Family Functioning and Strengths in Families of Children With Autism Spectrum Disorder in Saudi Arabia

Abstract

The purpose of this study was to investigate the relationship between family functioning and strengths in the context of parents of children with autism spectrum disorder (ASD) in Saudi Arabia. A total of 300 parents of a child with ASD completed a self-report questionnaire, the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Family Communication Scale (FCS), Family Satisfaction Scale (FSS), and Family Strengths Scale, to measure different balanced and unbalanced aspects of family cohesion and flexibility, family communication skills, extent of satisfaction with family functioning, and the accord and pride facets of family strength. The data were analyzed using independent sample t-test, F-test, and ANOVA. The severity of child's ASD symptoms and age of the child when diagnosed with ASD had a significant effect on a family's cohesion and flexibility, communication, and accord. The parents’ years of marriage and annual income also had a significant effect on cohesion, flexibility, communication, and family strengths. Contributions of the study, limitations, and implications for future research and practice are provided.

Keywords

autism spectrum disorder ASD Kingdom of Saudi Arabia KSA family functioning satisfaction communication strengths FACES IV

Introduction

Autism spectrum disorder (ASD) is a multifaceted neurological and developmental condition that impacts how individuals relate to others, communicate, study, and behave (American Psychiatric Association, 2013). Consequently, having a child with ASD has traditionally been considered to be challenging to the family (Xue et al., 2014). With the progressively growing number of children and individuals identified with ASD, examination of the quality of life considerations not merely of the persons with ASD but also within members of their family (Sikora et al., 2013) continues to be a significant matter for research.

The global prevalence of ASD has been estimated to be in the range of 0.19/1,000 to 11.6/1,000 indicating not only wide variances but also disparities in estimates (Chiarotti & Venerosi, 2020). Reports of the prevalence of ASD in Arab countries, such as the Kingdom of Saudi Arabia (KSA), have similarly been found to be disparate. For example, 42,500 confirmed cases of ASD (about 18/10,000) were reported to exist in the KSA in 2002 (Taha & Hussein, 2014). More recent reports suggest that ASD is found in one out of every 44 children in the age group of 8–16 years, with a 4.2 higher frequency of incidence in boys rather than girls (Abualhommos et al., 2022; AlBatti et al., 2022). ASD prevalence in children aged 6–12 years was found to be 2.618/1,000 in Jeddah, and 3.68/1,000 in Makkah with an overall prevalence of 2.81/1,000 children in both cities (Sabbagh et al., 2021). The increase in prevalence statistics indicates greater public awareness of ASD in the country, resulting in more parents seeking screening and correspondingly higher rates of diagnosis (Abualhommos et al., 2022).

The impact of ASD on the family can be multi-dimensional, as the family can be impacted financially, socially, and even from an employment perspective (Alallawi et al., 2022). For instance, families of children with ASD have been reported to have enhanced extents of stress and impaired family functioning (Rao & Beidel, 2009). In addition, parents of children with ASD have been found to be more likely to suffer from stress and have high levels of anxiety and depression (Alshahrani & Algashmari, 2021). The severity of ASD symptoms especially can lead to higher extents of stress (Manning et al., 2021).

The care and nurture of a child with ASD may also impact the systems and subsystems of the family. For example, there could be an impact to the daily existence and long-term perspectives of families. The added challenges, practical, psychological, and economic, of bringing up a child with ASD can result in reduced time for couples to spend together. Moreover, they can struggle to deal with their spouse's reaction to having a child with a disability and face challenges while balancing their role as a parent and a spouse (Brobst et al., 2009). Consequently, research has found that the parents of children with ASD are less satisfied with their relationship in contrast to parents of children without disabilities (Santamaria et al., 2012; Sim et al., 2016), in general, and to parents of children with Down syndrome (Santamaria et al., 2012) or intellectual disability (Kwok et al., 2014), in particular.

Nevertheless, there is an alternative perspective that submits that families, in general, can withstand stressful affairs quite well (Prime et al., 2020; Tomeny et al., 2012) and many indeed can adapt effectively (Raina et al., 2005; Tsibidaki & Tsamparli, 2009). Prime et al. (2020), for instance, during the COVD-19 pandemic, highlighted that family processes, shared family viewpoints, and intimate relationships can promote resilience. Hartshorne et al. (2013) suggested that parents of children with severe disabilities develop resilience when they view their situation as something they can handle. In the specific context of families having a member with ASD, Cridland et al. (2014) suggested that resilience and traumatic growth were positive facets of such family systems. Another study by Duca (2015) found that parental stress and family resilience can differently impact dyadic coping and dyadic adjustment in families impacted by ASD. Bayat and Schuntermann (2013) highlighted the need to support positive family processes to enhance the resilience of families having a member with ASD. In addition, different concepts are utilized to explain the strengths or well-being of a family, which are regarded as essential features of good functioning such as family quality of life and psychological well-being (Pozo & Sarriá, 2015; Samadi et al., 2013), social support and coping (Kahana et al., 2015; Zaidman-Zait et al., 2018), and family communication, marital strength, and satisfaction (Brown et al., 2020; Greenlee et al., 2022; Marciano et al., 2015; Ramisch et al., 2014; Wenzel et al., 2020).

Parents raising a child with ASD have reported lower functioning of their families and their own selves; this included reduced quality of life and higher extents of parenting stress (Pisula & Porębowicz-Dörsmann, 2017). Manning et al. (2011) found that severity of child problem behaviors, subjective social status, coping by depending on friends and family, and reframing (allowing them to view the situation in a more positive light) impacted family functioning. Another study (Kostiukow et al., 2019) suggested that the family systems of families with children with ASD have a higher likelihood of being disturbed, impacting family functioning. Consequently, there is a need to provide an early assessment of family functioning and subsequent support and therapy as required.

Theoretical Background

The basis of the paper is the family systems theory with emphasis on the Circumplex Model of Marital and Family Systems and Family Strengths Theory. The Circumplex model (Olson et al., 2019) describes a family's extent of functioning. The three fundamental premises of this theory posit that couples and families that are balanced, in contrast to unbalanced systems:

▪ Are inclined to be more functional (successful and happy)

▪ Have more affirmative communication

▪ Will more successfully change their extents of cohesion and flexibility to address stress and changes in development (Olson et al., 2019, p. 1)

The model comprises three dimensions, namely, cohesion, adaptability/flexibility, and communication. Cohesion signifies the emotional bonding between family members whereas flexibility signifies the degree to which a family system can respond to situational challenges by modifying its roles, rules, and power structure (Sarour & El Keshky, 2022; Tsibidaki, 2020). Communication, the third dimension, is regarded as an enabling dimension. In other words, families are aided by good communication to modify their extent of cohesion and flexibility thus increasing their capacity to deal with situational or developmental demands (Olson et al., 2019). The model submits that well-functioning families exhibit a balance in cohesion and flexibility which are between two curvilinear extremes. Consequently, families are less functional when they are excessively cohesive (enmeshed), overly distant (disengaged), overly susceptible to change (chaotic), or too resistant to change (rigid) (Sarour & El Keshky, 2022).

On the other hand, the premise of the family strengths viewpoint is that while all families have problems, they also have the capacity and readiness to identify their problems and deal with them (Defrain & Asay, 2007). The emphasis on family strengths reveals how families are successful when they encounter the inherent challenges of existence. Further, the intention of family strengths is to offer a measure of two facets, namely, pride and accord, exhibited by families that appear to have the capacity to deal with the challenges and conflicts that inevitably arise in the course of their existence (Tsibidaki, 2020). Pride indicates family features pertaining to loyalty, trust, and optimism in the family whereas accord indicates a family's sense of capability and command, their capacity to complete tasks, cope with challenges, and get along (Jones-Smith, 2013; Olson et al., 1982).

The Present Study

Overall, the family is predominant in the Arab society and continues to be so despite the tensions caused by contemporary developments including enhanced mobility, industrialization, and urbanization (Abdul-Haq, 2008). The family is considered to be the central societal element for human development and hence where participants are required to protect and support each other in both Islamic traditions and the Arabic culture (Al-Hakami & McLaughlin, 2016). Moreover, family laws and policies concerning marriage, child-rearing, divorce, child custody, and gender roles are based on Islamic foundations. Thus, family, in Saudi Arabia, is not just the principal societal unit where child development occurs but also has its religious basis (Almalki, 2020). Research related to families in Saudi Arabia with children with ASD has previously investigated families from different perspectives, such as parental stress and well-being (Alhuzimi, 2021); social support (Khusaifan & Keshky, 2021); anxiety (Althiabi, 2021); depression (Alquraini et al., 2019; Alshahrani & Algashmari, 2021); support needs (Alallawi et al., 2022); and community knowledge (Abualhommos et al., 2022). A recent study (Tsibidaki, 2020) examined family functioning and strengths in the context of families raising a child with cerebral palsy (CP) in Greek and Italy, two countries with the most family-oriented cultures in Europe, where the family has a high standing and value in the community. In this regard, the present study is proposed on similar lines in the context of families in Saudi Arabia who are raising a child with ASD. The purpose of the study is three-fold:

To investigate the perspective of parents of children with ASD in Saudi Arabia regarding family functioning and strengths

To investigate the relationship between family functioning and strengths in families of children with ASD in Saudi Arabia

To make recommendations for practice related to family strategies for raising a child with ASD in Saudi Arabia

The study hypothesizes that since families encounter many challenges due to the presence of a child with ASD in their home, they rely on their own strengths to deal with and function effectively. In addition, their levels of family functioning are high. The stated research parameters can be considered to be significant since they have not been adequately satisfied by existing research on families of children with ASD in Saudi Arabia. Moreover, determining family or child characteristics that influence family functioning will help relevant stakeholders to plan actions intended to reduce the adverse influence of ASD on the functioning of their families.

Method

The study used a quantitative approach with an electronic survey to obtain data concerning the perspectives of parents of children with ASD in Saudi Arabia regarding the functioning and strengths of their families. The researcher designed a questionnaire and shared it electronically (using a Google Form) with the parents using social media applications (specifically WhatsApp and email). The study used the snowball sampling method which entails referral, word of mouth, and associated techniques to identify probable participants for a study by means of previously identified participants (Hutchinson, 2004). That is, the sample was composed of parents who agreed to participate in the study and parents they invited. The selection of the sample commenced with the researcher randomly selecting parents of one child with ASD from a list of children enrolled in a mainstream school in Riyadh, KSA. The parents who agreed to participate reached out to other families to invite them to participate in the study. A total of 322 responses were received, of which 22 were incompletely filled in. Consequently, the sample of the study was composed of 300 parents.

Measures

The following instruments were utilized to collect data for the study in January–February 2023:

A self-report questionnaire of two sections, to obtain sociodemographic data and family ASD characteristics (see Table 1 for details).

Table 1.

Demographic Details and Family ASD Characteristics.

Demographic details	Frequency	%	ASD characteristics	Frequency	%
Gender			Number of children
Male	188	62.7	1	80	26.7
Female	112	37.3	2	92	30.7
Age (in years)			3	50	16.7
20–25	28	9.3	4	40	13.3
26–35	87	29.0	5	38	12.7
36–45	166	55.3	Age of child with ASD (in years)
≥46	19	6.3	≤ 2	117	39.0
Years of marriage			3–5	96	32.0
<5	28	9.3	6–10	63	21.0
5–10	56	18.7	11–18	24	8.0
11–15	58	19.3	Gender of child with ASD
16–20	139	46.3	Male	208	69.3
≥21	19	6.3	Female	92	30.7
Province of Residence			Severity of child's ASD symptoms
Riyadh	91	30.3	Mild	97	32.3
Makkah	100	33.3	Moderate	131	43.7
Eastern	49	16.3	Severe	50	16.7
Madinah	17	5.7	Very Severe	22	7.3
Al Baha	4	1.3	Birth order of child with ASD
Al Jawf	6	2.0	First	124	41.3
Northern	1	0.3	Second	52	17.3
Borders	6	2.0	Third	26	8.7
Qassim	8	2.7	Fourth	18	6.0
Ha’il	6	2.0	Only child	80	26.7
Tabuk	4	1.3	Age of child when diagnosed (years)
Aseer	4	1.3	<1	183	61.0
Jizan	4	1.3	1–2	108	36.0
Level of education			3–4	9	3.0
High school	88	29.3
Diploma	79	26.3
Bachelor	102	34.0
Post graduate	19	6.3
Doctoral	12	4.0
Occupation
Full time	188	62.7
Part time	13	4.3
Pensioner	6	2.0
Unemployed	93	31.0
Annual Income (in SAR)
<50,000	87	29.0
50,000 - <1,00,000	111	37.0
100,000 - <500,000	89	29.7
≥500,000	13	4.3

FACES IV (Family Adaptability and Cohesion Evaluation Scale) (Olson, 2019; Olson et al., 2006; Sarour & El Keshky, 2022): This scale contains 42 items evenly distributed across six subscales comprising various balanced and unbalanced aspects of family cohesion and flexibility. The balanced scales measure the aspects of family cohesion and family flexibility. The four unbalanced scales comprise two for cohesion (disengaged and enmeshed) and two for flexibility (rigid and chaotic). It may be noted that there is a significant body of research devoted to adapting FACES IV in various contexts and assessing their psychometric properties (Martínez-Pampliega et al., 2017; Olson, 2011; Priest et al., 2020; Rivero et al., 2010; Sarour & El Keshky, 2022; Türkdoğan et al., 2018; Vegas et al., 2022).

The FACES IV package includes two related scales: The Family Communication Scale (FCS) (Olson et al., 2006; Sarour & El Keshky, 2022) measures the family communication skills among the members of a family whereas the Family Satisfaction Scale (FSS) (Olson et al., 2006; Sarour & El Keshky, 2022) was designed specifically to measure family members’ extent of satisfaction with the functioning of their families.

Responses for all the items in the FACES IV package were obtained using a five-item Likert scale (1 – “Strongly disagree” to 5 – “Strongly Agree”). The coefficient alphas based on the present sample were 0.947 (Balanced Cohesion), 0.947 (Balanced Flexibility), 0.928 (Unbalanced Disengaged), 0.942 (Unbalanced Enmeshed), 0.945 (Unbalanced Rigid), 0.943 (Unbalanced Chaotic), and 0.943 (FCS) and 0.936 (FSS), all indicating high internal consistency.

Family Strengths (Family Strengths Scale) (Olson et al., 1987): This short 12-item self-report inventory offers a measure of two aspects, namely, accord and pride, exhibited by families which seem capable of coping with the struggles and disagreements that inevitably arise in the existence of a family. Responses were obtained using a five-item Likert scale (1 – “Very dissatisfied” to 5 – “Extremely satisfied”). The coefficient alpha value was found to be 0.862 (Pride) and 0.871 (Accord), again indicating high internal consistency.

The perceptions of parents regarding the functioning and strengths of their families were obtained using the Arabic version of the different elements of the questionnaire. The Arabic version of the FACES IV package was used directly (Sarour & El Keshky, 2022) whereas the family strengths scale was translated into Arabic using the back translation method (Khalaila, 2013).

Statistical Analyses

The data were analyzed using different statistical analyses: frequencies and percentages, descriptive statistics (mean and standard deviation), and inferential statistics (Pearson's correlation, independent sample t-test, F-test, ANOVA) using IBM's Statistical Package for the Social Sciences (SPSS) software version 24.0.

Results

Table 1 summarizes the demographic details of the participants and family ASD characteristics. The majority of the participants were fathers (62.7%) aged >35 years (61.6%), had been married for at least 5 years (90.7%), and were from Makkah (33.3%). All the participants had completed at least high school, and the majority were working full time (62.7%) with an annual income of <500,000 SAR (95.7%). The families of the participants were typically small (1–2 children) and had a male child (69.3%) with ASD aged ≤ 2 years (30.0%). The severity of the ASD symptoms was mostly moderate (43.7%). The child with ASD was typically the first child (41.3%) and had been diagnosed in its first year (61.0%).

The cohesion scores were computed using the participants’ FACES IV data (Table 2). The cohesion ratio is obtained by dividing the cohesion scores with the average of the enmeshed and disengaged aspects. Dividing the flexibility scores by the average of the chaotic and rigid aspects provides the flexibility ratio. Finally, calculating the mean of the flexibility and cohesion ratios provides the circumplex total ratio. Since scores above 1 signify healthy family systems (Olson, 2011), greater balance was indicated in the family systems of the participants. Also, it appeared that the majority of the participants were from healthy families (81.3%).

Table 2.

Cohesion Scores.

Cohesion scores	Minimum–maximum	M±SD
Cohesion ratio	0.29–2.540	1.334±0.415
Flexibility ratio	0.22–2.500	1.127±0.376
Circumplex total ratio	0.329–2.500	1.232±0.338
Family system	Frequency	%
Unhealthy	56	18.7
Healthy	244	81.3

Note: M = mean; SD = std. deviation

The descriptive statistics and correlation analysis of the scales are presented in Table 3. The mean scores indicated that the families of the participants rigidly followed norms and functions (high balanced cohesion score). Also, there appeared to be limited opportunity for privacy between members of the family (high unbalanced enmeshed score). The correlation analysis revealed that all the dimensions were highly correlated (p < .01). The correlations indicated that it was possible for a family to be excessively cohesive while being resistant to change, or for them to be overly distant and overly susceptible to change. Moreover, any negative impacts to family communication would reflect in a lowering of family accord. Also, family accord could be adversely impacted by any impact to family pride.

Table 3.

Correlation Analysis.

Construct	Min–Max	M±SD	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)
Balanced cohesion (1)	7–35	25.617±7.134	1
Balanced flexibility (2)	7–35	24.603±6.794	0.686**	1
Unbalanced disengaged (3)	7–35	15.183±5.964	−0.719**	−0.706**	1
Unbalanced enmeshed (4)	7–35	23.850±7.914	0.625**	0.683**	−0.704**	1
Unbalanced rigid (5)	7–35	26.987±6.417	0.676**	0.716**	−0.732**	0.666**	1
Unbalanced chaotic (6)	7–35	17.817±7.429	−0.723**	−0.837**	0.699**	−0.650**	−0.666**	1
Family communication (7)	10–50	37.077±9.038	0.728**	0.804**	−0.787**	0.652**	0.720**	−0.732**	1
Family satisfaction (8)	10–50	38.607±8.343	0.569**	0.734**	−0.633**	0.563**	0.598**	−0.662**	0.642**	1
Pride (9)	7–35	23.807±5.791	0.467**	0.532**	−0.554**	0.438**	0.465**	−0.529**	0.505**	0.527**	1
Accord (10)	5–25	17.357±4.427	−0.603**	−0.716**	0.666**	−0.570**	-.574**	0.689**	−0.722**	−0.610**	−0.631**	1

**Correlation significant at 0.01 (2-tailed)

The severity of the child's ASD symptoms (F/t = 50.330, F/t = 58.045, p < .01) and the age of the child when diagnosed (F/t = 5.129, p < .01, F/t = 3.138, p < .05) were found to significantly influence balanced cohesion and balanced flexibility. In addition, age of child with ASD was found to impact (at p < .05) unbalanced enmeshed (F/t = 2.605), unbalanced rigid (F/t = 3.605), and unbalanced chaotic (F/t = 2.804). The severity of the child's ASD symptoms impacted (at p < .01) unbalanced disengaged (F/t = 62.39), unbalanced enmeshed (F/t = 45.136), unbalanced rigid (F/t = 54.458), and unbalanced chaotic (F/t = 62.851). The birth order of child with ASD impacted (at p < .05) unbalanced disengaged (F/t = 2.861) and unbalanced rigid (F/t = 3.626), and the age of child when diagnosed impacted (at p < .05) only unbalanced disengaged (F/t = 3.075) (Table 4).

Table 4.

Difference in FACES IV Dimensions Based on Family ASD Characteristics.

Family ASD characteristics	F/t (p-value)
Family ASD characteristics	Balanced cohesion	Balanced flexibility	Unbalanced Disengaged	Unbalanced enmeshed	Unbalanced rigid	Unbalanced chaotic
Number of children	0.417 (0.797)	0.080 (0.988)	0.692 (0.598)	1.154 (0.331)	1.692 (0.152)	0.229 (0.922)
Age of child with ASD	1.363 (0.254)	1.774 (0.152)	1.805 (0.146)	2.605 (0.052)	3.605 (0.014)	2.804 (0.040)
Gender	0.065 (0.948)	0.820 (0.413)	−0.191 (0.848)	0.62 (0.536)	−0.063 (0.95)	0.389 (0.697)
Severity of child's ASD symptoms	50.330 (0.000)	58.045 (0.000)	62.39 (0.000)	45.136 (0.000)	54.458 (0.000)	62.851 (0.000)
Birth order of child with ASD	2.37 (0.053)	1.711 (0.148)	2.861 (0.024)	2.175 (0.072)	3.626 (0.007	1.484 (0.207)
Age of child when diagnosed	5.129 (0.006)	3.138 (0.045)	3.075 (0.048)	1.766 (0.173)	1.61 (0.202)	1.74 (0.177)

Moreover, the age of child with ASD was found to impact (at p < .05) family communication (F/t = 2.797) and accord (F/t = 2.821). The severity of the child's ASD symptoms impacted (at p < .01) family communication (F/t = 65.113), satisfaction (F/t = 545.749), pride (F/t = 29.083), and accord (F/t = 48.246). The age of child when diagnosed impacted (at p < .05) only accord (F/t = 3.390). Finally, the type of family system was found to negatively impact (at p < 0.01) family communication (F/t = –12.368), satisfaction (F/t = –8.946), pride (F/t = –5.798), and positively impact (at p < .01) family accord (F/t = 10.854) (Table 5).

Table 5.

Difference in Family Communication, Satisfaction, Strength Based on Family ASD Characteristics and Type of Family Systems.

Family ASD characteristics	F/t (p-value)
Family ASD characteristics	Family communication	Family satisfaction	Pride	Accord
Number of children	0.334 (0.855)	0.269 (0.898)	0.848 (0.496)	0.600 (0.663)
Age of child with ASD	2.797 (0.040)	1.386 (0.247)	1.106 (0.347)	2.821 (0.039)
Gender	0.637 (0.524)	−0.587 (0.557)	0.523 (0.601)	−1.611 (0.108)
Severity of child's ASD symptoms	65.113 (0.000)	545.749 (0.000)	29.083 (0.000)	48.246 (0.000)
Birth order of child with ASD	1.350 (0.251)	0.531 (0.713)	0.899 (0.465)	1.805 (0.128)
Age of child when diagnosed	2.286 (0.103)	1.824 (0.163)	0.619 (0.539)	3.390 (0.035)
Type of family system	−12.368 (0.000)	−8.946 (0.000)	−5.798 (0.00)	10.854 (0.000)

Balanced cohesion was found to be influenced by years of marriage (F/t = 2.462, p < .05). Both balanced cohesion (F/t = 6.585) and balanced flexibility (F/t = 4.865) were influenced by annual income (at p < .01). On the other hand, only annual income had a significant impact on unbalanced enmeshed (F/t = 2.947, p < .05), rigid (F/t = 3.352, p < .05), and chaotic (F/t = 5.73, p < .01) (Table 6). Annual income also had an impact on family communication (F/t = 6.83, p < .01), pride (F/t = 3.142, p < .05), and accord (F/t = 4.963, p < .01) (Table 7).

Table 6.

Difference in FACES IV Dimensions Based on Demographic Details.

Demographic details	F/t (p-value)
Demographic details	Balanced cohesion	Balanced flexibility	Unbalanced disengaged	Unbalanced enmeshed	Unbalanced rigid	Unbalanced chaotic
Years of marriage	2.462 (0.045)	1.248 (0.291)	1.513 (0.198)	1.325 (0.261)	0.674 (0.611)	0.930 (0.447)
Province of Residence	0.661 (0.789)	1.143 (0.325)	0.696 (0.755)	0.87 (0.578)	0.592 (0.848)	0.722 (0.729)
Level of education	0.498 (0.737)	1.96 (0.101)	0.441 (0.779)	0.317 (0.866)	0.672 (0.612)	1.186 (0.317)
Annual Income	6.585 (0.000)	4.865 (0.003)	1.800 (0.147)	2.947 (0.033)	3.352 (0.019)	5.73 (0.001)

Table 7.

Difference in Family Communication, Satisfaction, Strength Based on Demographic Details.

Demographic details	F/t (p-value)
Demographic details	Family communication	Family satisfaction	Pride	Accord
Years of marriage	0.978 (0.42)	0.673 (0.611)	0.286 (0.887)	0.267 (0.899)
Province of residence	0.468 (0.933)	0.704 (0.748)	0.455 (0.939)	1.727 (0.061)
Level of education	0.404 (0.805)	0.833 (0.505)	0.074 (0.990)	1.015 (0.400)
Annual income	6.83 (0.000)	0.751 (0.523)	3.142 (0.026)	4.963 (0.002)

Discussion

The principal objective of the present study was to investigate Saudi parents’ perspective of family functioning and strengths in the context of families with children with ASD. The participants were found to be mostly from healthy family systems with an inclination for higher cohesion than flexibility as signified by their rating of the FACES IV dimensions. This indicated a higher level of emotional bonding in contrast to the extent to which the family can adapt to challenging situations (Sarour & El Keshky, 2022; Tsibidaki, 2020). In addition, the families of the participants appeared to be rigid and enmeshed signifying rigid norms and functions in the family, and limited privacy. This was not surprising as this finding is consistent with the culture of Saudi Arabia, where the organization and functioning of families are based on Islamic traditions where there are clear specifications related to gender roles, rearing, and custody of children (Al-Hakami & McLaughlin, 2016; Almalki, 2020).

Moreover, correlation analysis using the participants’ responses revealed that the two balanced scales (balanced cohesion and balanced flexibility) were highly correlated, which signifies harmony in the balanced family function in the region with the healthiest levels of function (Olson, 2011). In addition, the two balanced scales were found to be highly and positively correlated with the enmeshed and rigid unbalanced scales and highly and negatively correlated with the disengaged and chaotic scales. This finding could be interpreted to infer that the participants were from those well-functioning families which exhibit a balance in cohesion and flexibility. Overall, the correlation study indicated that the participants seemed to be from families that were cohesive and flexible. In addition, it appeared that some of the families were possibly excessively cohesive and rigid, and others were possibly overly chaotic and disengaged (Sarour & El Keshky, 2022). The fairly high ratio scores (cohesion, flexibility, and circumplex total) which were all slightly greater than 1 (<1.5) confirmed that the participants were largely from balanced family systems (Olson, 2011).

The positive correlations found between the balanced scales, and family communication, family satisfaction, and pride, and a negative correlation with accord, signified a high level of cohesion and definition in the families. In contrast, the unbalanced scales were found to have negative correlations with family communication, family satisfaction, and pride, and a positive correlation with accord. The high scores on these scales indicate possibly lower levels of family satisfaction (Craddock, 2001). Moreover, it appears that the different dimensions of family functioning, apart from unbalanced disengaged and unbalanced chaotic, were typically negatively associated with accord and positively with pride.

The findings from the responses of the participants revealed that their family functioning from the perspective of adaptability, flexibility, communication, satisfaction, and strengths were influenced by some of their personal characteristics and some of the characteristics of their child with ASD. In particular, the severity of the child's ASD symptoms and age of the child when diagnosed were found to influence perceptions of balanced cohesion and balanced flexibility. On the other hand, the age of the child with ASD, severity of ASD symptoms, birth order of child with ASD, and age of child when diagnosed were some aspects that influenced the parents’ perceptions of the unbalanced scales. These findings indicated that the functioning of the families had been thrown out of balance when a child with ASD was born into the family. Moreover, if the child with ASD was born later in the birth order, there could have been a detrimental impact to an established system of family functioning. Furthermore, family ASD characteristics such as age of child with ASD, severity of the child's ASD symptoms, age of child when diagnosed, and type of family systems were found to influence the parents’ perceptions related to family communication, satisfaction, and the dimensions of strength. These findings are consistent with prior research which has reported the often adverse impact of ASD on families (Manning et al., 2021; Xue et al., 2014), and it can be inferred, family functioning, in general. In addition, while some researchers (Cridland et al., 2014; Duca, 2015; Hartshorne et al., 2013) have suggested that some families respond positively to a change in their situation by viewing it as something they can handle, the findings of the present study are not sufficient to validate or confirm this in the participants’ families.

In addition, the parents’ demographic characteristics, such as years of marriage and annual income, positively influenced their perceptions of the balanced and unbalanced scales, family communication, and family strengths. The parents’ demographic characteristics had no impact on perceptions of family satisfaction. Interestingly, neither the province of the families’ residence nor the parents’ level of education had any impact on the parents’ perceptions regarding cohesion and flexibility. This indicated that families across the country functioned in a similar fashion with regard to communication and structure, which is not surprising as they strictly follow Islamic traditions as regards gender roles and bringing up of their children (Al-Hakami & McLaughlin, 2016; Almalki, 2020).

Conclusion

Research related to families of individuals with ASD has previously been undertaken with emphasis on different aspects of ASD, and parental and familial support and well-being. Recent research of the functioning of families in different contexts resulted in the use of a family systems perspective based on the Circumplex Model of Marital and Family Systems and Family Strengths Theory (Defrain & Asay, 2007; Olson et al., 2019) to inform the present study.

The present study thus investigated Saudi parents’ perspective of family functioning and strengths in the context of families with children with ASD. Overall, the study found that families of a child with ASD in Saudi Arabia were typically healthy and balanced. Nevertheless, facets such as the severity of the child's ASD symptoms, child's present age, age when diagnosed, birth order were found to influence the parents’ perceptions of their family's overall functioning, that is, their functionality, their affirmative communication, and their effectiveness in modifying their extents of flexibility and cohesion to deal with stress and changes in development (Olson et al., 2019, p. 1). On the other hand, apart from years of marriage and annual income, the demographics of the parents did not have as extensive an impact on the parents’ perceptions of their family's overall functioning. Nevertheless, the study found indications that family communication was more predictable in the participating families together with indications that the families were not excessively cohesive. Also, there were indications that the participating families believed that they function effectively.

The findings of the study thus indicate that the hypothesis that families rely on their own strengths to deal with and function effectively when there is a child with ASD in their home can be accepted. Moreover, the levels of family functioning are high in such homes. This study is believed to be among the first to utilize the FACES IV questionnaire with validating scales (family communication, family satisfaction, and family strengths) in the context of families with a child with ASD in Saudi Arabia.

Limitations of the Study

This study has various limitations. First, the study was performed using participants from across the country. However, cultural aspects of the regional differences, if any, were not scrutinized. Second, the participants were from families having only one child with ASD. Thus, the perspectives of parents who may have multiple children with ASD was not considered. Third, the participating families were fairly affluent and well-educated as the recruitment of the participants commenced in Riyadh, and it can be inferred that these parents reached out to other parents in similar social circumstances. Consequently, the perspectives of a more diverse group of Saudi parents may have been overlooked. Fourth, the age of the child with ASD was not limited to a certain age group. Therefore, the perceptions obtained were from families with different extents of experience in functioning with a child with ASD. Focusing on a narrower age group could perhaps have provided more specific outcomes. Fifthly, the cultural aspects of family functioning in Saudi Arabia were not examined in detail. A future researcher could incorporate this facet. Finally, the present study was cross-sectional in nature. A future researcher could use a longitudinal approach to examine the family functioning at different time periods.

Implications for Practice

The findings of the study provided insights regarding the functioning of parents of a child with ASD in Saudi Arabia. Consequently, the following recommendations are submitted:

The emphasis on early identification and diagnosis of ASD should be increased. This can be facilitated by increasing parents’ awareness of symptoms and levels of severity through countrywide awareness programs.

Families of children with ASD should be invited to participate in support and advocacy groups and collaborate in diagnostic and treatment meetings. Exposure to other families in the same situation could help build their effectiveness and confidence as a family.

Parents and other caregivers of children with ASD should receive training regarding the different interventions and treatments available to help their children.

The province administration can establish centers to provide counseling and support for families of children with ASD.

The Family Ministry in Saudi Arabia can implement measures for routine monitoring of families of children with ASD to ensure that these families receive the support and resources they require.

Footnotes

Acknowledgment

Researchers Supporting Project number (RSP2023R486), King Saud University, Riyadh, Saudi Arabia.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

Researcher Supporting Project number (RSP2023R486).

Informed consent

Informed consent was obtained from all individuals who participated in the study.

ORCID iD

Talal E. Alhuzimi

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