Challenging Behaviors, Family Management, and Autism: Relationships with Mutuality and Perceived Difficulty

Background

Families of children with autism spectrum disorder (ASD) frequently experience elevated stress associated with challenging behaviors such as aggression and restricted and repetitive behaviors. These behaviors can disrupt family functioning and negatively affect overall well-being. Family management processes are the ways in which families perceive, organize, and carry out the day-to-day management of a child’s condition, including shared understanding between caregivers and perceived difficulty of management. Family management processes may help explain variability in how families respond to challenging behaviors when parenting a newly diagnosed child with ASD. To this end, the current study examined whether challenging behaviors (aggression and ritual behaviors) are associated with family management patterns (parent mutuality and perceived difficulty) among parents of children newly diagnosed with autism.

Methods:
Data were drawn from baseline assessments of 359 parents enrolled in an intervention trial for parents of children newly diagnosed with ASD (within 12 months). Child challenging behaviors were measured using Pervasive Developmental Disorder Behavior Inventory (PDDBI) subscales assessing aggression (aggregate) and restricted and repetitive (ritual) behaviors. Family management was assessed using Family Management Measure (FaMM) subscales of mutuality and perceived difficulty. Descriptive statistics were calculated, and Pearson correlations and linear regression models were used to examine associations between challenging behaviors and family management outcomes.

Results:

Results:

The sample was predominantly White/Caucasian (63.4%) and Black/African American (29.1%), with smaller representation from other racial and ethnic groups. Most parents reported completing a bachelor’s (24.4%) or master’s degree (22.9%). The sample included 111 women and 92 men, with a mean parent age of 36.6 years (SD = 6.1) and a mean child age of 4.18 years (SD = 1.8). Correlation analyses indicated that aggression was positively associated with perceived difficulty (r = 0.26, p < .001) and negatively associated with mutuality (r = −0.16, p = .002), while ritual behaviors were positively associated with difficulty (r = 0.19, p < .001) but not significantly associated with mutuality (p = .20). Regression analyses showed that higher levels of aggression were associated with greater perceived difficulty (β = 0.016–0.018, p < .001) and lower mutuality (β = −0.008, p = .002). Ritual behaviors were also associated with greater perceived difficulty (β = 0.014, p < .001) but were not significantly associated with mutuality.

Conclusion/Implications:

Findings demonstrate that challenging behaviors in children with ASD are associated with increased perceived family difficulty and, in the case of aggression, reduced caregiver mutuality. While the causal direction of this relationship is unknown, one possibility is that behavioral challenges may disrupt collaborative family management processes important for family well-being. Testing the direction of these relationships with longitudinal data is an important next step in this research. This work is vital to social work practice because family management processes are responsive to intervention, and within the purview of many social workers’ scope of practice. A clear implication of this study is the importance of emphasizing family-centered approaches that support both individual caregivers and the caregiving unit.