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A d u l t s L i v i n g with Autism Spectrum Disorder : Self Perceived Traits of Autism, Marital Quality, Parenting Competency and Anxiety Symptoms Winnie Yu Pow La u B. Com.; B. A. (Hons); M. Ed. (Dist); PGDip (C&F Psyc) A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2015 School of Psychology Abstract Autism Spectrum Disorder (ASD) are life-long conditions characterised by socio- communication deficits and stereotyped behaviours (American Psychiatric Association, 2013). To date, little is known about experiences of adults living with ASD, especially for those who manage to develop couple relationships and become parents (Howlin & Moss, 2012). This research examines the associations between self-perceived traits of autism and marital quality, parenting sense of competency and anxiety symptoms in adults affected by ASD. Uniquely, the sample encompasses 1) adults diagnosed with ASD whose children also have diagnosis of ASD; 2) non-ASD diagnosed parents who have children diagnosed with ASD and; 3) non-ASD parents who have typically developing children. Parents of children diagnosed with ASD are particularly targeted for their susceptibility to tendency towards autism (Bernier, Gerdts, Munson, Dawson, & Estes, 2011), and their distinctively high prevalence of psychiatric illness and marital breakdowns (Benson & Kersh, 2011; Hayes & Watson, 2013). Effects of child versus parental traits of autism were considered simultaneously. The thesis entails five empirical studies of which four have been published in peer- reviewed journals and one currently under review. Study 1 (chapter 5) investigated the associations between adult attachment style, marital quality and parenting satisfaction in adults formally diagnosed with Asperger’s Disorder/Asperger’s Syndrome (AS; a higher functioning variant of ASD). Strikingly, as high as 82% of this group reported insecure adult attachment style as opposed to 22% of non-ASD controls. Interestingly no association between insecure attachment style and marital dissatisfaction was found in the AS group, and their marital satisfaction did not differ from the non-ASD controls. Diagnosis of AS in child, but not in parent, was associated with parenting satisfaction. Study 2 (chapter 6) advanced the research by exploring the link between parental self-perceived traits of autism and parenting sense of efficacy in a significantly large sample of Australian parents (n=346). Interestingly, nearly half (47%) of the parents diagnosed with ASD rated themselves below the recommended diagnostic cut-off on the Autism Spectrum Quotient (AQ) whereas about 20% of the non-diagnosed parents of children with ASD scored above the cut-off on the AQ. Low parenting sense of efficacy was noted in undiagnosed mothers who scored highly on the AQ and in fathers who had formal diagnosis of ASD. These findings highlighted the importance of measuring traits of autism in parents of children with ASD and called for a reliable tool for this purpose. Thus Study 3 and Study 4 were devoted to test factorial solutions for the AQ. Study 3 (chapter 7) was based on data from 455 I Australian adults of whom 141 had clinical diagnosis of ASD. Study 4 (chapter 8) drew from 4,192 Taiwanese parents of whom 1,208 had children with ASD. Each study resulted in a factor model (AQ-39 and AQ-Chinese respectively) that demonstrated significantly improved goodness of fit than previously published factorial solutions for the AQ. The AQ was found to have consistent reliability across non-clinical and clinical populations, was culturally robust and its constructs corresponded with the current diagnostic taxonomy of ASD. The AQ-Chinese was the first AQ factorial solution tailored to the Mandarin-speaking community. Study 5 (chapter 9) employed the AQ-Chinese to test the link between self- perceived traits of autism and anxiety symptoms in 491 Taiwanese couples raising children with ASD. Unique to this study were its couple-centred approach and its inclusion of all anxiety domains. Large effect sizes were found in social phobia and post traumatic stress disorders for both genders, and in general anxiety disorder and agoraphobia for female. These associations were irrespective of child’s tendency towards autism, spouse’s AQ scores and the couples’ compatibility in their tendency towards autism. Findings from this research offer imperative theoretical and clinical implications in regard to broad autism phenotype in parents of children with ASD, parenting training and couple counselling approaches for adults with ASD, effects of child versus parental traits of autism on parental psychosocial functioning, cultural influence in autism, screening and diagnosing ASD in adults who are high functioning and research and clinical utility of the AQ. II Declaration by Author This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the policy and procedures of The University of Queensland, the thesis be made available for research and study in accordance with the Copyright Act 1968 unless a period of embargo has been approved by the Dean of the Graduate School. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis. III Publications during Candidature Lau, W.Y.P. & Peterson, C. (2010). Asperger Syndrome in Parent and in Child: The Effect on Marital Satisfaction and Family Dynamic. In: The IX International Congress of Autism Europe, poster session, Catania: Italy. Lau, W.Y.P., Peterson, C. & Kelly, A. (2010). Asperger Syndrome in Marriage and Parenthood. In: The 9th International Meeting for Autism Research (IMFAR), poster session. Philadelphia, USA. Lau, W.Y.P. & Peterson, C. (2010). When Asperger Syndrome Runs In The Family. In: The 27th International Congress of Applied Psychology (ICAP), poster session. Melbourne: Australia. Lau, W. Y. P. & Peterson, C. C. (2011). Adults and children with Asperger syndrome: Exploring adult attachment style, marital satisfaction and satisfaction with parenthood. Research in Autism Spectrum Disorders, 5, 392–399. Lau, W. Y. P., Peterson, C. C., Attwood, T. J., Garnett, M. S. & Kelly, A. B. (under review). Parents on the Autism Continuum: Self-Perceived Autistic Traits and Parenting Efficacy. (submitted on 17 May 2014). Lau, W. Y. P., Kelly, A. B. & Peterson, C. C. (2013). Further Evidence on the Factorial Structure of the Autism Spectrum Quotient (AQ) for Adults with and without a Clinical Diagnosis of Autism. Journal of Autism and Developmental Disorders, 43 (12), 2807-2815. Lau, W. Y. P., Gau S. S., Chiu, Y. N., Wu, Y. Y., Chou, W. J., Liu, S. K. & Chou, M. C. (2013). Psychometric properties of the Chinese version of the Autism Spectrum Quotient (AQ). Research in Developmental Disabilities, 34, 294-305. Lau, W. Y. P., Gau S. S., Chiu, Y. N., Wu, Y. Y. (2014). Autistic Traits in Couple Dyads as a Predictor of Anxiety Spectrum Symptoms. Journal of Autism and Developmental Disorders. First published online in June 2014. doi: 10.1007/s10803-014-2151-5. IV Publications Included in the Thesis 1. Publication incorporated as Study 1 (chapter 5): Lau, W. Y. P. & Peterson, C. C. (2011). Adults and children with Asperger syndrome: Exploring adult attachment style, marital satisfaction and satisfaction with parenthood. Research in Autism Spectrum Disorders, 5, 392–399. Contributor Statement of Contribution Winnie Yu Pow Lau (candidate) Recruited sample (100%) Developed and chose measures (100%) Performed data analyses (100%) Prepared tables (100%) Wrote manuscript drafts (100%) Revised manuscript for publication (70%) Prof. Candida Peterson (primary Supervised (100%) supervisor) Revised manuscript for publication (30%) V 2. Publication incorporated as Study 2 (chapter 6): Lau, W. Y. P., Peterson, C. C., Attwood, T. J., Garnett, M. S. & Kelly, A. B. (under review). Parents on the Autism Continuum: Self-Perceived Autistic Traits and Parenting Efficacy. (submitted on 17 May 2014). Contributor Statement of Contribution Winnie Yu Pow Lau (candidate) Recruited sample (80%) Developed and chose measures (100%) Performed data analyses (100%) Prepared tables (100%) Wrote manuscript drafts (100%) Revised manuscript for publication (70%) Prof. Candida Peterson (primary Supervised (80%) supervisor) Revised manuscript for publication (20%) Prof. Tony Attwood Recruited sample (10%) Dr Michelle Garnett Recruited sample (10%) Ass.
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