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J Autism Dev Disord (2011) 41:848858

DOI 10.1007/s10803-010-1105-9

ORIGINAL PAPER

Feeling Good, Feeling Bad: Influences of Maternal Perceptions


of the Child and Marital Adjustment on Well-being in Mothers
of Children with an Autism Spectrum Disorder
Diane M. Lickenbrock Naomi V. Ekas
Thomas L. Whitman

Published online: 14 September 2010


Springer Science+Business Media, LLC 2010

Abstract Mothers of children with an autism spectrum


disorder (n = 49) participated in a 30-day diary study
which examined associations between mothers positive
and negative perceptions of their children, marital adjustment, and maternal well-being. Hierarchical linear modeling results revealed that marital adjustment mediated
associations between positive perceptions and maternal
well-being. Mothers who reported higher levels of positive
perceptions of the child were higher in marital adjustment
and well-being. Results also revealed that marital adjustment moderated the relation between negative perceptions
and negative maternal affect. Mothers low in marital
adjustment had a positive association between negative
maternal perceptions of the child and negative maternal
affect. These findings highlight the dynamic roles that

Diane M. Lickenbrock is now at The Pennsylvania State University.


This research study was supported by the Institute for Scholarship in
the Liberal Arts at the University of Notre Dame. The second author
was also supported by an NIMH training grant (2 T32 HD007184-28)
We would like to thank the parent support groups for their help and
support in participant recruitment as well as the mothers who gave
their time to participate in this research study. We would also like to
thank Cindy Bergeman and Anthony Ong for their help in the
development of this project.
D. M. Lickenbrock  T. L. Whitman
University of Notre Dame, South Bend, Indiana, USA
N. V. Ekas
University of Miami, Coral Gables, Florida, USA
D. M. Lickenbrock (&)
Department of Human Development and Family Studies,
The Pennsylvania State University, South 1 and 2 Henderson
Building, University Park, PA 16802, USA
e-mail: dml31@psu.edu

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mothers perceptions and marital adjustment play in


determining maternal psychological outcomes.
Keywords Autism  Daily experiences  Marital
adjustment  Maternal well-being  Multilevel modeling 
Negative and positive maternal perceptions of the child

Autism spectrum disorders (ASDs) are a group of developmental disorders that are defined by social interaction
deficiencies, communication delays, and restricted, repetitive behavior patterns (American Psychiatric Association
2000). According to Kogan et al. (2009), ASD may occur
as frequently as 1 in 91 children. Because of the pervasive
features of the disorder, raising a child with an ASD often
exerts considerable pressure on the family (Whitman,
2004). For example, families must cope with the initial
diagnosis, search for treatment and intervention services,
modify their parenting practices, and manage the substantial financial burden of paying for services. These
challenges, although not unique to this disorder, are often
more severe than those confronted by families of children
with other disabilities (Koegel et al. 1992).
The socioemotional impact of raising a child with an
ASD on the family is extensive, affecting all of its
members (e.g., Higgins et al. 2005; Pottie et al. 2009).
For example, siblings of children with an ASD have been
reported as having more extensive behavioral and emotional problems than siblings of typically developing
children and siblings of children with other developmental
disorders (Bishop et al. 2007; Fisman et al. 2000). Most
research on the family, however, has focused on the
impact of an ASD on parent well-being (e.g., Pottie et al.
2009); of particular note is research indicating that fathers
of children with an ASD experience less stress than

J Autism Dev Disord (2011) 41:848858

mothers (Lee 2009; Tehee et al. 2009). This finding is not


surprising given that mothers typically have more
responsibilities for the daily care of the child with an
ASD (Tehee et al. 2009).

Effects on Mothers
Considerable research has been conducted examining the
adverse effects of raising a child with an ASD (e.g., Bishop
et al. 2007; Hastings and Brown 2002). For example, Ekas
and Whitman (2010) found that greater severity of ASD
symptoms was directly related to increased maternal stress.
Research has also indicated that the behavioral problems of
children with an ASD are associated with elevated psychological distress in mothers (e.g., Abbeduto et al. 2004;
Fisman and Wolf 1991; Olsson and Hwang 2001), which
can also affect parenting behaviors. For example, Osborne
and Reed (2010) found that increased parenting stress
among parents of children with an ASD was associated
with less parental involvement, communication, and limit
setting for the child. Moreover, mothers of children with an
ASD have been found to display increased rates of
depression (e.g., Ekas et al. 2009).
Although many studies suggest that raising a child with
an ASD can be a stressful experience for mothers; other
research reports that some mothers experience positive
psychological benefits. For example, mothers have reported
that their children have brought their family closer together
(Towbin et al. 2002) and helped them become more
resilient (Bristol 1987). A number of studies indicate that
the specific socioemotional impact on mothers well-being
varies and depends upon other factors, such as how they
perceive their child and the quality of their marital relationship. For example, several studies suggest that the
impact on mothers of children with an ASD may vary
depending upon whether they emphasize more the negative
attributes and deficiencies of the child (e.g., behavior
problems, symptom severity; Ekas and Whitman 2010;
Phelps et al. 2009; Pottie et al. 2009) or their positive
attributes and accomplishments (Hastings and Taunt 2002).
The current study examined both the influence of negative
and positive maternal perceptions in mothers of children
with an ASD.

Importance of the Marital Relationship


In addition to the impact of an ASD on mothers psychological well-being, mothers relationships with others may
be affected. For example, results of a study by Lee (2009)
suggest that a child with an ASD can have an adverse direct
impact not only on the parents individually (e.g., parenting

849

stress), but also on the marital relationship. More generally,


higher rates of divorce and separation have been found in
parents of children with developmental disabilities in
comparison to parents of typically developing children
(Risdal and Singer 2004). However, many parents of
children with developmental disorders have reported that
the child brings them closer together (Risdal and Singer
2004). Other research suggests that the marital relationship
may sometimes buffer the stress of having a child with an
ASD (Risdal and Singer 2004).
Marital adjustment is defined as the functioning and
success of marital partners, and it encompasses the concepts of marital satisfaction and happiness (Crane et al.
1990, p. 87). This construct is most commonly assessed by
self-report measures which encompass marital conflict,
quality, and happiness (i.e., Marital Adjustment Test;
Locke and Wallace 1959). However, the Marital Adjustment Test was designed to measure marital adjustment
over a longer duration than 1 day. Therefore, the present
study utilized a checklist in which mothers reported their
daily interactions with their spouses. Overall, the present
study examines the direct effect of marital adjustment on
maternal well-being as well as its role as a mediator and
moderator of the impact of the child with an ASD on
maternal functioning.

The Present Study


The present study is the first to employ a 30-day daily
diary methodology in evaluating the antecedents of
maternal well-being in mothers of children with an ASD.
However, this general methodology has previously been
employed in the study of stress and coping in both typical
populations and in families of children with an ASD (e.g.,
Ong et al. 2006; Smith et al. 2010). Daily dairy methods
avoid errors associated with retrospective studies (Bolger
et al. 2003). Moreover, through the use of daily diary
methods, both interindividual differences and intraindividual change can be examined (Bolger et al. 2003). In
the present study, the use of daily diaries allowed for the
relationships between maternal perceptions of their child,
the marital relationship, and maternal well-being to be
examined in a more dynamic way than is possible when
using a cross-sectional or more traditional longitudinal
research designs.
Past research examining how children with ASDs
influence their mothers well-being has traditionally
emphasized their negative impact rather than the potential
positive impact. Most commonly, studies have evaluated
parental stress and depression (e.g., Olsson and Hwang
2001). Several studies, however, have focused on the
positive outcomes of raising a child with autism (e.g., Ekas

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850

et al. 2009; Hastings et al. 2005). The present study


expands this research by examining the influence of
maternal perceptions of the child and the marital relationship on both positive and negative aspects of maternal
well-being. Only a few studies in the area of autism have
measured both positive and negative outcomes in the same
study (e.g., Hastings et al. 2005; Hastings and Taunt 2002;
Pottie et al. 2009). These studies suggest that positive and
negative dimensions of parental outcomes are only modestly correlated and thus may be relatively independent of
one another (e.g., Hastings and Taunt 2002). This perspective is further reinforced by studies of typical populations and children with other developmental disabilities
in which these two dimensions are predicted by different
factors (e.g., Trute and Hierbert-Murphy 2002; Watson and
Clark 1997; Zatura and Reich 1983).
In the present study, we examined how different types of
maternal perceptions of the child (negative and positive)
and marital adjustment influenced maternal well-being.
Consistent with past research, we hypothesized that
mothers negative perceptions of the child would directly
predict negative maternal affect, but not positive maternal
affect (Cohen et al. 2005; Hastings et al. 2005; Zatura and
Reich 1983) and mothers positive perceptions of the child
would be directly associated with higher positive maternal
affect, but not negative maternal affect. We also predicted
that marital adjustment would be directly related to positive
maternal affect and inversely related to negative maternal
affect.
In addition, we examined whether the marriage mediated or moderated the relationship between mothers perceptions of their children with an ASD and their wellbeing. Although, to our knowledge, past research in the
area of autism has not specifically examined the influence
of the marital relationship on well-being, research with
mothers of children with other disabilities have found that
stressful events affect the quality of the marriage as well as
the well-being of the partners (e.g., Cohan and Bradbury
1997; Gerstein et al. 2009). Moreover, research with families of children with an ASD has found that the amount of
social support received from their spouse mediated the
relationship between life events (negative and positive) and
maternal well-being (e.g., Pottie et al. 2009). Still other
research has suggested that the marital relationship may
serve as a protective factor (e.g., Pottie et al. 2009; Risdal
and Singer 2004), and may buffer the relationship between
stress and well-being. In the present study we hypothesized
that marital adjustment would mediate the relationship
between mothers perceptions of their child (positive and
negative) and maternal well-being (positive and negative).
We also examined whether marital adjustment might
moderate the relationship between maternal perceptions of
the child and maternal well-being

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J Autism Dev Disord (2011) 41:848858

Method
Participants
Participants were part of a larger longitudinal study
examining stress and well-being in mothers of children
with an ASD. Participants were recruited through both a
regional autism service center and local autism support
groups. Mothers had to have at least one child younger than
18 years of age who had been diagnosed with an ASD in
order to participate. This study took place in two phases:
the first a cross-sectional phase and the second a longitudinal, daily diary phase. During the cross-sectional phase,
mothers completed questionnaires (e.g., demographic
information, life satisfaction, self-control, social support,
etc.) at one time-point. The 122 mothers, who completed
phase 1 of the study, were contacted through a letter
seeking their permission to participate in phase 2, the daily
diary portion. Mothers who chose not to take part in phase
2 returned a prepaid postcard indicating their decision.
Fifty mothers expressed interest in phase 2, resulting in a
42% response rate. Forty-nine mothers from phase 2 were
included in the present study; one mother was removed
from the study because she did not have data pertaining to
the marital relationship. Therefore, only data from phase 2
(n = 49) was used in the present study because we were
interested in assessing daily relationships. Participants
received no compensation for study participation.
The marital status of the mothers was as follows: married (87.8%), divorced (6.1%), widowed (2.0%), and single
(4.1%). Mothers were predominately Caucasian (93.9%).
Socioeconomically, 36.8% of the mothers had annual
household incomes greater than $75,000, 42.9% earned
$74,999 to $25,000, and 16.3% earned less than $24,999.
The majority of mothers either completed college or had
some college training (69.3%) or completed postgraduate
training (20.4%); and the remainder had a high school
degree or less (10.2%). Mothers ranged in age from 29 to
61 (M = 41.19, SD = 7.01). Children were between the
ages of 2 and 18 (M = 10.18, SD = 4.31), and were predominately male (77.6%). Four families had at least one
other child who was also diagnosed with an ASD. Test of
differences between the individuals who participated in the
current daily diary study (n = 49) compared to the
remainder of the total sample (n = 73) revealed no significant differences between groups with regard to marital
status, household income, race, age (mother or child), or
child gender.
Procedure
The daily diary data was collected over 30 consecutive
days. Participants were randomly assigned to receive an

J Autism Dev Disord (2011) 41:848858

initial mailing of a 10-, 15-, or 20-day diary packet that


contained several questionnaires including daily measures
of positive and negative life events, positive and negative
maternal affect, locus of control, positive and negative
perceptions of the child, parenting stress, and child symptom severity. A second mailing containing the remaining
days of questionnaires was mailed separately. Participants
were asked to respond to the questionnaires each evening
and return the completed diaries at the end of each designated period.
Measures
Negative Perceptions of the Child
Mothers negatively oriented perceptions of their children
were examined through the identification of childrens
autism-related symptomatology and evaluation of the
degree to which these symptoms were stressful to them.
Specifically, mothers were asked each day via an 8-item
scale whether the child displayed specific ASD and other
related symptoms, specifically problems and deficiencies in
the following areas: behavioral, motor, emotional, communication and comprehension, cognitive, social interaction, and sensory difficulties. If mothers indicated yes, that
a specific deficiency or problem (e.g., motor difficulties,
self-regulation difficulties) was displayed, they indicated
the degree of stress experienced in response to that
symptom on a 7-point Likert scale ranging from 1(not at
all) to 7 (extremely). A total score was computed with a
high score indicating more negative perceptions of the
child. Possible scores ranged from 0 to 56. Being that not
all events occurred on the same day, Cronbach alphas
could not be calculated.
Positive Perceptions of the Child
Mothers positively oriented perceptions of their children
were examined through the identification of their childrens
competencies and accomplishments within domains in
which children with an ASD frequently show delays are
challenged, including: behavioral, motor, emotional, communication and comprehension, cognitive, social situations, and sensory. For each domain, mothers indicated
whether their child displayed competency (e.g., motor
skills, self-regulation) that day. If the mothers indicated
yes, they then used a 7-point Likert scale ranging from 1
(not at all) to 7 (extremely) to indicate the degree of
enjoyment they experienced in response to that event. A
total score was computed with a high score indicating
higher enjoyment. Possible scores ranged from 0 to 56.
Being that not all events occurred in 1 day, a Cronbach
alpha could not be calculated.

851

Marital Adjustment
The Small Life Events Scale (Zatura et al. 1986) was used
to evaluate how mothers perceived their daily relationship
with their spouse. For this study, 12 events (positive and
negative) were chosen for this evaluation. Sample questions include I argued with my spouse and I kissed and/
or had pleasing contact with my spouse. Participants were
asked to indicate if the event had occurred that day. If the
event did occur, participants used a 7-point Likert-type
scale to indicate how stressful (negative events) or how
enjoyable (positive events) were (1 = not at all to
7 = extremely). An average marital well-being score was
computed with a high score indicating high marital wellbeing. In order to create the average score negative items
were reverse coded and then averaged with the positive
items. This was done in order to obtain a marital well-being
score that captured both positive and negative events.
Possible scores ranged from 1 to 7. Being that not all
events occur on the same day, Cronbach alphas could not
be calculated for this measure.
Maternal Well-Being
The Positive and Negative Affect Schedule (PANAS;
Watson et al. 1988) is a 20-item self-report measure
designed to measure two dimensions of mood: positive
mood (10 items) and negative mood (10 items). Participants indicated the extent to which they experienced each
affective state, such as distressed or inspired, on a
daily basis by using a 7-point Likert-type scale ranging
from 1 (not at all) to 7 (extremely). Total scores were
created separately for positive and negative mood. A high
score indicated high levels of that affective state with
possible scores ranging from 10 to 70 each mood. On
Day 1, Cronbachs alphas were .93 for positive affect and
.92 for negative affect. Watson et al. (1988) reported
high internal consistency, adequate testretest reliability,
and external validity with measures of distress and
psychopathology.
Data Analysis Plan
Hierarchical Linear Modeling (HLM; Raundenbush and
Bryk 2002) was used to test all research questions in the
current study. HLM is used when the data possesses a
hierarchical structure, and is appropriate for this study
because there are 30 daily diaries nested within each participant. HLM allows for simultaneous estimation of two
models: the Level 1 model and the Level 2 model. The
Level 1 model, the day-level model, addresses questions
pertaining to intraindividual change (e.g. within-person
change). The Level 2 model, the person-level model,

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J Autism Dev Disord (2011) 41:848858

allows for the investigation of interindividual differences in


intraindividual change (e.g. between-person differences;
Nesselroade 1991). Lower-level mediation (Bauer et al.
2006), a specific type of HLM model, was used to examine
the research questions in the current study because the data
was on a day-level. Specifically, we were able to examine
how each variable (e.g. negative perceptions of the child,
positive perceptions of the child, marital adjustment,
mother positive well-being, mother negative well-being)
was related to each other on a daily level. Moreover, we
were able to test whether marital adjustment mediated the
relationship between perceptions of the child (positive or
negative) and maternal well-being. The last research
question was moderational in nature, and therefore we used
HLM to assess a daily moderational framework.

Results
Results are presented in four parts. First, descriptive analyses and zero-order correlations were conducted between
all variables. Second, analyses were conducted to determine whether possible covariates should be included in the
models. Third, lower-level mediation models that were
used to test our first research questions are presented.
Fourth, moderation models were used to test our second
research question.
Preliminary Analyses
Descriptive statistics are presented in Table 1. The skewness and kurtosis suggested that all of the variables were
normally distributed, except for negative maternal affect,
which revealed a peaked distribution but still had an
acceptable kurtosis value (close to 10). Therefore, there
were no severe violations of normality. Overall, mothers
reported higher daily negative perceptions of the child than
daily positive perceptions of the child. Secondly, mothers
mean marital adjustment (M = 4.32) is slightly above the
average on the 7-point Likert scale. Lastly, mothers
reported higher daily positive affect than daily negative
affect.

Table 2 Correlations between maternal affect, marital adjustment,


and maternal perceptions of the child
1

1. Negative perceptions of the child


2. Positive perceptions of the child

.24a

3. Marital adjustment

-.04

.23a

4. Negative maternal affect

.43** -.10

5. Positive maternal affect

-.40

-.38*

.46** .47**

-.27a

p B .10; * p \ .05; ** p \ .01. Variables were averaged across the


30-days

Correlation analyses were conducted to examine associations between the variables of interest. The correlations
were mean-level, thus the variables were averaged across
the 30-days. In Table 2, negative maternal perceptions of
the child and positive maternal perceptions of the child
were found to be unrelated, however, there was a nonsignificant trend suggesting that the higher the positive
maternal perceptions of the child, the higher the negative
maternal perceptions of the child. Negative maternal perceptions of the child were positively associated with negative maternal affect and not related to positive maternal
affect. Marital adjustment was not significantly related to
negative affect, however, there was a non-significant trend
suggesting that it was positively associated with positive
maternal affect. Similarly that positive and negative
maternal affect were negatively, but non-significantly,
correlated with one another.
Lower-Level Mediation Models
The first model examined whether marital adjustment
mediated the relationship between negative maternal perceptions of the child and negative maternal affect. As
shown in Fig. 1, the direct path from negative perceptions
of the child to negative maternal affect was found to be
significant such that mothers who reported higher negative
perceptions of their children also reported increased daily
negative affect. Additionally, the path from marital
adjustment to daily negative affect was significant such that
mothers who reported as higher marital adjustment also

Table 1 Descriptive statistics for variables


N

Mean

SD

Negative perceptions of the child

49

12.30

7.73

1.00 to 32.60

.74

-.19

Positive perceptions of the child

49

11.45

4.54

3.70 to 23.07

.60

-.16

Marital adjustment

49

4.32

1.16

1.00 to 6.55

-.80

1.45

Negative maternal affect


Positive maternal affect

47
48

18.20
39.00

8.25
10.60

10.30 to 58.50
11.17 to 57.06

2.82
-.49

11.61
.08

Note: Variables were averaged across the 30-days to report the descriptive statistics

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Range

Skewness

Kurtosis

J Autism Dev Disord (2011) 41:848858

853

.34 (SE=.05)***
Negative
Maternal Affect

Negative Maternal
Perceptions

-1.57 (SE=.46)**

.02 (SE=.004)**

-1.20 (SE=.41)**
Marital
Adjustment

Marital
Adjustment

B
Negative Maternal
Perceptions

Negative
Maternal Affect

Positive Maternal
Perceptions

Positive
Maternal Affect
2.35 (SE=.42)***

Positive Maternal
Perceptions

.26 (SE=.05)***

.01 (SE=.004)**

Positive
Maternal Affect
2.03 (SE=.43)***

Marital
Adjustment

Marital
Adjustment

Fig. 1 Mediation models with negative perceptions of the child.


** p \ .01, *** p \ .0001. Dashed lines indicate non-significant
paths. Models predicted negative maternal affect (a) and positive
maternal affect (b)

Fig. 2 Mediation models with positive perceptions of the child.


** p \ .01, *** p \ .0001. Dashed lines indicate non-significant
paths. Models predicted negative maternal affect (a) and positive
maternal affect (b)

reported lower levels of daily negative affect. The path


from negative perceptions of the child to marital adjustment was found to be non-significant. Therefore, there was
no relationship found between negative perceptions of the
child and marital adjustment. Even though the total effect
was found to be non-significant, researchers suggest testing
the indirect effects, because it is possible that mediation is
present if the total indirect effect is significant (Hayes
2009; MacKinnon et al. 2000). Therefore, the random
indirect and total effects were calculated and 95% confidence intervals computed following the suggestion of
Bauer et al. (2006). In this model, the random indirect
effect was .01 (SE = .01) and the 95% confidence interval
did contain zero (-.01 to .04). The random total effect was
.35 (SE = .46) and the 95% confidence interval did contain
zero (-.55 to 1.25). Thus, there was no significant evidence that mediation, partial or complete, was present in
this model.
The second mediation model tested whether marital
adjustment mediated the relationship between negative
maternal perceptions of the child and positive maternal
affect. As shown in Fig. 1b, the path from marital adjustment to positive affect was significant such that mothers
who reported higher marital adjustment also reported
higher positive affect each day. The remaining paths were
found to be non-significant. Being that this model only had
one significant path; the random indirect effect and the
random total effect were not calculated.
The third model tested whether marital adjustment was a
mediator between positive maternal perceptions of the
child and negative maternal affect. As shown in Fig. 2a, the
path from positive perceptions of the child to marital
adjustment was significant such that mothers who reported
higher levels of positive perceptions of the child also

reported higher in marital adjustment. Additionally, the


path from marital adjustment and negative affect was significant such that mothers who reported higher levels of
marital adjustment also reported lower levels of negative
affect. The path from positive perceptions of the child to
negative affect was found to be non-significant. The random indirect effect and random total effect was tested in
order to conclude that this model had full mediation. The
random indirect effect was -.02 (SE = .01) and the 95%
confidence interval did not contain zero (-.03 to -.01).
The random total effect was -.06 (SE = .41) and the 95%
confidence interval did contain zero (-.85 to .74). Being
that random indirect effect did not contain zero and the
random total effect did contain zero, it could be concluded
that full mediation existed in this model.
The fourth model tested whether marital adjustment was
a mediator between positive maternal perceptions of the
child and positive affect. As shown in Fig. 2b, all of the
paths were significant. More specifically, the direct path
from positive perceptions of the child to positive maternal
affect was significant such that mothers who reported
greater positive perceptions of their children also reported
higher levels of positive affect. The path from positive
perceptions of the child to marital adjustment was significant such that mothers who reported greater positive perceptions of their children also reported higher levels of
marital adjustment. Lastly, the path from marital adjustment to positive affect was significant such that mothers
who reported greater marital adjustment also reported
higher levels of positive affect. The random effect and
random total effect was tested in order to determine whether this model had full or partial mediation. The random
indirect effect was .03 (SE = .01) and the 95% confidence
interval did not contain zero (.01 to .06). The random total

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20

Table 3 Parameter estimates for the moderation model measuring


marital adjustment as a moderator between negative perceptions of
the child and maternal negative affect

Intercept
Day
Negative perceptions of the child
Marital adjustment
Negative perceptions of the child X

19.12 (1.43)
.01 (.08)
.36(.06)
-1.36 (.41)
-.06 (.03)

df
13.33***

42

.13

42

5.85***
-3.27**

42
42

-2.02*

42

Marital adjustment
* p \ .05; ** p \ .01; *** p \ .001

effect was .30 (SE = .13) and the 95% confidence interval
did not contain zero (.03 to .56). Being that both the random indirect effect and the random total effect 95% confidence intervals were found to not contain zero, it could be
concluded that partial mediation existed in this model,
more specifically, that there was evidence that positive
perceptions of the child had both a direct effect as well as
an effect mediated through the marital relationship.
The final set of 4 models tested the extent to which
marital adjustment moderated the associations between: (a)
negative maternal perceptions of the child and negative
maternal affect; (b) negative maternal perceptions of the
child and positive maternal affect; (c) positive maternal
perceptions of the child and negative maternal affect; and
(d) positive maternal perceptions of the child and positive
maternal affect. As shown in Table 3, the only moderation
model that was found to be significant was the model in
which marital adjustment moderated the relationship
between negative maternal perceptions of the child and
negative maternal affect. Using Aiken and Wests (1991)
procedures for examining significant interaction effects, we
used a computer program by Dawson and Richter (2006) to
graph the significant moderator interaction (see Fig. 3).
Separate negative affect and negative perceptions of the
child regression lines were generated for days of high
marital adjustment (1 standard deviation above the mean)
and low marital adjustment (1 standard deviation below the
mean). Specifically, it was found that for mothers high in
marital adjustment there was no apparent association
between negative perceptions of their children and negative
affect. However for mothers low in marital adjustment,
there was a positive association between negative perceptions of their children and negative affect. All of the other
moderation models were found to be non-significant.

Discussion
Past research examining how children with an ASD influence their mothers well-being has emphasized the impact

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Negative Maternal Affect

B (SE)

18
16
14
12
10
8
6

Low Marital Adjustment


High Marital Adjustment

Low Negative Maternal


Perceptions

High Negative Maternal


Perceptions

Fig. 3 Moderation model with marital adjustment as a moderator


between negative perceptions of the child and negative maternal
affect

of the childrens deficiencies and problems rather than their


positive characteristics. Moreover, while research with
parents of children with an ASD has typically measured
parents negative socioemotional outcomes (e.g., Olsson
and Hwang 2001), few studies have focused on the positive
socioemotional outcomes associated with raising a child
with an ASD (e.g., Ekas et al. 2009). Even fewer studies
have evaluated both positive and negative maternal outcomes in the same study (e.g., Pottie et al. 2009). The
present study expands this research by examining, on a
daily level, both negative and positive dimensions of not
only mothers perceptions of her child but also maternal
well-being. Moreover, although previous research has
examined the effects of raising a child with an ASD on
maternal well-being (e.g., Bishop et al. 2007; Ekas and
Whitman 2010; Pottie et al. 2009; Tehee et al. 2009), the
present study is the first to address the extent to which
mothers perceptions of their children with an ASD is
associated with both marital adjustment and maternal wellbeing across 30 consecutive days.
Correlational data indicated that positive and negative
maternal perceptions of the child were not significantly
related to one another. These preliminary results are consistent with research that indicates positive and negative
perceptions are separate dimensions with different antecedent influences (Hastings and Taunt 2002). Examining
the direct associations between maternal perceptions of the
child on maternal outcomes, we found support for our
hypotheses that negative perceptions of the child would be
associated with negative maternal affect, but not positive
maternal affect, and that positive perceptions of the child
would be associated with positive maternal affect, and not
negative maternal affect. These findings support previous
research suggesting that positive and negative maternal
outcomes may have different patterns of causal factors

J Autism Dev Disord (2011) 41:848858

(Cohen et al. 2005; Hastings et al. 2005; Zatura and Reich


1983). For example, Zatura and Reich (1983) also found
that positive life events were related to increased positive
affect, but not to psychological distress, and that negative
life events were positively related to distress, but not
positive affect. Additionally, previous research has found a
positive association between positive attributes of the child
and positive maternal outcomes (Bristol 1987; Towbin
et al. 2002). These results in conjunction with our own
suggest that by focusing on both the positive and negative
features of children with a developmental disability, a more
complete picture of the impact of this disability on parental
well-being is obtained.
Examining the direct relations between maternal perceptions of the child and marital adjustment, through our
longitudinal analyses, we found as hypothesized that positive maternal perceptions of the child with an ASD were
directly related to marital adjustment; specifically, mothers
who reported higher levels of positive perceptions of their
children also reported higher levels of marital adjustment.
These findings are generally consistent with the broader literature examining parents of children with developmental
disabilities. For example, Hastings and Taunt (2002) reported that parents who focused on the positive attributes of the
child with a disability, tended to also emphasize family
growth and gains, suggesting that focusing on the positive
accomplishments helps to promote positive family outcomes. Contrary to our hypothesis, mothers negative perceptions of their children were not associated with marital
adjustment. While previous research has typically found that
negative aspects of the child with developmental disability
have typically led to problems in the marriage, this is not
necessarily the case (Fisman and Wolf 1991). The results of
our study suggest that mothers may not have allowed negative perceptions of the child to carry-over into their feelings
about their marital relationship, and thus were able to differentiate their feelings as a mother from that as a wife
(Belsky et al. 1991; Cummings et al. 2000).
Regardless of how mothers perceived their children, the
marital relationship was found to directly relate to their
well-being. More specifically, there was a direct relation
between marital adjustment and maternal outcomes, such
that mothers who reported higher levels of marital adjustment also reported higher positive affect and lower negative affect. These results are generally consistent with past
studies examining the relationship between the marital
relationship and well-being (Cohen and Wills 1985;
Hetherington 2003; Williams 2003). For example, Hetherington (2003) found that lower marital satisfaction was
associated with lower psychological well-being. Moreover,
Williams (2003) found that greater marital stress was
associated with an increase in depression and lower overall
life satisfaction.

855

Another major objective of the present study was to


examine whether marital adjustment mediated and/or
moderated the relationship between maternal perceptions
of their child with an ASD and maternal well-being. We
found partial support for these meditational hypotheses.
More specifically, mothers who reported higher levels of
positive perceptions of their children also reported
increased marital adjustment, which, in turn, was associated with both lower levels of negative affect and higher
levels of maternal positive affect. These findings are consistent with other research examining the effects of social
support and mood in parents of children with autism
(Benson and Karlof 2009; Pottie et al. 2009; Pottie and
Ingram 2008). For example, Pottie et al. (2009) found that
social support was associated with positive and negative
daily mood in parents of children with autism, such that
social support increased positive mood and decreased
negative mood. In contrast, marital adjustment did not
mediate either of the relationships between negative perceptions of the child and the negative and positive indicators of maternal well-being. This finding supports more
general studies which claim that mothers of typically
developing children are capable of keeping different roles
and relationships distinct from one another (Belsky et al.
1991; Cummings et al. 2000). More generally, the results
of the meditational analyses, in conjunction, seemed to
indicate that marital adjustment plays a different role when
the effects of perceptions of the child or maternal wellbeing are considered, specifically, only mediating the effect
of positive perceptions of the child on maternal well-being.
We also found that marital adjustment served as a
moderator between negative perceptions of the child and
negative maternal affect. More specifically, for mothers
low in marital adjustment, the relation between negative
perceptions of the child and negative affect was directly
related, with more negative perceptions of the child associated with greater negative maternal affect. In contrast,
moderation was not supported for the influence of negative
perceptions of the child on positive maternal affect or the
influence of positive perceptions of the child on both
positive and negative maternal well-being. Thus, marital
adjustment appears to exacerbate the relationship between
mothers negative perceptions and negative maternal
affect, but does not serve as a protective factor.
When examined in conjunction, the results of the meditational and moderational analyses, suggest the complexity
of the role that marital adjustment plays in the relationship
between maternal perceptions of the child and maternal
well-being. However, the meditational analyses reveals
that marital adjustment can translate the influence mothers
positive perceptions of their children to their overall wellbeing by enhancing positive affect and reducing negative
affect. Marital adjustment does not play this role when

123

856

mothers negative experiences with her children are considered. Moreover, the meditational analyses indicate that
marital adjustment can further exacerbate mothers negative well-being when she views her child in a more negative fashion.
These results underline the importance of examining
both positive and negative maternal outcomes in one study.
Correlational results revealed that positive maternal affect
and negative maternal affect were not significantly related.
As indicated, the direct effects of positive and negative
maternal perceptions varied depending on which maternal
outcome was examined. Moreover, marital adjustment
played different meditational and moderational roles
depending whether maternal positive or negative outcomes
were considered. These findings support previous research
suggesting that positive and negative dimensions of
parental outcomes are relatively independent of one
another (e.g., Hastings and Taunt 2002), and that these two
dimensions are predicted by different factors (e.g., Trute
and Hierbert-Murphy 2002; Watson and Clark1997; Zatura
and Reich 1983).
Limitations, Future Directions, and Conclusions
There are several limitations to the present study. First,
mothers in this sample were mostly better educated, married, Caucasian, and living above the poverty line.
Research needs to examine whether findings from this
study generalize to less advantaged and racially diverse
populations. Second, it is not clear how relationships found
in this study change over a longer period of time. Future
studies should consider utilizing a broader longitudinal
time-line, for example, extending from the time when the
child is first diagnosed to when the child enters to school to
the time the child enters adolescence.
Third, our measure of marital adjustment, taken from the
Small Life Events Questionnaire (Zatura et al. 1986), was
not a commonly used measure of marital adjustment.
Future studies should consider replicating these results with
an established and more commonly used measure of marital satisfaction. Fourth, the present study used only
maternal self-report measures. By having solely maternal
report, we have potentially obtained a more limited view of
mothers day-to-day lives, for this reason it would be
helpful to have multiple measures of child characteristics,
marital adjustment, maternal well-being, including reports
from the father and siblings. Lastly, the present study only
examined the daily effects of raising a child with an ASD
on mothers, and not on the other members of the family
system such as fathers and siblings. Therefore, future
studies need to consider the impact of on all members of
the family in order to obtain a more complete picture of the
day-to-day events in families of children with an ASD, and,

123

J Autism Dev Disord (2011) 41:848858

in particular, how the impact ripples dynamically across


family members.
One implication of our results is for future studies to
incorporate an intervention for parents of children with an
ASD that not only to help parents cope with the challenges
of having a child with an ASD, but also to aid them
appreciate the positive characteristics of the child as well
as the gains that can be made through intervention. This
study also stresses the need to support the marital partnership, and to aid family members in negotiating their
roles within the family unit, and, in particular, to help
partners appreciate how the marital relationship can serve
as a built-in support system. Such an intervention should
focus not only on increasing awareness but also on teaching effective communication, listening skills, and conflict
resolution skills (Cummings et al. 2008). By supplying
couples with different skills and strategies the well-being
of individual family members can be enhanced (Cummings
et al. 2008). Taken together, results from our study
underscore the importance of studying both the negative
and positive aspects of raising a child with an ASD on a
daily level. Overall, our findings demonstrate that marital
adjustment, can serve as an important piece of the puzzle
that aids parents in their ability to cope with raising a child
with an ASD.

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