After the Diagnosis: Improving Maternal Mental Health
Parents worldwide often experience a range of emotions when their child is first diagnosed with autism, including shock, sadness and grief, anger, and loneliness. Mothers, in particular, appear to face unique challenges that potentially have an impact on their mental health and wellbeing. This includes high levels of psychological distress, depressive symptoms, and social isolation. Almost 40% of mothers report levels of clinically significant parenting stress and between 33% and 59% report significant depressive symptoms following a diagnosis of autism spectrum disorder (ASD). The prevalence of psychological distress among mothers of children with ASD suggests a need to address parental mental health during the critical period after the child’s autism diagnosis and when parents are learning to navigate the complex system of autism services.
A study published in the journal Pediatrics examined whether a brief cognitive behavioral intervention, problem-solving education (PSE), decreases parenting stress and maternal depressive symptoms during the period immediately following a child’s diagnosis of ASD. A randomized clinical trial compared 6 sessions of PSE with usual care. Settings included an autism clinic and 6 community-based early intervention programs. Participants were mothers of 122 young children who recently received a diagnosis of ASD. The intervention group received PSE, a manualized cognitive behavioral intervention delivered in six 30-minute individualized sessions. The usual care group mothers received the services specified in the child’s Individualized Family Service Plan or Individualized Educational Plan which typically includes speech and language therapy, occupational therapy, and social skills training. Neither specifically includes parent-focused mental health services.
The results indicated that at a 3-month follow-up assessment, PSE mothers were significantly less likely than those serving as controls to have clinically significant parental stress (3.8% vs 29.3%). For depressive symptoms, the risk reduction in clinically significant symptoms did not reach statistical significance; however, the reduction in mean depressive symptoms was statistically significant. The findings demonstrate evidence of PSE’s short-term efficacy and potential to reduce clinically significant psychological distress during this critical juncture—when parents first learn of an ASD diagnosis and must navigate a complex service system on their child’s behalf.
The findings have implications for clinical practice. Practitioners need to be aware that parents experience a myriad of emotions when receiving a diagnosis of ASD and many go through stages of grief. Likewise, professionals working with families of children with an ASD should be aware of negative effects of stress and anxiety and assist in offering services that directly address parental needs and support maternal mental health. Strengthening maternal problem-solving skills might serve as a buffer against the negative impact of life stressors and thereby reduce parental stress and attenuate depressive symptoms in the months immediately following a child’s ASD diagnosis. Future research is needed to examine the effect of intervention over a longer follow-up period and to assess whether the intervention worked differently among subgroups of mothers, which could help better identify those who are most likely to benefit from the intervention.
Improving Maternal Mental Health After a Child’s Diagnosis of Autism Spectrum Disorder: Results From a Randomized Clinical Trial. Emily Feinberg, CPNP, ScD; Marilyn Augustyn, MD; Elaine Fitzgerald, DrPH; Jenna Sandler, MPH; Zhandra Ferreira-Cesar Suarez, MPH; Ning Chen, MSc; Howard Cabral, PhD; William Beardslee, MD; Michael Silverstein, MD, MPH. JAMA Pediatrics. doi:10.1001/jamapediatrics.2013.3445
Published online November 11, 2013.
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. Dr. Wilkinson is also editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.