Autism spectrum disorders are lifelong disabilities that present multiple challenges for families. The behavior problems and autism symptoms of children with autism spectrum disorder have repeatedly been documented as a significant source of stress for parents (Hastings & Brown, 2002
; Hastings, Kovshoff et al., 2005
; Herring et al., 2006
; Lecavalier, Leone, & Wiltz, 2006
; Lounds, Seltzer, Greenberg, & Shattuck, 2007
). Despite evidence that the behaviors and symptoms of autism spectrum disorder profoundly impact families, few researchers have examined reciprocally the role that the family environment may have on the course of symptoms and maladaptive behaviors over time. Specifically, questions remain regarding how positive aspects of the family environment, particularly affective expression and relationship quality, may be related to the developmental course of autism spectrum disorder.
In the general child development literature, maternal warmth and the quality of the parent– child relationship have long been shown to be predictive of child adaptation and behavioral functioning (Borkowski, Ramey, & Bristol-Powers, 2002
). Similarly, parent–child relationship quality is an important factor for adjustment during adolescence and young adulthood among families with typically developing children (Overbeek, Stattin, Vermulst, Ha, & Engels, 2007
). Less is known, however, about the association between family processes and developmental outcomes for adolescents and adults with autism. In the past, the prevailing belief was that mothers of children with autism were cold and rejecting, and they were labeled by professionals as “refrigerator mothers,” perhaps explaining why few researchers have examined the role of positive family processes, such as relationship quality and warmth (for an exception, see Orsmond, Seltzer, Green-berg, & Krauss, 2006
) on the development of children with autism. In this study we investigated the bidirectional interplay between positive family processes and behavior problems and autism symptoms in families of adolescents and adults with autism spectrum disorder.
In populations at-risk for behavior problems, family processes, including positive maternal affective expression, have been consistently hypothesized as potential mechanisms in behavioral development. For instance, in a study of low birth weight babies, maternal warmth moderated the effect of birth weight on behavior problems, with higher warmth associated with fewer problems when risk was high (Tully, Arseneault, Caspi, Moffitt, & Morgan, 2004
). Main effects of the family environment on behavioral outcomes have likewise been demonstrated. Work with monozygotic twins has shown less negativity and more warmth from mothers to predict fewer antisocial behavior problems in high-risk children, demonstrating how environmental effects can be causal factors in the development of behavior problems (Caspi et al., 2004
). Similarly, negative and positive emotional expressions have been associated with externalizing behaviors and social competence, respectively (Eisenberg et al., 2001
). Collectively, these studies elucidate how environmental factors, specifically positive maternal affect, can influence the course of behavioral development among individuals with biological risks for behavior problems.
Positive family processes may also be influential in promoting mental health and reducing symptomatology during adulthood. For instance, connections between positive family environments and more optimal outcomes have been demonstrated in studies of individuals with schizophrenia and their families. In a study of ethnicity and schizophrenia, warmer family environments post-hospitalization were associated with a lower risk of relapse for Mexican American individuals with schizophrenia (Lopez et al., 2004
). Relatedly, mothers' expressions of warmth and praise toward their son or daughter with schizophrenia, in addition to the quality of the parent– child relationship, have been linked with greater life satisfaction among adults with schizophrenia (Greenberg, Knudsen, & Aschbrenner, 2006
). Given the similarities associated with some aspects of parenting an individual with schizophrenia and an individual with autism (Greenberg, Seltzer, Krauss, Chou, & Hong, 2004
; Seltzer, Abbeduto, Krauss, Greenberg, & Swe, 2004
), these findings suggest that positive aspects of the family environment might also serve a protective function for autism symptomatology during adolescence and adulthood.
Although associations between family-level factors and children's developmental trajectories have been widely examined in studies of typically developing children (Borkowski et al., 2002
), less attention has been given to understanding family processes within families of individuals with an autism spectrum disorder. This lack of research on the role of the family environment in the developmental course of autism spectrum disorder presumably stems from the prevailing consensus that autism is a complex genetic disorder and clearly not caused by poor parenting, as earlier theorists had incorrectly postulated (Folstein & Rosen-Sheidley, 2001
). However, even given the strong role of genetics in the etiology of autism, there is evidence that the phenotypic expression of the disorder is still influenced by the family environment (Greenberg, Seltzer, Hong, & Orsmond, 2006
). As such, positive family processes may operate as potential mechanisms in the development of autism symptoms and maladaptive behaviors.
Recently, attention has been given to one unique family environmental factor, expressed emotion, as a potential explanatory variable among families of children with disabilities. Expressed emotion
is defined by high levels of criticism and/or emotional overinvolvement from one family member directed toward another family member with a disability or illness. Family expressed emotion has long been related to relapse among adults with schizophrenia (Sutcliff & Hooley, 1998) and has been examined more recently in families of children with intellectual disabilities (Beck, Daley, Hastings, & Stevenson, 2004
; Hastings, Daley, Burns, & Beck, 2006
) as well as autism spectrum disorder (Greenberg, Seltzer et al., 2006
). High levels of criticism, in particular, have been associated with elevated levels of maladaptive behaviors in individuals with disabilities (Hastings, Daley et al., 2006
). However, only examining the negative aspects of the family affective climate may be limiting for understanding the full range of family processes that influence development. Negative and positive well-being, for instance, are not necessarily on the same continuum of mental functioning (Ryff et al., 2006
). There remains a need to examine the positive aspects of emotional expression and other family processes among families with children with autism spectrum disorder.
Although researchers have begun to examine the impact of the family environment on the development of individuals with autism, gaps still remain in understanding the specific processes by which families adapt and change over time, especially later in the life course (Seltzer, Krauss, Orsmond, & Vestal, 2001
). Maternal warmth, praise, and the quality of the relationship between mother and son or daughter might be potential mechanisms that impact the developmental course of autism. As such, in the current study our aim was to extend the work of Greenberg, Seltzer et al. (2006)
, in which they examined negative components of expressed emotion (criticism and emotional overinvolvement) among families of adolescents and adults with autism. In the present study we examined linkages between the positive aspects of the family environment and subsequent child behavior and symptomatology in the same sample. Specifically, the influences of maternal warmth, praise, and relationship quality on change in children's autism symptoms and behaviors problems were investigated using a cross-lagged panel design. This longitudinal design allowed for an examination of the direction of effects between family process variables and behavior problems and symptoms in adolescents and adults with autism spectrum disorder.
We had three primary research questions: (a) What is the stability of warmth, praise, and relationship quality over an 18-month period among mothers of adolescents and adults with an autism spectrum disorder? (b) Are levels of maternal warmth, praise, and relationship quality predictive of later behavior problems and autism symptoms? (c) Are severity of behavior problems and autism symptoms predictive of later maternal warmth, praise, and relationship quality?
In examining these questions, we used a cross-lagged panel design, which allowed us to test the stability of effects over time as well as the lagged effects across domains. We also included control variables of important child characteristics. Because mother–child interactions across the life-span often vary depending on the gender of the child (Rossi & Rossi, 1990
), we controlled for child's gender in the bidirectional models of positive family processes and behavior problems and autism symptoms. Additionally, we controlled for a comorbid diagnosis of mental retardation because of the strong association between mental retardation and behavior problems and autism symptoms (Shattuck et al., 2007
Based on previous research, we hypothesized that high levels of maternal warmth, praise, and relationship quality would be associated with lower levels of behavior problems (internalizing, externalizing, and asocial), even after controlling for prior levels of behavior problems, child gender, and mental retardation status. Similarly, we hypothesized that these positive family factors (warmth, praise, and relationship quality) would be related to decreases in core autism symptoms (impairments in communication, impairments in social reciprocity, and repetitive behaviors and restricted interests) over an 18-month period. Reciprocally, we also expected that high levels of behavior problems and autism symptoms would be related to lower levels of maternal warmth, praise, and relationship quality.