Results indicate that mothers, but not fathers, who are caregivers of school-age children with AS/HFA are at increased risk of impaired physical well-being. We also found that the impaired maternal HRQL in the AS/HFA group is related to the extent of symptoms of hyperactivity and conduct problems in the child.
Since there is sparse data about the HRQL of parents who are caregivers of children with AS or HFA, we need to attempt to compare our results with the results of studies dealing with the well-being of parents of children with other types of disorders. Hence, our findings that the mothers of children with AS/HFA report impaired physical well-being resembles previous findings on caregivers of children with intellectual disability [13
] cerebral palsy [40
] and mental disorders [14
]. For example, Emerson [13
] reported that 20 percent of mothers of children with intellectual disability versus three percent of mothers of children without intellectual disability considered themselves to be "physically ill" due to the child's difficulties. Seltzer et al. [14
], and Magana et al. [15
] also found more physical symptoms or increased rates of physical health problems among mothers of adult children with severe mental disorders. Notably, there are also studies which suggest a genetically-linked increased rate of autoimmune disorders in parents of individuals with PDDs [41
The present study did not detect statistically significant differences between mothers in the AS/HFA group and mothers of the control group regarding their self-perceived mental well-being. This is in contrast with many previous studies that have shown that mothers' mental health is related to the child's disability [8
]. Of course it is possible that our failure to match such findings is due to the low power of the current study, given that the relatively small differences in mental health between parents in the AS/HFA and control groups did not reach statistical significance. Nevertheless, could there be any way to explain our findings of relatively good mental, but poor physical well-being among the mothers? Drawing on previous studies, we note that Weiss [7
] reported that psychosomatic problems were common manifestations of stress related to caregiving in parents of children with PDDs, and based on their findings, Magana et al. [15
] discussed whether mothers of adult children with mental illness were particularly vulnerable to physical health problems. From another standpoint, one might speculate whether the poorer self-rated maternal physical health in the AS/HFA group could be associated with particular personality traits. From a strictly theoretical perspective, a discrepancy between mental and physical health in these mothers could be related to the presence of alexithymic traits, meaning a reduced ability to engage in explicit emotional processing. A relationship between alexithymic personality and somatization has been reported [43
], and research on adults with AS has also found high rates of alexithymia in these individuals [45
]. However, the current study did not determine the presence of alexithymic traits in parents of children with AS/HFA.
Our finding that maternal physical health was poorer than paternal physical health in the AS/HFA group resembles results in a previous report on parenting a child with Down's syndrome, where mothers were more exhausted than fathers [12
]. However, our finding, that self-rated mental health did not differ between mothers and fathers of children with AS/HFA, is in contrast with previous studies. To illustrate, other researchers have reported more anxiety [17
] exhaustion [12
] child-care related stress, pessimism about the child's future, and use of antidepressants in mothers of these children [6
In similarity with the results by Hastings [16
], we found that maternal, but not paternal health in the AS/HFA group was related to particular behaviour characteristics of the child. Maternal mental health was related to the extent of symptoms of hyperactivity and conduct problems in the child, and maternal physical and mental health were related to the prosocial behaviour of the child. Previous research has suggested that coexisting behaviour problems in a child could be more stressful for parents than the severity of the child's core disability [16
]. Thus, our finding that maternal health was related to the extent of general behaviour problems of the child, and not to the degree of autistic symptoms reflected in the ASSQ-score, may be in similarity with findings in other studies. However, regarding the social competence of the child, which is a primary aspect of PDDs, we do note that our SDQ data indicates a relationship between maternal health and the prosocial behaviour of the child (ability to be considerate, to share, to be helpful and to be kind to younger children). Notably, the items and wordings of the ASSQ and of the prosocial behaviour scale of the SDQ cover somewhat different aspects of social competence in children. In consistency with other authors [2
], we believe that the prosocial behaviour scale of the SDQ may yield additional useful information about the behaviour characteristics of children with PDDs.
The main strength of the present study is the use of a well-defined sample of 32 school-age children with ICD-10 diagnosed AS or HFA and the control group of typically developing children. Likewise, the use of the SF-12, a well-validated measure of HRQL, and parent as well as teacher-ratings of the children's behaviour, strengthen our report.
However, there are also limitations of the present study, which must be acknowledged. The sample of individuals with AS/HFA was rather small. During the sampling procedure, children with comorbid medical disorders or ongoing medication were excluded from our sample. Whether the sampling method biased parental results in a positive direction is unknown. Thus, considering the issue of low power, it is quite possible that small differences in HRQL between parents in the AS/HFA and control groups were not detected in the current report. More, there were no statistically significant differences with regard to sociodemographic data between parents in the AS/HFA and control groups in this material. However, more mothers in the AS/HFA group were not employed and were lone parents. These important sociodemographic factors need further investigation in larger studies. Finally, the fact that parental health was only measured by the SF-12, and that no physical examination or review of the parents' medical records was performed, are also limiting factors.
To summarize, we found that parenting a child with AS/HFA was associated with impaired HRQL in mothers, but not in fathers, and that impaired maternal HRQL was associated with higher levels of behaviour problems in the child. We conclude that parental HRQL in children with AS/HFA needs further exploration in larger studies. Moreover, studies exploring the issues related to HRQL and sociodemographic circumstances in these parents would be of great interest.