**3. Method**

#### **3.1 Procedure and participants**

A total of 43 parents caring for 43 children with a confirmed diagnosis of ASD were recruited from two different sources in Tehran. The children were officially diagnosed as having ASD based on the psychiatrist who approved a report that is necessary for admission in special schools and clinical service deliveries. All the recruited children from special schools were registered with ISEO, and the children from preschool, kindergartens and daycare centres officially were registered in the ISWO.


The heads of the special schools and daycare centres were contacted in person with an official letter from the Iranian Ministry of Science, which approved the study and the researcher's identity to explain the study and to get permission to participate in the weekly or biweekly parental sessions at the centre and to distribute announcements and brochures about the study to recruit volunteer parents. Participants in this study had to meet the following criteria:


Families had two visits each. They were interviewed by the researcher about the way that they are dealing with the challenges associated with receiving the diagnosis of ASD for their children. Although both parents were invited and allowed to participate in the study, only a small group of couples accepted to participate; therefore, for each child, only one parent's information was considered. When both parents participated, only data of fathers were considered, because internationally there is a dearth of information regarding fathers of children with ASD. Two 90-min

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

sessions were considered. In the first session, parents were provided with the consent form, the information sheet and data collecting questionnaires and the aims of the study were discussed. In the second session, the interview was performed and the previously provided questionnaires which were completed by them were checked and collected. Therefore, the main aim of the first session was focused on informing parents about the study and resolving any possible queries and handing the self-completed questionnaires. The second session devoted to the qualitative interview that took 45–60 min with a 45–30 min fluctuation to cover the parental questions, reception and hospitality that they culturally obligate themselves to do.

The interview consisted of three open questions on the challenges of diagnosis, their most challenges with their child, and the way that they cope with the demands on them. Each main question had some probes to help parents to explain more and provide more detailed information.

The interview started by reminding the parents that the session would be recorded as they consented in the form they received in the first session. Therefore, all interviews were recorded and transcribed verbatim.

In sum, a group of 43 volunteer parents of children with ASD who consented to be participating in the study was contacted and interviewed. The group consisted of 16 (37.2%) fathers and 27 (62.8%) mothers.

#### **3.2 Parental information**

A mixed-method approach is adopted in which both qualitative and quantitative data were used to attain the aims and objectives of the present study based around standardized, self-completed parental rating scales and semi-structured interviews. The combined approach research method involves integrating quantitative and qualitative approaches to generating new knowledge. Combining methods activates their complementary strengths and helps to overcome their discrete weaknesses [22]. In this type of research, different information will be brought together [23]. The basic presumption is that qualitative and quantitative approaches are compatible with a pragmatist paradigm perspective. The pragmatist paradigm has been

A total of 43 parents caring for 43 children with a confirmed diagnosis of ASD were recruited from two different sources in Tehran. The children were officially diagnosed as having ASD based on the psychiatrist who approved a report that is necessary for admission in special schools and clinical service deliveries. All the recruited children from special schools were registered with ISEO, and the children from preschool,

• Recruiting parents from schools: three public and private special schools (two

• Recruiting parents from the public and private preschools and daycare centres which provide rehabilitation and educational services on daycare bases: three public and private schools (one public and two private) were approached.

The heads of the special schools and daycare centres were contacted in person with an official letter from the Iranian Ministry of Science, which approved the study and the researcher's identity to explain the study and to get permission to participate in the weekly or biweekly parental sessions at the centre and to distribute announcements and brochures about the study to recruit volunteer parents.

• parents of children with a confirmed and registered diagnosis of ASD as their

• parents of children with ASD in an age range between 3 and 17 years;

• parents who were caring for their child with ASD at the time of the study.

Families had two visits each. They were interviewed by the researcher about the way that they are dealing with the challenges associated with receiving the diagnosis of ASD for their children. Although both parents were invited and allowed to participate in the study, only a small group of couples accepted to participate; therefore, for each child, only one parent's information was considered. When both parents participated, only data of fathers were considered, because internationally there is a dearth of information regarding fathers of children with ASD. Two 90-min

kindergartens and daycare centres officially were registered in the ISWO.

public and one private) for children with ASD were approached.

Participants in this study had to meet the following criteria:

• parents who were the residence of Tehran; and

gaining popularity since the 1980s [24].

*Parenting - Studies by an Ecocultural and Transactional Perspective*

**3.1 Procedure and participants**

main diagnosis;

**108**

**3. Method**

Parental demographic data in this study are presentedin the following table (**Table 1**).

#### **3.3 Children information**

Parents in this study were caregiving 11 (26%) girls and 32 (74%) boys. The children ranged from 3 to 17 years (mean = 8.2, SD = 2.9). About 39 (91%) children were living with both parents, and 4 (9%) were living with their mothers (**Table 2**). Sixteen children (37%) were the only child and 26 (60.5%) had one or two sibling (s) and there was one child (2%) who had over three siblings. **Table 3** (see below) shows more information about the ASD symptoms severity in children based on their parents' reports and understanding.

#### **3.4 Measures**

The five parental scales covered parental general health, reported stress, family functioning, coping style and parental satisfaction with caring for a child with a developmental disability. A specially devised socio-demographic questionnaire was used to collect data about parents' and children's demographic information (i.e. parents and child's gender, living places, parental level of education, profession, ethnicity and families' main wage earner, etc.; see **Tables 1** and **2**). The three scales used to collect data about children's ASD severity were well-validated parent-report instruments that had been used in the past research internationally.

#### *3.4.1 Parental scales*

#### *3.4.1.1 Scales with Iranian norms*

1.General health questionnaire [25]: this is a 28-item questionnaire recommended for screening the assessment of psychiatric morbidity [26] with calculated reliability through test-retest of 0.80. The calculated Cronbach's α for the present study was 0.93. The reported tests re-test reliabilities in other

#### *Parenting - Studies by an Ecocultural and Transactional Perspective*


**Table 1.**

*Parental demographic information, frequencies and percentage based on their gender.*

studies ranged from 0.51 to 0.90 and split-half reliability was shown to be 0.95. The reported Cronbach's α for the Iranian population (calculated on a 751 member sample) was 0.85.

2.Coping styles questionnaire (CSQ) [27]: this scale is a 60-item Likert scale questionnaire assessing coping style of four primary dimensions: rational, emotional, avoidance and detached coping. Rational style is determined by a

*Descriptive statistics (mean, standard deviation, maximum and minimum scores) of the children's scales (frequencies (and percentage) of the children who scored above and below the cut-off scores for ASD based on*

**Variable Frequency Percentage**

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

3–7 19 44% 8–17 24 56%

Girls 11 30% Boys 32 70%

First child 24 56% Second child 12 28% Third child 6 14% Fourth child 1 2%

Special school 19 44% Special unit (Clinic) 19 44% Mainstream school 5 12%

Yes 26 60.5% No 17 39.5%

Yes 26 60.5% No 17 39.5%

> **Maximum score**

**Minimum score**

28.11 5.30 39 15 43 (100%) 0

80.58 17.8 116 48 32 (74%) 11 (26%)

92.09 21.48 160 54 40 (93%) 3 (7%)

**Number (%) of children above the cut-off score**

**Number (%) of children under the cut-off score**

*Demographic data (frequencies and percentages) on children with ASD (N = 43).*

**deviation**

**Children's age**

**Children's gender**

**Type of the schooling which children attend**

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

**Verbal communication of children**

**Scale Mean Standard**

**Birth order**

**Homeschooling**

**Table 2.**

Social communication questionnaire (SCQ)

Autism behavior checklist (ABC)

*parental report).*

**Table 3.**

**111**

Gilliam autism rating scale (ASD)


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

#### **Table 2.**

*Demographic data (frequencies and percentages) on children with ASD (N = 43).*


#### **Table 3.**

*Descriptive statistics (mean, standard deviation, maximum and minimum scores) of the children's scales (frequencies (and percentage) of the children who scored above and below the cut-off scores for ASD based on parental report).*

2.Coping styles questionnaire (CSQ) [27]: this scale is a 60-item Likert scale questionnaire assessing coping style of four primary dimensions: rational, emotional, avoidance and detached coping. Rational style is determined by a

studies ranged from 0.51 to 0.90 and split-half reliability was shown to be 0.95. The reported Cronbach's α for the Iranian population (calculated on a 751

**Variable Mothers Fathers**

*Parenting - Studies by an Ecocultural and Transactional Perspective*

Middle school level 2 (7%) 2 (13%) High school graduate 15 (56%) 5 (31%) University education 10 (37%) 9 (56%)

Education 3 (11%) 6 (37%) Technical — 5 (19%) Commercial 2 (7%) 3 (18%) Medical 1 (4%) 2 (13%) Unemployed 21 (78%) —

Fars 18 (67%) 13 (82%) Turkish 8 (30%) 1 (6%) Kurdish — 1 (6%) Other Iranian 1 (3%) — Armenian — 1 (6%)

under 30 2 (8%) — –39 16 (59%) 6 (37%) –49 8 (29%) 7 (44%) –59 1 (4%) 3 (18%)

Yes 5 (22%) 3 (19%) No 21 (77%) 13 (81%)

Mothers 25 (93%) 1 (6%) Fathers — 9 (56%) Both 2 (7%) 6 (38%)

Mothers 1 (4%) — Fathers 20 (74%) 11 (69%) Both 6 (22%) 5 (31%)

*Parental demographic information, frequencies and percentage based on their gender.*

**Parents family relationship (marriage between family members)**

3 (11%) 24 (89%)

— 16 (100%)

**Parents' education**

**Parents' job**

**Parents' ethnicity**

**Parents' age**

**Single parents**

**Child primary caregiver**

**Main wage earner of the family**

Yes No

**Table 1.**

**110**

**N = 27 (%) N = 16 (%)**

member sample) was 0.85.

16-item scale that assesses the active problem-solving type of coping. Detached coping style evaluated by 15 items'sub-scale assesses participants viewing the problem in a realistic light but with not identifying the problem logically. Emotion-oriented style of coping is determined by 16 items that denote a focus on the negative emotions associated with the subject and one's helplessness to solve the problem. The avoidant coping was evaluated by 13 items that deal with behaviours such as pretending that the problem does not exist and trying to ignore it. In the present study, the reported reliability through Cronbach's α was 0.88 for the rational style of coping style and 0.71 for the emotional style of coping. This amount for avoidant coping was 0.56, and for the detached style, it was 0.42. The obtained reliability through the test-retest correlation was 0.93. This correlation for the emotional style of the coping strategy was 0.96%. The reported internal consistency (range from 0.69 to 0.85) and good test-retest reliability over 3 months (range from 0.70 to 0.80) are reported for the scale. The avoidant and emotion-oriented coping factors are also interdependent. The reported reliability for the Iranian population was 0.81 [28].

focused on a single aspect of ASD core symptoms. Three following scales were

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

2.Gilliam autism rating scale (GARS2) [35]: this is a behaviour checklist developed for use in people aged 3–22 years. The scale consists of 42 items, each describing a feature of individuals with ASD. The Iranian norm was obtained from 658 children with age ranged from 3 to 22 years (mean age of 11.7 years and SD 4.1); Cronbach's α of 0.95 was reported for all the 42 items; and a cut-off score of over 30 yielded the best balance between sensitivity (0.96) and specificity (1.00) [36]. In this study, Cronbach's α was 0.84.

3.The Persian version of the social communication questionnaire (SCQ) [37] translated by Sasanfar and Ghadami [38]: this is a 40-item, parent-report questionnaire that rates the child on characteristic autistic behaviours derived from the Autism Diagnostic Interview-Revised (ADI-R) [39]. The reported Cronbach's α coefficient for the Iranian sample was 0.82 (based on a sample of 712 children aged 6–13) which is acceptable but lower than α of 0.90 reported for the English scale. In this study, Cronbach's α was 0.82 (N = 43 obtained on

The Persian translation of four scales that had been used in Western countries was identified (see below). Persian translations were also available for two other scales that were used—General health questionnaire and Coping Styles Questionnaire—and these also have Iranian norms. However, for two scales (i.e. Family functioning and the Parenting Stress Index), the translation from English into Persian was done by the researcher with back-translation that was checked by a native English speaker experienced in learning disability to check on the accuracy.

1. two parental scales (general health questionnaire and coping styles

2. one parental scale was originally developed and standardized in Iran (parental satisfaction with caring for a child with developmental disability

questionnaire) and two child diagnosis scales (GARS2 and SCQ) were the western scales with Iranian norms which have already been translated and

3. one parental scale (family functioning) and one child diagnosis scale (ABC) was translated by the author into Persian without previous Iranian norms.

1.Autism Behavior Checklist (ABC) [33]: this scale (57 items) is described as a series of typical behaviours common in children with ASD and aims to assess the presence of these behaviours in an individual. Scores between 54 and 67 points are considered with a moderate probability of the disorder, inconclusive scores range between 47 and 53 points, and scores below 47 points discard ASD. In the current study, the calculated Cronbach's α (N = 43) was reported to be 0.82. Volkmar et al. [34] found a split-half reliability of 0.70 for this scale. These authors investigated the discriminating validity of ABC using 94 children with ASD and 63 clinically non-ASD children. The rate of diagnoses

chosen:

was reported to be 78%.

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

a sample of 43 members).

In sum, the following scales were used:

*3.4.3 Translation of measures*

used in Iran;

**113**

index, PSCDDI); and

3.Parental satisfaction with caring for a child with developmental disability index (PSCDDI) [29]: a 12-item scale was derived from the literature reviews and pilot testing in two subscales of "Personal Satisfaction" and "Child Satisfaction" in Iran. The internal consistency across the six items in each factor was assessed using Cronbach's α. For personal satisfaction, it was 0.88, and for child satisfaction, it was 0.83. These results suggest a high degree of consistency across the items in each factor. Test-retest reliability was assessed by correlating a subsample of the parents'scores (n = 70) on the PSCDDI measures calculated on their first and second administration of the scale. Across all 12 items, the Pearson product-moment correlation was r = 0.82 (p < 0.001).
