Adaptation of the Psychosocial Assessment Tool for Families of Children with Autism Spectrum Disorders

Background: Families of children with Autism Spectrum Disorders (ASD) are at increased risk for difficulties with psychosocial adjustment, but there is no established measure for identifying risk among these families.

Objectives:  The Psychosocial Adjustment Tool (PAT 2.0) is a brief screening measure designed to stratify families on level of psychosocial risk at the time their child is diagnosed with cancer. The measure identifieds families at need for universal, targeted, and clinical levels of support, consistent with NIMH models for prevention. The objective of this study is to adapt the PAT 2.0 for use in families of children with ASD.

Methods:  Parents of 31 children with an ASD completed the PAT 2.0 and Parenting Stress Index (PSI).

Results:  Parents (77% mothers) of 31 children completed the PAT 2.0. 87% of children were male and 94% were Caucasian. Ages ranged from 2 years, 6 months to 14 years, 11 months (Mean=6 years, 11 months; SD=3 years). 97% of caregivers completed at least a high school education.

Conclusions:  

Table 1

Descriptive Statistics

PAT 2.0 Scale	Scale Range	Mean	Standard Deviation	Range
Total	0-7	1.44	.583	.517-3.06
Structure and Resources	0-8	1.13	1.12	0-4
Family Problems	0-10	2.10	1.40	0-5
Social Support	0-4	.16	.374	0-1
Stress Reaction	0-3	.06	.250	0-1
Family Beliefs	0-4	1.10	1.012	0-3
Child Problems	0-14	9.19	2.738	4-14
Sibling Problems	0-14	1.26	1.843	0-7

Table 2

Pearson Correlation Matrix Among PAT Scales

	SRS	FPS	SSS	SRS	FBS	CPS
Total PAT	.491**	.660**	.657**	.169	.705**	.551**
Structure and Resources (SRS)	-	.461**	.268	-.150	.106	.111
Family Problems (FPS)	-	-	.479**	172	.205	.160
Social Support (SSS)	-	-	-	-.115	.310	.294
Stress Reaction (SRS)		.-	-	-	.238	-.165
Family Beliefs (FBS)	-	-	-	-	-	.258

Total PAT score was significantly correlated with the total score from the PSI (r=.599, p<.01). PAT scores were divided into quartiles. One-Way ANOVA indicated significant differences between quartiles in raw total PSI score (F(3, 24)=5.770, p=.001). Post-hoc analyses indicated significant differences only between quartiles 1 and 4 and 2 and 4. 87% of families endorsed PAT total scores of one standard deviation of the mean.

Discussion: Families of children with ASD's experience varying levels of psychosocial stress, which may increase risk for poor outcomes. On the PAT 2.0, a measure designed to identify at-risk families in a pediatric oncology population that was adapted for ASD, families reported few psychosocial difficulties, with the exception of child behavior problems. PAT subscale scores were significantly correlated with the total PAT score, except for the stress reaction scale. This scale focused on trauma reactions, a construct that may not be meaningful in this population. In contrast to prior studies, which used this measure to divide families into three groups, a single cut-off was the most effective at identifying at risk families in this study. Further refinement of this measure for use in an ASD population with a larger sample size is warranted to increase its utility as a method for identifying families that are at risk.