Psychological Distress in Jordanian Parents of ...

Perspectives in Psychiatric Care

ISSN 0031-5990

Psychological Distress in Jordanian Parents of Children With Autism Spectrum Disorder: The Role of Trait Mindfulness Ahmad Rayan, PhD and Muayyad Ahmad, PhD Ahmad Rayan, PhD, is Assistant Professor, Faculty of Nursing, Psychiatric and Mental Health Nursing, Zarqa University, Zarqa, Jordan; and Muayyad Ahmad, PhD, is Professor, Faculty of Nursing, Clinical Nursing Department, University of Jordan, Amman, Jordan.

Search terms: Anxiety, autism, child, depression, mindfulness, parent, stress Author contact: [email protected], with a copy to the Editor: [email protected] Conflict of Interest Statement The authors declare that they have no conflict of interest. No changes in the author affiliation subsequent to the time of the study. The authors acknowledge the partial funding from the University of Jordan.

AIM: This study examines the role of mindfulness in predicting psychological distress in Arab parents of children with autism spectrum disorder (ASD). METHOD: In this descriptive study, parents of 104 children with ASD completed measures of psychological distress and mindfulness. The severity of autism in children was measured using the DSM-V criteria. RESULTS: After controlling for parental age and gender and the severity level of ASD, mindfulness was significantly associated with the levels of anxiety, stress, and depression in parents (anxiety: β = 0.49, p < .001; stress: β = 0.55, p < .001; depression: β = 0.53, p < .001). CONCLUSION: Mindfulness-based intervention may help to reduce psychological distress in Arab parents of children with ASD.

First Received May 2, 2016; Final Revision received August 13, 2016; Accepted for publication August 21, 2016. doi: 10.1111/ppc.12187

Compliance With Ethical Standards Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent: “Informed consent was obtained from all individual participants included in the study.” In many low- and middle-income countries, the autismrelated resources for parents who have a child with autism spectrum disorder (ASD) are scarce (Brezis, 2015). As with most other disabilities, ASD often requires life-long care. Unfortunately, countries with limited resources had a dearth of studies to inform the development of supportive interventions for parents. Research found that parents of children with ASD report higher levels of stress, anxiety, and depression compared with both parents of typically developing children and parents of children with other disabilities (Almansour, Alzahrani, & Algeffari, 2013; Bitsika, Sharpley, & Bell, 2013; Falk, Norris, & Quinn, 2014; Firth & Dryer, 2013; Hayes & Watson, 2013; Merkaj, Kika, & Simaku, 2013).

Symptoms of autism include deficits in social interaction (DSIs) and restricted interests and repetitive behaviors (RIRBs). DSIs are manifested by difficulties in the use of appropriate verbal and nonverbal communication in social interaction, in addition to impairments in social reciprocity and attention. The RIRBs are manifested by strong adherence to routines, restricted interests, stereotyped and repetitive movement or speech, and hypo- or hypersensitivity to sensory stimulations (American Psychiatric Association [APA], 2013a). Difficulties in dealing with children with ASD are likely to cause psychological exhaustion in parents. There is little public interest in ASD in the Arab world. Although the reported prevalence of ASD has increased markedly throughout the world in recent decades (Hansen, Schendel, & Parner, 2015), limited statistics are available regarding the prevalence of ASD in the Arab world, including Jordan (Taha & Hussein, 2014). In contrast, in the United States, there is great public interest in ASD, which has become the fastest growing disability, with prevalence rates of one in 88 children (Centers for Disease Control and Prevention, 2012). In Jordan, which is considered a middle-income Arab country, services for individuals with disability started in the late 1970s (Hadidi, 1998). These services focused basically

1 Perspectives in Psychiatric Care 00 (2016) 1–8 C 2016 Wiley Periodicals, Inc.

Psychological Distress in Jordanian Parents of Children With Autism Spectrum Disorder: The Role of Trait Mindfulness

an initial support for MBIs to help parents of children with ASD, and as there is little evidence on this topic worldwide. It could be worthwhile for future researchers to develop a mindfulness-based intervention specific to Arab parents of children with ASD and test its effectiveness on their psychological well-being. Key to this work will be how to adapt an effective MBI, which is consistent with the needs of Arab parents of children with ASD. This study has a number of limitations that require attention when interpreting the results. The sample size used in the current study is small in relation to the number of predictors in the multiple regression analysis. Therefore, a larger sample size is needed for future research to confirm the results obtained in the current study. One of the challenges in conducting the current study was the recruitment of a relatively large sample. Most parents of children with ASD already have high levels of stress and may not be able to participate in research. Parents of children with ASD are usually busy with child care; this makes them refrain from participating in research or other activities outside the home (Sawyer et al., 2010). Another potential limitation of this study was the reliance on parental reports, and using a convenience sample. Finally, using multifactor scales, such as Baer’s Five Factor Mindfulness Questionnaire instead of the MAAS, could be more informative. The researchers acknowledge that the MAAS indirectly measures mindful awareness by assessing mindlessness and that it does not allow for an examination of specific mindfulness skills that may be relevant to the development of mindfulness-based interventions. Despite these limitations, the current study provided initial support for the possible helpful role of mindfulness for parents of children with ASD. Future research may want to examine the effectiveness of MBI for parents of children with ASD, which will likely help reduce their psychological distress. Greater mindfulness may lead to greater parental acceptance, which is very helpful for parents of children with ASD, as it is a chronic and pervasive disorder.

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