Parent-Child Interactions in Families of Adults with Autism Spectrum Disorder during an Intervention Focused on Increased Social and Adaptive Functioning

Background: Research on adults with autism spectrum disorder (ASD) has found that a significant proportion of these individuals struggle to attain independence, and continue to live with their parents well into adulthood. Yet, we know little about relationships between adults with ASD and their parents, and the few studies to date have relied solely on parent-report questionnaires and interviews assessing parent perspectives when investigating their associations with young adult outcomes. This is a clinically important gap in our knowledge as enhancing the understanding of parent-young adult relationships may aid in the development of treatments for adults with ASD.

Objectives: The current pilot study is the first to use observational coding to assess positivity and control during parent-young adult discussions regarding autonomy, and to examine how the correlates of these relationship characteristics are associated with change during the course of a recently published intervention to enhance coping and adaptive skills in young adults with ASD.

Methods: Eleven adults with ASD (aged 18 – 39) were recruited from the wait list of an ongoing randomized control trial designed to improve coping skills and adaptive skills (Oswald et al., 2017). Adults and one parent engaged in a standardized discussion task with their parents and were given assessments of adaptive behavior (Adaptive Behavior Assessment-3rd Edition, Harrison & Oakland, 2003; Adult Behavior Checklist, Achenbach & Rescorla, 2003) before and after receiving the intervention. The discussions were coded with the Iowa Family Rating Scales (Melby et al., 1998) for levels of parent and child positivity and controlling behavior.

Results: There was high levels of baseline positivity in both parents and adults with ASD. Levels of controlling behaviors in dyads (e.g., behaviors that served to control, influence, or dominate the opinions, actions, or points of view of others) were negatively associated with changes in levels of adult adaptive functioning. Specifically, controlling behaviors observed in dyads before intervention were negatively associated with growth on conceptual adaptive behaviors—which consist of items regarding an individual’s academic, communicative, and self-direction skills (rs(9) = -.66, p = 0.03). The association with growth on adaptive behavior was similar for both parent and child control (see Figure 1).

Conclusions: Higher levels of control during conversations about autonomy may prevent adults from making improvements in the skills required to attain independence. Perhaps, in consideration of their children’s strengths and difficulties, parents of adults with ASD may feel the need to more closely guide their young adult’s behavior by lecturing or directing their thinking about how to live independently. However, parents who use controlling communication may be limiting their young adults’ ability to develop decision-making and self-direction skills. Findings emphasize the need to better understand features of the parent-child relationship and their association with the functioning of young adults with ASD. This is especially true given that the emerging literature indicates that interventions targeting self-determination and coping skills appear to be most effective for promoting optimal outcomes in young adults with ASD (Hume, Loftin, & Lantz, 2009; Oswald et al., 2017; Palmen, Didden & Lang, 2012).