A Mixed Methods Investigation of Parental Reflective Functioning, Parental Stress and Demand Avoidance Difficulties in Autistic Children

Background

Demand avoidance (DA) difficulties appear to be a growing area of clinical need; however, these are poorly understood and current investigations focus primarily on the internal attributes of the child. This speaks to wider gaps in the understanding of autistic children’s behaviours and difficulties from a family systems perspective, which is surprising given assertions that behavioural difficulties may in part emerge from and be maintained by these transactional relationships. Within this complex dynamic, research has demonstrated an influence of parental stress on behaviour problems in autistic children and, given the range of distinct challenges this parent group may be facing, variables that influence the impact of parental stress are a point of interest for potential intervention. Parental reflective functioning (PRF) is one such factor. It is not well established how PRF operates in relation to autistic children and PRF has not been investigated in relation to DA difficulties in autistic children. This has implications for the transferability and utility of psychological interventions targeting PRF to this parent group. More generally, exploration of parents’ understanding of their child’s DA and related difficulties will provide much needed insight to inform professionals working with such families regarding their potential support needs.

Aims

This study aimed to investigate how parents reflect on the behaviours and distress of their autistic children in relation to demands and to consider how this relates to their parental stress. This includes establishing whether their parental stress levels and PRF features are different compared to parents of neurotypical children or autistic children without DA difficulties.

Method

A convergent mixed method design was used. Two hundred twenty-five participants (185 parents of autistic children with DA difficulties; 8 with children with autism only; and 32 with neurotypical children) completed an online survey, and 13 parents of autistic children with DA difficulties engaged in semi-structured interviews. Descriptive statistics and non?parametric ANCOVA and correlational analyses were completed on quantitative data and qualitative data was analysed using reflexive thematic analysis with a predominantly inductive design.

Results

Parents of autistic children with DA difficulties were significantly more stressed and showed differences in two of the three PRF features compared to parents of neurotypical 2 BRP 2324 2315275 25511260 Thesis Research Portfolio children, but parents of autistic children without DA difficulties showed no group differences. The themes illustrated parents’ experience of Grappling with understanding, Responding under ambivalence, and Co-(dys)regulation of distress.

Conclusions and Recommendations

Further investigation of PRF interventions appears warranted for parents of autistic children with DA difficulties. Parents may benefit from support with emotion regulation skill development to alleviate expressive suppression, promote mentalisation and mitigate stress. Further research is needed to understand the implications of improved certainty about mental states on parent wellbeing and practices, and the impact of self-efficacy on parents’ PRF and stress. Future investigations that incorporate both parent and child’s experience of interest and curiosity in mental states would provide useful insight into the influence of characteristics from both parties and their interactions on the operation of PRF.