Effects of Written Emotional Disclosure on the Stress of Mothers of Children with Autism

Autism spectrum disorder is a complex neurodevelopmental disorder whose clinical manifestations include impaired social communication, behaviors, interests, and limited and repetitive activities. Poor eye communication, lack of emotion or social interaction, impaired use of non-verbal behaviors, and lack of age-appropriate communication are the main manifestations of this disorder. This disorder is one of the main causes of disability in children under 5 years old. The exact cause of this disorder has not yet been determined, and it can often be diagnosed by comparing autistic childrenchr('39')s speech and performance with those of their peers. In comparison to parents of typically functioning children or parents of children with other developmental disabilities (i.e. Down’s syndrome or cerebral palsy), parents or caregivers of children with an autism spectrum disorder experience more parenting stress which makes its management imperative. Parenting stress in this group of women results in depression, anxiety, divorce, reduced family cohesion and physical health, more incidence of behavioral problems in the children, and problems related to parenting. Thus, it is imperative to identify effective methods that target improvement in caregiverschr('39') mental health. The problems that mothers face in raising their children from an early age put a lot of pressure on parenting skills, and if the parentschr('39') understanding of the demands of their role is greater than the resources and methods available for coping with them, so that they will be unable to restore balance in the usual ways, it will lead to stress in parents. In the case of parents of children with autism, maternal stress is reported more than the paternal stress, and more than mothers of children with other developmental disorders and mothers of normal children. Therefore, given that the caregivers of (75%) of children with autism are their mothers, it is not unbelievable that mothers of this group of children struggle with a lot of stress. Mothers of children with autism are their primary caregivers, leading to depression, anxiety, quitting job, and suicide. Thus, effective interventions to improve the mental health of caregivers of children with autism seem necessary and the need to improve their mental health is felt. However, the results of studies that have been done so far indicate that this emotional revelation intervention through writing has been inconsistent or even ineffective on the mental health of mothers of children with autism. This study aimed to evaluate the efficacy of written emotional disclosure in parenting stress of mothers with autistic children.

In this study, conducted in 2019, a quasi-experimental design including pre-test, post-test, and control group was used. First, a sample size of 70 mothers with autistic children were selected and tested from the autistic schools in Tehran. In pre-test, the Parenting Stress Index-short form (PSI-SF) was administered individually to experimental group (n = 35) and control group (n=35). Then, written emotional disclosure, at least 15 minutes, twice a week over an 8-week period was conducted in experimental group whereas the control group received no intervention. Three mothers in the experimental group withdrew from the study due to personal reasons. Therefore, the study continued with 67 mothers. After the intervention, the parenting stress was measured again in both groups. In the intervention group, the mothers first wrote about their deepest feelings and negative experiences of caring for an autistic child. Topics for mothers to write about included their feelings when they found out their children were diagnosed with autism; writing down the most difficult situations they had experienced in communicating with their autistic children; the most important issues that had made them upset in their daily lives about their children; and what do they do when their children do not cooperate with them?
Ethical considerations of the research, including informed consent to participate in the research and obtaining consent from the participants, observing the principle of confidentiality and avoiding bias in announcing the results of the study, have been observed. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (independent t-test and paired t-test) in SPSS 16.

The results of independent t-test showed that there was no statistically significant difference between parenting stress of mothers (P = 0.881) and its subscales (P <0.05) before the intervention, but after the intervention this difference was significant (P <0.001), so that in the experimental group, the scores of parenting distress were significantly lower than the control group but the scores of parenting stress of mothers and other subscales were significantly higher. The results of paired t-test showed that parenting stress of mothers and its subscales in the control group were not significantly different before the treatment and after the treatment (P <0.05), but the scores of parenting distress after the intervention decreased significantly in the experimental group and parenting stress scores and its other subscales increased significantly (P <0.001). The results of independent t-test showed that the reduction of parenting stress scores of mothers and its subscales was less in the intervention group than the control group (P <0.001).
In addition, the independent and paired t-test analysis showed that written emotional disclosure was effective in reducing parenting distress sub-scale in experimental group (29.06 + 6.01) (p< 0/001). Also٫ the intervention could not improve the scores of parenting stress among experimental group (128.78 + 12.29) (p< 0.001).  

Written emotional disclosure, as a useful therapeutic intervention could be effective in improving parenting distress sub-scale٫ but ineffective in improving parenting stress. The findings of this study could also reinforce the hypothesis that expressing positive emotions about chronic stress may lead to more adaptive functions. This study suffers from some limitations. It was conducted on limited number of mothers with autism children, the same gender, and therefore, its generalizability is reduced. The results of this study show that the intervention of written emotional disclosure has been effective in increasing parenting stress of mothers with autistic children. Therefore, it is recommended to perform this method under the supervision of a consultant to control its negative effects. It is also suggested that future research, in addition to examining the variables affecting the effectiveness of this intervention, standardize the intervention pattern in writing positive, negative, and neutral emotions and use more follow-up sessions to enable more comparison.