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View of Perceived Social Support and Psychological Well-being among Mothers of Children with Autism Spectrum Disorder in Al-Nasiriyah City

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Perceived Social Support and Psychological Well-being among Mothers of Children with Autism Spectrum Disorder in Al-Nasiriyah City

Asmaa N. Hussein1 and Dr. Qahtan Q. Mohammed, PhD2

1M.S.C student University of Baghdad ,College of Nursing , Psychiatric Mental Health Nursing, Iraq, Email: [email protected]

2Assistant Professor, University of Baghdad, College of Nursing ,Psychiatric and Mental Health Nursing Department, Iraq.

Abstract

Background: Autism spectrum disorder: is a characteristic of chronic deficiencies in the capacity to initiate and retain mutual social contact and social communication and by a number of behavioral and desire behaviors that are limited, repeated an inflexible.

Methodology A descriptive correlational design was performed for the purposes of the current study that are stated earlier to assess the influence of perceived social support on psychological well-being of mothers with Autistic children. This study started from January 15th, 2021 to March 14th 2021. The questionnaire was designed by the researcher to measure the purpose of the study. A convenient sample was selected consecutively from (100) mothers has child with ASD. The data was collected through the use of a questionnaire, which consists of (3) parts: part one: the demographic information for mothers and child, part two: Multidimensional Scale of Perceived Social Support, part three: measure of Psychological Wellbeing. The information was analyzed in this study by using statistical package for social science program (IBM SPSS) version 24.0.

Results: It was evident through the results that the observed social support among mothers with autistic children has a significant impact on their mental health at p-value = 0.001, respectively. Also the findings show moderate level of social support and depict that mother of autistic children having moderate to high psychological wellbeing in which 50% having moderate level and 41% having high level.

Conclusions: The study concluded that the effect of perceived social support on the mental health of mothers who have an autistic child has an effective effect on achieving the psychological well-being of the mother.

Recommendations: This study recommended that health care institutions develop supportive plans and open a section concerned with the mental health of the mother who takes care of the child with autism spectrum disorder within the plans and programs of centers specialized in caring for children with autism and to make these centers specialized for the mother and

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Keywords: Perceived Social Support, Psychological Well-being, Mothers of autistic child Introduction

Autism spectrum disorder: is a characteristic of chronic deficiencies in the capacity to initiate and retain mutual social contact and social communication and by a number of behavioral and desire behaviors that are limited, repeated and inflexible. (1). ASD: refers to a category of diverse brain growth disorders. ASD is characterized by difficulties in social interaction, as well as verbal, nonverbal, and repetitive motor interaction. It can also be followed by learning disability and physical health issues such as sleep and digestive problems (2).

ASD: is a life-long, normally stable illness requiring constant vocabulary, social skills, and everyday life impairment, Child rearing problems, which are present at an late age, place powerful emphasis on parental ability. If the expectations of the parents of parental expectations position, outweigh their coping resources without being able to restore an a state of balance ,by the normal techniques and tactics, he will create tension. Stress by parent of child with ASD, which in (77%) of cases exceeds clinically relevant levels. (3). Stress, fear, and strong strain on parents face problems associated with primary treatment of child with ASD (4).

Compared to parents of children with no impairments, tension faced by parents in the treatment of child with ASD exceeds. (5). In addition, the involvement of social support plays a significant role among parent of child with ASD in buffering tension and anxiety(6).

High maternal stress levels can have a negative impact on psychological and emotional well-being, resulting in reduced well-being reports and elevated rates of recorded exhaustion, depression, and anxiety (7). A study found that mothers encountered feelings of anger, embarrassment, and remorse because of their children's troublesome activities with behavioral disorders and anxiety when they were unable to provide their children with the requisite treatment appropriately (8).

Mothers with children with intellectual disabilities reported feelings of shame due to social isolation and responsibility as the source of their child's disabilities, which led to the low self-esteem, powerlessness and desperation of the mothers (9). Many mothers are unable to partake in group events or even income-generating events due to the continuous treatment needed for children with psychiatric disabilities, resulting in withdrawal and social alienation, leading to further experiences of mothers' stress, anxiety and depression (10).

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Objectives of the Study

The study aims at determining the influence of perceived social support on psychological well-being in mothers of children with autism.

Methodology

Administrative arrangements:

After getting the approval of the council of the College of Nursing regarding the study, the researcher has submitted description including the objectives and project of the study to the Ministry of Planning/ Central Council of Statistics as well to Department of Training and Human Development in Thi-Qar Health Directorate to get official permissions to carry out the study. After that, the permission was sent to Thi-Qar Autism Center in Al- Nasiriya City.

Design and setting of study:

A descriptive correlational design was conducted on (100) Mothers of Children with Autism Spectrum Disorder. The study was conducted in Thi-Qar Autism Center in Al-Nasiriya City, this is center the only center in the city contains mothers for children with ASD and children with autism. City in a period january12th, 2021 to March 14th 2021. , after getting official permission from Thi-Qar Autism Center.

Instrument of study:

The study instruments was designed to meet the objectives of current study which was consisting of three parts: the first part includes the covering letter, demographical data for mother and child; the second part includes the items related to Multidimensional Scale of Perceived Social Support (MSPSS) (11); and the third part includes the items related to Psychological Well Being Scale (PWB) (12).

Multidimensional Scale of Perceived Social Support (MSPSS): was developed by Zimet et al. (1988) consist of 12 items and evaluates three different aspects : family information include ( items 3, 4, 8 & 11) friends information include (items 6, 7, 9 &12 ) and Significant Other information include (items 1 ,2 ,5 &10). Each item in the scale was divided into seven level of Likert scale and rated from 1 to 7 as follow: very strongly disagree=1, strongly disagree=2, moderately disagree= 3, neutral= 4, mildly agree=5, strongly agree=6, and very strongly agree= 7. The level of perceived social is estimated by calculation the range score for the total score which divided into three levels: low= 12 – 36, moderate= 37 – 60, and high= 61 – 84, the higher score indicates high perceived social support. The level of

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perceived social support for each item is estimated by calculating the cut-off points for the mean score and divided into three level: low=1 – 3, moderate= 4 – 5, and high= 6 – 7.

Psychological well-being scale (PWS): developed by (Ryff, C. D., Almeida, D. M., Ayanian, J. S., Carr, D. S., Cleary, P. D., Coe, C. … Williams, D. (2010). The scale consists of 18 items and evaluates six different aspects: the autonomy aspect include items are (15, 17, and 18); the environmental mastery aspect include items are (4, 8, and 9); the personal growth aspect include items are (11, 12, and 14); the positive relations with others aspect include items are (6, 13, and 16); the purpose in life aspect include items (3, 7, and 10); and the self-acceptance aspect include items are (1, 2, and 5). Each item in the scale was divided into seven level of Likert scale and rated from 1 to 7 as follow: strongly agree=1, somewhat agree=2, a little agree= 3, neither agree or disagree= 4, a little disagree=5, somewhat disagree=6, and strongly disagree= 7; the score is reversed for the items 1, 2, 3, 8, 9, 11, 12, 13, 17, and 18. The level of psychological wellbeing is estimated by calculation the range score for the total score which divided into three levels: low= 18 – 54, moderate= 55 – 90, and high= 91 – 126. The level of sub-domain (aspects) was also calculated through range score for the total score of each sub-domain and scored as follow: low= 3 – 9, moderate= 10 – 15, and high= 16 – 21. The level of psychological wellbeing for each item is estimated by calculating the cut-off points for the mean score and divided into three levels: low=1 – 3, moderate= 4 – 5, and high= 6 – 7.

Statistical Analysis

Data are analyzed through the application of descriptive statistical data analysis approach and inferential data analysis by using statistical package for social science program version 24.

Results

Table (1): Distribution of Mothers According to their Socio-demographic Characteristics

List Characteristics f %

1 Age

M±SD= 31.7±6

20 – 29 year 34 34

30 – 39 year 50 50

40 – 49 year 16 16

Total 100 100

2 Level of education Doesn’t read & write 0 0

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Read & write 0 0

Primary school 9 9

Intermediate school 18 18

Secondary school 21 21

Institute/ college 47 47

Postgraduate 5 5

Total 100 100

3 Marital status

Married 99 99

Divorced 0 0

Separated 1 1

Widowed 0 0

Total 100 100

4 Residency

Low class neighborhood 50 50

High class neighborhood 50 50

Total 100 100

5 Mother’s occupation

Employee 44 44

Private work 0 0

Retired 0 0

Housewife 56 56

Total 100 100

6 Husband’s occupation

Employee 72 72

Free works 25 25

Retired 0 0

Jobless 3 3

Total 100 100

7 Perceived monthly income

Insufficient 11 11

Barely sufficient 28 28

Sufficient 61 61

Total 100 100

8 Kinship

Relative 51 51

Strange 49 49

Total 100 100

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Table (2): Assessment of Perceived Social Support among Mothers with Autistic Child

Perceived Social Support f % M SD

Low 22 22

51.70 14.854

Moderate 44 44

High 34 34

Total 100 100

f: Frequency, %: Percentage

M: Mean for total score, SD: Standard Deviation for total score Low= 12 – 36, Moderate= 37 – 60, High= 61 – 84

Table (3): Overall Assessment of Psychological Wellbeing among Mothers of Autistics Child

Psychological Wellbeing f % M SD

Low 9 9

80.99 17.641

Moderate 50 50

High 41 41

Total 100 100

f: Frequency, %: Percentage, M: Mean for total score, SD: Standard Deviation for total score Low= 18 – 54, Moderate= 55 – 90, High= 91 – 126

Table (4): Simple Linear Regression for Assessment the Influence of Perceived Social Support on Psychological Wellbeing among Mothers with Autistic Children (N=100) Dependent

variable

Independent

Unstandardized Coefficients

Standardized Coefficients

t Sig.

B Std. Error Beta Perceived social

support 1.046 0.057 0.881 18.411 .001

Dependent variable: Psychological wellbeing

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Discussion:

The analysis of findings in table (1) revealed that half of them were aged between 30-39 years old. This result in line with that by Benson (2012) who had studied ."Network characteristics, perceived social support, and psychological adjustment in mothers of children with autism spectrum disorder" concerning level of education, marital status, and occupation;

The result showed that the highest percentage among mothers is referring that they graduated from institute and college (47%), (99%) percent of them were married, regarding the occupational status; (56%) of mothers are housewives and (44%) percent of them were employees Regarding husbands' occupation, monthly income, and kinship, (72%) percent of them were employees, (61%) percent of families had a sufficient perceived monthly income, and (51%) percent of mothers their husbands were not-relative and (49%) percent were relative. This result similar to that by Fayyad and Faraj (2019), El Sawy, Awadalla, Mohamed, Zaki, and Mohamed (2011) who studied. "Efficacy of Mindfulness-Based Intervention to Raise the Awareness of Caregivers of Children with Autism Spectrum Disorder in Al-Nasiriya City", "Study of some environmental and genetic determinants of autism in Egyptian children". respectively stated that 70% percent of husbands were employees, having a sufficient monthly income respectively.

The analysis of findings in table (2) the assessment of the perceived social support indicated that the level was moderate (44%) to high (34%), submitted that the level of perceived social support among mothers of children with autism as well as mothers of normally developed children was high. concluded that the level of the perceived social assistance for mothers of child with autism was low compared with the mother of typically developed children who shown a high level of perceived social support. The moderate degree of perceived social support is not an issue, especially in such difficult living and epidemiological conditions, and the presence of a high level is considered a very good result and indicates a good level of social support for mothers who have children with autism.

However, many mothers missed social support, so it is necessary to measure the perceived social support during different periods to find out the real support that is permanently present in a specific area. Thus the social support is strengthened through educational programs.

The analysis in table (3) depicted that mother of autistic children having moderate to high psychological wellbeing in which 50% having moderate level and 41% having high level. This result in line with that by Nikmat, Ahmad, Oon, and Razali (2008) who studied.

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disorder", that submitted that mothers of children with autism were having a moderate level of psychological well-being. The emergence of this result can be interpreted as the previous result, due to the difficult circumstances faced by mother of child with autism, obtaining such a result is a good thing in itself, so it is necessary to make the positive improvements and adjustments that are always required in the mother's life in order to improve the psychological health of him that affects and in a big way on children, and consequently, the effect on the course of treatment that they receive according to the nature of this change that was made, so it is very important to know all the burdens and problems they are exposed to and how to alleviate them, because neglecting these problems will negatively affect mothers, which in turn will indicate a negative trend on children's health.

The analysis in table (4) the perceived social support has a great impact on the psychological well-being of mothers who have children with autism, in other words, the more perceived social support the psychological well-being will be better. This result compatible with that by Benson (2012) stated that a direct positive path between perceived social support and well-being among mothers of children with autism. The researchers opinion, social support is one of the important elements for the mental health of all individuals, especially mothers who care for a child with autism for instance, if a person has spent a hard day at work or after a year full of sadness without receiving adequate social support represented by family, friends and the outside environment.

This could lead the individual to become depressed, isolated and feeling lonely, so how is it the case for a mother who takes care of her son and daughter with autism spectrum disorder, which continues to affect the life of the child if he does not undergo the treatments required to treat this disorder and thus has an adverse effect on the mental health of the mother in case She did not receive adequate support that might make her overcome the pressures and face them. Therefore, perceived social support is an essential and important element in achieving the psychological well-being of mothers. In addition, social support is an important factor in reducing stress and tension and enhances the mother's ability to deal with her problems as well as dealing with the requirements of her affected child disturbance.

Conclusions:

(1) Most of mothers have child with ASD are married young age range from 30 – 39 year old, graduated from institute and college, housewives, sufficient monthly income and the kinship between the mothers of autistic children and their husbands refer to relative.

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(2) More than half of the autistic children are males, with an age group ranging from 3 to 5 years of age, with the duration of the disease, which formed a great majority, by 1-3 years, which is led by the order of the first child in the family by a rate close to the parity.

Recommendations:

(1).The health care institutions should developing supportive plans and opening a department concerned with the mental health of the mother who takes care of a child with autism spectrum disorder within the plans and programs of centers specialized in caring for autistic children and making these centers specialized for mother and child.

(2).Add awareness programs regarding autism spectrum disorder as part of the care programs for pregnant women in health centers and hospitals to have a level of knowledge and understanding about how this disorder occurs, what are its causes, and how to avoid future exposure to their children with it by avoiding risk factors in its occurrence.

References

(1) World Health Organization. 2018. International Classification of Diseases (11th Revision).

[online]Availablat:<https://icd.whoint/browse11/l

(2) Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Robinson, C., Carpenter, L., et al. (2016). Brief report: Prevalence of self-injurious behaviors among children with autism spectrum disorder—A population based study. Journal of Autism and Developmental Disorders, 46, 3607–3617.

(3) Kiami, S. R., and Goodgold, S. (2017). Support needs and coping strategies as predictors of stress level among mothers of children with autism spectrum disorder. Autism Res.

(4) Bitsika, V., & Sharpley, C. F. (2017). The association between autism spectrum disorder symptoms in high-functioning male adolescents and their mothers’ anxiety and depression. Journal of Developmental and Physical Disabilities, 29(3), 461-473

(5) Giovagnoli, G., Postorino, V., Fatta, L. M., Sanges, V., DePeppo, L., Vassena, L., … Mazzone, L. (2015).Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder. Research in Developmental Disabilities, 45, 411–

421.

(6) Pozo, P., & Sarriá, E. (2014). A global model of stress in parents of children with autism spectrum disorders(ASD). Annals of Psychology, 30, 180–191.

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(7) Giallo, R., Wood, C. E., Jellett, R., & Porter, R. (2013). Fatigue, wellbeing and parental self- efficacy in mothers of children with an Autism Spectrum Disorder. Autism.

(8) Geere, J. L., Gona, J., Omondi, F. O., Kilafu, M. K., Newton, C. R., & Hartley, S. (2012).

Caring for children with physical disability in Kenya: Potential links between care giving and carers’ physical health. Child Care Health and Development 39(3), 381-392.

(9) Gona, J. (2016). Autism and other neurodevelopmental disabilities on the Kenyan coast.

Unpublished doctoral dissertation. Tilberg University. Downloaded on 17/10/2019.

(10) Gona, J. K., Newton, C. R., Rimba, K. K., Mapenzi, R., Kihara, M., Vijver, F. V., &

Abubakar, A. (2016). Challenges and coping strategies of parents of children with Aautism on the Kenyan Coast. Rural and remote health 16:3517.

(11) Zimet G.D., Dahlem N.W., Zimet S.G., Farley G.K. The Multidimensional Scale of Perceived Social Support. J. Pers. Assess..

(12) Ryff, C. D., Almeida, D. M., Ayanian, J. S., Carr, D. S., Cleary, P. D., Coe, C., … Williams, D. (2010). National Survey of Midlife Development in the United States (MIDUS II), 2004- 2006: Documentation of psychosocial constructs and composite variables in MIDUS II Project 1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research.

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