Health of mothers of children with intellectual disability or autism spectrum disorder: a review of the literature

Main Article Content

Jenny Fairthorne http://orcid.org/0000-0002-9884-0117 Nick de Klerk Helen Leonard

Abstract

Background

The deficits associated with intellectual disability (ID) and autism spectrum disorder (ASD) place a burden on their co-residing families which may impact maternal health.

Objectives

We aimed to compare the health of mothers of children with ID or ASD to that of other mothers and to each other, according to the disability sub-group of their child.

Methods

Due to the broad scope of articles in our chosen area, we searched data-bases multiple times, each time using a different combination of search terms related to ID and ASD, carers and health. Papers were retained which met six criteria and were then sorted into two groups. Firstly, we grouped all papers which compared the health of mothers of children with ID or ASD to other mothers. Secondly, we grouped papers which compared maternal health by the sub-group of the child’s disability.

Results

We retained 60 papers. Researchers consistently identified poorer health in the mothers of children with ID or ASD. Further, the research suggested that mothers of children with Down syndrome had the least impaired health and mothers of children with ASD, and particularly ASD without ID, the most impaired health.

Conclusion and implications

Providing more support, such as home services, for mothers of children with ID or ASD and health issues, might make the way for the improved health of these mothers. Importantly, mothers of children with ASD without ID were identified as a group needing special assistance. Further research into the correlates of poorer health in mothers of children with ID or ASD is implicated so that more informed supports and interventions can be developed to assist these mothers.

 

Article Details

How to Cite
FAIRTHORNE, Jenny; DE KLERK, Nick; LEONARD, Helen. Health of mothers of children with intellectual disability or autism spectrum disorder: a review of the literature. Medical Research Archives, [S.l.], n. 3, june 2015. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/204>. Date accessed: 08 dec. 2024.
Keywords
Health, mothers, disability, autism, Down, Asperger, parents, psychiatric
Section
Review Articles

References

Adams, H, J Matson, and J Jang. 2014. "The relationship between sleep problems and challenging behavior among children and adolescents with autism spectrum disorder." Research in Autism Spectrum Disorders 8 (9):1024-1030, DOI: 10.1016/j.rasd.2014.05.008

Allik, H, J-O Larsson, and H Smedje. 2006. "Health-related quality of life in parents of school-age children with Asperger syndrome or high-functioning autism." Health and Quality of Life Ourcomes 4 (1), DOI: 10.1186/1477-7525-4-1

Baghdadli, A, R Pry, C Michelon, and C Rattaz. 2014. "Impact of autism in adolescents on parental quality of life."Quality of Life Research:1-10, DOI: 10.1007/s11136-014-0635-6

Baker-Ericzén, M, L Brookman-Frazee, and A Stahmer. 2005. "Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders." Research and Practice for Persons with Severe Disabilities 30 (4):194-204, URL: http://www.rchsd.org/documents/2014/02/stress-levels-adaptability-in-parents-of-toddlers.pdf

Baron-Cohen, S, S Wheelwright, R Skinner, J Martin, and E Clubley. 2001. "The Autism Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians."Journal of Autism and Developmental Disorders 31 (1):5-17, DOI: 10.1023/a:1005653411471

Blacher, J, S Lopez, J Shapiro, and J Fusco. 1997. "Contributions to depression in Latina mothers with and without children with retardation: implications for caregiving." Family Relations 46 (4):325-34, DOI: 10.2307/585093

Bolton, P, A Pickles, M Murphy, and M Rutter. 1998. "Autism, affective and other psychiatric disorders: patterns of familial aggregation." Psychological Medicine 28 (2):385-95, DOI: 10.1017/S0033291797006004

Bourke, J, B Ricciardo, A Bebbington, K Aiberti, P Jacoby, P Dyke, M Msall, C Bower, and H Leonard. 2008. "Physical and mental health in mothers of children with Down syndrome." Journal of Pediatrics 153 (3):320-6, DOI:10.1016/j.jpeds.2008.02.047

Bromley, J, D Hare, K Davison, and E Emerson. 2004. "Mothers supporting children with autistic spectrum disorders: social support, mental health status and satisfaction with services."Autism 8 (4):409-23, DOI: 10.1177/1362361304047224

Browne, G, and P Bramston. 1998. "Stress and the quality of life in the parents of young people with intellectual disabilities."Journal of Psychiatric and Mental Health Nursing 5 (5):415-421, DOI: 10.1046/j.1365-2850.1998.00154.x

Caldwell, J. 2008. "Health and access to health care of female family caregivers of adults with developmental disabilities."Journal of Disability Policy Studies 19 (2):68-79, DOI: 10.1177/1044207308316093

Cantwell, J, O Muldoon, and S Gallagher. 2014. "Social support and mastery influence the association between stress and poor physical health in parents caring for children with developmental disabilities."Research in Developmental Disabilities 35 (9):2215-2223, DOI: 10.1016/j.ridd.2014.05.012

Chen, S, Ryan H, T Heller, and E Chen. 2001. "Health status of mothers of adults with intellectual disability." Journal of Intellectual Disability Research 45 (5):439-49, DOI: 10.1046/j.1365-2788.2001.00352.x

Corrice, A , and L Glidden. 2009. "The Down syndrome advantage: fact or fiction?" American Journal on Intellectual and Developmental Disabilities 114 (4):254-68. DOI: 10.1352/1944-7558-114.4.254-268

Cotton, S, and A Richdale. 2006. "Brief report: parental descriptions of sleep problems in children with autism, Down syndrome, and Prader-Willi syndrome." Research in Developmental Disabilities 27 (2):151-61, DOI:10.1352/1944-7558-114.4.254-268

Daniels, J, U Forssen, C Hultman, S Cnattingius, D Savitz, M Feychting, and P Sparen. 2008. "Parental psychiatric disorders associated with autism spectrum disorders in the offspring." Pediatrics 121 (5):1357-62, DOI: 10.1542/peds.2007-2296

Dardas, L, and M Ahmad. 2014. "Psychosocial correlates of parenting a child with autistic disorder." Journal of Nursing Research 22 (3), DOI: 10.1097/jnr.0000000000000023

DeGrace, B, C Hoffman, T Hutson, and T Kolobe. 2014. "Families' experiences and occupations following the diagnosis of autism." Journal of Occupational Science 21 (3):309-321, DOI: 10.1080/14427591.2014.923366

Dumas, J, L Wolf, S Fisman, and A Culligan. 1991. "Parenting stress, child behavior problems, and dysphoria in parents of children with autism, Down syndrome, behavior disorders, and normal development." Exceptionality 2 (2):97-110. DOI:
10.1080/09362839109524770

Eisenhower, A, B Baker, and J Blacher. 2005. "Preschool children with intellectual disability: syndrome specificity, behaviour problems and maternal well-being." Journal of Intellectual Disability Research 49 (9):657-71, DOI: 10.1111/j.1365-2788.2005.00699.x

Eisenhower, A, B Baker, and J Blacher. 2009. "Children's delayed development and behavior problems: impact on mothers' perceived physical health across early childhood." Social Science and Medicine 68 (1):89-99, DOI:10.1016/j.socscimed.2008.09.033

Eisenhower, A, J Blacher, and B Baker. 2013. "Mothers’ perceived physical health during early and middle childhood: relations with child developmental delay and behavior problems." Research in Developmental Disabilities 34 (3):1059-68, DOI:10.1016/j.ridd.2012.12.002

Emerson, E. 2003. "Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child's difficulties." Journal of Intellectual Disability Research 47 (4-5):385-99, DOI: 10.1046/j.1365-2788.2003.00498.x

Emerson, E, A McCulloch, H Graham, J Blacher, G Llwellyn, and C Hatton. 2010. "Socioeconomic circumstances and risk of psychiatric disorders among parents of children with early cognitive delay."American Journal on Intellectual and Developmental Disabilities 115 (1):30-42, DOI:
10.1352/1944-7558-115.1.30

Estes, A, J Munson, G Dawson, E Koehler, XH Zhou, and R Abbott. 2009. "Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay." Autism 13 (4):375-87, DOI: 10.1177/1362361309105658.
Firth, I, and R Dryer. 2013. "The predictors of distress in parents of children with autism spectrum disorder." Journal of Intellectual and Developmental Disability 38 (2):163-171, DOI: 10.3109/13668250.2013.773964.
Fairthorne, J, G Hammond, J Bourke, P Jacoby and H Leonard. (2014). "Early mortality and primary causes of death in mothers of children with intellectual disability or autism spectrum disorder: a retrospective cohort study." PloS one, 9 (12). DOI: 10.1371/journal.pone.0113430

Fairthorne, J, P Jacoby, J Bourke, N de Klerk and Leonard, H. (2015). "Onset of maternal psychiatric disorders after the birth of a child with autism spectrum disorder: A retrospective cohort study." Autism, DOI: 10.1177/1362361314566048

Fairthorne, J, P Jacoby, J Bourke, N de Klerk and Leonard, H. (2015). "Onset of maternal psychiatric disorders after the birth of a child with intellectual disability: a retrospective cohort study." Journal of Psychiatry Research, 61 223–230. DOI: 10.1016/j.jpsychires.2014.11.011

Gallagher, S, A Phillips, M Drayson, and D Carroll. 2009. "Caregiving for children with developmental disabilities is associated with a poor antibody response to influenza vaccination." Psychosomatic Medicine 71 (3):341-4, DOI: 10.1097/PSY.0b013e31819d1910

Gallagher, S, and J Whiteley. 2013. "The association between stress and physical health problems in parents caring for children with intellectual disabilities is moderated by children's challenging behaviours."Journal of Health Psychology 18 (9):1220-1231, DOI: 10.1177/1359105312464672

Griffith, G, R Hastings, S Nash, and C Hill. 2010. "Using matched groups to explore child behavior problems and maternal well-being in children with Down syndrome and autism." Journal of Autism and Developmental Disorders 40 (5):610-9, DOI: 10.1007/s10803-009-0906-1

Gupta, V. 2007. "Comparison of parenting stress in different developmental disabilities." Journal of Developmental and Physical Disabilities 19 (4):417-25, DOI: 10.1007/s10882-007-9060-x

Hamlyn-Wright, S, R Draghi-Lorenz, and J Ellis. 2007. "Locus of control fails to mediate between stress and anxiety and depression in parents of children with a developmental disorder." Autism 11 (6):489-501, DOI: 10.1177/1362361307083258

Harvey, J, M O'Callaghan, and B Vines. 1997. "Prevalence of maternal depression and its relationship to ADL skills in children with developmental delay." Journal of Paediatrics and Child Health 33 (1):42-6, DOI: 10.1111/j.1440-1754.1997.tb00989.x

Hedov, G, G Anneren, and K Wikblad. 2000. "Self-perceived health in Swedish parents of children with Down's syndrome." Quality of Life Research 9 (4):415-22, DOI: 10.1023/A:1008910527481

Herring, S, K Gray, J Taffe, B Tonge, D Sweeney, and S Einfeld. 2006. "Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: associations with parental mental health and family functioning." Journal of Intellectual Disability Research 50 (12):874-82, DOI: 10.1111/j.1365-2788.2006.00904.x

Hodapp, R, T Ly, D Fidler, and L Ricci. 2001. "Less stress, more rewarding: parenting children with Down syndrome" Parenting 1 (4):317-37, DOI:
10.1207/S15327922PAR0104_3

Hoppes, K, and S Harris. 1990. "Perceptions of child attachment and maternal gratification in mothers of children with autism and Down syndrome." Journal of Clinical Child and Adolescent Psychology 19 (4):365-70, DOI:
10.1207/s15374424jccp1904_8
Ingersoll, B, and D Hambrick. 2011. "The relationship between the Broader Autism Phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders." Research in Autism Spectrum Disorders 5 (1):337-44, DOI:10.1016/j.rasd.2010.04.017

Ingersoll, B, K Meyer, and M Becker. 2011. "Increased rates of depressed mood in mothers of children with ASD associated with the presence of the Broader Autism Phenotype." Autism Research 4 (2):143-8, DOI: 10.1002/aur.170

Jeans, L, R Santos, D Laxman, B McBride, and W Dyer. 2013. "Examining ECLS-B: maternal stress and depressive symptoms when raising children with ASD." Topics in Early Childhood Special Education 33 (3):162-171, DOI: 10.1177/0271121413481680

Ji, B, I Zhao, C Turner, M Sun, R Yi, and S Tang. 2014. "Predictors of health-related quality of life in Chinese caregivers of children with autism spectrum disorders: a cross-sectional study." Archives of Psychiatric Nursing, DOI: 10.1016/j.apnu.2014.06.001

Jokiranta, E, A Brown, M Heinimaa, K Cheslack-Postava, A Suominen, and A Sourander. 2013. "Parental psychiatric disorders and autism spectrum disorders." Psychiatry Research 207 (3):203-211, DOI:10.1016/j.psychres.2013.01.005

Kanner, L. 1943. "Autistic disturbances of affective contact." Nervous child 2 (3):217-250, URL: http://neurodiversity.com/library_kanner_1943.pdf

Kelso, T, D French, and M Fernandez. 2005. "Stress and coping in primary caregivers of children with a disability: a qualitative study using the Lazarus and Folkman Process Model of Coping." Journal of Research in Special Educational Needs 5 (1):3-10. doi: 10.1111/j.1471-3802.2005.00033.x

Khanna, R, S Madhavan, M Smith, J Patrick, C Tworek, and B Becker-Cottrill. 2011. "Assessment of health-related quality of life among primary caregivers of children with autism spectrum disorders." Journal of Autism and Developmental Disorders 41 (9):1214-27, DOI: 10.1007/s10803-010-1140-6

Kunihira, Y, A Senju, H Dairoku, A Wakabayashi, and T Hasegawa. 2006. "‘Autistic’ traits in non-autistic Japanese populations: relationships with personality traits and cognitive ability." Journal of Autism and Developmental Disorders 36 (4):553-566, DOI: 10.1007/s10803-006-0094-1

Lach, L, D Kohen, R Garner, J Brehaut, A Miller, A Klassen, and P Rosenbaum. 2009. "The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders." Disability and Rehabilitation 31 (9):741-52, DOI:10.1080/09638280802242163

Larsson, H, W Eaton, K Madsen, M Vestergaard, A Olesen, E Agerbo, D Schendel, P Thorsen, and P Mortensen. 2005. "Risk factors for autism: perinatal factors, parental psychiatric history, and socioeconomic status." American Journal of Epidemiology 161 (10):916-25, DOI: 10.1093/aje/kwi123

Lee, C, C. Lopata, M Volker, M Thomeer, R Nida, J Toomey, S Chow, and A Smerbeck. 2009. "Health-related quality of life of parents of children with high-functioning autism spectrum disorders." Focus on Autism and Other Developmental Disabilities 24 (4):227-239, DOI: 10.1177/1088357609347371

Lenhard, W, E Breitenbach, H Ebert, H Schindelhauer-Deutscher, and W Henn. 2005. "Psychological benefit of diagnostic certainty for mothers of children with disabilities: lessons from Down syndrome." American Journal of Medical Genetics 133A:170-5, DOI: 10.1002/ajmg.a.30571

Leonard, H, E Glasson, N Nassar, A Whitehouse, A Bebbington, J Bourke, P Jacoby, G Dixon, E Malacova, C Bower, and F Stanley. 2011. "Autism and intellectual disability are differentially related to sociodemographic background at birth." PLoS ONE 6 (3):e17875, DOI: 10.1371/journal.pone.0017875

Llewellyn, G, D McConnell, L Gething, R Cant, and H Kendig. 2010. "Health status and coping strategies among older parent-carers of adults with intellectual disabilities in an Australian sample." Research in Developmental Disabilities 31 (6):1176-86, DOI: 10.1016/j.ridd.2010.08.003

Losh, M , R Adolphs, M Poe, S Couture, D Penn, G Baranek, and J Piven. 2009. "Neuropsychological profile of autism and the Broad Autism Phenotype." Archives of General Psychiatry 66 (5):518-26, DOI: 10.1001/archgenpsychiatry.2009.34

Lovell, B, M. Moss, and M Wetherall. 2012. "The psychosocial, endocrine and immune consequences of caring for a child with autism or ADHD." Psychoneuroendocrinology 37 (4):534-42, DOI: 10.1016/j.psyneuen.2011.08.003

Magaña, S, and M Smith. 2006. "Health outcomes of midlife and older Latina and Black American mothers of children with developmental disabilities." Mental Retardation 44 (3):224-34, DOI: 10.1352/0047-6765(2006)44[224:HOOMAO]2.0.CO;2

McStay, R, D Trembath, and C Dissanayake. 2014. "Stress and family quality of life in parents of children with autism spectrum disorder: parent gender and the double ABCX model." Journal of Autism and Developmental Disorders:1-18, DOI: 10.1007/s10803-014-2178-7

Montes, G, and J Halterman. 2007. "Psychological functioning and coping among mothers of children with autism: a population-based study." Pediatrics 119 (5):1040-6, DOI: 10.1542/peds.2006-2819

Morgan, V, M. Croft, G Valuri, S Zubrick, C Bower, T McNeil, and A Jablensky. 2012. "Intellectual disability and other neuropsychiatric outcomes in high-risk children of mothers with schizophrenia, bipolar disorder and unipolar major depression." British Journal of Psychiatry 205 (4):282-289, DOI: 10.1192/bjp.bp.111.093070

Mouridsen, S, B Rich, T Isager, and N Nedergaard. 2007. "Psychiatric disorders in the parents of individuals with infantile autism: a case-control study." Psychopathology 40 (3):166-71, DOI: 10.1159/000100006
Mugno, D, L Ruta, VG D'Arrigo, and L Mazzone. 2007. "Impairment of quality of life in parents of children and adolescents with pervasive developmental disorder." Health and Quality of Life Outcomes 5 (22):15-23, DOI:10.1186/1477-7525-5-22

Mugno, D, L Ruta, V D’Arrigo, and L Mazzone. 2007. "Impairment of quality of life in parents of children and adolescents with pervasive developmental disorder." Health and Quality of Life Outcomes 5:22, DOI: 10.1186/1477-7525-5-2

Neely, J , E Amatea, S Echevarria-Doan, and T Tannen. 2012. "Working with families living with autism: potential contributions of marriage and family therapists." Journal of Marital and Family Therapy 38 ( 1):211-226, DOI: 10.1111/j.1752-0606.2011.00265.x

Norlin, D, and M Broberg. 2013. "Parents of children with and without intellectual disability: couple relationship and individual well-being." Journal of Intellectual Disability Research 57 (6):552-566, DOI: 10.1111/j.1365-2788.2012.01564.x

Olsson, M, and C Hwang. 2001. "Depression in mothers and fathers of children with intellectual disability." Journal of Intellectual Disability Research 45 (6):535-43, DOI: 10.1046/j.1365-2788.2001.00372.x

Olsson, M, and C Hwang. 2008. "Socioeconomic and psychological variables as risk and protective factors for parental well-being in families of children with intellectual disabilities." Journal of Intellectual Disability Research 52 (12):1102-13, DOI: 10.1111/j.1365-2788.2008.01081.x

Patterson, J, and R Blum. 1996. "Risk and resilience among children and youth with disabilities." Archives of Pediatrics and Adolescent Medicine 150 (7):692-8, DOI: 10.1001/archpedi.1996.02170320038006

Paynter, J, E Riley, W Beamish, M Davies, and T Milford. 2013. "The double ABCX model of family adaptation in families of a child with an autism spectrum disorder attending an Australian early intervention service." Research in Autism Spectrum Disorders 7 (10):1183-1195, DOI: 10.1016/j.rasd.2013.07.006

Piven, J, G Chase, R Landa, M Wzorek, J Gayle, D Cloud, and S Folstein. 1991. "Psychiatric disorders in the parents of autistic individuals." Journal of the American Academy of Child and Adolescent Psychiatry 30 (3):471-8, DOI: 10.1097/00004583-199105000-00019

Practicing Chiropractors' Committee on Radiology Protocols. 2006. "Descriptions of levels of evidence grades and recommendations." URL: http://www.pccrp.org/docs/PCCRP%20Section%20I.pdf

Rizk, S, K Pizur-Barnekow, and A Darragh. 2011. "Leisure and social participation and health-related quality of life in caregivers of children with autism." Occupation, Participation and Health 31 (4):164-71, DOI: 10.3928/15394492-20110415-01

Sanders, J, and S Morgan. 1997. "Family stress and adjustment as perceived by parents of children with autism or Down syndrome: implications for intervention." Child and Family Behavior Therapy 19 (4):15-32, DOI: 10.1300/J019v19n04_02

Schieve, L, S Boulet, M Kogan, M Yeargin-Allsopp, C Boyle, S Visser, S Blumberg, and C Rice. 2011. "Parenting aggravation and autism spectrum disorders: 2007 National Survey of Children’s Health." Disability and Health Journal 4 (3):143-152, DOI: 10.1016/J.DHJO.2010.09.002

Scott, B, L Atkinson, H Minton, and T Bowman. 1997. "Psychological distress of parents of infants with Down syndrome." American Journal on Mental Retardation 102 (2):161-71, DOI:10.1352/08958017%281997%29102%3C0161%3APDOPOI%3E2.0.CO%3B2

Seltzer, M, F Floyd, J Song, J Greenberg, and J Hong. 2011. "Midlife and aging parents of adults with intellectual and developmental disabilities: impacts of lifelong parenting." American Journal on Intellectual and Developmental Disabilities 116 (6):479-99, DOI: http://dx.doi.org/10.1352/1944-7558-116.6.479

Singhi, P, L Goyal, D Pershad, S Singhi, and B Walia. 1990. "Psychosocial problems in families of disabled children." British Journal of Medical Psychology 63 (2):173-82, DOI: 10.1111/j.2044-8341.1990.tb01610.x

Smith, L, M Seltzer, and J Greenberg. 2012. "Daily health symptoms of mothers of adolescents and adults with Fragile X syndrome and mothers of adolescents and adults with autism spectrum disorder." Journal of Autism and Developmental Disorders 42 (9):1836-1846, DOI: 10.1007%2Fs10803-011-1422-7

Stoneman, Z. 2007. "Examining the Down syndrome advantage: mothers and fathers of young children with disabilities." Journal of Intellectual Disability Research 51 (12):1006-17, DOI: 10.1111/j.1365-2788.2007.01012.x

Stores, R, G Stores, B Fellows, and S Buckley. 1998. "Daytime behaviour problems and maternal stress in children with Down's syndrome, their siblings, and non-intellectually disabled and other intellectually disabled peers." Journal of Intellectual Disability Research 42 (3):228-37, DOI: 10.1046/j.1365-2788.1998.00123.x

Sullivan, P, C Magnusson, A Reichenberg, M Boman, C Dalman, M Davidson, E Fruchter, C Hultman, M Lundberg, and N Långström. 2012. "Family history of schizophrenia and bipolar disorder as risk factors for autism." Archives of General Psychiatry 2:1-5, DOI: 10.1001/archgenpsychiatry.2012.730

Thompson, B, K Diamond, R McWilliam, P Snyder, and S Snyder. 2005. "Evaluating the quality of evidence from correlational research for evidence-based practice." Exceptional Children 71 (2):181-194, DOI: 10.1177/001440290507100204

Totsika, V, R Hastings, E Emerson, D Berridge, and G Lancaster. 2011. "Behavior problems at 5 years of age and maternal mental health in autism and intellectual disability." Journal of Abnormal Child Psychology 39 (8):1137-47, DOI: 10.1007/s10802-011-9534-2

Totsika, V, R Hastings, E Emerson, G Lancaster, and D Berridge. 2011. "A population-based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability." Journal of Child Psychology and Psychiatry 52 (1):91-9, DOI: 10.1111/j.1469-7610.2010.02295.x

Veisson, M. 1999. "Depression symptoms and emotional states in parents of disabled and non-disabled children." Social Behavior and Personality 27 (1):87-98, DOI: 10.2224/sbp.1999.27.1.87
Watson, S, S Hayes, and E Radford-Paz. 2011. "'Diagnose me please!': a review of research about the journey and initial impact of parents seeking a diagnosis of developmental disability for their child." In International Review of Research in Developmental Disabilities, edited by R Hodapp, 31-62. Academic Press, URL: https://books.google.com.au/books?hl=en&lr=&id=E3cL1-MJyDoC&oi=fnd&pg=PA31&ots=vGXppU6D7P&sig=szhMUOH8hSgaaxkDYhPNsPGnotM#v=onepage&q&f=false

Watt, M, and S Wagner. 2012. "Parenting a child with autism spectrum disorder: parental work context." Community, Work and Family 16 (1):1-19, DOI: 10.1080/13668803.2012.692890

Werner, S., and C. Shulman. 2014. "Does type of disability make a difference in affiliate stigma among family caregivers of individuals with autism, intellectual disability or physical disability?" Journal of Intellectual Disability Research, DOI: 10.1111/jir.12136

Woodgate, R, C Ateah, and L Secco. 2008. "Living in a world of our own: the experience of parents who have a child with autism." Qualitative Health Research 18 (8):1075-83, DOI: 10.1177/1049732308320112

Yamaki, K, K Hsieh, and T Heller. 2009. "Health profile of aging family caregivers supporting adults with intellectual and developmental disabilities at home." Journal of Intellectual and Developmental Disabilities 47 (6):273-84, DOI: 10.1352/1934-9556-47.6.425

Zablotsky, B, C Bradshaw, and E Stuart. 2013. "The association between mental health, stress, and coping supports in mothers of children with autism spectrum disorders." Journal of Autism and Developmental Disorders 43 (6):1380-93, DOI: 10.1007/s10803-012-1693-7