7.**

*Frequencies of the coping style scale based on the scales scoring system.*


#### **Table 8.**

*\*\**p *< 0.01.*

*The correlations between the parental measures and indicators of ASD in children (N = 43).*


#### **Table 9.**

emotional style of coping. A similar correlation is seen with adopting the emotional coping style and parental stress, whereas those parents who used rational coping

There was also a significant negative correlation between parental tendencies towards using a rational style of coping style and a child's ABC score (see **Table 8**). This indicated that parents whose children with ASD showed fewer behavioural problems showed more tendencies towards using the rational style of coping style.

styles had better health and less stress.

*The correlations coefficients between parental measures scales.*

**Parental stress**

Family functioning

**Table 5.**

*(N = 43).*

Coping style:

Parental satisfaction

*\**p *< 0.05. \*\**p *< 0.01.*

**Table 6.**

**116**

**Family functioning**

General health 0.66\*\* 0.009 0.31\* 0.58\*\* 0.67\*\* Parental stress 0.05 0.27 0.56\*\* 0.53\*\*

*Descriptive statistics (mean, standard deviation, maximum and minimum scores) of the parental scales*

1. Rational coping 41.8 6.8 57 29 *Mothers* 39.6 6.9 57 29 *Fathers* 45 5.6 55 32 2. Emotional coping 34.2 6.6 52 20 *Mothers* 40.9 6.5 57 25 *Fathers* 36.6 5.4 50 28

**Scale Mean Standard deviation Maximum score Minimum score** General health questionnaire 12.2 8.1 28 0 *Mothers* 15 7.5 28 2 *Fathers* 8.1 7.1 23 0 Parental stress index 113.5 17.4 146 79 *Mothers* 120.3 17.6 151 91 *Fathers* 111.1 18.6 140 78 Family functioning 27.4 5.6 43 17 *Mothers* 28.2 5.6 43 19 *Fathers* 25.2 4.6 32 17 Parental Satisfaction 33.5 10.4 70 17 *Mothers* 34.4 11.4 70 17 *Fathers* 32.3 8 46 22

*Parenting - Studies by an Ecocultural and Transactional Perspective*

Rational coping 0.66

**Parental satisfaction** **Rational coping**

0.23 0.11 0.01

0.19 0.25

**Emotional coping**

*Summary of regression analysis for parent and child variables predicting parent's general health.*

Based on McDonald [40], because of the application of a large number of statistical tests in the present study analyses, there is a probability of an increased level of reporting the statistical significance merely on chance. Regression analysis was used not only to reduce this problem but also to control the multivariate relationships among the data. However, this analysis should be considered as exploratory, and for

*Parenting - Studies by an Ecocultural and Transactional Perspective*

**5.1 Impacts of ASD on parental coping styles based on their explanation**

*DOI: http://dx.doi.org/10.5772/intechopen.92700*

*Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran*

they would use.

of stress and poorer general health conditions.

**ASD features**

**119**

**5.2 Relationship between parental coping style and other children with**

There was a statistically significant negative correlation between parental rational coping style and the severity of ASD symptoms (ABC scores) in their children, which suggests that lower levels of behavioural challenges of the child will increase the probability of adopting a rational style of coping. Although mothers were the majority of the participants in the present study, the number of fathers compared to previous studies was considerable (N = 16, 37%). Contrary to Hastings and colleagues [8] findings on the difference between mothers and fathers of children with ASD and their coping styles, no difference was seen in the present study. Hence, in the interview, parents showed an inconsistency between coping styles of mothers and fathers in the way that they are dealing with the demands of caregiving on factors such as gender roles connected to work and child-rearing in most cultures [45]. Fathers according to Iranian culture are supposed to be strong and less emotional to be able to cope and handle different challenges for the family. Based on the

The parental coping style in the present study was evaluated by the CSQ questionnaire for which Iranian norms were available. It had already been used with different groups of Iranians in different studies [42, 43]. However, the findings of this study would suggest that the scale was not sufficient enough to identify Iranian parental coping style of parents who were taking care of children with ASD. There was poor Cronbach's α on two subscales (Avoidant = 0.56 and Detached = 0.42), which may indicate that CSQ does not capture the specific difficulties that Iranian parents who are caring for a child with ASD may experience and the types of style

Most of the available studies in the field of parental caregivers for children with ASD were categorized into the qualitative or quantitative methods and there is a dearth of studies using mixed methods. A mixed method enables comparisons of data collected from both a qualitative and quantitative perspective. Therefore, one of the strengths of the present study is adopting a mixed method to answer the research questions. Analysis of the interviews in the qualitative part of study showed that only 13 (30%) parental responses to a question on style that they use to cope with problems in their family were categorized under the 'rational style' of coping and a larger number (N = 16, 37%) were categorized under the 'avoidance style'. Based on CSQ questionnaire responses, for the rational style, the number of parents was 26 (60%), and for the avoidance style of coping, it was 4 (10%), which indicates an inconsistency between the findings of the interview and the questionnaire in this study. It indicates that parents echoed a more realistic perspective of their behavior when dealing with challenges associated with caregiving for a child with ASD. But there was a consistency between the interview and questionnaire regarding the detached style of coping style, which was the least used method among parents in this study and the emotional style was reported to be used as a method of coping for almost 1/3 of parents (N = 11, 26% in interview, N = 12, 28% in questionnaires). It was also found that 7 parents (16%) were using the religious style. In this study, this type of coping style was put under the emotional style of parental coping although Tarakeshwar and Pargament [44] presented data to suggest that religious coping may help to reduce stress and some symptoms of the general health indicators such as depression in parents of children with ASD. But the finding of the present study showed that adopting emotional coping correlated with a higher level

#### **Figure 1.**

*Variables predicting parental general well-being resulting from regression analysis.*

aiding the development of hypotheses, further research might be considered because of the relatively small sample of the participants in this study.

The chosen dependent variable for this analysis was parental general health, and the possible predictor variables included child characteristics (such as their age and considering 7 as the mean and coding 7 and under 1 and 8 and a above 2, gender 'as employed and unemployed coded 1 for employed and 2 for unemployed'). The results of the Enter model of regression showed that six variables contributed to the model as significant predictors (*R*<sup>2</sup> = 0.864, [N = 43], p = 0.005, *F* = 14.79). The result of regression analysis is shown in **Table 9**.

The above figure (**Figure 1**) displays the relationship between the predictor variables and also draws on the correlation analyses previously reported.

#### **5. Discussion**

The increasing prevalence rates for ASD globally [41] draw the attention of the researchers to impact caregivers who are mainly parents who experience unique challenges resulting in a variety of psychological outcomes which are generally classified as negative. These outcomes are issues such as elevated levels of poorer general well-being and adopting a dysfunctional coping style. The main aim of the service providers is to understand the challenges associated with caregiving to a child with ASD. However, this is not an easy task to perform. The findings of the present study showed that ASD impacts differently on parents and there is no common response among them.

ASD based on present knowledge is a life-long disorder that impacts the entire family, yet there is a dearth of studies sought to address family dynamics and parental challenges. There are correlations between factors such as behavioural challenges of the child with ASD and general parental well-being. As an example, Hastings and colleagues [8] reported that the maladaptive behavior of the child with ASD impacted on the coping styles of parents. This finding was replicated in the present study. It is also reported that the functional level of the child with ASD impacted the level of stress in mothers which is resulting in paternal stress boosting [9].

*Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran DOI: http://dx.doi.org/10.5772/intechopen.92700*

#### **5.1 Impacts of ASD on parental coping styles based on their explanation**

The parental coping style in the present study was evaluated by the CSQ questionnaire for which Iranian norms were available. It had already been used with different groups of Iranians in different studies [42, 43]. However, the findings of this study would suggest that the scale was not sufficient enough to identify Iranian parental coping style of parents who were taking care of children with ASD. There was poor Cronbach's α on two subscales (Avoidant = 0.56 and Detached = 0.42), which may indicate that CSQ does not capture the specific difficulties that Iranian parents who are caring for a child with ASD may experience and the types of style they would use.

Most of the available studies in the field of parental caregivers for children with ASD were categorized into the qualitative or quantitative methods and there is a dearth of studies using mixed methods. A mixed method enables comparisons of data collected from both a qualitative and quantitative perspective. Therefore, one of the strengths of the present study is adopting a mixed method to answer the research questions. Analysis of the interviews in the qualitative part of study showed that only 13 (30%) parental responses to a question on style that they use to cope with problems in their family were categorized under the 'rational style' of coping and a larger number (N = 16, 37%) were categorized under the 'avoidance style'. Based on CSQ questionnaire responses, for the rational style, the number of parents was 26 (60%), and for the avoidance style of coping, it was 4 (10%), which indicates an inconsistency between the findings of the interview and the questionnaire in this study. It indicates that parents echoed a more realistic perspective of their behavior when dealing with challenges associated with caregiving for a child with ASD. But there was a consistency between the interview and questionnaire regarding the detached style of coping style, which was the least used method among parents in this study and the emotional style was reported to be used as a method of coping for almost 1/3 of parents (N = 11, 26% in interview, N = 12, 28% in questionnaires).

It was also found that 7 parents (16%) were using the religious style. In this study, this type of coping style was put under the emotional style of parental coping although Tarakeshwar and Pargament [44] presented data to suggest that religious coping may help to reduce stress and some symptoms of the general health indicators such as depression in parents of children with ASD. But the finding of the present study showed that adopting emotional coping correlated with a higher level of stress and poorer general health conditions.

#### **5.2 Relationship between parental coping style and other children with ASD features**

There was a statistically significant negative correlation between parental rational coping style and the severity of ASD symptoms (ABC scores) in their children, which suggests that lower levels of behavioural challenges of the child will increase the probability of adopting a rational style of coping. Although mothers were the majority of the participants in the present study, the number of fathers compared to previous studies was considerable (N = 16, 37%). Contrary to Hastings and colleagues [8] findings on the difference between mothers and fathers of children with ASD and their coping styles, no difference was seen in the present study. Hence, in the interview, parents showed an inconsistency between coping styles of mothers and fathers in the way that they are dealing with the demands of caregiving on factors such as gender roles connected to work and child-rearing in most cultures [45]. Fathers according to Iranian culture are supposed to be strong and less emotional to be able to cope and handle different challenges for the family. Based on the

aiding the development of hypotheses, further research might be considered because

The chosen dependent variable for this analysis was parental general health, and the possible predictor variables included child characteristics (such as their age and considering 7 as the mean and coding 7 and under 1 and 8 and a above 2, gender 'as employed and unemployed coded 1 for employed and 2 for unemployed'). The results of the Enter model of regression showed that six variables contributed to the model as significant predictors (*R*<sup>2</sup> = 0.864, [N = 43], p = 0.005, *F* = 14.79).

The above figure (**Figure 1**) displays the relationship between the predictor

The increasing prevalence rates for ASD globally [41] draw the attention of the researchers to impact caregivers who are mainly parents who experience unique challenges resulting in a variety of psychological outcomes which are generally classified as negative. These outcomes are issues such as elevated levels of poorer general well-being and adopting a dysfunctional coping style. The main aim of the service providers is to understand the challenges associated with caregiving to a child with ASD. However, this is not an easy task to perform. The findings of the present study showed that ASD impacts differently on parents and there is no

ASD based on present knowledge is a life-long disorder that impacts the entire

family, yet there is a dearth of studies sought to address family dynamics and parental challenges. There are correlations between factors such as behavioural challenges of the child with ASD and general parental well-being. As an example, Hastings and colleagues [8] reported that the maladaptive behavior of the child with ASD impacted on the coping styles of parents. This finding was replicated in the present study. It is also reported that the functional level of the child with ASD impacted the level of stress in mothers which is resulting in paternal stress

variables and also draws on the correlation analyses previously reported.

of the relatively small sample of the participants in this study.

*Variables predicting parental general well-being resulting from regression analysis.*

*Parenting - Studies by an Ecocultural and Transactional Perspective*

The result of regression analysis is shown in **Table 9**.

**5. Discussion**

**Figure 1.**

boosting [9].

**118**

common response among them.

regression analysis, the second predicting parental general well-being reported to be child's gender, and in this study, parents of female children with ASD were more prone to health problems. This finding was opposite to what Hastings and Brown [46] reported on the child's gender and parental anxiety and depression in the UK in which no significant relationship reported between parental general well-beings and their own and child gender. The difference here may root from Iranian cultural beliefs, which indicate that compared to boys, girls are more fragile and need more protection and help. Any type of disability may, therefore, increase the need for caring and supervision of the girls and place extra pressure on parents. Sabih and Sajid [47] reported similar findings in their study of Pakistani parents.

are rarely being heard from a society with limited resources and support. Hence, there are some shortcomings with the present study, and the presented findings should be considered in the shade of these limitations. Firstly, the data reflected the ideas and approaches of urban parents who are better educated. Secondly, parents

*Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran*

presented finding does not necessarily echo the ideas of all Iranian parents. Thirdly, Iran is a diverse society consisting of different ethnic and socioeconomic classes and the presented finding might not cover the ideas of all these groups. The findings of the present study might serve as a preliminary insight into the coping style adopted by Iranian parents to deal with challenges associated with ASD diagnosis for their child. It should be pointed out that the interpretation of the interview transcriptions and notes from the interviews were not checked with parents to receive their

ASD had multiple impacts on Iranian parents. In the sample of Iranian parents in this study, a majority of them experienced a considerable amount of problems with their general well-being. They also used less effective coping styles to face the

These impacts were similar to the reported finding on caregiving challenges and parental coping style in other countries, but there were some differences regarding parental age and gender of the child and also the adopted coping style that might be explained in the light of Iranian culture or the limitations of available support and

The author expresses his appreciation and gratitude to Professor Roy McConkey for his very helpful comments and suggestion on the first draft of the manuscript and appreciates the parents' trust and time during the study. The Iranian State Welfare Organization's (Maryam Pourseid Mohammad) and the Iranian Special Education Organization's (Ameneh Mahmoodizadeh) very kind assistance was very

in this study are volunteers who agreed to participate in this study and the

approval and to ensure the validation of the judgments.

*DOI: http://dx.doi.org/10.5772/intechopen.92700*

associated demand of caregiving for a child with ASD.

services from both formal and informal aspects.

The author declares no conflict of interest.

**6. Conclusion**

**Acknowledgements**

vital in this study.

**121**

**Conflict of interest**

The difference between the mother's age and the adopted coping style was interesting. It was found that older mothers in the present study used a more rational style of coping strategy compared to younger mothers. This might indicate that mothers were able to use more problem-focused and rational styles of coping through the passing of time and the probable experiences or training they might have gained on dealing with their child with ASD. Hastings and colleagues [8] believe that factors like smaller social support networks affect the development of coping efforts in parents of children with ASD. There appears to be that parents of children with ASD use a verity of coping styles and there is no particular common coping strategy style among caregivers of children with ASD [48] regardless of the common features and core symptoms of this diagnosis. Although there is a difference between parents of children with and without ASD regarding the coping style they use [8] within families because family circumstances are heterogeneous.

### **5.3 Relationship between parental coping style and other parental qualification related to their general well beings**

The present study found a statistically significant positive correlation between parental emotional style of coping style and their impaired general health, and between emotional coping style and higher levels of parental stress. Hastings and colleagues [8] also found that an emotional-focused coping style was an unhelpful approach to cope with demands associated with taking care of a child with ASD. In their study on a sample consisting of 74 mothers and 61 fathers of preschool and school-age children with ASD, they found that the religious style of coping was related to more mental health problems in mothers and fathers of children with ASD. In the present study, those parents who used a rational style of coping style showed statistically significant negative correlations with parental general health and an increased level of stress. This indicates that parents who used a rational style of coping style were more satisfied with their health and they also showed lower levels of parental stress.

Parents may adopt unproven theories of false beliefs regarding the causes of ASD [49]. Although these beliefs and search could be considered as a necessary part of the coping style process [50], but when these supposed treatments prove inadequate or if parents receive conflicting advice, this could increase parental stress, with impact on their health, family functioning and their satisfaction with the caring role and it may force them to use less rational styles of coping with the situation. The parental coping style was correlated. Parents adopting rational styles were less inclined to adopt emotional styles of coping.

Finally, parents adopting emotional coping reported poorer health and more stress, whereas those who used rational coping had more improved general wellbeing. An available wealth of data in the field of impacts of caregiving on parents generally echoes the ideas and coping styles of over 30 Caucasian female caregivers [51]; therefore, another positive point of the present study is that ideas of this group *Parental Coping Styles of Individuals with Autism Spectrum Disorders: A Report from Iran DOI: http://dx.doi.org/10.5772/intechopen.92700*

are rarely being heard from a society with limited resources and support. Hence, there are some shortcomings with the present study, and the presented findings should be considered in the shade of these limitations. Firstly, the data reflected the ideas and approaches of urban parents who are better educated. Secondly, parents in this study are volunteers who agreed to participate in this study and the presented finding does not necessarily echo the ideas of all Iranian parents. Thirdly, Iran is a diverse society consisting of different ethnic and socioeconomic classes and the presented finding might not cover the ideas of all these groups. The findings of the present study might serve as a preliminary insight into the coping style adopted by Iranian parents to deal with challenges associated with ASD diagnosis for their child. It should be pointed out that the interpretation of the interview transcriptions and notes from the interviews were not checked with parents to receive their approval and to ensure the validation of the judgments.

#### **6. Conclusion**

regression analysis, the second predicting parental general well-being reported to be child's gender, and in this study, parents of female children with ASD were more prone to health problems. This finding was opposite to what Hastings and Brown [46] reported on the child's gender and parental anxiety and depression in the UK in which no significant relationship reported between parental general well-beings and their own and child gender. The difference here may root from Iranian cultural beliefs, which indicate that compared to boys, girls are more fragile and need more protection and help. Any type of disability may, therefore, increase the need for caring and supervision of the girls and place extra pressure on parents. Sabih and

Sajid [47] reported similar findings in their study of Pakistani parents.

*Parenting - Studies by an Ecocultural and Transactional Perspective*

The difference between the mother's age and the adopted coping style was interesting. It was found that older mothers in the present study used a more rational style of coping strategy compared to younger mothers. This might indicate that mothers were able to use more problem-focused and rational styles of coping through the passing of time and the probable experiences or training they might have gained on dealing with their child with ASD. Hastings and colleagues [8] believe that factors like smaller social support networks affect the development of coping efforts in parents of children with ASD. There appears to be that parents of children with ASD use a verity of coping styles and there is no particular common coping strategy style among caregivers of children with ASD [48] regardless of the common features and core symptoms of this diagnosis. Although there is a difference between parents of children with and without ASD regarding the coping style they use [8] within families because family circumstances are heterogeneous.

**5.3 Relationship between parental coping style and other parental qualification**

The present study found a statistically significant positive correlation between parental emotional style of coping style and their impaired general health, and between emotional coping style and higher levels of parental stress. Hastings and colleagues [8] also found that an emotional-focused coping style was an unhelpful approach to cope with demands associated with taking care of a child with ASD. In their study on a sample consisting of 74 mothers and 61 fathers of preschool and school-age children with ASD, they found that the religious style of coping was related to more mental health problems in mothers and fathers of children with ASD. In the present study, those parents who used a rational style of coping style showed statistically significant negative correlations with parental general health and an increased level of stress. This indicates that parents who used a rational style of coping style were more satisfied with their health and they also showed lower

Parents may adopt unproven theories of false beliefs regarding the causes of ASD [49]. Although these beliefs and search could be considered as a necessary part of the coping style process [50], but when these supposed treatments prove inadequate or if parents receive conflicting advice, this could increase parental stress, with impact on their health, family functioning and their satisfaction with the caring role and it may force them to use less rational styles of coping with the situation. The parental coping style was correlated. Parents adopting rational styles

Finally, parents adopting emotional coping reported poorer health and more stress, whereas those who used rational coping had more improved general wellbeing. An available wealth of data in the field of impacts of caregiving on parents generally echoes the ideas and coping styles of over 30 Caucasian female caregivers [51]; therefore, another positive point of the present study is that ideas of this group

**related to their general well beings**

were less inclined to adopt emotional styles of coping.

levels of parental stress.

**120**

ASD had multiple impacts on Iranian parents. In the sample of Iranian parents in this study, a majority of them experienced a considerable amount of problems with their general well-being. They also used less effective coping styles to face the associated demand of caregiving for a child with ASD.

These impacts were similar to the reported finding on caregiving challenges and parental coping style in other countries, but there were some differences regarding parental age and gender of the child and also the adopted coping style that might be explained in the light of Iranian culture or the limitations of available support and services from both formal and informal aspects.

#### **Acknowledgements**

The author expresses his appreciation and gratitude to Professor Roy McConkey for his very helpful comments and suggestion on the first draft of the manuscript and appreciates the parents' trust and time during the study. The Iranian State Welfare Organization's (Maryam Pourseid Mohammad) and the Iranian Special Education Organization's (Ameneh Mahmoodizadeh) very kind assistance was very vital in this study.

#### **Conflict of interest**

The author declares no conflict of interest.

*Parenting - Studies by an Ecocultural and Transactional Perspective*

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*DOI: http://dx.doi.org/10.5772/intechopen.92700*

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