Applying the Vulnerability Stress Adaptation Model of Marriage to Couples Raising an Autistic Child: A Call for Research on Adaptive Processes

Parents of children on the autism spectrum are particularly susceptible to strain in their romantic relationships due to unique risk factors. While some relationships deteriorate, however, others endure and thrive. The Vulnerability Stress Adaptation (VSA) Model of Marriage (Karney & Bradbury, 1995; Fig. 1) offers a framework to explain, not only poor marital outcomes, but also the process by which degradation of relationships occurs over time. The VSA Model posits that a combination of internal (within-person) vulnerabilities and external stressors influence relationship quality and, in turn, stability, by affecting couples\u27 abilities to collaborate to adapt to stressors and solve problems (i.e., adaptive processes). With robust theoretical grounding, this review comprehensively summarizes and integrates literature pertaining to the romantic relationships of couples raising an autistic child through the lens of the VSA Model. Vulnerabilities, stressors, and adaptive processes relevant to these couples are identified, and empirical evidence pertaining to the proposed pathways in the VSA Model is explored. The body of research reviewed provides support for many of the proposed pathways in the VSA Model, especially related to certain stressors (i.e., child behavior problems) and vulnerabilities (i.e., parent depression), yet it falls short in exploring mechanisms by which these factors beget marital dysfunction (i.e., through adaptive processes). Additional gaps and methodological limitations in the literature are highlighted, and recommendations for future research are provided

Brief Report: Does Gender Matter in Intervention for ASD? Examining the Impact of the PEERS® Social Skills Intervention on Social Behavior Among Females with ASD

A paucity of research has been conducted to examine the effect of social skills intervention on females with ASD. Females with ASD may have more difficulty developing meaningful friendships than males, as the social climate can be more complex (Archer, Coyne, Personality and Social Psychology Review 9(3):212–230, 2005). This study examined whether treatment response among females differed from males. One hundred and seventy-seven adolescents and young adults with ASD (N = 177) participated in this study. When analyzed by group, no significant differences by gender emerged: PEERS® knowledge (TASSK/TYASSK, p = .494), direct interactions (QSQ, p = .762), or social responsiveness (SRS, p = .689; SSIS-RS, p = .482). Thus, females and males with ASD respond similarly to the PEERS® intervention

Changes in Depressive Symptoms Among Adolescents with ASD Completing the PEERS® Social Skills Intervention

Depression is a common concern among people with autism spectrum disorder (ASD) and is often associated with social skills and relationship challenges. The present data, from a randomized controlled trial, examined the effect of PEERS® on self-reported depressive symptoms via the Children’s Depression Inventory (CDI) among 49 adolescents with ASD. Findings revealed that many CDI subscale scores declined (p’s \u3c 0.05) and were related to direct social contact on the Quality of Socialization Questionnaire at posttest (p’s \u3c 0.05). Exploratory analyses uncovered that suicidality was less evident following PEERS®. Findings support the notion that social functioning and depression may be intimately intertwined in ASD; therefore, bolstering social skills in ASD may positively influence other domains of functioning, including mental health

Examining the Links Between Challenging Behaviors in Youth with ASD and Parental Stress, Mental Health, and Involvement: Applying an Adaptation of the Family Stress Model to Families of Youth with ASD

Raising a child with autism spectrum disorder (ASD) poses unique challenges that may impact parents’ mental health and parenting experiences. The current study analyzed self-report data from 77 parents of youth with ASD. A serial multiple mediation model revealed that parenting stress (SIPA) and parental mental health (BAI and BDI-II) appears to be impacted by challenging adolescent behaviors (SSIS-PBs) and, in turn, affect parental involvement (PRQ), controlling for social skills (SSIS-SSs). Further, the study explored the malleability of parents’ mental health over the course of a social skills intervention, and provides modest evidence that parent depressive symptoms decline across intervention. This study illustrates the importance of considering the entire family system in research on youth with ASD

The Role of Loneliness as a Mediator Between Autism Features and Mental Health Among Autistic Young Adults

Autistic adults commonly experience anxiety and depression. These mental health concerns are often tied to social experiences, such that mental well-being can be supported by social connection and deteriorated by loneliness. The mediating role of social and emotional loneliness (i.e. social isolation and lack of emotional attachment, respectively) between autism features and mental health has yet to be empirically tested among autistic adults. Here, 69 autistic young adults completed self-report questionnaires assessing social contact (Friendship Questionnaire), autism features (Autism Quotient), mental health (Liebowitz Social Anxiety Scale, Social Phobia Inventory, Beck Depression Inventory), and loneliness (Social and Emotional Loneliness Scale for Adults). Positive associations emerged between autism features, social loneliness, family loneliness, social anxiety, and depression. In addition, more social contact was related to less social and family loneliness and less social anxiety but was not related to depression. Mediation analyses indicated significant indirect effects of social contact and autism features on mental health through social loneliness. Indirect effects partially held substituting family loneliness for social loneliness and did not hold using romantic loneliness. In light of these results, the scientific and clinical implications of the role of loneliness for autistic young adults are discussed and recommendations provided. Lay abstract Autistic adults commonly experience mental health concerns including social anxiety and depression, which can have negative effects on their quality of life. It is not completely clear, however, why rates of mental health concerns are so high. Some evidence suggests that social connectedness might play a key role. The goal of this study was to explore links between loneliness, mental health concerns, autism features, and social contact among autistic adults and test whether the links between mental health with autism features and social contact can be explained by loneliness. Researchers in this study collected data using questionnaires completed by 69 autistic young adults. Autistic adults who reported more autism features also reported more social and family loneliness, higher levels of social anxiety and depression, and fewer initiated social contacts. In addition, adults with more social contact initiations were likely to report lower levels of social and family loneliness and social anxiety but not depression. Results showed that the link from social engagement and autism features to social anxiety and depression symptoms could be mostly explained by loneliness. The results of this study expand previous findings by illustrating one factor (loneliness) that might be responsible for the high rates of mental health concerns among adults on the autism spectrum. These findings highlight the importance of studying factors related to mental health concerns among autistic adults and ways to best support social connectedness for the mental well-being of autistic young adults

Social Difficulties in Youth with Autism With and Without Anxiety and ADHD Symptoms

Social difficulties inherent to autism spectrum disorder are often linked with co‐occurring symptoms of anxiety and attention deficit hyperactivity disorder (ADHD). The present study sought to examine the relation between such co‐occurring symptoms and social challenges. Parents of adolescents with autism (N = 113) reported upon social challenges via the social responsiveness scale (SRS) and anxiety and ADHD symptomatology via the Child Behavior Checklist. Results revealed differences in SRS scores across co‐occurring symptom subgroups (Anxiety, ADHD, Both, Neither)—namely, adolescents with autism and anxiety as well as those with autism, anxiety, and ADHD showed greater scores on the SRS than the other groups. Implications for research and clinical practice are discussed and recommendations are offered. Lay Summary Anxiety and attention deficit hyperactivity disorder (ADHD) symptoms are related to greater social challenges for adolescents with autism spectrum disorder. The present study found that autism with anxiety and autism with anxiety and ADHD, was related to greater social difficulties than autism alone. Findings provide further support for the intertwined nature of anxiety and ADHD symptoms in autism. What this may mean for research and clinical practice is considered and recommendations are suggested

Social Difficulties in Youth with Autism With and Without Anxiety and ADHD Symptoms

Social difficulties inherent to autism spectrum disorder are often linked with co‐occurring symptoms of anxiety and attention deficit hyperactivity disorder (ADHD). The present study sought to examine the relation between such co‐occurring symptoms and social challenges. Parents of adolescents with autism (N = 113) reported upon social challenges via the social responsiveness scale (SRS) and anxiety and ADHD symptomatology via the Child Behavior Checklist. Results revealed differences in SRS scores across co‐occurring symptom subgroups (Anxiety, ADHD, Both, Neither)—namely, adolescents with autism and anxiety as well as those with autism, anxiety, and ADHD showed greater scores on the SRS than the other groups. Implications for research and clinical practice are discussed and recommendations are offered. Lay Summary Anxiety and attention deficit hyperactivity disorder (ADHD) symptoms are related to greater social challenges for adolescents with autism spectrum disorder. The present study found that autism with anxiety and autism with anxiety and ADHD, was related to greater social difficulties than autism alone. Findings provide further support for the intertwined nature of anxiety and ADHD symptoms in autism. What this may mean for research and clinical practice is considered and recommendations are suggested

A Psychometric Analysis of the Social Anxiety Scale for Adolescents Among Youth with Autism Spectrum Disorder: Caregiver–Adolescent Agreement, Factor Structure, and Validity

Social anxiety is common among adolescents with autism spectrum disorder (ASD). An ongoing challenge for both research and clinical practice in ASD is the assessment of anxious symptomatology. Despite its widespread use in samples of youth with ASD, the Social Anxiety Scale for Adolescents (SAS-A) has not received psychometric evaluation within this population; thus, the validity of its use in research and clinical practice for ASD remains unclear. The present study conducted a psychometric analysis of caregiver and adolescent SAS-A forms in a sample of adolescents with ASD (N = 197). Results revealed (1) poor caregiver–adolescent item-level agreement, (2) a two-factor structure, (3) lack of measurement invariance between reporters, and (4) modest evidence for convergent and discriminant validity. Overall, findings suggest that this measure demonstrates reasonable psychometric properties in an ASD sample. Lack of measurement invariance, however, calls for careful interpretation of research involving the SAS-A in ASD samples, particularly when the primary goal is to compare adolescent and caregiver reports. The implications of these findings for future research and clinical practice are discussed

Applying the Vulnerability Stress Adaptation Model to Romantic Relationships of Couples Raising a Child with ASD

Cross-sectional evidence indicates that raising a child with autism spectrum disorder (ASD) is associated with strain on caregivers’ romantic couple relationship, yet many couple relationships thrive (Hock et al., 2012; Markoulakis et al., 2012). Research on general population samples highlights changes in couple romantic relationships across short and longer periods of time (e.g., Karney & Bradbury, 1997); little is known, however, about how the relationships of couples raising a child with ASD unfold and which couples are at greater risk for deterioration than others. According to the Vulnerability Stress Adaptation (VSA) Model, couple romantic relationships are directly shaped by how couples work together to solve problems (i.e., adaptive processes); vulnerabilities brought into the relationship and stressors faced by each partner impact adaptive processes. In the present study, longitudinal growth curve models examined changes (four time points across three years) in observed problem-solving interactions among 189 couples (378 parents) raising a child (aged 5-12) with ASD. Each partner completed questionnaires assessing the broader autism phenotype (BAP; vulnerability) as well as their own parenting stress and their child’s ASD symptoms and emotional and behavioral problems (i.e., stressors) at the first time point. Results revealed declines, on average, in the responsiveness of partners (Sensitivity), ability to work together (Cooperation) to come to a satisfying resolution (Conflict Resolution), and positivity (Enjoyment). Composite scores (Solution Focused Reciprocity and Positive Togetherness) also demonstrated declines across time. The sharing of the interaction (Balance), partner-directed behaviors (Engagement), and hostility (Irritation) remained stable. Growth mixture modeling revealed no unique subgroups of couples. Stressors were not significant predictors of the intercept or slope of Solution Focused Reciprocity and Positive Togetherness. Couples with higher Father BAP demonstrated steeper declines in couple adaptive processes over time, especially in the context of low initial levels of mother-reported stress. Mother BAP, however, appeared to be protective against declines in Positive Teamwork in the context of a high initial level of father-reported stress. Findings highlight areas of strength and weaknesses that can be leveraged or supported to promote healthy and long-lasting couple relationships, and in turn, well-adjusted families