Health-related quality of life in children and adolescent with ASD: the role of mothers’ emotional symptoms

Objective: Health-related quality of life (HRQOL) in children with autism spectrum disorder (ASD) has been the subjects of many studies. However, there is limited literature about the effects of parental mental health problems on the HRQOL of children with ASD. This study aims to compare HRQOL of ASD children and their mothers’ emoti- onal problems with healthy controls and to investigate the associations between ASD children’s HRQOL and mater- nal psychiatric symptoms. Methods: The sample consisted of 81 ASD patients and 79 healthy controls, with an age range of 2-18 years, and an equal number of mothers. Childhood Autism Rating Scale was used to check severity of autistic symptoms, Kinder Lebensqualitätsfragebogen: Children’s Quality of Life Questionnaire-revised (KINDL-R) was used to examine child HRQOL, Beck Depression Inventory (BDI) was used to evaluate maternal depressive symptoms, and State-Trait Anxiety Inventory (S-STAI, T-STAI) was used to assess maternal anxiety symptoms. Results: BDI and T-STAI total scores were significantly higher, KINDL-R total score, physical well- being, family, social, and school subscores were significantly lower in children with ASD than the control group. BDI total score was significantly higher, self-esteem and social subscores of KINDL-R were significantly lower in the severe ASD group. Self-esteem and school subscores of KINDL-R were significantly lower in ASD children with clinically anxious mothers. Among ASD children, family and school subscores of KINDL-R were negatively corre- lated with BDI total score. Conclusions: ASD patients have lower HRQOL than typically developing peers. Mothers of ASD children experience greater anxiety and depressive symptoms. Self-esteem and school performance in ASD children appear to be linked with maternal anxiety symptoms. Family and school problems in ASD children may be associated with maternal depressive symptoms. (Anatolian Journal of Psychiatry 2019; 20(5):548-555)

OSB’li çocuk ve ergenlerde sağlıkla ilişkili yaşam kalitesi: Annelerin emosyonel belirtilerinin rolü

Amaç: Otizm spektrum bozukluğu (OSB) olan çocuklarda sağlıkla ilişkili yaşam kalitesi (SİYK) birçok araştırmanın konusu olmuştur. Anne-babanın ruh sağlığı sorunlarının OSB'li çocukların SİYK'sine etkileri konusunda ise, sınırlı bilgi vardır. Bu çalışmada OSB’li çocukların SİYK’sinin ve annelerinin duygusal sorunlarının sağlıklı kontrollerle karşılaştırılması ve OSB’li çocukların SİYK’si ve annelerinin psikiyatrik belirtileri arasındaki ilişkinin incelenmesi amaçlanmıştır. Yöntem: Örneklem, yaşları 2-18 arasında değişen 81 OSB hastası, 79 sağlıklı kontrol ve eşit sayıda annelerden oluşuyordu. Otistik belirtilerin şiddetini kontrol etmek için Çocukluk Otizm Derecelendirme Ölçeği, SİYK’yi ölçmek için Kinder Lebensqualitätsfragebogen: Çocukların Yaşam Kalitesi Anketi-Revize Edilmiş (KINDL- R), annelerin depresif belirtilerini değerlendirmek için Beck Depresyon Ölçeği (BDÖ) ve annelerin anksiyete belirti- lerini değerlendirmek için Durumluk-Sürekli Anksiyete Ölçeği (DAÖ, SAÖ) kullanıldı. Bulgular: OSB’li çocukların annelerinde BDÖ ve SAÖ toplam puanları anlamlı olarak yüksekti. OSB’li çocuklarda KINDL-R toplam puanı, fiziksel iyilik, aile, sosyal ve okul alt puanları anlamlı derecede düşüktü. BDÖ toplam puanı ağır OSB’li çocukların annele- rinde anlamlı derecede yüksekti. Ağır OSB’li çocukların KINDL-R benlik saygısı ve sosyal alt puanları anlamlı olarak düşüktü. Anksiyöz annelerin OSB’li çocuklarında KINDL-R benlik saygısı ve okul alt puanları daha düşüktü. OSB’li çocukların annelerinin BDÖ toplam puanı ve KINDL-R aile ve okul alt puanları arasında ters yönlü bir ilişki vardı. Sonuç: OSB hastaları, tipik olarak gelişen akranlarına göre daha düşük SİYK’ye sahiptir. OSB’li çocuklarının anne- leri daha fazla anksiyete ve depresif belirtiler yaşamaktadır. OSB’li çocukların benlik saygısı ve okul başarısı annele- rinin anksiyete belirtileri ile ilişkili gibi görünmektedir. OSB’li çocukların okul ve aile sorunları annelerinin depresif belirtileriyle ilişkili olabilir. (Anadolu Psikiyatri Derg 2019; 20(5):548-555)

PDF

___

Ikeda E, Hinckson E, Krägeloh C. Assessment of quality of life in children and youth with autism spectrum disorder: a critical review. Qual Life Res 2014; 23:1069-1085.

Ozonoff S, Goodlin-Jones BL, Solomon M. Evi-dence-based assessment of autism spectrum disorders in children and adolescents. J Clin Child Adolesc Psychol 2005; 34:523-540.

Kamp-Becker I, Schröder J, Muehlan H, Rem-schmidt H, Becker K, Bachmann CJ. Health-related quality of life in children and adolescents with autism spectrum disorder. Z Kinder Jugend-psychiatr Psychother 2011; 39:123-131.

Lee LC, Harrington RA, Louie BB, Newschaffer CJ. Children with autism: quality of life and par-ental concerns. J Autism Dev Disord 2008; 38:1147-1160.

Kuhlthau K, Orlich F, Hall TA, Sikora D, Kovacs EA, Delahaye J, et al. Health-related quality of life in children with autism spectrum disorders: results from the autism treatment network. J Autism Dev Disord 2010; 40:721-729.

Dey M, Landolt MA, Mohler-Kuo M. Health-related quality of life among children with mental disor-ders: a systematic review. Qual Life Res 2012; 21:1797-814.

Ingersoll B, Hambrick DZ. The relationship be-tween the broader autism phenotype, child sever-ity, and stress and depression in parents of children with autism spectrum disorders. ResAutism Spectr Disord 2011; 5:337-344.

Kousha M, Attar HA, Shoar Z. Anxiety, depres-sion, and quality of life in Iranian mothers of chil-dren with autism spectrum disorder. J Child Heal Care 2016; 20:405-414.

Wang J, Hu Y, Wang Y, Qin X, Xia W, Sun C, et al. Parenting stress in Chinese mothers of children with autism spectrum disorders. Soc Psychiatry Psychiatr Epidemiol 2013; 48:575-582.

Phetrasuwan S, Shandor Miles M. Parenting stress in mothers of children with autism spectrum disorders. J Spec Pediatr Nurs 2009; 14:157-165.

Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord 1980; 10:91-103.

Sucuoğlu B, Öktem F, Gökler B. Otistik çocukların değerlendirilmesinde kullanılan ölçeklere ilişkin bir çalışma. 3P Derg 1996; 4:117-121.

Ravens-Sieberer U, Bullinger M. Assessing health-related quality of life in chronically ill chil-dren with the German KINDL: first psychometric and content analytical results. Qual Life Res 1998; 7:399-407.

Ekinci O, Isik U, Gunes S, Ekinci N. Under-standing sleep problems in children with epilepsy: Associations with quality of life, attention-deficit hyperactivity disorder and maternal emotional symptoms. Seizure 2016; 40:108-113.

Eser E, Yüksel H, Baydur H, Erhart M, Saatli G, Ozyurt CB, et al. The psychometric properties of the new Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Turk Psikiyatri Derg 2008; 19:409-417.

Beck AT. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.

Hisli N. Validity and reliability of Beck Depression Inventory in university students. Turk Psikol Derg 1989; 7:3-13.

Tekinarslan IC. A comparison study of depression and quality of life in Turkish mothers of children with down syndrome, cerebral palsy, and autism spectrum disorder. Psychol Rep 2013; 112:266-287.

Spielberger CD, Gorsuch Lushene RE. STAI Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, 1970.

Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res 2011; 63:467-472.

Öner N, LeCompte A. Handbook of State-Trait Anxiety Inventory. İstanbul: Boğaziçi University Press, 1998.

Egilson ST, Ólafsdóttir LB, Leósdóttir T, Sae-mundsen E. Quality of life of high-functioning children and youth with autism spectrum disorder and typically developing peers: Self- and proxy-reports. Autism 2017; 21:133-141.

Clark BG, Magill-Evans JE, Koning CJ. Youth with autism spectrum disorders. Focus Autism Other Dev Disabl 2015; 30:57-64.

DeVries M, Geurts H. Influence of Autism Traits and Executive Functioning on Quality of Life in Children with an Autism Spectrum Disorder. J Autism Dev Disord 2015; 45:2734-2743.

Kamp-Becker I, Schröder J, Remschmidt H, Bach-mann CJ. Health-related quality of life in adoles-cents and young adults with high functioning autism-spectrum disorder. Psychosoc Med 2010; 31:7.

Tilford JM, Payakachat N, Kovacs E, Pyne JM, Brouwer W, Nick TG, et al. Preference-based health-related quality -of-life outcomes in children with autism spectrum disorders. Pharmacoecono-mics 2012; 30:661-679.

Kuhlthau K, Kovacs E, Hall T, Clemmons T, Orlich F, Delahaye J, et al. Health-related quality of life for children with ASD: Associations with behavi-oral characteristics. Res Autism Spectr Disord 2013; 7:1035-1042.

Machado Junior SB, Celestino MIO, Serra JPC, Caron J, Pondé MP. Risk and protective factors for symptoms of anxiety and depression in parents of children with autism spectrum disorder. Dev Neurorehabil 2014; 19:1-8.

Barker ET, Hartley SL, Seltzer MM, Floyd FJ, Greenberg JS, Orsmond GI. Trajectories of emotional well-being in mothers of adolescents and adults with autism. Dev Psychol 2011; 47:551-561.

Zablotsky B, Anderson C, Law P. The Association Between Child Autism Symptomatology, Maternal Quality of Life, and Risk for Depression. J Autism Dev Disord 2013; 43:1946-1955.

Firth I, Dryer R. The predictors of distress in parents of children with autism spectrum disorder. J Intellect Dev Disabil 2013; 38:163-171.

Williams J, Steel C, Sharp GB, DelosReyes E, Phillips T, Bates S, et al. Parental anxiety and quality of life in children with epilepsy. Epilepsy Behav 2003; 4:483-486.

Davis E, Mackinnon A, Waters E. Parent proxy-reported quality of life for children with cerebral palsy: is it related to parental psychosocial dis-tress? Child Care Health Dev 2012; 38:553-560.

Li Y, Ji CY, Qin J, Zhang ZX. Parental anxiety and quality of life of epileptic children. Biomed Environ Sci 2008; 21:228-232.

Türkoğlu S, Bilgiç A, Türkoğlu G, Yilmaz S. Impact of Symptoms of Maternal Anxiety and Depression on Quality of Life of Children with Cerebral Palsy. Archieve of Neuropsychiatry 2016; 53:49-54.

McStay RL, Dissanayake C, Scheeren A, Koot HM, Begeer S. Parenting stress and autism: The role of age, autism severity, quality of life and problem behaviour of children and adolescents with autism. Autism 2014; 18:502-510.