Research in Autism Spectrum Disorders 4 (2010) 217228

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Research in Autism Spectrum Disorders

Journal homepage: http://ees.elsevier.com/RASD/default.asp

Coping, distress, and well-being in mothers of children with autism

Paul R. Benson *
Department of Sociology and Center for Social Development and Education, University of Massachusetts Boston, 100 Morrissey Boulevard,
Boston, MA 02125, United States

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 24 June 2009
Received in revised form 10 August 2009
Accepted 11 September 2009

As is the case in stress research generally, studies examining the relationship between
coping and mental health outcomes in parents of children with autism frequently classify
parental coping methods as being either problem- or emotion-focused. We argue that this
dichotomization of coping strategies oversimplies the way parents respond to their
childs autism. In the present study, the coping methods employed by 113 mothers of
children with autism were investigated using the Brief COPE (Carver et al., 1989).
Exploratory factor analysis of Brief COPE subscales identied four reliable coping
dimensions: engagement coping, distraction coping, disengagement coping, and cognitive
reframing coping. In addition, using multiple regression, we examined the relationship of
coping strategies to negative and positive maternal outcomes (depression, anger, and
well-being). In general, maternal use of avoidant coping (distraction and disengagement)
was found to be associated with increased levels of maternal depression and anger, while
use of cognitive reframing was associated with higher levels of maternal well-being. In
several instances, child characteristics, particularly severity of child maladaptive behavior,
moderated the effect of coping on maternal outcomes. Study ndings are discussed in light
of previous research in the area; in addition, study limitations and clinical implications are
highlighted.
2009 Elsevier Ltd. All rights reserved.

Keywords:
Autism
Coping
Distress
Well-being
Mothers

1. Introduction
Prior research clearly indicates that the demands of raising a child with autism can result in marked psychological distress
for many parents (see Glasberg, Martins, & Harris, 2007; Hastings, 2008 for recent reviews). However, it is also clear that
parents vary substantially in their ability to successfully respond to the challenges linked to their childs autism, with some
parents experiencing signicant mental health problems, while other parents experience relatively few of these difculties
(Benson, 2006; Benson & Karlof, 2009). It is also noteworthy that research has shown that many parents experience positive
gains as a result of raising a child with autism or other disability, including personal growth, improved relationships with
others, and increased patience and empathy (Hastings & Taunt, 2002; Pakenham, Sofronoff, & Samios, 2005; Scorgie &
Sobsey, 2000).
Coping strategies have been posited as one mechanism by which individuals respond to threats of stress, including
stressors associated with parenting a child with autism. Based on the stress and coping model of Lazarus and Folkman
(1984), researchers have often grouped coping methods into two general types, problem-based coping (strategies aimed at
solving the problem or doing something to change the source of stress) and emotion-based coping (strategies aimed at

* Tel.: +1 617 287 7255; fax: +1 617 287 7249.

E-mail address: paul.benson@umb.edu.
1750-9467/$ see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.rasd.2009.09.008

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P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

reducing or managing feelings of distress associated with the stressor). In studies of family caregivers, including parents of
individuals with autism and intellectual disability, use of emotion-focused coping strategies (e.g., denial, venting) have
generally been found to be associated with higher levels of psychological distress, while use of problem-focused coping
methods (e.g., planning, taking action to address the problem) have often, but not always, been associated with improved
mental health outcomes (Abbeduto et al., 2004; Aldwin & Revenson, 1987; Seltzer, Greenberg, & Krauss, 1995). In addition,
problem- and emotion-focused coping have sometimes been found to moderate the effects of stressors on caregiver distress.
For example, in a recent study comparing the coping strategies used by mothers of preschool and adolescent children with
ASD, Smith, Seltzer, Tager-Flusberg, Greenberg, and Carter (2008) found that for mothers of preschoolers, lower levels of
emotion-focused coping and higher levels of problem-focused coping were associated with improved maternal well-being,
regardless of child symptom severity. For mothers of adolescents, however, coping was often related to maternal well-being
only when child symptoms were severe.
While the distinction between problem-focused and emotion-focused coping has served an important heuristic purpose
in stress research, evidence suggests that it oversimplies how people deal with adversity (Carver, Schneier, & Weintraub,
1989; Lazarus, 1996; Skinner, Edge, Altman, & Sherwood, 2003). Many important coping methods, such as use of social
support, fail to t clearly into either the problem- and emotion-focused coping category. In addition, many coping methods
serve both instrumental and affective functions. For example, while taking direct action against a source of stress clearly
involves problem-solving, it may also reduce negative emotions associated with the stressor, such as anxiety (Skinner et al.,
2003; Folkman & Moskowitz, 2004). For this reason, studies examining the factor structure of widely used coping scales, such
as the Way of Coping-Revised (Folkman & Lazarus, 1985), typically identify multiple coping dimensions rather than just two
(e.g., Aldwin & Revenson, 1987; Dunkel-Schetter, Feinstein, Taylor, & Falke, 1992; Folkman & Lazarus, 1985). Similarly,
Carver et al. (1989) included 14 conceptually distinct types of coping in their theoretically derived COPE inventory. While
some of the coping strategies identied by Carver et al. (1989) map closely onto the problem- vs. emotional-focused coping
classicatory schema (e.g., active coping, planning), others did not t clearly into either coping type.
To our knowledge, only one study to date has examined the structure of coping by parents with children with autism. In
that study, Hastings, Kovshoff, Brown, et al. (2005) used exploratory factor analysis to classify the coping methods used by
135 parents of children with autism in the UK. Based on their analysis of parent responses on the Brief COPE (Carver, 1997),
four reliable coping dimensions were extracted, which they termed active avoidance coping, problem-focused coping, positive
coping, and religious/denial coping. While the rst two of these dimensions corresponded closely to the emotion- and
problem-focused coping categories commonly used in stress research (cf. Folkman & Lazarus, 1985), the latter two were
viewed as being more specic to the unique circumstances associated with parenting a child with autism or other disability.
In bivariate analyses, Hastings, Kovshoff, Brown, et al. (2005) found passive avoidant and religious/denial coping to be
signicantly related to increased parent stress, anxiety, and depression, while problem-focused coping was unrelated to any
of these distress measures (positive coping was negatively correlated with depression only). Potential interactions between
parental coping strategies and child characteristics were not examined in this study.
As can be gleaned from the above review, the existing literature on coping by parents of children with autism is limited
and leaves many key issues unresolved. Aside from the one study by Hastings, Kovshoff, Brown, et al. (2005), very little is
known about the underlying structure of coping strategies used by parents of children with autism. In addition, very few
studies of families of children with disabilities have examined how different coping methods are associated with parent
distress and well-being, and, in particular, whether the effects of different coping strategies on parent outcomes are
moderated by child characteristics such as the severity of child autism symptomatology or maladaptive behavior. Although
coping has been found to buffer the effects of high levels of stress on caregiver distress in some studies of parents of persons
with autism and intellectual disability (Essex, Seltzer, & Krauss, 1999; Seltzer et al., 1995; Smith et al., 2008), other studies
have failed to replicate this nding (Abbeduto et al., 2004). Finally, as noted by Smith et al. (2008), there continues to be some
debate in the literature regarding the extent to which the relationship between autism and maternal psychological
functioning is primarily driven by decits specic to autism or, alternatively, by child maladaptive behaviors more generally,
with some studies indicating that maternal distress is primarily associated with child problem behaviors (Hastings,
Kovshoff, Ward, et al., 2005; Herring et al., 2006), while others have emphasized the pivotal role played by core autism
symptoms (Eisenhower, Baker, & Blancher, 2005; Ello & Donovan, 2005; Lecavlier, Leone, & Wiltz, 2006). Clearly, additional
research is needed that directly assesses the relative impact of these two child-related stressors on maternal distress and
well-being.
The aim of the present study was to contribute to the literature on autism and the family by investigating the structure of
coping used by mothers of children with autism and by examining how these empirically derived coping categories are
linked to maternal psychological functioning. In so doing, the study sought to replicate key aspects of Hastings, Kovshoff,
Brown, et al.s (2005) factor analysis of coping among British parents of children with autism and Smith et al.s (2008)
comparative study of the impact of coping strategies on maternal distress and well-being. In addition, the present study
extended the work of Smith and colleagues by comparing the effects of two child-related stressors, autism symptoms and
maladaptive behaviors, on maternal outcomes. Finally, as did Smith et al. (2008), the effects of maternal coping and child
characteristics on negative and positive maternal outcomes were examined, specically depressed mood, anger, and
psychological well-being. While a good deal of past research has examined the impact of child disability and parenting stress
on maternal depression (Singer, 2006), much less attention has been given to examining anger as an outcome, particularly
within the context of parenting children with ASD (however, see Benson & Karlof, 2009). In addition, relatively little

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219

attention has been given to the potential effects of coping on positive parent outcomes (cf. Folkman & Moskowitz, 2000,
2004). Research involving both disabled and non-disabled populations, however, has indicated that a variety of benecial
outcomes, including the acquisition of new skills and relationships (e.g., Hastings & Taunt, 2002; Schafer & Coleman, 1992),
personal growth (e.g., Nolen-Hoeksema, Larson, & Grayson, 1999; Park, Cohen, & Murch, 1996), and spiritual or religious
transformation (e.g., Pargament, 1997; Pearce, 2005), can result from confronting stressful situations, even when the
situation is chronic and unable to be successfully resolved. In this study attention was focused on one specic potential
benet of effective coping, feelings of personal happiness and well-being.
In summary, the present study sought to investigate the coping strategies used by mothers of children with autism and
the relationship of these strategies to negative and positive parent outcomes. Specically, three research questions were
addressed: (1) What is the underlying structure of coping strategies used by mothers of children with autism; (2) To what
extent are different coping methods and child-related stressors (i.e., autism symptoms and maladaptive behaviors)
associated with maternal distress and well-being; and (3) Under what circumstances, if any, is the interaction of coping
strategies and child stressors linked to maternal outcomes?
2. Methods
2.1. Participants
The current study was undertaken as part of an ongoing longitudinal study of children with ASD and their families
(Benson & Karlof, 2008, 2009; Benson, Karlof, & Siperstein, 2008). The full study sample (142 children, aged 69, and 136
parents) was recruited into the study in 2002 and 2005 from a variety of public and private schools, multi-system special
needs programs, and autism service organizations located in eastern and central Massachusetts. The present paper utilizes
information collected in 2005 from a subsample of 113 mothers of children whose autism diagnosis had been conrmed
through the use of the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter, & Le Couteur, 1994).
In terms of child characteristics, most were male (87%) and Caucasian (83%), with a mean age of 8.6 years (S.D. = 1.5).
According to parent report, the primary mode of communication for 19% of children was through non-verbal means.
Seventy-six percent of the children in the sample attended a typical or inclusive classroom for at least part of the school day,
while 24% attended a fully self-contained special needs classroom.
In terms of parent and family characteristics, family income averaged between $70,000 and $80,000 a year, but varied
substantially within the sample, ranging from under $30,000 (14%) to over $140,000 a year (15%). Parent educational level
was also generally high, with 64% of mothers identifying themselves as college graduates.
2.2. Procedure
Data on participating parents were gathered through in-home interviews and self-administered questionnaires. Parent
questionnaires included items on child, parent, and family characteristics, school services, and other issues, while parent
interviews were used to collect information on a variety of other issues, including the impact of the child with autism on the
family and the ways that parent activities may have been altered to accommodate to the needs of the child with autism
(Benson & Karlof, 2008; Benson et al., 2008). Data on variables included the present study were collected though the use of
parent questionnaires only.
2.3. Measures
2.3.1. Coping measures
As did Hastings, Kovshoff, Brown, et al. (2005), we assessed mothers coping strategies using the Brief COPE (Carver, 1997),
an abbreviated version of the COPE inventory developed by Carver et al. (1989). In its situational format, the Brief COPE uses a
4-point Likert scale (1 = I havent been doing this at all to 4 = Ive been doing this a lot) to query respondents on how frequently
they employ 28 different behaviors and cognitions when coping with a specic stressful situation (in the present study,
parenting a child with autism). Following Carver (1997), maternal responses were initially grouped into 14 theoretically
derived subscales consisting of two items each (acceptance, active coping, planning, behavioral disengagement, denial,
substance use, humor, positive reframing, religious coping, self-distraction, use of emotional support, use of instrumental support,
and venting emotions). In the present investigation, Cronbachs alpha reliabilities across the 14 subscales averaged .72 (range:
.54.93). These reliabilities are similar to those reported in Carver (1997) and indicate acceptable to excellent internal
consistency for the abbreviated subscales.
2.3.2. Maternal depressed mood
Mothers level of depressed mood was measured using a short form of the Center for Epidemiologic Studies-Depression Scale
(CES-D; Radoff, 1977; Ross & Mirowsky, 1984). Using the CES-D short form, respondents were asked, On how many days during
the past week did you. . . (a) feel you couldnt get going, (b) feel sad, (c) have trouble going to sleep or staying asleep, (d) feel
everything was an effort, (e) feel lonely, (f) feel you couldnt shake the blues, (g) have trouble keeping your mind on what you
were doing? Responses on the seven items were added to produce an index score ranging from of 049 (mean = 15.2,

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P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

S.D. = 12.2; Cronbachs alpha = .86). As is common with count variables, the distribution of responses on the CES-D short form
were highly positively skewed. For this reason, in the analyses below, we utilized a square-root transformation of CES-D short
form scores in order to correct for variable non-normality (Cohen, Cohen, Aiken, & West, 2003).
2.3.3. Maternal anger
Parent anger was assessed using a three-item measure developed by Ross (1996). Using this measure, respondents were
asked, On how many days during the past week did you. . . (a) feel annoyed with things or people, (b) feel angry, (c) yell at
someone? These items are intended to represent escalating forms of anger, with the rst two indicating feelings of anger
and the last a behavioral expression of anger (Ross & Van Willigen, 1996). Responses were summed to create an index
ranging from 0 to 21 (mean = 7.8, S.D. = 5.3). Like the CES-D, the distribution of responses on the anger index was highly
positively skewed and a square-root transformation was utilized in order to correct for non-normality. In this study,
Cronbachs alpha for the anger measure was .78.
2.3.4. Maternal well-being
Maternal well-being was also assessed using a three-item measure developed by Ross (1996). Using this measure,
respondents were asked, On how many days during the past week did you. . . (a) enjoy life, (b) feel happy, (c) feel hopeful
about the future? Responses were summed to create an index of 0 to 21 (mean = 12.1, S.D. = 6.6). In this study, Cronbachs
alpha for the well-being measure was .92.
2.3.5. Child autism symptoms
Severity of child autism symptoms was assessed using the parent-report version of the Social Responsiveness Scale (SRS;
Constantino, 2000). Using a 4-point Likert scale (1 = never true to 4 = almost always true), the SRS is a 65-item scale that
ascertains quantitative data on the frequency of a wide array of autistic traits, including social awareness (e.g., Knows when
he/she is too close to someone or invading someones space), social information processing (e.g., Concentrates too much on
part of things rather than seeing the whole picture [reverse coded], capacity for reciprocal social response (e.g., Is able to
imitate others actions), social use of language (e.g., Gets frustrates when trying to get ideas across in conversations), and
stereotypic/repetitive behaviors/preoccupations (e.g., Has repetitive odd behaviors, such as hand apping or rocking).
Responses are summed across SRS items to generate a total score that serves as an index of autism symptom severity, with
higher scores indicating more severe impairment. Prior psychometric studies on the SRS indicate good reliability and
validity, with SRS scores being signicantly correlated with symptom scores generated by the ADI-R (Constantino et al.,
2003). Because a substantial minority (19%) of children with autism in the present study were non-verbal, 12 SRS items
specically requiring verbal language on the part of the child were excluded from the measure used in the present analysis,
resulting in a 53-item autism symptom scale (mean = 148.1, S.D. = 22.9). Cronbachs alpha for the modied SRS was .93,
indicating excellent internal consistency.
2.3.6. Child maladaptive behavior
Severity of child maladaptive behavior was assessed using the problem behavior scale of the Nisonger Child Behavior
Rating Form Parent Version (NCBRF; Aman, Tasse, Rojahn, & Hammer, 1996). The 66-item NCBRF problem behavior scale
utilizes a 4-point Likert scale (1 = Did not occur or was not a problem to 4 = Occurred a lot or was a serious problem) and taps
several dimensions of maladaptive behavior commonly seen in children with autism, including non-compliance,
hyperactivity, self-injury, aggression, ritualism, and irritability (Lecavlier, Aman, Hammer, Stoica, & Matthews, 2004).
Cronbachs alpha for the NCBRF problem behavior scale was .93 in the current study (mean = 51.9, S.D. = 24.3).
2.3.7. Family socioeconomic status
Based on prior research indicating that coping responses differ by socioeconomic status (Pearlin, 2000), family SES was
included as a control variable in the present analysis. Family SES was assessed using an additive index composed of each
parents standardized education and income scores (in one-parent families, only the mothers education and income scores
were utilized, with the nal SES score weighted to adjust for number of parents).
3. Results
3.1. Factor structure of coping strategies
Exploratory factor analysis was used to identify the underlying structure of coping strategies used by our sample of
mothers of children with autism. However, in contrast to Hastings, Kovshoff, Brown, et al. (2005), in the present analysis,
factor analysis was performed on the 14 theoretically derived subscales of the Brief COPE rather than on the measures 28
individual items. The rationale for utilizing this analytical strategy is two-fold. First, as several investigators have noted
(Bernstein & Teng, 1989; Briggs & Cheek, 1986; Gorsuch, 1983), because many factor analytic techniques (including
exploratory factor analysis) assume interval-level data, use of multi-category scales, including the Brief COPE, can exaggerate
the number of factors needed when criteria applicable to continuous data is used. One proposed solution to this problem is to
combine items into subscales and then factor analyze the subscales, assuming that they have been shown to have acceptable

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221

levels of inter-item reliability (Bernstein & Teng, 1989; Briggs & Cheek, 1986; Hudek-Knezevic, Kardum, & Vukmirovic,
1999). A second reason for factor analyzing the Brief COPE on the scale (rather than the item) level stems from concerns
regarding the adequacy of the sample size (N = 113), which was deemed to be too small to allow for item-level analysis (cf.
Gorsuch, 1983).
To explore the factor structure of Brief COPE subscales, a principal components factor analysis with varimax rotation was
used, employing the Scree-test as a criterion for the extraction of the optimal number of factors. Following Hastings, Kovshoff,
Brown, et al. (2005), subscales were retained if they met two criteria: (1) they loaded >0.40 on one of the factors and <0.40 on
the other factors; and (2) their loading on the main factor was positive. Based on these criteria, all items were retained, with four
factors being extracted (rst seven eigenvalues: 3.63, 2.48, 1.44, 1.02, 0.96, 0.86, 0.71), explaining 61.2% of the common
variance. As shown in Table 1, Factor 1 (termed engagement) included four Brief COPE subscales (use of instrument support,
active coping, planning, and use of emotional support), all of which reected active involvement by the mother in addressing the
stressful situation posed by their childs autism. Factor 2 (termed distraction) also included four subscales (self-distraction,
humor, self-blame, and venting), each of which reected attempts by the mother to distract herself from the stressor, while
Factor 3 (termed disengagement) included three Brief COPE subscales (substance use, behavioral disengagement, and denial),
each of with involved attempts by the mother to deny or distance herself from the situation. Lastly, Factor 4 (cognitive
reframing), included three scales (acceptance, use of religion, and positive reframing), all of which described maternal efforts to
positively restructure or reframe their beliefs about the stresses related to their childs autism.
Table 1 also displays Cronbachs alpha reliabilities for each of the four coping dimensions extracted from the factor
analysis. As shown, these values ranged from .73 (distraction) to .86 (engagement), indicating good internal consistency for
all four empirically derived coping dimensions.
3.2. Predicting maternal distress and well-being
For each respondent, a score on each coping dimension (engagement, distraction, disengagement, and cognitive
reframing) was obtained by summing maternal scores on the relevant Brief COPE subscales. The resulting four coping scales
were then used to address our two remaining research questions regarding the effects of different forms of coping and childrelated stressors on maternal psychological distress and well-being. In order to address these questions, we conducted a
series of multiple regressions, with separate regressions being performed for each of the four coping strategies extracted
from our prior factor analysis as well as for each of the two child-related stressors examined (autism symptoms and
maladaptive behavior). In each regression, a stressor variable, a coping variable, and a multiplicative term denoting the
interaction of the stressor and coping variables (stressor x coping) were entered simultaneously into the regression equation.
We also included family SES as a control variable in each regression.1
Tables 24 present the regression results for the three dependent variables, maternal depressed mood, anger, and wellbeing, respectively. Each table also presents two models, one for each child-related stressor, autism symptoms (Model 1) and
maladaptive behavior (Model 2), with each column representing the standardized coefcients (betas) associated with a
separate regression examining the effect of a specic coping strategy on a specic maternal outcome.
As shown in Table 2, distraction and disengagement coping were signicant predictors of maternal depressed mood,
with higher levels of each form of coping linked to higher levels of depression. In contrast, coping via engagement and
cognitive reframing were each unrelated to maternal depressed mood. In addition, child maladaptive behavior severity
was found to be positively associated with maternal depression, regardless of the type of coping examined, while symptom
severity was not a signicant predictor of depressed mood in any of the regressions. Lastly, two signicant interactions
between coping and maladaptive behavior were uncovered. As illustrated by the data plot presented in Fig. 1, when
severity of child maladaptive behavior was high, distraction coping was unrelated to maternal depressed mood.2 However,
when maladaptive behavior severity was low, mothers who used higher levels of distraction to cope with their childs
autism reported signicantly higher levels of depressed mood compared to mothers who used lower levels of distraction.
Similarly, higher use of disengagement coping was signicantly related to higher levels of depression only in mothers of
children with lower levels of maladaptive behavior, not in mothers whose children displayed higher levels of problem
behavior.
Next, we examined predictors of maternal anger. As shown in Table 3, higher use of distraction as a coping strategy was
associated with higher levels of maternal anger, while engagement and cognitive reframing were unrelated to this outcome.
In addition, as in the regressions predicting depression, child maladaptive behavior was positively associated with maternal
anger, regardless of the type of coping examined, while autism symptomology was signicantly linked to anger only in the
regressions assessing the impact of engagement and cognitive reframing. Finally, one signicant interaction between coping

1
As suggested by Cohen et al. (2003), in all regressions, predictor variables were centered over their means in order to control for multi-collinearity
between rst-order and interaction terms.
2
The data plot displayed in Fig. 1 graphically illustrates the relationship between distraction coping and depressed mood for mothers reporting low (1
S.D. below the mean) and high (1 S.D. above the mean) scores for child maladaptive behavior (see Cohen et al., 2003). Two additional data plots illustrating
the signicant interaction of (1) maternal disengagement and child maladaptive behavior on maternal depressed mood, and (2) maternal disengagement
and child maladaptive behavior on maternal anger revealed a similar pattern of effects as found in Fig. 1. Data plots of these interactions are available from
the author upon request.

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P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

Table 1
Second-order factor analysis of Brief COPE subscales.

Percent of total variance

Cronbachs alpha

Factor 1
Engagement

Factor 2
Distraction

Factor 3
Disengagement

Factor 4
Cognitive reframing

25.9
0.86

17.8
0.73

10.3
0.78

7.3
0.74

Brief COPE subscale and items (original item number in parenthesis)

Use of instrumental support
.803
(10) Help and advise from others
(23) Advise/help from others about what to do

.224

.021

.164

Active coping
(2) Concentrate on doing something about situation
(7) Take action to make situation better

.789

.084

.166

.175

Planning
(14) Come up with strategy about what to do
(25) Think about what steps to take

.789

.063

.009

.254

Use of emotional support

(5) Get emotional support from others
(15) Get comfort and understanding from someone

.744

.319

.123

.030

Self-distraction
(1) Turn to work or other activities to distract
(19) Do something to think about it less

.060

.733

.199

.134

Humor
(18) Make jokes about the situation
(28) Make fun of the situation

.046

.685

.192

.275

Self-blame
(13) Criticize myself
(16) Blame myself for things that happen

.008

.647

.391

.230

Venting
(9) Say things to let feelings escape
(21) Express negative feelings

.362

.579

.272

.046

Substance use
(4) Use alcohol/drugs to get through
(11) Use alcohol/drugs to feel better

.040

.007

.776

.134

Behavioral disengagement
(6) Give up trying to deal with it
(16) Give up attempts to cope

.062

.303

.665

.028

Denial
(3) Say to myself, This isnt real
(8) Refuse to believe what has happened

.200

.140

.575

.334

Acceptance
(20) Accept reality of what has happened
(24) Learn to live with the situation

.164

.046

.089

.724

Religion
(22) Find comfort in religious beliefs
(27) Pray or meditate

.202

.066

.183

.679

Positive reframing
(12) See in a different light to make seem more positive
(17) Look for something good in situation

.321

.273

.332

.477

Signicant loadings are italicized in bold type.

and child maladaptive behavior was found. Similar to the interaction noted above for maternal depressed mood, when child
maladaptive behavior severity was more severe, there was no association between disengagement coping and anger.
However, when child problem behaviors were less severe, mothers who used higher levels of disengagement to cope with
their childs difculties reported signicantly higher levels of anger compared to those who used lower levels of
disengagement.
Finally, we examined the predictors of maternal well-being (see Table 4). As shown, disengagement and cognitive
reframing each exerted a signicant main effect on maternal well-being, with lower levels of disengagement and higher
levels of cognitive reframing, linked to higher levels of well-being among mothers of children with autism. In addition, two
signicant interactions were uncovered in the regressions predicting maternal well-being: one between engagement coping
and child autism symptoms and a second between engagement coping and child maladaptive behavior. As illustrated by the

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223

Table 2
Regressions predicting maternal depressed mood.
Variable

Coping strategy
Engagement

Distraction

Disengagement

Cognitive reframing

Model 1
Family SES
Autism symptom severity
Coping
Coping  Symptom severity
R2

.317***
.121
.059
.161
.137**

.345***
.012
.358***
.029
.212***

.271**
.013
.401***
.171
.226***

.295***
.109
.001
.148
.127*

Model 2
Family SES
Problem behavior
Coping
Coping  Problem Behavior
R2

.308***
.330***
.017
.076
.222***

.341***
.262**
.284***
.224**
.327***

.264***
.273***
.352***
.252***
.323***

.299***
.337***
.017
.010
.206***

The coefcients shown are standardized betas. Each coping strategy was entered into a separate regression model.
*
p < .05.
**
p < .01.
***
p < .001.

Table 3
Regressions predicting maternal anger.
Variable

Coping strategy
Engagement

Distraction

Disengagement

Cognitive reframing

Model 1
Family SES
Autism symptom severity
Coping
Coping  Symptom severity
R2

.174
.198*
.132
.030
.083

.205*
.103
.405***
.041
.219***

.110
.102
.469***
.139
.235***

.156
.212*
.053
.089
.076

Model 2
Family SES
Problem behavior
Coping
Coping  Problem behavior
R2

.162
.329***
.037
.099
.158***

.190*
.248**
.360***
.091
.271***

.099
.261**
.426***
.183*
.294***

.150
.361***
.047
.060
.153**

The coefcients shown are standardized betas. Each coping strategy was entered into a separate regression model.
*
p < .05.
**
p < .01.
***
p < .001.

data plot presented in Fig. 2, when child autism symptoms were less severe, engagement was unrelated to well-being;
however, when symptoms were more severe, engagement exerted a signicant positive effect on maternal well-being.
Similarly, when child maladaptive behavior was less severe, engagement was unrelated to well-being; however, when
maladaptive behavior was more severe, mothers who reported high use of engagement as a way of coping with their childs
autism had signicantly higher levels of well-being compared to mothers who reported lower use of engagement as a coping
strategy.3
4. Discussion
The purpose of the present study was to investigate the structure of coping strategies used by mothers of children with
autism and to assess the relationship of those empirically derived coping dimensions to maternal mental health. Expanding
upon previous research, both positive and negative maternal outcomes were examined. In addition, the present study also
compared the role played by two child-related stressors, autism symptoms and. maladaptive, behaviors, in the prediction of
maternal distress and well-being. Finally, partially, replicating prior analysis by Smith et al. (2008), the moderating effects of
different coping strategies on the relationship between child-related stressors and maternal outcomes were also
investigated.

3
A data plot illustrating the signicant interaction of maternal engagement and child maladaptive behavior on maternal well-being followed the same
pattern as shown in Fig. 2 and is available from the author upon request.

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P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

Table 4
Regressions predicting maternal well-being.
Variable

Coping strategy
Engagement

Distraction

Disengagement

Cognitive reframing

Model 1
Family SES
Autism symptom severity
Coping
Coping  Symptom severity
R2

.215*
.209*
.225*
.225*
.189***

.223*
.142
.072
.109
.092*

.186
.077
.388***
.185
.189***

.243**
.223**
.350***
.137
.215***

Model 2
Family SES
Problem behavior
Coping
Coping  Problem behavior
R2

.215**
.176
.260**
.226*
.164***

.226*
.123
.074
.159
.094

.175
.058
.329**
.058
.154**

.244**
.171
.322***
.092
.182***

The coefcients shown are standardized betas. Each coping strategy was entered into a separate regression model.
*
p < .05.
**
p < .01.
***
p < .001.

Fig. 1. Data plot illustrating the signicant interaction of distraction coping and child maladaptive behavior in the prediction of maternal depressed mood.

Turning rst to our ndings regarding the structure of coping, our exploratory factor analysis of maternal responses on
the Brief COPE (Carver, 1997) uncovered four conceptually and empirically distinct coping dimensions which we termed
engagement, distraction, disengagement, and cognitive reframing. The rst dimension, engagement coping, included a
variety of ways of coping, such as planning and active problem-solving, which correspond closely to the category of problemfocused coping as generally conceptualized in the stress literature (cf. Lazarus & Folkman, 1984; see also Hastings, Kovshoff,
Brown, et al., 2005). Engagement coping was also found to correspond to the construct of approach-oriented coping (Roth &
Cohen, 1986) in that engagement coping strategies orient the mother into more direct contact with sources of stress related
to their childs autism. In contrast, disengagement, the second coping dimension uncovered in our factor analysis, entailed
maternal behaviors and cognitions geared generally toward withdrawal from the stressor through substance use, denial, and
giving up attempts to cope. A third broad-based coping strategy was termed distraction coping and involved maternal efforts
to cope with their childs autism through the discharge and modulation of emotion (e.g., venting, self-blame, humor, and
orienting attention away from the stressful situation), while a nal coping dimension, cognitive reframing, consisted of
efforts by the mother to come to terms with their childs autism in a positive way through acceptance, cognitive
restructuring, and use of religion.
In addition to examining the structure of maternal coping, the present study also examined the impact of different coping
strategies on maternal depressed mood, anger, and well-being. In regard to the prediction of maternal depression and anger,
it is noteworthy that neither engagement nor cognitive reframing was found to be related to these negative parent outcomes
in our regression analyses. In contrast, greater use of distraction and disengagement coping were generally found to linked to
higher levels of depression and anger. These ndings are largely consistent with the ndings of both Hastings, Kovshoff,

P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

225

Fig. 2. Data plot illustrating the signicant interaction of engagement coping and child autism symptoms in the prediction of maternal well-being.

Brown, et al. (2005) and Smith et al. (2008) and suggest that use of problem-focused coping strategies have minimal impact
on reducing maternal distress, while use of avoidant strategies (distraction and disengagement) increase parent distress. In
addition, to these main effects, in several instances, child maladaptive behavior was also found to moderate the effects of
distraction and disengagement on maternal distress. In these cases, distraction and disengagement coping exerted a
signicant positive effect on distress only when child maladaptive behaviors were less severe, while having no effect on
distress when problem behaviors were more severe. These ndings suggest, at least in some instances, that heavy use of
avoidant coping strategies may be particularly problematic for mothers whose children with autism display relatively less
intense behavioral difculties.
A somewhat different pattern of ndings emerged when the relationship of coping to maternal well-being was examined,
with disengagement coping exerting a signicant negative effect on well-being, while distraction coping was found to be
unrelated to this outcome. In addition, consistent with the stress-buffering hypothesis (Cohen & Willis, 1985), engagement
coping was found to be exert a signicant positive effect on maternal well-being only in cases where child symptoms were
more, rather than less, severe (the same moderating effect was found between engagement coping and child maladaptive
behavior). Finally, consistent with the ndings of Smith et al. (2008), use of cognitive reframing strategies was found to exert
a signicant main effect on well-being, with higher use of cognitive reframing (i.e., acceptance, positive restructuring, use of
religious coping) associated with higher levels of maternal well-being. The value of positive cognitions as a coping method
has been well documented in the stress literature (Folkman & Moskowitz, 2004) and appears to be particularly helpful in
stressful situations that are either chronic or largely uncontrollable. Likewise, prior studies have indicated that acceptance
and positive reframing can promote improved mental health among parents of children with autism and other disabilities
(Hastings & Taunt, 2002; Lloyd & Hastings, 2008; Pakenham et al., 2005; Scorgie & Sobsey, 2000) Finally, study ndings
highlight the potential positive effects of religiosity on well-being. In recent years, research on religious coping by parents of
children with disabilities has increased (Coulthard & Fitzgerald, 1999; Ekas, Whitman, & Shivers, 2009; Tarakeshwar &
Pargament, 2001). These studies suggest religiosity to be a complex construct, with religious coping affecting parents in both
positive and negative ways. In a recent study of mothers of children with ASD, for example, Ekas et al. (2009) found religious
beliefs and spirituality to be associated with improved parental mental health, while greater involvement in religious
activities (e.g., frequency of church attendance, engaging in prayer) was related to greater distress. It is noteworthy that in
the present study, our factor analysis classied religious coping (along with acceptance and positive reframing) as a
benecial coping method, while Hastings, Kovshoff, Brown, et al.s (2005) factor analysis of the same instrument, the Brief
COPE (Carver, 1997) placed religious coping in the same category as denial.4 Clearly, additional research is needed to better
explicate the multifaceted role played by religion in the coping process, both generally and specically in terms of parenting
children with autism.
A nal issue addressed by present study concerned assessing the relative strength of two different child-related stressors,
autism symptoms and maladaptive behaviors, in the prediction of maternal distress and well-being. In regard to the
prediction of maternal depressed mood and, to a somewhat lesser extent, maternal anger, severity of child maladaptive
behavior was clearly the more powerful predictor of the two, a nding consistent with most studies in the eld (cf. Hastings,

4
It is important to recall, however, that the Hastings et al. (2005a) study factor analyzed the Brief COPE at the item-level, while the present study did so at
the subscale level.

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P.R. Benson / Research in Autism Spectrum Disorders 4 (2010) 217228

2008). Interestingly, however, severity of child problem behaviors was not found to be a signicant predictor of maternal
well-being in the present study. This nding requires replication, but suggests that the well documented association
between child problem behaviors and parent distress may not hold for positive parent outcomes such as life satisfaction,
happiness, and psychological well-being.
In discussing the ndings and implications of the present study, it is important to note its limitations as well. First, the
analyses reported here utilized cross-sectional data and thus no causal inferences can be made based on these data.5 Second,
because of the necessarily voluntary nature of the sample, selection biases may have operated among study participants,
which could cause their responses to differ from those who chose not participate. Third, because the measures used in this
study were based on self-report, it is possible that some of the associations noted were inated due to shared-method
variance. Finally, it is important to note that the present study utilized a predominately upper middle-class, Caucasian
sample of mothers, thus limiting the generalization of study ndings to non-white and lower socioeconomic populations, as
well as to fathers and other caregivers.
In conclusion, the present study demonstrated how the impact of coping on psychological outcomes among mothers of
children with autism can differ, depending on the specic type of coping strategy used and outcome examined. Consistent
with previous research, study ndings generally indicate that over-reliance on avoidant coping methods are likely to
promote rather than reduce, maternal distress, while use of positive coping strategies, such as engagement and cognitive
reframing, are likely to have their greatest impact on improving parents sense of happiness and well-being. Thus
interventions that seek to reduce parents use of avoidant coping, while facilitating their use of positive behavioral and
cognitive coping strategies are particularly important. In addition, study ndings suggest that child maladaptive behaviors,
rather than autism symptoms, per se, are the key driver of the link between autism and maternal distress. For this reason,
professional interventions aimed at enhancing parents ability to manage their childs problem behaviors may be especially
benecial since, if successful, they would serve not only to reduce behavior-related parent stress, but also to buttress parent
self-condence, efcacy, and positive coping skills as well (Marcus, Kunce, & Schopler, 2005; McConachie & Diggle, 2007;
Moes, 1995; Singer, Ethridge, & Aldana, 2007; Sofronoff & Farbotko, 2002). Study ndings also point to the need for
interventions which assist parents in better managing feelings of depression and anger which are often associated with
parenting a child with autism (Benson & Karlof, 2009; Coon, Thompson, Steffen, Sorocco, & Gallagher-Thompson, 2003).
Finally, interventions aimed at promoting a sense of mindfulness and a positive acceptance on the part of parents of children
with autism also may be useful, especially as parents and their children grow older (Blackledge & Hayes, 2006; Lloyd &
Hastings, 2008; Singh et al., 2006).
Acknowledgements
Special thanks are extended to the mothers who participated in this study and to Kristie Karlof, Dorothy Robison, and Zach
Rossetti for their invaluable help in data collection. The research on which this paper is based was supported by the U.S.
Department of Education, Grant No. H324C040092 (A Longitudinal Study of Children with ASD and Their Families During
the Elementary School Years).
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