2013. Vol.4, No.4, 445-453
Published Online April 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.44063
Copyright © 2013 SciRes. 445
Marital Patterns among Parents to Autistic Children
Hadas Doron, Adi Sharabany
Department of Social Work, Tel-Hai Academic College, Tel-Hai, Israel
Received January 8th, 2013; revised February 8th, 2013; accepted March 4th, 2013
Copyright © 2013 Hadas Doron, Adi Sharabany. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
The present research aims to examine the mental welfare of parents to autistic children, the degree of so-
cial support they receive and their perceived satisfaction with it, and how these variables affect their cou-
plehood. The research population included parents of children between the ages of 4 and 17 diagnosed
within the autistic spectrum. Each parent (within 33 couples) received a personal questionnaire, which
was completed by 32 women and 23 men. The research questionnaire was composed of four measures:
demographics; degree of child’s autism; social support; and mental wellbeing and closeness/distance in
the marital relationship. We found that social and familial support is statistically related to positive mari-
tal relationships and that the older the child, the less emotional wellbeing is felt by the parents and the
more distant their relationship.
Keywords: Autistic Children; Marital Relations; Well Being; Social Support
Marital Patterns of Parents of Autistic Children
Various factors were found to influence the couple relation-
ship of parents to autistic children. In families in which a child
was diagnosed with autism and when another disability was
discovered, some changes occur that may affect the relation-
ships within the family as well as its daily routine. Daily activi-
ties become more cumbersome and demand planning, early
preparation, and investment of many resources. Some studies
that examined such couple relationships discovered that parents
encounter difficulties in their marital relations and in reciprocal
interactions between family members (Margalit & Heiman,
1986; Benson & Gross, 1989; Baxter et al., 2000). The disa-
bility of a child may influence the weave of a marital relation-
ship in several ways; it redesigns the organization of the family
life and creates a fertile soil for conflicts. The disability has re-
percussions on most of the things parents do together: it af-
fects sleeping arrangements, work, meals, time spent away from
the child, and more (Pazerstone, 1987).
The present research aims to examine the mental welfare of
parents to autistic children, the social support they receive and
their perceived satisfaction with it, and how these variables af-
fect their couplehood.
The Effect of the Diagnosis of Disability on the
Many studies have found that a child with special needs
evokes increased stress and anxiety in his or her family, as well
as defensiveness and need for control among family members
(Margalit & Heiman, 1986; Baxter et al., 2000; Benson &
Gross, 1989). The psychological influences that parents to such
children experience are usually weariness and the tendency to
become reserved and disengaged from social life. Another ex-
pression of parental behavior is impatience towards family
members. Heiman (2002) measured the attitudes and feelings of
parents to children with special needs in order to determine
family resilience and the parents’ coping ability. She found that
parents of children with special needs tend to react to the diag-
nosis process with emotional outbursts, anger, frustration, guilt,
confusion, and sometimes even physical sensations and physi-
cal reactions (Heiman, 2002). Kubler-Ross (1978) claimed that
reactions of denial and anger prevent parents from taking part
in the early intervention process with their developmentally de-
layed children. The assumption is that the procreation of a child
with a developmental disability causes deep disappointment to
parents and results in personal and functional crises accompa-
nied by psychological stress, strong feelings of loss, and decline
in self-esteem (Rimerman & Portwictz, 1985). Guilt may be the
most common reaction among parents following diagnosis.
They tend to search for a rational explanation to the diagnosis
and often feel responsible for the disability. When a child is di-
agnosed as disabled, the family as a whole experiences a crisis,
meaning that the demands of the new situation ascend the fam-
ily’s ability to reorganize (Baum, 1962; Duvdevani, 2000).
Mental Wellbeing among Parents to Autistic Children
Mental wellbeing among parents to autistic children is de-
scribed in the literature and measured through the following
1) Stress—Raising autistic children constitutes a powerful
and continual stress factor for their parents regarding the diffi-
culties in caring for them and the emotional load experienced
by the family. Parents undergo a cumulative effect of stress and
the weakening of defense mechanisms that enabled fostering of
hope when the children were younger. As they grow up, their
parents mature and concern for their future increases. This
H. DORON, A. SHARABANY
finding is in line with Hollroyd, Brown, Wilker and Simmons’
(1975) research that found that the more mature the child, the
more the families were assessed as stressful.
Tobing and Glenwick (2001) found a relationship between
level of autism and parental stress. When deficits in language;
cognition; and sociality were high, so was the degree of stress
experienced by the parents. Additionally, they found a positive
relationship between the severity of functioning deficiency of
the children and the stress reactions among the mothers.
Although many studies point to psychological difficulties
among families of children diagnosed with functional deficien-
cies (such as autism), there are studies that show the ability of
some families to display appropriate adaptation (Leyser, 1994;
Abbott & Meredith, 1986; Salisbury, 1987).
2) Fear of uncertainty—One of the characteristics of autism
is the difficulty in conducting an assessment. The diagnosis
process may take a long time and doubts and differences of
opinion may arise that negatively affect both parents and chil-
dren during his period (Wikler, Wason, & Hatfield, 1983; Paz-
erstone, 1987). This situation may give rise to anticipation and
hope, from which the fall is harsh and discouraging (Hertz,
3) Anger—Cohen (1962) and Kennedy (1970) discuss typi-
cal stages of a crisis following the diagnosis of a disabled child.
One of the phases that follows a period of grief entails rage,
anger, frustration, and difficulty in restraining these feelings. It
was found that among some of the parents the anger they feel
towards their disabled children badly affects their couple rela-
tionship (Pazerstone, 1987; Heiman, 2002).
4) Weariness—Coping with raising disabled children and
with its psychological effects results in feelings of weariness
and mental burnout. Mental burnout is defined as a sense of
emotional, physical, and mental exhaustion caused by a con-
stant and continual mental load; one of its characteristics is the
feeling of chronic weariness (Levy-Shiff & Shulman, 1997).
Like fear and the anger, weariness brings about a series of pro-
blems. It is nerve-racking, and most exhausted parents act out
their rage on one another or on their children. It aggravates
existing tensions and creates new ones. Stressful relations,
loathsome routines, and disappointments leech the energy of
the parents and wear them out. Sometimes the weariness is so
deep it is hard to identify and struggle against (Pazerstone,
1) Friends and extended family—when parents are told that
their child is disabled or handicapped, they face the problem of
how to tell relatives and friends (McCormack, 1989). Despite
their stress, studies show that many parents actively engage in
searching for personal and professional sources of support.
Many parents reported often discussing the child’s issue with
the family (Heiman, 2002), which assists in moderating the
stress. Relations with grandparents who tend to grant their chil-
dren mental support and practical help in caring for the child
also provide a sense of normality (Lazer, 1995). Sometimes a
family may modify its structure and bring a relative into the
nuclear family’s home in order to alleviate strain and assist the
parents in taking care of the disabled child and his or her
healthy siblings. Such a change may give rise to new strains
and disturb the balance of the family. Social support and reac-
tions from the social environment depend greatly on the parents
and the way they deal with the situation (Kumpfer & Alva-
rado, 2003; Joronen & Astedt-Kurki, 2005). Encountering the
public may be a completely different story. When one goes out
in public with a disabled, exceptional child, people may exag-
geratedly stare or be deterred, which is difficult for many par-
ents. Support groups are offered in many areas to help parents
recognize their feelings and reconcile with their child’s condi-
tion (McCormack, 1989). Additional help from the community
may gain expression in external placements and special educa-
tion settings that may also alleviate the pressure on parents (Duv-
devani, 2000). The key to the constitution of family life is ex-
tending alliances and adapting a support system at all levels—
family-practitioners community. “Society must provide the
person and his family with possibilities and support that will
satisfy their needs” (Joronen & Astedt-Kurki, 2005: p. 85). Ac-
cording to Turnbull and Turnbull (2002), most parents define
quality of life as their children having more support, more
friends. Additional studies (Rimmerman & Portwicz, 1987; Dunn
et al., 2001) indicate that one of the factors found to most mod-
erate the strain and hardships experienced by parents is social
2) Receiving help—The disability of a child requires the fa-
mily, in most cases, maintain contact with various practitioners
and experts. The essence of these contacts and their scope is
very different between families. Often families of low socio-
economic status fail to provide appropriate medical treatment
(Sameroff, 2006; Bal, Van-Oost, & Debourdeaudhuij, 2003;
Carbonell et al., 2002). Certain children receive limited techni-
cal assistance in hospitals, clinics, or at home. Parents who can
afford to retain professionals enjoy their assistance at home as
well (physiotherapists, occupational therapists, doctors, nurses
etc.). These efforts advance the child and may reduce the fam-
ily’s sense of solitude. In contrast, they may impede the fam-
ily’s autonomy and independence. Most families need extra
assistance, but being exposed to too much advice may bring
about infantilism and limit the parents’ freedom to choose their
own way of solving problems (Pazerstone, 1987). How the
medical and developmental data is communicated to the parents
is very significant (Hertz, 2003). Kazak (1984) stated that par-
ents require the heavy involvement of health and welfare ser-
vices and that place of residence and living conditions are ex-
How people accept help may stem from cultural differences.
Women tend to seek help and accept it more willingly than men.
A husband may be jealous of his wife’s ability to seek psycho-
logical assistance from professionals and display mixed emo-
tions regarding this matter (Baker-Ericzen, Brookman-Frazee,
& Stahmer, 2005; Bayat, 2007; Beck, Daley, Hastings, & Ste-
venson, 2004; Benzies & Mychasiuk, 2009; Black & Lobo,
2008; Boyd, 2002). One way to bring parents closer is to equal-
ize the opportunities they receive. Among many families this
means offering extra support to men (on the part of friends,
relatives and practitioners) as well as additional opportunities to
be constructively involved with the child; while mothers should
be granted more opportunities to be away from the family so
they can achieve personal fulfillment. Such modifications bring
couples closer and assist them in coping with the problems they
face in complementary ways (Pazerstone, 1987). Leyser (1994)
stresses the need for professionals to be more sensitive to fa-
milial characteristics (socio-economic, cultural, and lifestyle)
and to adjust adequate interventions. A support program is es-
pecially important for mothers who bear the lion’s share of
childrearing. Cohen and Cohen (1962) also mentioned possi-
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H. DORON, A. SHARABANY
bilities of financial aid.
Changes in Marital Life among Parents to Autistic
1) Communication between partners—as mentioned above,
feelings of shame and guilt find expression in the parents’ in-
ability to communicate with one another regarding the child
(Duvdevani, 2000). Most commonly, the mother is the main
caregiver for the special needs child, and this may lead to the
partner’s feelings of redundancy. Both partners may feel that
they do not have as much time as before to be with each other
to enjoy each other’s company. In Heiman’s study (2002), when
parents of a disabled child were asked about the ramifications
of their situation on various areas of their life, some indicated
intensification of their relationship and communication between
them. Others asserted that interpersonal communication was ne-
gatively affected, new problems were created, and there was a
fear of taking responsibility. More arguments, expressions of
anger, and impatience occur (Heiman, 2002). Parents are fun-
damentally divided in their perception of the nature of their
obligations towards the child. They evaluate his or her future
options differently, advocate different intervention programs,
and may perceive professionals in a different light. They there-
fore may attempt to settle many disagreements within an atmos-
phere of a profound emotional load. Each of the partners feels
deep ambivalence towards the child, the future, and advice
from practitioners. This ambivalence is confusing, usually kept
in, but bursting out at times of conflict between the partners
(Walsh, 1998; Walsh, 2003). It also strengthens the basis for
disagreement in the marriage. Mixed emotions prevent both the
husband and wife from listening to the other’s ideas and grasp-
ing the despair and loneliness of each other. Their common
ambivalence, especially if not expressed, may also limit emo-
tional options and increase the distance between them (Pazer-
stone, 1987). Moreover, it was found that the higher the stress,
the less the parents perceive they function efficiently and the
more they display negative behavior, speech, and emotion to-
wards their children (Beruchin, 1990).
2) Alliance—Some parents feel that their children’s disabil-
ity strengthens their feeling of obligation towards one another.
The relationship of common grief and misfortune with happi-
ness arising from pain may improve their relationship. The rear-
ing of disabled children entails much learning, which may also
preserve the vitality of a marriage. The partners’ feeling of be-
ing allies in a common struggle strengthens them in the face of
solitude and despair. The question is how to keep and subsist
despite the present pain and how to find ways to moderate the
strains imposed on the family. The difficulty does not reside in
that few parents deal with the problem, but mainly because only
a few freely talk about the strains on their marriage or on their
ways of coping. It must therefore be determined that both par-
ents and perhaps the children need external psychological help
(Twoy, Connolly, & Novak, 2007). A severe disability under-
mines the mental strength of the family. The couple cannot to
be expected to meet all these needs without assistance; indeed,
when parents do receive help from relatives and friends, or pro-
fessionals, they are more apt to offer support to one another.
Atzils’s (1982) study suggests improvement in the parents’
ability to cope when there is a flexible division of the burden
with each of them investing according to their cognitive capa-
bilities and their ability to seek and receive help in handling
additional demands. Such a pattern of adjustment allows for
more successful coping, based both on acknowledging the spe-
cial demands and the ability to meet them, on avoiding over-
load on one of the parents, and developing a mutual support
Parents who raise disabled children are under extreme pres-
sure. Both mothers and fathers have personal reactions to deal
with, in addition to those of their partner. Some marriages are
shattered due to the tremendous strain involved in raising a dis-
abled child, while many other couples feel their relationship has
grown stronger in light of the difficulties (McCormack, 1989).
Many mothers and fathers need to be taught to separate be-
tween their marriage and the child and his disability (Pazer-
3) Leisure time—At some time in life many parents discover
that family life restricts their movements. We renounce many
aspects of our freedom in order to be parents. Certain people
long for a pause from the emotional responsibility, the anxiety
for the wellbeing of their children, their happiness and their
welfare. Others long for the days when they could be more fle-
xible, since a child imposes new restrictions on their job, leisure,
sleep, and sexual relations. Yet a third group stresses the lack of
economic independence, e.g., the inability to resign from a un-
pleasant job (Baker-Ericzen, Brookman-Frazee, & Stahmer,
2005; Plumb, 2011). In more positive cases, the pleasure of be-
ing a parent is balanced with the loss of freedom or surpasses it.
The disability of a child may undermine this balance. Concern
for the future is very burdensome for both parents. Practical du-
ties affect the little leisure time they have left. Parents feel too
weary to go out, while enjoyment from former recreation fades
until it is finally abandoned. Tired people begin to treat their
weariness as obvious and unchallengeable. “Exceptional” par-
ents need to spend more time alone than other parents, yet many
times they have less free time (Pazerstone, 1987; Parsons &
4) Role division—Research (Atzil, 1982) shows that division
of the burden (i.e., organizing to handle the special difficulties
resulting from the situation) between the parents for the most
part influences the nature of coping. Most families divide the
necessary duties between family members, yet the mother is
responsibility for more elements than any other family member
(Pazerstone, 1987), with her burden as high as double of that
carried by the father (Atzil, 1982; Carr, 1988). Whatever the
arrangements are, the disability may complicate the partners’
feelings regarding the division of labor in the household. Many
parents face cost-benefit considerations regarding whether to
stay at home with the children and handle the household or to
go out to work, with the solution depending on many factors.
One of them is the nature of family life: the enjoyment vs. sor-
row that is involved in staying at home with the children most
of the day. When a child is too much of a burden on the mo-
ther’s mental and physical resources, she feels that she gives
more and receives less than she should. Even if she knows that
her husband takes on some duties, she might feel resentful of
his freedom and his regular breaks from “exceptional parent-
hood” because he works outside the home. It seems that fathers
are more apt to cut themselves off from the concerns of home
and focus their attention elsewhere (Benzies & Mychasiuk,
2009; Boyd, 2002). Nevertheless, the husband’s relative dis-
connectedness may deepen his guilt feelings towards the dis-
ability. Such feelings do not benefit either parent, especially if
they are felt by the mother. However, there is another aspect in
which women are more successful: intensive occupation with
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H. DORON, A. SHARABANY
the immediate needs of the child provides them with many
opportunities to reconcile with the loss. Mothers learn treatment
routines for their children, find assistance, and locate health
services. The daily necessity of taking care of the child’s prob-
lems forces them to stand firm in the face of their doubts and to
re-examine painful emotions (Pazerstone, 1987). It should be
kept in mind that in the framework of their traditional roles,
mothers are the primary caregivers, and this affects both the
degree of familiarity with the functioning and state of the child
and their emotional involvement. Fathers, on the contrary, are
more distant by virtue of their role as breadwinners, and this
affects both their familiarity and emotional involvement (Atzil,
1982). These role differences may generate preconditions for
conflict. Atzils’ (1982) study on the division of the burden re-
veals that women report doing more than they would want to do
at home, while men report doing less than they would desire.
The research also examined the degree of consent between
mothers and fathers regarding parenthood and revealed that the
more the mother reported greater efforts, the less effort was
reported by the father, and vice versa. According to Nye (1976),
mothers are expected to take on a larger part of the burden of
parenthood and perceive it in a positive light, while fathers
perceive it is acceptable to reduce their part in running the
home. Mothers therefore lack opportunities to leave the house
and occasionally disconnect themselves (Bristol, Gallagher, &
5) Stability in marriage—Despite sincere love between the
partners, the family may resemble a prison. Two undesirable
possibilities confront dejected parents: they can run away, save
themselves, and abandon their partner and children; alterna-
tively, they can stay, but then they begin to feel hatred towards
family members and mourn for lost opportunities. Some threa-
ten to leave their families, whether as a way to communicate
their despair or to prevent the possibility of being abandoned
(Pazerstone, 1987). Adjusting to marriage is important and
affects the parents’ ability to cope with raising their children,
their ability to resolve conflicts, their satisfaction from marriage,
their relationship with their partner, cooperation and their part-
ner’s expectation of fulfillment. The birth of a child with a de-
velopmental delay disturbs the balance and compels modifica-
tion of the family and couple organization. Due to the multipli-
city of tasks, parents have much less time for themselves (Le-
vy-Shiff & Shulman, 1997; Brobst, Clopton, & Hendrick,
Existing problems in the relationship in addition to coping
with an autistic child may turn life intolerably hard and the
familial unit may even come apart. When partners function as a
team it may render coping easier (Green, 1998). Farber (1962)
refers to two types of crises in family and couple life following
the birth of a child with developmental delay:
1) Tragic crisis: extreme frustration due to the modification
of goals, ambitions, and the substance of life.
2) Role change crisis: coping with the child demands a high
level of commitment from both parents, which in the long run
creates a fixation in the development of the family and in the
role of the parents. This fixation generates worry, dissatisfac-
tion, and grief.
The child represents to his parents a psychological and
physical expression of themselves, an integration of the hered-
ity of their characteristic traits, both positive and negative. The
characteristics of the child reflect the uniting good between the
parents. Disability or retardation may represent the worse that
may have come from one of the partners (Ryckman & Hen-
derson, 1965). This sense of failure may cause mutual accusa-
tions (Levy-Shiff & Shulman, 1997). Parents to autistic chil-
dren report lower levels of intimacy in their marriage compared
to parents to normative children or to children with other dis-
abilities (Fisman, Wolf, & Noh, 1989). Marom (1994) found
that parents to children with developmental delay perceive their
marriage more negatively compared to parents of children of
the same chronological or mental age. Nevertheless, some stu-
dies report that the presence of an exceptional child may posi-
tively affect the marriage, provided that the families have found
appropriate ways to communicate and improve physical and
mental cooperation. Moreover, parents can leave their problems
aside and make use of the child as a uniting factor (Levy-Shiff
& Shulman, 1997). Some researchers failed to find any influ-
ence of the child’s disability on marital life; moreover, they
claim that the marital system and the parental system should be
separate. When pressure on the parental system is not transmit-
ted to the marital system, an atmosphere of support and en-
couragement is developed (Wikler, 1981; Kazak & Marvin,
1984). Satisfaction from marriage was found as the best pre-
dictor for positive coping of a mother dealing with a disabled
child (Friedrich, 1979; Twoy, Connolly, & Novak, 2007). De-
spite the hardships involved in the upbringing of a child with
special needs and its affect on different life stages, parents men-
tion positive couple relationships as a source of support and en-
couragement (Durlak et al., 2007; Heyman, 2001; Havens, 2005;
Brobst, Clopton, & Hendrick, 2009).
In summary, relationships take different forms in different
marriages, but were found to be much more intense among pa-
rents to exceptional children. The presence of a disabled child
may transform the familial structure in some ways: it might
loosen the boundaries protecting the autonomy of distinct sys-
tems within the family; it may make the family more vulnerable
to the intervention of external bodies, especially clinicians and
other professionals, so that it may reinforce the traditional role
division and make it abhorrent (Pazerstone, 1987; Brobst, Clop-
ton & Hendrick, 2009; Black & Lobo, 2008).
The aim of the present study is to examine the mental well-
being of parents of children diagnosed with an autistic disorder,
the social support they receive and their perceived satisfaction
with it, and how these factors affect the closeness of the couple
relationships of the parents.
We aspire in this study to respond to some shortcomings that
characterize former studies as follows:
First, we have found that many essays written by parents
about their family experiences lack reference to substantive
disagreements between the partners. Most stress the valuable
virtues of the partner and the firm support he/she offers. When
describing the advancement of their children, they don’t neces-
sarily reveal issues that might undermine their marriage (Pazer-
stone, 1987). We hope that our research, focusing on the par-
ents’ experience rather than that of the exceptional child, will
allow for the sincere uncovering of hardships and obstacles in
such marriages that have been scarcely studied until now.
Second, since the population of autistic children is relatively
scarce for empirical sampling, most studies have been con-
ducted on families with diverse disabilities. The focus of our
research is innovative in that it only includes the autistic popu-
Our research hypotheses are:
H1. There is a relationship between the intensity of a child’s
Copyright © 2013 SciRes.
H. DORON, A. SHARABANY
autism and aspects of couplehood of the parents (less closeness
and more distance between partners).
H2. There is a relationship between social, familial and pro-
fessional support and satisfaction with these sources of support,
and positive couple relationship.
H3. The more severe a child’s autism, the less emotional
wellbeing is experienced by the parents.
The research population included parents of children aged 4
to 17 diagnosed within the autistic spectrum. Each parent (with-
in 33 couples) received a personal questionnaire; 32 women and
23 men completed the questionnaire. The participants all live in
the northern region of Israel. The demographic characteristics
of the sample are as follows: 27.3% (N = 15) have secondary
education, 73% (N = 40) have academic education. No subject
had only primary education. The average length of marriage
was 15.46 years (SD = 5.91); average number of children was
2.77 (SD = 1.03); age M = 35. All participants were married at
the time of the study.
Our research questionnaire was composed of four measures:
Demographic questionnaire—measuring the following vari-
ables: age, gender, education, length of marriage, child’s age,
family monthly income, date of child’s diagnosis, and charac-
teristics of his autism.
Degree of child’s autism—a measure examining the child’s
autism characteristics including five items scaled 1 - 5, with the
score for each child calculated as the sum, ranging from 5
(mild-level disability) to 25 (severe-level disability).
Social support questionnaire—including 15 items referring to
the extent to which the subjects perceive they receive help and
support from various elements in his environment (partner, close
family, neighbors, and professionals). The items refer also to
the extent to which the respondents are satisfied with the help
they receive. The questionnaire was based on the Lazarus and
Folkman (1984) support questionnaire, and was adjusted to the
new state of parenthood by Levi-Shieff (1995). In order to ex-
amine whether items could be divided into different factors, a
factor analysis was conducted separately for level of support
and perceived level of satisfaction with the support.
Two factors were found for level of support: the level of so-
cial and familial support (items 8, 10, 12, = .803) and the
level of professional support (items 14, 16, 18, = .709); addi-
tionally, two factors were found for satisfaction with the sup-
port: satisfaction from support from family and friends (items:
9, 11, 13; = .853) and satisfaction from professional support
(items 15, 17, 19; = .709).
The questionnaire was built on a five-level Likert scale (1 =
not at all; 5 = to a great extent). High correlations were found
between the support factors and the satisfaction factors, both in
the familial domain (r = .78, p < .000) and in the professional
domain (r = .78; p < .000). The instrument’s overall reliability
was = .825.
Mental wellbeing questionnaire—intended to measure the
emotional adjustment of the parents to the diagnosis of their
child. The questionnaire contains 16 items taken from Yaku-
tiel’s (1990) measure. The subjects were required to rate the
degree to which they agree with each item (five-point Likert
scale) in the present. A 1 rating points to better emotional well-
being, while a 5 rating indicates lower emotional wellbeing.
The emotional wellbeing rate is calculated as the average of the
answers to the items, after reversing reversed items. Statistical
reliability of the scale was found high ( = .82) (Yakutiel,
1995). Reliability of the present sample = .839.
Closeness/distance in the relationship questionnaire—intend-
ed to measure the marital adjustment of the parents, and to as-
sess changes in marital life that took place since the diagnosis
of their child from the parents’ viewpoint. The questionnaire
contains 19 items, most of which were composed by Yakutiel
(1995), that include various statements referring to the marital
system and the changes it underwent since the child’s diagnosis.
The items are rated on a five-point Likert scale (1 indicating a
distant relationship and 5 indicating a close relationship). The
items indicate change in the marital relationship: some indicate
a positive change—more closeness, love, and understanding
(items: 52, 51, 50, 49, 48, 47, 43, 41, 39, 36; = .927) and
some, a negative change—more distance, anger, and feelings of
neglect between the partners (items: 46, 45, 44, 42, 40, 38, 37;
= .916). Two additional items (53, 54) were added by us and
refer to the relationship with other children in the family. The
subjects were asked to rate the degree to which each statement
reflects their marital relations since the diagnosis of their child.
The research population was recruited during three months
through various treatment centers that deal with education and
treatment of autistic children and advising their parents. The ad-
ministration of the questionnaires was partially direct (question-
naires were completed in the presence of the researchers and
handed to them) and partially by means of communication tech-
nologies (emails). Participants were promised full secrecy and
that their data would not be used for any purpose other than for
To examine Hypothesis 1, Pearson correlations were calcu-
lated, as presented in Table 1.
Table 1 indicates that Hypothesis 1 was refuted: No rela-
tionship was found between the level of a child’s autism and
closeness/distance between his or her parents.
In order to examine Hypothesis 2, Pearson correlations were
Pearson correlations between the severity of the child’s autism and ma-
rital aspects of the parents (closeness/distance).
Severity of autism
Women Negative relationships (distance)
N = 32 − .072 (.695)
Positive relationship (closeness)
N = 32 − .171 (.350)
Men Negative relationship (distance)
N = 24 .067 (.755)
Positive relationship (closeness)
N = 24 − .066 (.758)
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H. DORON, A. SHARABANY
calculated between the support received by the families—fa-
milial and professional—perceived satisfaction with the support,
and positive/negative relations among the parents, as presented
in Table 2.
Table 2 points to a moderate positive relationship between
receiving social support from family and satisfaction with such
support, and marital closeness. i.e., Hypothesis 2 was partially
confirmed—social and familial support is related to positive
To examine Hypothesis 3, Pearson correlations were calcu-
lated between parents’ mental wellbeing and intensity of the
child’s autism, see Table 3.
Table 3 refutes Hypothesis 3: No relationship was found
between the level of the parents’ emotional wellbeing and the in-
tensity of their child’s autism.
Table 4 presents Pearson correlations between the age of the
child and the variables of emotional wellbeing and positive/ne-
gative relationships among the parents.
Pearson correlations between the support (familial and professional)
received by the family, their satisfaction with the support, and aspects
of the parents’ marital relations (closeness/distance).
.213 (.116) − .044 (.746) .184 (.178) .150 (.271)
.315* (.018) .137 (.312) .339* (.011) .100 (.462)
Child’s autism .186 (.169) .201 (.138) − .014 (.918) .090 (.511)
Note: *P < .05, **P < .01.
Pearson correlations between emotional wellbeing and severity of the
Women Severity of
Men Severity of
Pearson correlations between child’s age, emotional wellbeing and clo-
seness/distance of the parents’ marital relations.
Negative wellbeing N = 56 .036 (.792)
Positive wellbeing N = 56 − .309* (.020)
Negative relationship (distance) N = 56 − .139 (.307)
Positive relationship (closeness) N = 56 − .390** (.003)
Note: *P < .05, **P < .01.
Table 4 indicates a negative significant relationship between
the age of the autistic child and both the positive emotional
wellbeing and positive marital relationship experienced by his
parents; meaning—the older the child, the less his parents feel
emotional wellbeing and the more distanced their relationship.
Table 5 shows Pearson correlations between the intensity of
the child’s autism and the level of support received and satis-
faction with it among the parents.
Table 5 shows that the more severe a child’s autism, the
more the fathers perceive they receive social support. No such
relationship was found among the mothers.
The present research examined the mental wellbeing of par-
ents to autistic children, the social support they receive and
their perceived satisfaction with it, and the closeness of their
marital relationships. Our research focused on a population of
parents living in northern Israel. The professional literature re-
fers mostly to parents of exceptional children in general, and
not specifically to parents to autistic children. In the present re-
search, we focus our inquiry on the specific population of par-
ents to autistic children, and this constitutes its main innova-
Contrary to our predictions, our findings indicate that the
level of a child’s autism is not statistically related to the close-
ness/distance of the marital relationship as reported by the par-
ents, nor to the emotional wellbeing they experience; neverthe-
less, we found that the severity of a child’s autism did correlate
with the father’s perception of social support, but not with that
of the mother. In accordance with our hypothesis, we found that
the more a couple receives support from the family and the more
it is satisfied with that support, the more the partners report ma-
rital closeness. Finally, a negative relationship was found be-
tween the child’s age and the emotional wellbeing of the par-
ents and their reported marital closeness.
The Severity of the Child’s Condition, the Emotional
Wellbeing of the Parents, and the Closeness/Distance
of Their Relationship
As mentioned, we failed to find a statistical relationship be-
tween reported closeness or distance in marital relations and the
severity of a child’s condition, nor between the severity of a
child’s condition and the parents’ emotional wellbeing. The
present research was conducted among parents to children who
had been positively diagnosed with autism. The literature (Dale,
Jahoda, & Knott, 2006; Plumb, 2011) as well as practice indi-
cates that the period of uncertainty prior to diagnosis is some-
times the most difficult, and entails the potential for low emo-
tional wellbeing and tense relationships between the parents.
The findings of the present research may suggest a renewed
Pearson correlations between the severity of the child’s autism, level of
social support, and satisfaction with the support.
Receiving support Satisfaction with support
Men Women Men Women
Severity of autism.050* .128 .335 .487
Note: *P < .05, **P < .01.
Copyright © 2013 SciRes.
H. DORON, A. SHARABANY
balance and personal and familial organization post-diagnosis,
which in turn brings about fewer hardships and less interper-
sonal tension. It is possible that the parents’ relationship and
their wellbeing are disrupted first and foremost by the disability
itself and by the definition of the child as “exceptional,” and not
necessarily by the severity of the symptoms (meaning, a child’s
low-severity condition may have more effect upon certain par-
ents than a child’s high-severity condition, and vice versa). This
may be a result of the parents’ personalities, the size of the fa-
mily, existing marital conflicts, the perception of the environ-
Another explanation relating to a mediating variable may be
that the more severe the child’s condition, the more support the
family receives from external factors, which relieves the strain
on the parents and enables a stable couplehood and greater emo-
Receiving Social Support and Perceived Satisfaction
with It, and the Parents’ Relationship
We found that the more social support the parents receive
from their families and the more they are satisfied with it, the
more they experience close relationships. In contrast, profes-
sional support was not found to be related to martial closeness.
These findings point to the significance and indispensability of
support from the extended family, which is more intimate and
more essential, and allows for rapprochement between the part-
ners. These are qualities not offered by professional assistance.
Additionally, social and familial support constitutes the envi-
ronment in which the parents are coping with their daily life
and with the child’s special needs. Practitioners as well as fami-
lies themselves should be aware of the importance of social and
familial support to the parents, and act to promote it.
The Autistic Child’s Age and His Parents’ Emotional
Wellbeing and Marital Closeness/Distance
We found a statistically significant negative relationship be-
tween the age of the child and his parents’ emotional wellbeing,
as well as their marital closeness. This means that the more au-
tistic children age, the less their parents are satisfied and the
less close they feel to each other. This finding can be accounted
for several ways: the development of autism-related deficiencies
that accompany the children’s growing up; the parents’ concern
for the fate of their children and finding the proper setting for
them; economic difficulties; financing of treatments, medical
care, and the like.
In addition, a statistically negative relationship was found be-
tween the children’s ages and the closeness between their par-
ents. This means that the parents’ relationships destabilize as
their children age. It is plausible that due to changes and dete-
rioration in the children’s condition parents are apt to experi-
ence more concerns and strains that negatively affect their cou-
plehood. Also, as the children grow older, placement alterna-
tives become fewer and parents face the task of finding an ap-
propriate place for their children for the rest of their lives, which
may cause considerable strain on a daily basis.
The Relationship between the Severity of the
Children’s Autism and Receiving Social Support and
Satisfactio n from It
We found that the more defects are displayed by their chil-
dren, the more fathers report receiving support. Among mothers
no such relationship was found. This finding and the next one
were the only ones to be found among men but not among wo-
men. It is plausible that receiving social support and being sat-
isfied with it are influential variables for men, who apparently
show less mental distress and apply more to the search for in-
stitutional help, according to the children’s needs. For women,
coping with treatment and attending to the children’s special
needs rises with the severity of their condition. Since this cop-
ing is intensive it may be that receiving social support and be-
ing satisfied with it is not sufficient to meet the needs of the
women, a fact that may point to their mental state.
Receiving Social Support and Perceived Satisfaction
In our research we found a statistically positive relationship
between receiving social support and satisfaction with it, among
both men and women. Apparently, support given to parents to
autistic children is somehow effective and provides some secu-
rity net for them. In addition, receiving all forms of support—
social, familial and professional—positively affects the couple
According to our present research, there are some reserve-
tions regarding the effect of the severity of the autistic symp-
toms. We assume that the mere fact of diagnosis of the autism
condition in a child affects his or her parents, regardless of the
severity of symptoms. Since most parents participating in this
research have only one diagnosed child, they cannot compare
the severity of his autistic state to that of other autistic children
within the family. A study population will including families in
which more than one sibling are diagnosed as autistic may re-
veal the affect of this variable on others.
In contrast to the severity of symptoms, the child’s age and
social support exert significant affect upon the parents.
1) Analysis of the demographic questionnaires reveal that
73% of our sample had academic education, data that may have
an effect on some other findings, such as parents applying to
receive support; their ability to be assisted by appropriate ser-
vice providers; and their understanding of their child’s condi-
tion, therefore eliminating its influence on the parents’ wellbe-
ing and couplehood, etc. It is possible that the education factor
skewed the findings towards a more positive or optimistic di-
rection, i.e., reporting fewer mental and relational problems than
2) Data collection procedure—questionnaires were usually
administered through various institutions that deal with autistic
children and their parents. Many institutions expressed their op-
position to participating in the study and confidentiality issues
made finding relevant families difficult.
3) In the attempt to sample couples, we encountered difficul-
ties in receiving responses from the men—many couples return-
ed the completed questionnaire of the woman only while men re-
frained from sharing their experiences.
4) Since not all the men completed the questionnaires, wo-
men outnumbered men in our sample, preventing us from ex-
amining intra-couple differences within a familial unit, limiting
us to only gender differences among the whole sample.
5) Many autistic children suffer concomitant disorders; there-
Copyright © 2013 SciRes. 451
H. DORON, A. SHARABANY
fore, the parents experienced difficulties in focusing their an-
swers only on their autistic condition.
Recommendations for Future Research
1) Future studies should try to locate parents to autistic chil-
dren who are not being treated or institutionalized. This is bas-
ed on the assumption that these parents have not yet entered the
stage in which they receive services, and therefore it would be
possible inquire as to their needs, their ability to cope with their
children’s disability, and their couplehood at an earlier stage.
2) Due to the uniqueness of autism and the special needs of
children diagnosed with it and their parents, there exists a need
to carry out more studies that deal specifically with this popula-
tion rather than with disabled children in general.
Abbott, D. A., & Meredith, W. H. (1986). Strengths of parents with re-
tarded children. Family Relations, 35, 371-375.
Baker-Ericzen, M. J., Brookman-Frazee, L., & Stahmer, A. (2005).
Stress levels and adaptability in parents of toddlers with and without
autism spectrum disorders. Research and Practice for Persons with
Severe Disabilities, 30, 194-204. doi:10.2511/rpsd.30.4.194
Bal, S., Crombez, G., Van Oost, P., & Debourdeaudhuij, I. (2003). The
role of social support in well-being and coping with self-reported
stressful events in adolescents. Journal of Child Abuse and Neglect,
27, 1377-1395. doi:10.1016/j.chiabu.2003.06.002
Baum, M. H. (1962). Some dynamic factors affecting family adjust-
ment to the handicapped child. Exceptional Children, 28, 387-392.
Baxter, C., Cummins, R., & Yiolitis, L. (2000). Parental stress attribu-
ted to family members with and without disability: A longitudinal
study. Journal of Intellectual and Developmental Disability, 25, 105-
Bayat, M. (2007). Evidence of resilience in families of children with
autism. Journal of Intellectual Disability Research, 51, 702-714.
Beck, A., Daley, D., Hastings, R. P., & Stevenson, J. (2004). Mothers’
expressed emotion towards children with and without intellectual
disabilities. Journal of Intellectual Disability Research, 48, 628-638.
Benson, B. A., & Gross, A. M. (1989). The effect of a congenitally han-
dicapped child upon the marital dyad: A review of the literature. Cli-
nical Psychology Review, 9, 747-758.
Benzies, K., & Mychasiuk, R. (2009). Fostering family resiliency: A re-
view of the key protective factors. Child and Family Social Work, 14 ,
Black, K., & Lobo, M. (2008). A conceptual review of family resilience
factors. Journal of Family Nursi ng, 14, 33-55.
Boyd, B. A. (2002). Examining the relationship between stress and lack
of social support in mothers of children with autism. Focus on Au-
tism and Other Developmen tal Disabilities, 17, 208-214.
Bristol, M., Gallagher, J., & Schopler, E. (1988). Mothers and fathers
of young developmentally disabled and non-disabled boys: Adapta-
tion and spousal support. Development Psychology, 24, 441-451.
Brobst, J., Clopton, J., & Hendrick, S. (2009). Parenting children with
autism spectrum disorders: The couple’s relationship. Focus on Au-
tism and Other Developmen tal Disabilities, 24, 38-49.
Carbonell, D. M., Reinherz, H. Z., Giaconia, R. M., Stashwick, C. K.,
Paradis, A. D., & Beardslee, W. R. (2002). Adolescent protective fac-
tors promoting resilience in young adults at risk for depression. Child
Adolescent Social Work Jour na l , 19, 393-412.
Carr, J. (1988). Six weeks to twenty one years: A londitudinal study of
children with down syndrome and their families. Journal of Child
Psychology and Psychiatry and Allied Disciplines, 29, 407-431.
Cohen, P. (1962). The impact of handicapped child on the family. So-
cial Work, 2, 137-142.
Cohen, S., & Cohen, J. (1962). Support systems for families of children
with severe disabilities in the USA. The Jewish Special Educator, 1,
Dale, E., Jahoda, A., & Knott, F. (2006). Mothers’ attributions follow-
ing their child’s diagnosis of autistic spectrum disorder: Exploring
links with maternal levels of stress, depression, and expectations
about their child’s future. Autism, 10, 463-479.
Dunn, M., Burbine, T., Bowers, C., & Tantleff, S. (2001). Moderators
of stress in parents of children with autism. Community Mental Heal-
th Journal, 37, 39-52. doi:10.1023/A:1026592305436
Durlak, J. A., Taylor, R. D., Kawashima, K., Pachan, M., DuPre, E., et
al. (2007). Effects of positive youth development programs on school,
family, and community systems. American Journal of Community
Psychology, 39, 269-286. doi:10.1007/s10464-007-9112-5
Duvdevani, A. (2000). Resilience and coping of parents and families of
children with developmental disabilities. In P. Klein (Ed.), Infants,
toddlers, parents and caregivers (pp. 251-271). Ramat Gan: Bar Ilan
Farber, B. (1962). Effects of a severely mentally retarded child on fa-
mily. In E. P. Trapp, & P. Himmelstein (Eds.), Readings on the ex-
ceptional child (pp. 59-68). New York: Appleton-Century.
Fisman, S. N., Wolf, L. C., & Noh, S. (1989). Marital intimacy in par-
ents of exceptional children. Canadian Journa l of Psychiatry, 34, 519-
Friedrich, W. N. (1979). Predictors of coping behavior of mothers of
handicapped children. Journal of Consulting and Clinical Psychol-
ogy, 47, 1140-1141. doi:10.1037/0022-006X.47.6.1140
Green, R. (1998). The explosive child. New York: Harper Collins.
Heyman, T. (2001). Coping process of parents of children with disabili-
ties. Issues in Special Education and Rehabilitation, 16, 37-47.
Heiman, T. (2002). Parents of children with disabilities: Resilience, co-
ping and future expectations. Journal of Developmental and Physical
Disabilities, 14, 159-171. doi:10.1023/A:1015219514621
Hertz, P. (2003). How does parental denial regarding their child’s de-
velopmental disability affect reflections and professional decisions?
Issues in Special Edu cation and Rehabilitation, 18, 37-43.
Hollroyd, J., Brown, N., Wilker, L., & Simmons, J. O. (1975). Stress in
families of institutionalized and non-institutionalized autistic chil-
dren. Journal of Community Psychology, 3, 26-31.
Joronen, K., & Astedt-Kurki, P. (2005). Familial contribution to adole-
scent subjective well-being. International Journal of Nursing Prac-
tice, 11, 125-133. doi:10.1111/j.1440-172X.2005.00509.x
Kazak, A. E., & Marvin, R. S. (1984). Differences, difficulties and ada-
ption: Stress and social network in families with a handicapped child.
Family Relations, 33, 67-77. doi:10.2307/584591
Kennedy, J. (1970). Maternal reaction to the birth of a defective baby.
Social Casework, 51, 410-416.
Kubler-Ross, E. (1978). To live until we say goodbye. New York: Si-
mon and Schuster.
Kumpfer, K. L., & Alvarado, R. (2003). Family-strengthening appro-
aches for the prevention of youth problem behaviors. American Psy-
chology, 58, 457-465. doi:10.1037/0003-066X.58.6-7.457
Lazarus, R. S., & Folkman, S. (1984). Coping and adaptation. In W. D.
Gentry (Ed.), The handbook of behavioral medicine (pp. 225-282).
New York: Guilford.
Lazer, Y. (1995). Resources for coping with external factors and crises
in Jewish families with children with developmental limitations. Is-
sues in Special Education and Rehabilitation, 10, 17-28.
Levy-Shiff, R., & Shulman, S. (1997). Families with a developmentally
disabled child: Parent-child marital and family relations. In I. Dovde-
vani, M. Hovav, A. Rimmerman, & A. Ramot (Eds.), Parents and per-
Copyright © 2013 SciRes.
H. DORON, A. SHARABANY
Copyright © 2013 SciRes. 453
sons with developmental disabilities (pp. 15-34). Jerusalem: Hebrew
Leyser, Y. (1994). Stress and adaptation in Orthodox Jewish families
with a disabled child. American Journal of Orthopsychiatry, 64, 376-
Margalit, M., & Heiman, T. (1986). Family climate and anxiety of fa-
milies with learning disabled boys. Journal of the American Acad-
emy of Child Psychiatry, 25, 841-856.
McCormack, A. (1989). The “tiding”: How to cope with the care of your
disabled child. Tel Aviv: Ach Publishers.
Nye, F. (1976). Role structure and analysis of the family. Beverly Hills:
Pazserstone, H. (1987). An exceptional child in the family. Hapoalim
Parsons, S., & Lewis, A. (2010). The home-education of children with
special needs or disabilities in the UK.
Ryckman, D. B., & Henderson, R. A. (1965). The meaning of retarded
children for his parents—A focus for counselors, Social Casework, 2,
Sameroff, A. (2006). Identifying risk and protective factors for healthy
child development. In A. Clarke-Stewart, & J. Dunn (Eds.), Families
count: Effect on child and adolescent development (pp. 53-76). New
York: Cambridge University Press.
Salisbury, C. L. (1987). Stressors of parents with young handicapped
and nonhandicapped children. Journal of the Division of Early Child-
hood, 11, 154-160.
Rimmerman, A., & Portwicz, D. (1987). Analysis of resources and
stress among parents of developmentally disabled children. Interna-
tional Journal of Reha bilitation, 10, 439-445.
Tobing, L., & Glenwick, D. (2001). Relation of the childhood autism
rating scale-parent version to diagnosis, stress, and age. New York:
Turnbull, A. P., & Turnbull, H. R. (2002). From the old to the new pa-
radigm of disability and families: Research to enhance family quality
of life outcomes. In P. L. James, C. D. Lavely, A. Cranston-Gingras,
& E. L. Taylor (Eds.), Rethinking professional issues in special edu-
cation (pp. 115-123). New York: Ablex Publishing.
Twoy, R., Connolly, P. M., & Novak, J. M. (2007). Coping strategies
used by parents of children with autism. Journal of the American
Academy of Nurse Practitioners, 19, 251-260.
Walsh, F. (1998). Strengthening family resilience. New York: Guilford
Walsh, F. (2003). Family resilience: A framework for clinical practice.
Family Process, 42, 1-18. doi:10.1111/j.1545-5300.2003.00001.x
Wikler, L. (1981). Chronic stress of families of mentally retarded chil-
dren. Family Relations, 30, 281-288. doi:10.2307/584142
Wikler, L., Wasow, M., & Hatfield, E. (1983). Seeking strengths in fa-
milies of developmentally disabled children. Social Work, 28, 313-