This study examined change prospectively in autism symptoms and maladaptive behaviors during a 4.5 year period in 241 adolescents and adults with an autism spectrum disorder who were 10-52 years old (mean = 22.0) when the study began. Although many individuals' symptoms remained stable, a greater proportion of the sample experienced declines than increases in their level of autism symptoms and maladaptive behaviors, and there were significant improvements in mean levels of symptoms. Individuals with mental retardation had more autism symptoms and maladaptive behaviors than those without mental retardation, and they improved less over time. Compared to adolescents, older sample members (31 and older) had fewer maladaptive behaviors and experienced more improvement in these behaviors over time.

This article seeks to elucidate the trajectory of development in adolescents and adults with autism. Prospective, retrospective, and cross-sectional studies are reviewed to reveal the manifestation of and changes in the core symptoms of autism in adolescence and adulthood. Comparing children with adolescents and adults, modest degrees of symptom abatement and improvement in skills have been documented in multiple studies, as are increases in verbal and decreases in performance IQ. Nevertheless, most individuals do not attain normative outcomes in adulthood and continue to manifest significant degrees of symptomatology and dependency. However, a small sub-group (about 15%) has more favorable adult outcomes.

We compared the occurrence and timing of divorce in 391 parents of children with an autism spectrum disorder (ASD) and a matched representative sample of parents of children without disabilities using a survival analysis. Parents of children with an ASD had a higher rate of divorce than the comparison group (23.5% vs. 13.8%). The rate of divorce remained high throughout the son/daughter's childhood, adolescence, and early adulthood for parents of children with an ASD, whereas it decreased following the son/daughter's childhood (after about age 8 years) in the comparison group. Younger maternal age when the son/daughter with ASD was born and having the son/daughter born later in the birth order were positively predictive of divorce for parents of children with an ASD. Findings have implications for interventions focused on ameliorating ongoing and long term marital strains for parents of children with an ASD. KeywordsAutism spectrum disorders; Divorce; Marital Relationship; and Parent Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/fam NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAutism spectrum disorders (ASD) are lifelong neurodevelopmental disorders involving a triad of impairments in communication, social reciprocity, and repetitive/restricted interests and behaviors (American Psychiatric Association, 2000). Parenting a son or daughter with an ASD poses several unique challenges (e.g., Seltzer, Krauss, Orsmond, & Vestal, 2001), which may take a toll on marriages. The extent of this toll in terms of divorce has been the topic of wide speculation in the media, with divorce rates of 80% and higher mentioned (Doherty, 2008;Solomon & Thierry, 2006), but the issue has not yet been addressed by empirical research. In this study, we compare the occurrence and timing of divorce among parents with an adolescent or adult with an ASD to a closely matched sample of parents of adolescents and adults without a disability drawn from a nationally representative sample. Family characteristics predictive of divorce are also identified.Several studies have examined parental divorce in heterogeneous samples of children with a variety of disabilities or specific populations of children with disabilities other than ASD. Some of these studies indicate that parents of children with a disability have an increased risk of divorce as compared to parents of children without a disability (Breslau & Davis, 1986;Witt, Riley, & Coiro, 2003; Wymbs, Pelhma, Molina, Gnagy, Wilson, & Greenhou...

The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief. Keywords bereavement; nonnormative parenting; death of child; parental grief; midlife Each year, over 50,000 U.S. children die (U.S. National Center for Health Statistics, 2000). The death of a child is one of the most painful events that an adult can experience and is linked to complicated/traumatic grief reactions (Prigerson et al., 1999). For parents, the dissolution of the attachment relationship with the child elicits severe anxiety and other negative emotions associated with loss (Bowlby, 1980). Parents might also experience guilt about having been unable to protect the child (Gilbert, 1997). Furthermore, because the death of a child defies the expected order of life events, many parents experience the event as a challenge to basic existential assumptions (Wheeler, 2001).In light of the significance of child death as a traumatic experience for parents, research on parental bereavement is more limited than might be expected. Most studies have been clinical NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript descriptions of participants in grief support groups (e.g., Compassionate Friends), so the findings likely have been influenced both by the self-selection factors that led individuals to seek this type of help and by the participants' experiences in the support groups. As a result, the findings cannot be generalized to the broader population of bereaved parents. Furthermore, drawing from traditional models of grief resolution that emphasize relatively short-term adaptations, researchers have usually assessed functioning for only a brief period during the acute phase of bereavement. Few studies have examined longer term outcomes, and most that have done so have used retrospective reports, which are subject to distortion when individuals recall their functioning many years earlier (e.g., Nelson & Frantz, 1996;Stehbens & Lascari, 1974).The purpose of the present study was to examine the life course impacts of parental bereavement in an unselected sample of adults who were studied prospectively from early adulthood, prior to the birth of the child, to middle age, usually many years after the death of the child. We ide...

The extent of current and future involvement by siblings of adults with disabilities is a function of the demands and constraints of midlife as well as the degree of closeness with the family of origin. The findings highlight the importance of clinicians' work to support and strengthen family relationships, which loom large in determining the extent to which siblings are involved in the care of a brother or sister with disabilities.

In the present study, 96 co-residing mothers of adolescents and adults with an autism spectrum disorder (ASD) participated in an 8-day diary study and reported on their daily experiences. In comparison with a nationally representative sample of mothers of children without disabilities, mothers of adolescent and adult children with ASD spent significantly more time providing childcare and doing chores, and less time in leisure activities. Fatigue, arguments, avoided arguments, and stressful events were also more common among mothers of individuals with ASD. However, mothers of individuals with ASD reported similar levels of positive interactions and volunteerism as the comparison group. Daily experiences were subsequently related to well-being in both groups. These findings highlight the need for family support services.

Expressed emotion measures the emotional climate of the family and is predictive of symptom levels in a range of medical and psychiatric conditions. This study extends the investigation of the effects of expressed emotion to families of individuals with autism. A sample of 149 mothers co-residing with their adolescent or adult child with autism over an 18-month period was drawn from a large multiwave longitudinal study. High expressed emotion was related to increased levels of maladaptive behavior and more severe symptoms of autism over time. Also, characteristics of the son or daughter influenced levels of maternal expressed emotion over time. Although autism is a complex genetic disorder, the effect of the family environment in shaping the behavioral phenotype should not be underestimated.

The present study examined the impact of autism symptoms and coping strategies on the well-being of mothers of children with ASD. The sample consisted of 153 mothers of toddlers and 201 mothers of adolescents drawn from two ongoing, longitudinal studies of families of individuals with ASD. For mothers of toddlers, lower levels of emotion-focused coping and higher levels of problemfocused coping were generally associated with better maternal well-being, regardless of the level of child symptomatology. For mothers of adolescents, coping often acted as a buffer when autism symptoms were high. Although there was evidence of maternal distress in both groups, the presence of significant buffering effects reflects adaptation in the face of stress, particularly for mothers of adolescents. Keywordscoping; autism symptoms; maternal well-being; toddlers; adolescents Raising a child with an autism spectrum disorder (ASD) is considered to be a highly stressful event for families (Duarte, Bordin, Yazigi, & Mooney, 2005). In comparison to parents of children with other disabilities (Down syndrome, fragile X syndrome, undifferentiated developmental disability, and cerebral palsy), mothers of individuals with ASD report more negative impact and poorer well-being during their children's preschool years (Eisenhower, Baker, & Blacher, 2005) and adulthood Blacher & McIntyre, 2006). Despite the challenges associated with caring for a child with a developmental disability, there is evidence that coping strategies may play a protective role for parents (Essex, Seltzer, & Krauss, 1999;Seltzer, Greenberg, & Krauss, 1995). The present study evaluated the impact of children's autism symptoms and maternal coping strategies on well-being in mothers of toddlers and mothers of adolescents with ASD. Child Characteristics and Maternal Well-BeingThe challenging behaviors of children with ASD have been repeatedly associated with poor maternal psychological well-being Allik, Larsson, & Smedje, 2006;Herring et al., 2006) and high levels of stress (Bromley, Hare, Davison, & Emerson, 2004;Lecavalier, Leone, & Wiltz, 2006). There is some Correspondence concerning this article should be addressed to: Leann E. Smith, Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705. Phone: (608) 890-1390; Fax: (608) NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript debate, however, if the core symptoms of ASD, or alternatively, behavior problems more generally, drive this connection between autism and maternal well-being. For instance, a recent study by Hastings, demonstrated that behavior problems of preschool children with autism, but not adaptive behavior or severity of autism symptoms, were associated with maternal stress. Similarly, in a study comparing toddlers and preschoolers with pervasive developmental disorder to those with developmental delays, emotional and behavioral problems predicted maternal stress, mental health problems, and family dysfunction above the effects of diagnosis, le...