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Mothers, autism and attachment: An exploration of parenting, perceived attachment and maternal knowledge

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Denise J Jones
Abstract:
As the prevalence of autism spectrum disorders (ASD) increases, additional research is necessary to explore the unique experiences of parenting a child with autism, attempting to understand the unique needs of families and children living with the disorder. To gain an understanding of the mother/child relationship, the present study investigated the perceived mother/child bond and level of attachment. Maternal knowledge of the characteristics common in children with autism spectrum disorder were explored to determine how maternal knowledge may influence the perceived mother/child relationship. Narratives of mother's perceptions of attachment were compared to the theoretical foundations of Bowlby's attachment theory. Overriding themes indicated that mother's perceptions of attachment supported prior research that suggested that children with autism can develop secure attachment relationships to a parent or caregiver. The outcomes of this research may assist mental health professionals develop an understanding of the unique needs of families as they face the challenges inherent in autism spectrum disorders. Research data revealed the need for services, not only for the child with autism, but for each individual in the family unit as well as the family as a whole.

v Table of Contents Acknowledgments..................................................................................................iv CHAPTER 1. INTRODUCTION........................................................................................1 Introduction to the Problem.....................................................................................1 Background of the Problem...................................................................................10 Statement of the Problem.......................................................................................15 Purpose of the Study..............................................................................................17 Research Questions................................................................................................18 Rationale for the Research Study...........................................................................19 Definition of Terms................................................................................................23 Assumptions...........................................................................................................24 Limitations of the Study.........................................................................................26 CHAPTER 2. LITERATURE REVIEW..........................................................................29 Theoretical Framework..........................................................................................29 Review of the Critical Literature...........................................................................36 Literature Review Themes.....................................................................................41 Characteristics of Autism and Diagnostic Challenges...........................................41 Treatment Issues....................................................................................................45 Parenting Children with Disabilities......................................................................48 Social Skills Development.....................................................................................53 Autism and Attachment.........................................................................................55 Evaluation of Research Designs............................................................................56

vi Summary................................................................................................................58 CHAPTER 3. METHODOLOGY....................................................................................60 Researcher’s Philosophy........................................................................................61 Research Design.....................................................................................................63 Sampling Design and Setting.................................................................................68 Data Collection Procedures....................................................................................71 Data Analysis Procedures......................................................................................73 Limitation of Research Design..............................................................................77 Credibility and Transferability..............................................................................79 Expected Findings..................................................................................................80 Ethical Issues in the Research Study.....................................................................81 Researcher’s Position Statement............................................................................83 Summary................................................................................................................85 CHAPTER 4. DATA COLLECTION AND ANALYSIS................................................86 Sampling................................................................................................................88 Participants............................................................................................................90 Presentation of Data and Data Analysis................................................................94 Perceptions of Attachment...................................................................................100 Maternal Knowledge............................................................................................117 Perceptions of Support.........................................................................................120 Summary of Themes in Data...............................................................................124 CHAPTER 5. DISCUSSION AND RECOMMENDATIONS......................................127

vii Summary of Results............................................................................................127 Discussion of Findings........................................................................................128 Review of Themes...............................................................................................129 Implications for Clinical Practice........................................................................141 Recommendations for Future Research...............................................................149 Conclusions..........................................................................................................152 REFERENCES................................................................................................................156 APPENDIX A. PRELIMINARY GUIDING INTERVIEW QUESTIONS...................172

1

CHAPTER 1. INTRODUCTION

Introduction to the Problem In recent years, the number of children meeting the diagnostic criteria under the category of pervasive developmental delay (PDD) in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-TR) has dramatically increased (American Psychiatric Association, 2000; Centers for Disease Control and Prevention, 2008; Yeargin-Allsopp et al., 2003). With the increase in the number of children diagnosed with PDD, it becomes essential for counseling professionals to gain an understanding of the needs of the individuals and their families in dealing with such disorders. Pervasive developmental delay is an umbrella term for a series of disorders presenting with pathology along a spectrum, often referred to as autism spectrum disorders (ASD), which includes autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, Rett’s disorder, and pervasive developmental disorder not otherwise specified. Autism is a complex developmental disability, typically manifesting itself within the first three years of a child’s life. Primary symptoms include impairments relating to affect, social interaction, non-verbal and verbal communication, eye contact, social isolation, as well as difficulties in understanding social reciprocity, repetitive behavioral patterns, restricted interests, and perseveration of thoughts. While children with autistic disorder may wish to engage in interactions with others, the social skills necessary to initiate and sustain social contacts are significantly lacking or absent (Scattone, 2007).

2 Language and cognitive delays are also common characteristics in individuals who receive a diagnosis along the autism spectrum. Children will be diagnosed with autistic disorder when they meet criteria set forth in the DSM-IV-TR (2000): A. A total of six (or more) items from (1), (2), and (3), with at least two from (1) and one each from (2) and (3): (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to developmental level (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2) qualitative impairments in communication as manifested by at least one of the following: (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3) restricted, repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) apparently inflexible adherence to specific, nonfunctional routines or ritual

3 (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole- bod movements) (d) persistent preoccupation with parts of objects B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder. (p. 75)

The American Psychiatric Association has proposed revisions to the DSM-V, due for publication in May 2013, whereby the diagnostic category of autism spectrum disorders would integrate autistic disorder, pervasive developmental delays NOS, childhood disintegrative disorder, and Asperger’s disorder. The proposed modification reflects the acknowledgement that symptoms of the disorders include a range severity, from mild to severe, as opposed to being a single distinct disorder. Thus the proposed change will shift the focus from the mere diagnosis to more accurate assessment of impairment severity. Diagnosing clinicians would need to consider the age of the individual, level of language, developmental stage, and intelligence of the individual in making a diagnosis (American Psychiatric Association, 2010). Kanner (1943) was the first to describe signs of affective and emotional discrepancies among a group of children, identifying “inborn autistic disturbances of affective contact” (p. 250). The children appeared to lack the innate ability necessary for emotional interaction with others, demonstrated the need for sameness, pre-occupation with certain objects, communication deficits, stereotypical movements, and presented with a range of sensory issues (Kanner, 1943; Wing, 1991). In the following year, Asperger identified a similar set of symptoms in a different group of children, who

4 presented with less severe impairments in language, behavior and socialization (Mayes, Calhoun, & Crites, 2001). Asperger determined that the presenting symptoms developed after a period of three to four years of normal childhood development (Wing, 1991). Asperger’s writings went relatively unnoticed until the 1980s, when following Wing’s confirmation of the disorder, Asperger’s Syndrome was proposed as a subgroup of autism (California Department of Developmental Services, 2002; Mayes et al., 2001). In the 20 years following Kanner’s initial writings relating to autism, the disorder became viewed as an anomaly of development attributed to maternal emotional behaviors (Kanner, 1968). Subsequent studies in the field of psychology have sought to further clarify the psychological underpinnings for autism and determine appropriate diagnostic classification for Asperger’s Syndrome (Mayes et al., 2001; Wing, 1991). Several theoretical approaches emerged in an attempt to explain the origins and advancement of the relationship between a mother and child and the potential impact the attachment bond may have on the child’s relationships during the lifespan (Ainsworth, 1969; Cox et al., 2008). Psychoanalytic psychology has focused on exploring the connection between parent/child attachment and the impact on human behavior, development and lifespan relationships (Bowlby, 1958; Cox et al., 2008). Bowlby developed an interest in the emotional and mental health of children and began exploring the relationship between mother and child (Mooney, 2010). Bowlby (1969) studied how environmental factors in early life led to emotional challenges throughout an individual’s life, and how separation from mother or caregiver in early childhood could produce lifelong consequences. Parental attitudes towards a child can be life changing, impacting

5 mental health development of a child (Bowlby, 1969; Mooney, 2010). In his work on attachment theory, Bowlby (1969) recognized differences between Autistic and normally developing children in relation to comfort seeking behaviors. Autistic and detached children failed to seek comfort from mother when tired or in pain. Children with normal development, who establish a secure attachment and warm, loving bond with the mother, will seek out mother for security and comfort (Ainsworth, 1979; Bowlby, 1958, 1969). Ainsworth (1979) continued to build upon the foundations for attachment established by Bowlby, conducting research through observation of mother/child interactions (Ainsworth, 1979). As the result of her research, Ainsworth established attachment categories and terminology to describe attachment patterns between mother and child.

Children that present with impairments in social functioning may demonstrate behaviors that resemble patterns of disorganized attachment between parent and child (Naber et al., 2007). A prominent feature among children with autism is the lack of social skills and inability to engage in reciprocal behaviors with others, including family. Many of the identified behaviors that are characteristic of attachment between mother and child would not be present in a child with autism, leading researchers to explore the relationship between autism and attachment. Rutgers et al. (2007) analyzed ten studies relative to autism and attachment, reporting findings that demonstrating variations in attachment security among children with autism. Secure attachment relationships were present in children with autism, but parent-child relationships demonstrated less sensitivity, flexibility and synchronous interaction, directly related to social impairments

6 present in the child. Furthermore, lower mental ability in children with autism appeared to correlate with less secure attachments. In exploring anxiety, distress and security relating to attachment, Bowlby (1973) indicated that behaviors of Autistic children demonstrated a lack of attachment and numerous indicators for chronic fear. However, attachment is but one component of the parent-child relationship and other parental roles have a complementary function in the relationship (Bowlby, 1969, 1982; Van Ijzendoorn et al., 2007). Heru and Drury (2006) validated the influence of family and family factors in the life of individuals diagnosed with psychiatric disorders. The authors posit that family-based interventions can reduce rates of relapse and improve the well- being for the family and individual. In recent years, medical personnel and other professionals in various specialties have been called upon to become part of family-centered and collaborative treatment teams when treating children with special health care needs (Elder & D’Alessandro, 2009; Dokken & Ahmann, 2006; Heru & Drury, 2006). With the growing numbers of children receiving a diagnosis of autism spectrum disorder, counseling professionals may be called upon to become part of a treatment team to determine effective and appropriate treatment modalities. In this role, counselors may assist children and families in many domains. For parents, who may be experiencing depressive symptoms or other mental health issues, a referral for mental health services may be given by a physician or nurse. Professional relationships between health professionals and mental health providers can be beneficial in ensuring access to care and identify the most appropriate counseling professional for each parent (Nicholson &

7 Clayfield, 2004). As professionals are placed in a parental advisory role, their knowledge of family dynamics can be instrumental in the establishment of appropriate plans of referral (Dokken & Ahmann, 2006; Heru & Drury, 2006). A thorough review of the extant studies in this field determined a substantial paucity of knowledge relating to the lived experiences of mothers parenting a child with autism spectrum disorder, more specifically that relating to the perceptions of the level of attachment and bonding with the child. Determination of potential possible treatment for an individual with autism spectrum disorder should be made through team collaboration with consideration given to the environments in which the individual lives, family values and their treatment preferences. Evidence based treatments should be utilized and the choice of treatment focused on the values and preferences of the family (National Autism Center, 2009). Human services professionals may benefit from understanding the perceptions and lived experiences of mothers as they parent a child with autism, gaining insight into maternal notions of attachment. Additionally, maternal knowledge of the characteristics of autism should be explored to determine if a potential relationship amongst the level of maternal knowledge and the perceived attachment and connection between mother and child. Understanding maternal experiences and perceptions may assist in the determination of necessary family and individual interventions. In light of the lack of knowledge on the phenomenon of parenting children with autism, the present study attempted to bridge the gap in the extant research. Much of the existing research on autism spectrum disorder has placed a focus on analysis of characteristics and pathology of children on the spectrum (Koyama,

8 Tachimori, Osada, & Kurita, 2006; Layne, 2007), social skills development (MacIntosh & Dissanayake, 2006; McCoy & Hermansen, 2007; Owen-DeSchryver, Carr, Cale, & Blakeley-Smith, 2008; Scattone, 2007), educational and school issues (Coffey & Obringer, 2004), comorbid disorders among children with autism spectrum disorder, and treatment issues for individuals with autism (Goldstein & Schwebach, 2004; Hazell, 2007; Kaplan, Dewey, Crawford, & Wilson, 2001). Nevertheless, appropriate determination of treatment and efficacy of interventions continue to be problematic. Dyck, Piek, Hay, and Hallmeyer (2007) explored research results on developmental disabilities in children with autism, identifying deficits in social interactions, motor coordination, performance intelligence, social cognitive abilities, and receptive language. An analysis of differences in social skills deficits between children with high-functioning autistic disorder and Asperger’s disorder demonstrated that both groups exhibited social skills deficits in relation to cooperation, self-control, and assertion across settings (MacIntosh & Dissanayake, 2006). Research relating to educational issues has focused on the potential benefits of social interactions in children with autism placed in regular education settings, with findings yielding mixed outcomes (Owen-DeSchryver et al, 2008). Most of the prior studies on autism are outdated and obsolete, often placing focus on quantitative approaches to inquiry. Within the last decade, a modest amount of research has been conducted to explore parenting issues relating to children with autism, with studies placing a specific focus on measurement of parental stress (Catherall & Iphofen, 2007; Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Gray, 1993; Kasari &

9 Sigman, 1997; Rodrique, Morgan, & Geffken, 1990; Tomanik, Harris, & Hawkins, 2004; Weiss, 2002). Fox, Vaughan, Wyatte, and Dunlap (2002) conducted a qualitative study among 20 families parenting children with developmental disabilities to explore the impact of the disability on the family. Overriding themes suggested that parents experienced difficulty in coming to terms with a disabled child, with family functioning significantly impacting the pervasive nature of problematic behaviors, and significant need for support from caring individuals and professionals. Families reported experiencing stress due to medical concerns and feeling a sense of a detachment from friends who could not relate to the unique problems of parenting a disabled child. Parents also reported initially having no knowledge of the child’s disability, but being thrust into dealing with problems inherent to the disability. Utilizing a qualitative approach to conduct this research provided an opportunity to explore the lived experience of being a mother parenting a child with autism. The relationship between maternal knowledge of the characteristics of autism was investigated to determine if the amount of knowledge may impact mother’s perceived attachment with the child, or impact on the functioning of the family and familial relationships. The prevalence of autism has increased exponentially since Kanner’s first recognition of affective discrepancies among a group of children (Holburn, 2008). While service delivery among persons with autism spectrum disorder has increased, identifying children in need of services can be problematic, as diagnostic criteria may vary from community to community. Most recent estimates of prevalence of the disorder were

10 determined to have risen from previous estimates of approximately 6 or 7 of every 1,000 children to a prevalence of 1 in every 110 children. The data represents an increase of 57% among 8 year-old children in the designated study sites between 2002 and 2006 (CDC, 2009; Holburn, 2008; Rice, 2009). The prevalence of identified autism spectrum disorders increased more in males than females, with a 60% increase among males and 48% respectively. In exploring the increase in the number of children with Asperger’s Syndrome in Australia, Stiefel, Shields, Swain, and Innes (2008) indicate that while the prevalence rate for children receiving an Asperger’s diagnosis has increased, only half of the children with autism spectrum disorders are currently receiving an appropriate diagnosis. Many children receive alternative diagnoses or are not seen for an assessment. Identification and diagnosis of autism spectrum disorder continues to be problematic and it remains unclear whether increased prevalence can be attributed to a definition of autism spectrum disorder that is broader in scope, genuine increase individuals with autism spectrum disorders, or if efforts to diagnose have improved (CDC, 2008, 2009).

Background of the Problem Autism spectrum disorder refers to a broad set of clinical features indicative of delays in development, as defined by the Diagnostic Statistical Manual of Mental Disorders (DSM-IV-TR) diagnostic criteria for Pervasive Developmental Delays (American Psychiatric Association, 2000). While autism spectrum disorders occur among all socioeconomic, racial and ethnic groups, the risk for autism appears to be correlated to gender and is four times more likely to occur in males than in females

11 (Beard-Pfeuffer, 2008). Autism was first identified in 1943 by Kanner, a child psychologist who identified a set of unusual characteristics of affective behavior in a group of children. The children presented with difficulty in relating to self and others, and Kanner emphasized the characteristics had been present since birth. Social deficits presented as significant impairments in non-verbal and verbal communication, difficulty initiating contact with others, and the inability to imitate others (Kanner, 1943, 1968; Pelios & Lund, 2001). Kanner’s patients presented with behaviors indicating a lack of, or disturbances in, attachment (Pelios & Lund, 2001). Mother’s entrance and exit from the room elicited no response, and absence of either parent or both parents appeared to go unnoticed. Relationships to household members appeared no different than the relationship to other people (Kanner, 1943). However, since the children’s solitary behaviors were present from birth, Kanner (1968) would not attribute the children’s solitude to deficiencies in the relationships between parents and the affected child. Since Kanner’s initial discovery and identification of the characteristics for Autistic disorders, etiology and diagnosis for the disorder continued to be problematic (Kanner, 1968). Since the inception of the initial diagnostic criteria for autism, the criteria have been revised to include a spectrum of disorders (CDC, 2009; California Department of Developmental Services, 2002). Due to the broad range of behaviors and pathology children with autism spectrum disorders may exhibit, inexperienced professionals may be unable to recognize the presenting behaviors as characteristic of autism spectrum disorder, delaying early diagnosis. Symptoms may appear in children

12 18 to 24 months of age, but diagnosis is seldom made by this age (Coonrod & Stone, 2004). As research continues into the prevalence, diagnosis and treatment of autism spectrum disorder, many professional organizations, such as Autism Society of America (Herbert, 2008), Autism Speaks (2009), and Autism Research Institute (2010) differ in their perspective relating to the possible causes and treatments for autism spectrum disorder. Such organizations, along with numerous others, often differ in the guidance offered to families in dealing with the multiple challenges posed by autism spectrum disorder. Levy and Hyman (2005) suggested treating professionals provide support to parents that may choose alternative treatments for the child with autism. The professional can assist in developing an understanding of the potential benefits and possible harm of each type of treatment. Prior qualitative research that has explored how families cope with autism indicated the benefits of support from family, friends, advocacy groups, support groups, religion, and service providers. Coping methods tend to change over time with more reliance on emotional focused, as opposed to problem focused coping (Gray, 2006). A thorough review of the related literature indicated that a majority of prior research relating to parenting and autism has focused on quantitative measurement of parental stress, coping, and self-efficacy (Dunn et al., 2001; Gray, 2006; Hoffman, Sweeny, Lopez-Wagner, Nam, & Botts, 2008; Mak, Ho, & Law, 2007; Kuhn & Carter, 2006; Orsmond, Lin, & Seltzer, 2007; Montes & Halteman, 2007; Osborne, McHugh, Saunders, & Reed, 2008; Pottie & Ingram, 2008; Phetrasuwan & Miles, 2008; Schieve,

13 Blumberg, Rice, Visser, & Boyle, 2007). There has been little focus placed on the phenomenon of parenting a child with autism. Existing research has demonstrated that parenting a child with developmental disabilities can be stressful, and parenting a child with autism can increase the level of stress and negative pathology (Schieve et al., 2007; Hoffman et al., 2008). Rates of alcoholism are higher among parents and first degree relatives of children with autism spectrum disorder (Layne, 2007). Stressors particular to parenting a child with autism include communication challenges, problematic behaviors, self-care deficiencies, lack of community understanding, and poor or deficient attachment patterns (Pelios & Lund, 2001; Beard-Pfeuffer, 2008; Schieve et al., 2007). Sensory dysfunction may heavily influence behaviors, as a child with autism is unable to interpret taste, touch, smell, and sound. Parents can be a valuable resource in the development of appropriate strategies to minimize stress for the child. Parental involvement can also improve treatment outcomes (Beard-Pfeuffer, 2008). An extensive literature review exploring autism and attachment revealed a minimal amount of existing research. Research conducted to date relative to attachment has focused on quantitative measurement and data analysis relating to attachment based on assessment and observations. In meta-analysis of prior research on autism and attachment, Rutgers and colleagues (2004) indicated that research utilizing direct observations has suggested children on the autism spectrum are able to form attachment relationships. Patterns of disturbances in attachment were more significant in children with autism, in comparison to normally developing children. Naber and colleagues

14 (2007) conducted a quantitative study on attachment in toddlers with autism and other developmental disorders. The authors noted severity of the disorder enhances the risk of the development of insecure attachment patterns, which could be due, in large part, to the child’s developmental level. There is a scarcity of studies on autism and attachment, particularly those conducted within the United States. What remains unknown is the phenomenon of parenting a child with autism spectrum disorder, particularly as it relates to the thoughts and experiences relative to the level of attachment and bonding between mother and child. It is still unknown how a mother parenting a child with autism may describe the attachment relationship with the child, and whether the attachment relationship is seen as problematic. As the number of children receiving a diagnosis on the autism spectrum is rising, counseling professionals may be called upon to provide support for the increasing population. Layne (2007) indicated minimal numbers of counselors receiving training specific to dealing with the autistic population. In addition, counselors are more likely to provide services for the family unit on behavior management issues, assist with issues relating to marital discord, or work with parents and/or siblings individually, as well as providing services to the child with autism. King and associates (2006) explored the priorities, value systems and worldview of parents of children with autism or Down syndrome in conjunction with levels of adaptation. King et al. (2006) noted that study outcomes may benefit parents in understanding common areas in feelings, thoughts and beliefs among other parents raising a child with autism or Down syndrome. The potential for problems within the family should be considered and anticipated by helping

15 professionals, with authors suggesting the provision of support groups for parents. Through the present study, the phenomenological experiences of mothers parenting a child with autism was be explored in an effort to aid in the understanding of parenting issues specific to the disorder, and to gain better understanding of mother’s perceptions on the attachment bond with the child. The level of information provided to mothers by treating professionals was be explored to determine if maternal knowledge of behaviors characteristic of the disorder may impact perceptions of the parent/child attachment bond. The study findings and outcomes may assist in determining if maternal knowledge may remediate some perceived parenting difficulties and impact the attachment and bond between mother/child. Such information may aid in understanding the unique experiences and patterns of attachment among each family. Bowlby (1977) encouraged therapists to utilize principles of attachment theory to guide choice of technique, assess change and illustrate the therapeutic process throughout treatment. Assessment of attachment patterns in the client can help determine precipitating events contributing to negative symptomology.

Statement of the Problem

As the number of children being diagnosed with autism is increasing, counseling professionals may be called upon to assist children and families in navigating through their lives. Counseling professionals must possess empathy to effectively work with clients (Rogers, 1951), and knowledge of the experiences and lives of others can augment empathic understanding (Gray, 2006; Layne, 2007; Rutgers et al., 2004; Phetrasuman & Miles, 2009). There is presently a scarcity of research relating to the phenomenological

16 experiences of families dealing with autism or exploring issues relating to the attachment bond between mothers and children with autism. Attachment theory established a foundation for exploring attachment, the conditions impacting normal childhood development, and the development of bonds of affection between a child and their mother. The theory set the foundation for future research exploring interpersonal aspects influencing the development of personality (Ainsworth & Bowlby, 1991). Additional research was needed to explore the relationship between mother’s perceptions of attachment and maternal knowledge of the characteristics of the disorder. It was assumed that a level of maternal knowledge may impact mother’s perception of the mother/child relationship. Research outcomes may assist the counseling professional in discerning appropriate service needs and counseling interventions for parents and children living with autism. Josefi and Ryan (2004) noted that within the last decade, research on treatment for children with autism has increased, but has largely focused on behavioral therapy, with other areas of research investigation being overlooked. There exists little knowledge relating to the meaning of the disability of a child within the family context (King et al., 2006). The outcomes of this research study may assist counseling students, educators, and practitioners in understanding the challenges inherent in parenting a child with autism in relation to patterns of attachment and bonding within the family, as well as knowledge of the disorder. Advancing an understanding of the lived experiences among this population may help promote accurate determination of the challenges facing each family, including consideration for the strengths possessed by mothers parenting a child with autism.

17

Purpose of the Study

The purpose of the research study was to explore and understand the experience of parenting a child with autism in an effort to determine the perceptions of mothers in relation to attachment, bonding, and comprehension of negative pathology common to the disorder. In an effort to understand maternal knowledge of the characteristics of the disorder relating to social deficits posing the potential to mimic negative attachment patterns, the level of support and information provided to mothers following the diagnosis was explored. Concepts surrounding the attachment relationship between mother and child were explored by Bowlby, who viewed attachment patterns as influential in the development of a child throughout the lifespan (Bowlby, 1956, 1958). The biological etiology for attachment patterns is viewed as equivalent to instinctual drives and tied to regulation of emotions (Corbin, 2007). Bowlby (1956, 1958) developed theoretical concepts for attachment patterns, exploring the relationship between parents and children relative to normal childhood development. Attachment theory suggests a predictable, quality attachment bond between child and mother, providing a forum for the child to be comforted, a safe base from which the child can explore, and a basis for an affectionate bond (Bowlby, 1956, 1958). The quality of a child’s attachment bond becomes the basis for attachment relationships throughout life and reduces risks for negative pathology (Bowlby, 2007; Corbin, 2007; Zeanah & Smyke, 2008). Children remain mentally healthy when an intimate relationship with a mother or mother figure is established and maintained. The

Full document contains 181 pages
Abstract: As the prevalence of autism spectrum disorders (ASD) increases, additional research is necessary to explore the unique experiences of parenting a child with autism, attempting to understand the unique needs of families and children living with the disorder. To gain an understanding of the mother/child relationship, the present study investigated the perceived mother/child bond and level of attachment. Maternal knowledge of the characteristics common in children with autism spectrum disorder were explored to determine how maternal knowledge may influence the perceived mother/child relationship. Narratives of mother's perceptions of attachment were compared to the theoretical foundations of Bowlby's attachment theory. Overriding themes indicated that mother's perceptions of attachment supported prior research that suggested that children with autism can develop secure attachment relationships to a parent or caregiver. The outcomes of this research may assist mental health professionals develop an understanding of the unique needs of families as they face the challenges inherent in autism spectrum disorders. Research data revealed the need for services, not only for the child with autism, but for each individual in the family unit as well as the family as a whole.