Daily experiences and well-being of Chinese parents of children with autism

Abstract

Parents of children with autism experience significant stress and challenges in daily life that can impact their well-being. Using a daily diary method, the present study examined the same-day and next-day associations between child-related stress, social support, coping, and parental well-being outcomes (i.e. life satisfaction, positive and negative affect). A total of 76 parents (58 mothers) of autistic children participated in the study and completed daily diaries for 14 consecutive days. Multilevel modeling analyses indicated that child-related stress and social support were associated with same-day life satisfaction only in mothers. Moreover, positive coping on a given day was not only related to more positive affect and higher life satisfaction on the same day but also to higher life satisfaction on the next day, whereas negative coping was only related to higher negative affect and lower positive affect on the same day in both parents. These findings emphasize the benefits of positive coping and social support in raising children with autism, which may contribute toward the further development of existing support programs for parents of children with autism.

Lay abstract

The present study examined the influences of child-related stress, parental coping and social support on parental daily subjective well-being (i.e. positive and negative affect, life satisfactory) in Chinese families of children with autism spectrum disorder. For 14 days, a total of 76 parents (58 mothers) participated in the study and completed daily diaries. For mothers, child-related stress was related to lower life satisfaction; social support was related to higher life satisfaction that day. These daily relations were not found for fathers. Across all parents, avoidant coping was associated with higher negative affect and lower positive affect on the same day. Notably, daily positive coping was related to greater same-day positive affect as well as greater same-day and next-day life satisfaction. Interventions aimed at increasing positive coping and social support, and reducing child-related stress and avoidant coping are important to help parents maintain well-being, particularly for mothers of children with autism.

Keywords

autism spectrum disorder child-related stress coping daily diary social support well-being

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication and repetitive and restrictive behavior patterns and interests (American Psychiatric Association [APA], 2013). Children with ASD often experience emotional and behavioral problems such as anxiety and disruptive behaviors (Factor et al., 2017; McRae et al., 2019). Evidence shows that global levels of ASD symptoms and behavioral problems are positively associated with global parenting stress and negatively associated with parental subjective well-being (Estes et al., 2009; McStay et al., 2014). For Chinese parents of children with autism in particular, the cultural beliefs associated with having a child with a disability expose parents to various stigmas and social discrimination (Chan & Lam, 2018). These culture beliefs may adversely affect the ways in which parents cope with stress and the social support they need, causing them additional emotional distress (Ji et al., 2014).

However, little is known about the extent to which child-related stress is associated with parental day-to-day well-being. Parents may face different challenges in their everyday life when dealing with the demands of raising an autistic child (Pozo et al., 2014), and the daily variations in perceived child-related stress can result in daily fluctuations in their well-being. Moreover, few studies have sought to understand whether parental coping behaviors and perceived social support are associated with daily variations in parental well-being. The present study employed a daily diary approach to examine the daily associations between child-related stress, coping, social support, and subjective well-being among Chinese parents who have a child with ASD.

The double ABCX model of family adaptation (McCubbin & Patterson, 1983) provides a comprehensive framework to explain parental adaptation in families of autistic children. Parental adaptation refers to the ability of the parent to respond to stress, and can be measured in terms of parental subjective well-being in their daily life (Bohadana et al., 2019). Subjective well-being is often conceptualized as a multifaceted construct with affective reactions (i.e. positive and negative affect) and cognitive judgments (i.e. life satisfaction) (Andrews & Withey, 1976). Specifically, positive and negative affect are the affective components of subjective well-being, referring to the emotions an individual expresses and experiences in daily life (Watson et al., 1988). Moreover, life satisfaction represents how an individual evaluates or judges the quality of his or her life and thus reflects the cognitive component of subjective well-being (Diener, 1984). We evaluated both components to obtain a broader understanding of parents’ adaptations to raising children with autism.

In the double ABCX model (McCubbin & Patterson, 1983), parental adaptation outcomes depend on the interrelations among several factors: (aA) stressors and pile-up of demands (e.g. child’s diagnosis of ASD), (bB) internal and external resources (e.g. social support), and (cC) coping strategies. These factors interact and ultimately determine positive or negative family adaptation (xX). Consistent with this model, several studies have documented that global levels of parental subjective well-being are affected by factors such as a child’s autistic symptoms (McStay et al., 2014) and emotional and behavioral problems (Gardiner & Iarocci, 2015), parental coping strategies (Meleady et al., 2020), and social support (Paynter et al., 2013). However, prior studies have primarily relied on global measures, and thus little is known about the day-to-day dynamics of how child-related stress, coping strategies, and social support affect parents’ subjective well-being in Chinese families of ASD children.

To date, some diary studies conducted in Western countries have focused on the daily associations and identified multiple factors that may influence parental daily well-being, despite only examining one of the influential factors in the double ABCX model. These studies include how daily fluctuations in stressors (aA components) such as child ASD symptoms and behavioral problems predict changes in parents’ daily affect (e.g. Hartley et al., 2016; Mihaila & Hartley, 2018). For example, using a 30-day diary design, Ekas and Whitman (2011) found that child-related stress resulting from ASD symptoms and associated behavioral problems was linked to increased negative affect on the same day for mothers.

In addition to the same-day effect, child-related stress may have an enduring lagged effect (usually referring to the next-day effect, that is, whether the effect of stress on parental well-being can extend beyond a 24-h period). The results of the lagged associations, however, were inconsistent. Specifically, by employing a 14-day diary design, Mihaila and Hartley (2018) found that fluctuations in children’s ASD symptoms and behavioral problems on a given day predicted changes in next-day fathers’ level of positive affect; whereas Ekas and Whitman (2011) indicated that child-related stress had little impact on mothers’ next-day negative affect over a period of 30 consecutive days. The mixed evidence may be attributed to differences in study design (14 day vs 30 day daily diary) or participants (mothers vs fathers). Moreover, the inconsistent findings may be due to the complexity of the determinants of parental well-being. According to the double ABCX model (McCubbin & Patterson, 1983), various factors (e.g. social support, coping) can jointly influence daily variations in parental well-being.

Within the Chinese context, the public believes that parents are responsible for their children’s ASD diagnosis and tends to view children’s ASD symptoms as a reflection of parental incompetence (Cheung et al., 2019). The misunderstandings about ASD may contribute to the lack of help and care from society toward families of autistic children (Sun et al., 2013). Chinese parents have to shoulder most of the daily caregiving burdens themselves, which may put them at increased risk of daily distress and compromised life satisfaction (Clark et al., 2019).

Studies have also identified social support as an important external resource, which corresponds to the “bB” component of the double ABCX model that may mitigate psychological distress and promote life satisfaction among parents of ASD children (Ekas et al., 2010; Zablotsky et al., 2013). Social support is defined as the emotional, informational, and instrumental assistance that one receives from their social network, which includes family members, friends, or specialists (Dunst et al., 1986). A daily diary study in families of autistic children showed that daily levels of social support were associated with parental daily well-being (Pottie et al., 2009). On days characterized by higher perceived social support, parents reported lower negative affect and higher positive affect through bi-weekly measures over 3 months. Given that the degree of social support is likely to impact momentary experiences and daily well-being (Rook, 2001), a daily diary design may provide a more complete picture of the salutary effects of social support on the daily well-being of parents of children with autism.

In addition, a growing body of research suggests that the use of coping strategies, “cC” components of the double ABCX model, affects the level of perceived well-being of parents of children with autism (Ghanouni & Hood, 2021). Coping refers to cognitive and behavioral efforts to deal with internal and external stressors (Lazarus & Folkman, 1984). Two coping strategies are often used by parents of children with ASD: positive coping (e.g. planning or taking actions to alter stressors) and avoidant coping (e.g. denial, disengagement, or avoidance of the stressful situation; Lai & Oei, 2014; Vernhet et al., 2019). A systematic review by Ghanouni and Hood (2021) emphasized the importance of coping for families of individuals with autism, and concluded that previous studies were mainly cross-sectional and descriptive. Thus, it is still unclear how the association between coping and parental adaptation unfolds at a day-to-day level in families of autistic children.

Coping is a dynamic process with daily fluctuations such that an individual uses more positive coping on some days and less on other days (Blaxton & Bergeman, 2017). To the best of our knowledge, only one study has investigated the impacts of daily coping on well-being in parents of autistic children (Pottie & Ingram, 2008). By using bi-weekly measures for 12 weeks, researchers revealed that high levels of positive coping on a particular day helped parents alleviate stress and promote positive mood on that day, while avoidant coping was linked to increased daily negative mood. Hence, it is necessary to further explore how parents cope with the daily stress of rearing an autistic child and how these daily fluctuations in coping affect their well-being outcomes.

Culturally, Chinese parents may use more avoidant coping when raising children with ASD due to their fear of being subject to social discrimination (Ji et al., 2014; Tait et al., 2016). Moreover, a social security or welfare system has yet to be established in China (Su et al., 2018), so many parents have limited access to formal support and thus have to train and educate their children on their own. These challenges are likely to impact the perception of daily well-being of Chinese parents who have a child with autism. However, to the best of our knowledge, no studies have explored the daily associations between parenting experiences and parental well-being in Chinese families of children with autism. As social and cultural contexts shape how individuals experience everyday life (Ji et al., 2014; Lin, 2015), the impact of various factors and the applicability of the double ABCX model may be different in Chinese settings than in Western settings. In this way, more research is needed to better understand parental daily experiences within the Chinese cultural context in order to inform intervention efforts.

Although the influences of child-related stress (e.g. Mihaila & Hartley, 2018), social support (e.g. Pottie et al., 2009), and coping (e.g. Pottie & Ingram, 2008) on daily well-being of parents of children with autism have been evident, most studies exclusively focused on the unique impact of one specific factor. Given factors often coexist in families (Zaidman-Zait et al., 2018), examining only one factor may lead to an oversimplification of the impacts of different factors on parental adaptation to their children’s ASD. Through the tandem analysis of multiple daily factors, the current study aimed to examine how various factors in the double ABCX model jointly influence parental daily well-being.

Previous studies also suggest that gender differences influence the daily experience of raising a child with ASD (McStay et al., 2014; Vernhet et al., 2019). Mothers appear to be impacted more by their children’s ASD symptoms and experience higher levels of stress than fathers (Allen et al., 2013; Ang & Loh, 2019; Dardas & Ahmad, 2014). This is especially the case for Chinese mothers, as in the Chinese cultural context, one of the main family obligations of a mother is to take care of all family members (Gau et al., 2010). Chinese mothers are often the round-the-clock caregivers for their children and may face greater burdens than fathers when caring for a child with autism (Lin, 2015). Therefore, mothers may be more vulnerable than fathers to the adverse effects of child-related stress, and thus experience more negative affect and less positive affect in their daily lives.

In addition, mothers tend to use more positive coping, including problem-focused coping and positive reframing, and are more open to seeking professional support and family support (Dabrowska & Pisula, 2010). In contrast, fathers report greater use of avoidant coping and less social support (Hastings et al., 2005; Pozo et al., 2014). This literature suggests that mothers and fathers differ in their use of coping strategies and family resources, such that mothers appear to be more impacted by child-related stress when a day is characterized by less social support and lower positive coping.

Consequently, this study used a daily diary design to explore the joint influences of child-related stress, coping, and social support on subjective well-being among Chinese parents of children with autism, and then examined parent gender differences in these daily associations. The daily diary method (i.e. repeatedly assess individuals’ experience each day) can capture parents’ daily experiences and their naturally occurring relationship with subjective well-being (Kiang & Buchanan, 2014). The daily diary study investigates within-person effects, and the research question then could be “if parents confront more child-rated stress than their typical levels at one day, would their levels of well-being be lower than usual?” Using this design, researchers can disaggregate daily (i.e. within-parent) effects from the chronic (i.e. between-parent) effects, as repeated observations are nested within parents (Wang & Maxwell, 2015). Furthermore, assessing parents’ everyday experiences in natural situations may reduce recall bias and increase ecological validity (Verhagen et al., 2016). This design also allows researchers to examine the temporary dynamics between daily experiences and concurrent (i.e. same-day effect) as well as subsequent (i.e. next-day effect) well-being outcomes (Chiang & Lam, 2020).

Guided by the double ABCX model (McCubbin & Patterson, 1983) and prior literature (e.g. Ekas & Whitman, 2011; Hartley et al., 2016; Pottie et al., 2009), we hypothesized that higher levels of child-related stress and avoidant coping and lower levels of social support and positive coping would be positively associated with parental negative affect and negatively associated with parental positive affect and life satisfaction on the same day and on the next day. Moreover, parent gender would moderate these daily associations such that mothers would be more affected.

Method

Participants

A total of 79 parents (60 mothers and 19 fathers) of children with ASD aged between 3 and 13 years participated in the study. Participants were recruited via posters distributed online in mainland China. To be eligible to participate, parents had to provide a confirmed diagnosis of their child’s ASD by a certified pediatric psychiatrist from a local hospital according to the diagnostic criteria for ASD in the Diagnosis and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013). Three parents who completed less than 3 days of daily diaries were excluded from the analyses. The final sample consisted of 76 parents of children with ASD (M age = 36.36 years, SD = 3.95 years; 58 mothers and 18 fathers). Among them, 98.7% of the parents were biological parents of children with ASD, and 97.4% were of the Chinese Han ethnicity. Most (97.4%) of the parents were currently married, while the remainder (2.6%) were divorced. Parents were relatively well educated: 36.8% had a graduate degree, 53.9% had a college degree, and 9.2% had a high-school degree or lower. With respect to employment status, 71.1% were employed full-time, 3.9% were employed part-time, and 25% were unemployed. Most families (85.5%) had an annual household income at or above the average for urban Chinese families (i.e. 87,668 RMB, or approximately US$13,760; China Bureau of Statistics, 2020).

Procedure

All procedures were approved by the university’s Institutional Review Board (IRB). After providing informed consent, parents completed background questionnaires regarding their sociodemographic characteristics. Following this, a 14-day daily diary protocol was initiated. Consistent with most previous diary studies (e.g. Hartley et al., 2016; Mihaila & Hartley, 2018), we chose the 14-day diary because it was sufficient to provide nuanced information about daily fluctuations in variables through 14 days of repeated observations. At the same time, this choice cannot impose too much response burden on participants, which helps improve participant compliance and reduces the likelihood of missing data and attrition from the study (Bolger & Laurenceau, 2013). Participants completed online daily surveys at approximately the same time each day (i.e. at bedtime) for 14 consecutive days. They received a web link through WeChat (a Chinese social networking software application) at 8 p.m. each night that directed them to a Qualtrics survey. The surveys included items about daily positive and negative affect, life satisfaction, child-related stress, social support, and coping strategies. Each survey took approximately 10 min to complete. Parents were instructed to report the daily diaries according to events that had occurred within the last 24 h. Research assistants first explained the procedure to the participants, and then addressed the questions and concerns the participants had during the daily diary period. To enhance study participation, all the participants were asked to set the WeChat message alarm open and received a daily reminder to fill out the questionnaires before going to bed. Each daily entry was time stamped by the survey system. Compliance was high: parents completed 983 out of the 1064 expected daily entries, with an average of 13.07 diaries (SD = 2.31). Little’s (1988) missing completely at random (MCAR) test indicated that the data met the pattern of MCAR (χ²(2) = 1.83, p = .177). While community members were not involved in the design or data interpretation of this study, they helped participant recruitment and were provided with updates on the study results.

Measures

Positive and negative affect

Parents’ daily positive and negative affect was measured via the Positive and Negative Affect Scale (PANAS; Watson et al., 1988). The PANAS consists of 10 items that measure positive affect (e.g. excited) and 10 items that measure negative affect (e.g. irritable). The parents were asked to rate the extent to which they experienced each affect that day using a 5-point Likert-type scale (1 = very slightly or not at all to 5 = extremely). Total scores were created separately for positive and negative affect; higher scores indicate higher levels of that affect. The Chinese version of the PANAS is widely used and has shown good psychometric properties (Huang et al., 2003). Internal consistencies were averaged across each daily assessment (positive affect = .96; negative affect = .94).

Life satisfaction

Daily life satisfaction was assessed using one item (i.e. “How satisfied were you with your life today?”) from 1 (very dissatisfied) to 5 (very satisfied). This single item is derived from the Satisfaction with Life Scale (SWLS; Diener et al., 1985) and has been widely used in previous daily diary studies (e.g. Maher et al., 2013). Research indicates that this item shows adequate reliability (Lucas & Donnellan, 2012) and correlates with many other variables, including daily mood and mental health (Maher et al., 2015).

Child-related stress

Daily child-related stress was measured through six items developed for this study. The purpose of developing this scale was to examine perceived stress of parents in response to children’s core symptoms of ASD and associated problems, including restricted and/or repetitive behaviors and interests, communication, social interaction, emotion regulation, behavior problems, and adaptive living skills. These symptom domains were commonly used in previous diary studies that assess the daily stressors of parents of children with ASD (Ekas & Whitman, 2011; Hartley et al., 2016; Mihaila & Hartley, 2018). For each item, parents indicated the degree of stress they experienced in coping with their child’s symptoms during the past 24 h. Examples of items were “Did you feel stressed when your child displayed any repetitive behaviors or restricted interests?” (restricted and/or repetitive behaviors and interests) and “Did you feel stressed when your child had problems communicating with others?” (communication). Items were rated on a 5-point Likert-type scale ranging from 1 (not at all) to 5 (extremely) and were summed into a total score. The higher the total score, the greater the child-related stress experienced by the parents. The internal consistency of child-related stress was α = .89.

Coping strategiess

Two items adapted from the Brief COPE (Carver, 1997) were used to measure parents’ daily coping behaviors, with one item measuring positive coping (i.e. “Today, I actively and confidently coped with the challenges caused by my child.”) and one item measuring avoidant coping (“Today, I passively and avoidantly coped with the challenges caused by my child.”). Parents were asked to indicate the extent to which they used these coping responses throughout the day to manage child-related stress on a 5-point Likert-type scale ranging from 1 (totally disagree) to 5 (totally agree). This single-item measure of positive and avoidant coping has been successfully used in previous daily diary studies and has shown good validity (e.g. Finkelstein-Fox et al., 2019). However, the reliability for these two coping strategies was not calculated as these were measured via a single item.

Social support

Social support was assessed through four items that were created for this study. Parents rated the extent to which they received social support from (a) their spouse/partner, (b) their parents/in-laws, (c) their friends or colleagues, or (d) professionals (e.g. care staff or teachers) that day. Responses ranged from 1 (totally unhelpful) to 5 (very helpful). The scores of these items were summed, with higher scores indicating higher degrees of daily social support. The internal consistency of social support in the current study was α = .71.

Data analyses

To examine our hypotheses, multilevel models (MLMs) were conducted using hierarchical linear modeling 8 (HLM 8; Raudenbush et al., 2019). This approach is well-suited for the current study with a nested structure of data, where repeated measures in the 14-day diary (Level 1) nested within parents (Level 2). We tested six two-level MLMs, with day-level variables (i.e. child-related stress, positive coping, avoidant coping, and social support) modeled at Level 1 and parent-level variable (i.e. parent gender) modeled at Level 2. The outcome variables were parental well-being (i.e. positive affect, negative affect, and life satisfaction) on the current day and the following day. Thus, Level 1 of the MLMs estimated associations between parents’ experiences on a given day and their well-being on the same day and the next day; Level 2 estimated whether same-day and next-day associations varied by parent gender (see Figure 1 for the statistical model).

Figure 1.

The statistical model of parent gender moderating the daily relationships between parenting experiences and parental well-being.

At Level 1, all predictors were person-mean centered within parents. Moreover, as suggested by the research (Wang & Maxwell, 2015), we additionally controlled for day of study (0 = Day 1) to minimize the impacts of systematic changes of daily measures across the 14-day period.

At Level 2, parent gender was dummy coded (0 = fathers, 1 = mothers) and then entered into the models. In addition, consistent with previous studies (e.g. Mihaila & Hartley, 2018), parents’ average levels of child-related stress, positive coping, avoidant coping, and social support over the 14 days were grand-mean centered and included as Level 2 predictors of the intercept to control for between-parent differences in stress, coping, and social support on parental well-being. We also considered the ages of children, the ages of parents, parents’ educational levels, and family incomes as potential Level 2 covariates. Correlational analyses indicated that none of these variables correlated with indicators of well-being (ps > .05). Therefore, we did not enter these variables into the models for parsimony. Finally, given that previous studies indicated that the responses to daily events might vary across parents of ASD children (e.g. Ekas & Whitman, 2011; Hartley et al., 2017), the effects of intercept and slope were specified as random in all models.

To examine same-day associations, we estimated three MLMs with daily levels of negative affect, positive affect, and life satisfaction as the outcome variables, respectively. The equation for the same-day model was as follows.

Level 1

\begin{array}{l} Same - Day Affect \\ / Life {Satisfaction}_{t} = β_{0} + β_{1} (Child - {Related Stress}_{t}) + \\ β_{2} ({Positive Coping}_{t}) + \\ β_{3} ({Avoidant Coping}_{t}) + \\ β_{4} ({Social Support}_{t}) + \\ β_{5} (Day of Study) + e_{t .} \end{array}

Level 2

\begin{array}{l} β_{0} = γ_{00} + γ_{01} (Average Child - Related Stress) + γ_{02} (Average Positive Coping) \\ + γ_{03} (Average Avoidant Coping) + γ_{04} (Average Social Support) + γ_{05} (Parent Gender) + u_{0} . \\ β_{1} - β_{4} = γ_{10 - 40} + γ_{11 - 41} (Parent Gender) + u_{1 - 4 .} \\ β_{5} = γ_{50} + u_{5 .} \end{array}

To examine next-day associations, similar MLMs were estimated, but with daily stress, coping, and social support predicting next-day well-being (i.e. positive and negative affect and life satisfaction), after controlling for prior-day well-being. The equation for next-day model was as follows.

Level 1

\begin{array}{l} Next - Day Affect / Life {Satisfaction}_{t + 1} = β_{0} + β_{1} (Child - {Related Stress}_{t}) + β_{2} ({Positive Coping}_{t}) \\ + β_{3} ({Avoidant Coping}_{t}) + β_{4} ({Social Support}_{t}) + β_{5} (Affect / {Life Satisfaction}_{t}) \\ + β_{6} (Day of Study) + e_{t + 1 .} \end{array}

Level 2

\begin{array}{l} β_{0} = γ_{00} + γ_{01} (Average Child - Related Stress) + γ_{02} (Average Positive Coping) \\ + γ_{03} (Average Negative Coping) + γ_{04} (Average Social Support) + γ_{05} (Parent Gender) + u_{0} . \\ β_{1} - β_{4} = γ_{10 - 40} + γ_{11 - 41} (Parent Gender) + u_{1 - 4} \\ β_{5} - β_{6} = γ_{50 - 60} + u_{5 - 6 .} \end{array}

Missing data were handled with the full information maximum likelihood (FIML). The FIML uses all of the available data to estimate model parameters, thus, individuals with missing data could still be included in analyses (Enders, 2010). This approach has least bias and shows least variability across simulated data sets compared with other commonly used methods such as list-wise deletion (Young & Johnson, 2013).

Finally, post hoc power analyses for each MLM were conducted using Monte Carlo simulations. The results indicated that 14 out of 24 within-person paths from predictors to outcomes had powers more than .80. In addition, 8 out of 24 cross-level moderations (i.e. parental gender moderated the associations between within-person predictors and outcomes) achieved more than .80.

Results

Descriptive statistics

Study variables displayed daily fluctuations across the 14-day period (see Figure 2). Bivariate correlations between study variables at the day level are shown in Table 1. Correlation analyses indicated that daily positive affect was positively correlated with daily life satisfaction, positive coping, and social support and negatively correlated with avoidant coping. Daily negative affect was positively correlated with daily child-related stress and avoidant coping and negatively correlated with life satisfaction and positive coping. Parents’ daily life satisfaction was positively correlated with positive coping and social support and negatively correlated with child-related stress and avoidant coping. Daily child-related stress was positively correlated with avoidant coping and negatively correlated with positive coping. Moreover, daily positive coping was positively correlated with daily stress and negatively correlated with avoidant coping.

Figure 2.

Daily fluctuations of study variables across the 14-day period.

Table 1.

Bivariate correlations between study variables at the day level.

Variable	1	2	3	4	5	6
1. Positive affect
2. Negative affect	.06
3. Life satisfaction	.35***	−.33***
4. Child-related stress	.01	.42***	−.24***
5. Positive coping	.32***	−.20***	.39***	−.23***
6. Avoidant coping	−.26***	.21***	−.27***	.23***	−.50***
7. Social support	.26***	.03	.37***	.03	.16***	−.06

***

p < .001.

In addition, we conducted a series of t-tests to examine the potential differences of daily experience and subjective well-being between mothers and fathers. Results indicated that mothers experienced more negative affect (t = −3.28, p = .001) and lower life satisfaction (t = 2.26, p = .024) than fathers. Moreover, mothers experienced more child-related stress (t = −4.68, p < .001) and perceived less social support (t = 3.37, p = .001) than fathers, but they used more positive coping (t = −2.76, p = .006) and less avoidant coping (t = 2.05, p = .041).

Same-day associations between stress, coping, social support, and well-being

Negative affect

At the between-parent level, average child-related stress was positively associated with the intercept for negative affect (γ₀₁ = .47, p < .001), thus indicating that parents who on average experienced more child-related stress than other parents reported higher average levels of negative affect. At the within-parent level, daily avoidant coping was positively associated with the same-day level of negative affect (γ₃₀ = .48, p = .034; see Table 2).

Table 2.

Multilevel models predicting same-day positive and negative affect and life satisfaction.

Variable	Negative affect		Positive affect		Life satisfaction
Variable	Coefficient (SE)	t ratio	Coefficient (SE)	t ratio	Coefficient (SE)	t ratio
Intercept, γ₀₀	14.47 (.54)	26.95***	21.33 (1.16)	18.35***	3.62 (.10)	37.49***
Average child-related stress, γ₀₁	0.41 (.09)	4.73***	0.19 (.13)	1.43	−0.04 (.01)	–2.42*
Average positive coping, γ₀₂	−0.46 (.55)	−0.82	3.51 (.98)	3.59***	0.41 (.12)	3.37***
Average avoidant coping, γ₀₃	0.93 (.63)	1.47	−1.28 (.89)	−1.44	−0.02 (.10)	–0.22
Average social support, γ₀₄	0.08 (.10)	0.77	0.22 (.15)	1.45	0.07 (.02)	3.74***
Parent gender, γ₀₅	0.44 (.62)	0.72	−0.80 (1.30)	−0.62	−0.06 (.10)	–0.61
Child-related stress, γ₁₀	0.19 (.16)	1.22	0.23 (.24)	0.97	0.01 (.01)	1.08
Parent gender, γ₁₁	0.01 (.16)	0.01	−0.14 (.25)	−0.58	−0.04 (.02)	–2.38*
Positive coping, γ₂₀	−0.25 (.27)	−0.92	1.06 (.33)	3.17**	0.14 (.05)	2.80**
Parent gender, γ₂₁	−0.25 (.32)	−0.80	−1.12 (.43)	−2.62	−0.07 (.06)	–1.13
Avoidant coping, γ₃₀	0.48 (.22)	2.16*	−0.63 (.29)	−2.17*	−0.13 (.08)	−1.69
Parent gender, γ₃₁	0.02 (.27)	0.09	−0.13 (.34)	−0.40	0.02 (.08)	0.29
Social support, γ₄₀	−0.08 (.09)	−0.96	0.01 (.08)	0.05	0.02 (.01)	1.12
Parent gender, γ₄₁	−0.03 (.10)	−0.29	0.11 (.11)	1.07	0.04 (.02)	2.17*
Day of study, γ₅₀	−0.13 (.03)	−4.58***	−0.22 (.03)	−6.28***	0.01 (.01)	0.27

SE: standard error.

Day 1 of study was coded as 0.

p < .05, **p < .01, ***p < .001. ***p < .001.

Positive affect

As shown in Table 2, average positive coping was positively related to the intercept for positive affect (γ₀₂ = 3.51, p < .001). In addition, more positive coping (γ₂₀ = 1.06, p = .002) and less avoidant coping (γ₃₀ = −.63, p = .033) on a given day were significantly correlated with more positive affect within the same-day; that is, on days of above average positive coping and below average avoidant coping, parental positive affect was higher.

Life satisfaction

As shown in Table 2, between-parent effects were significant; average positive coping (γ₀₂ = .41, p = .001) and social support (γ₀₄ = .07, p < .001) were positively correlated with the intercept for life satisfaction, whereas average child-related stress was negatively correlated with the average level of parental life satisfaction (γ₀₁ = −.04, p = .018). At the within-parent level, more positive coping was associated with higher levels of life satisfaction on the same day (γ₂₀ = .14, p = .006). Moreover, the interaction between child-related stress and parent gender was significant (γ₁₁ = −.04, p = .020). Single slope analysis was conducted to probe the significant interaction (Preacher et al., 2006). The results showed that the negative effect of daily child-related stress on the same-day level of parental life satisfaction was significant for mothers (b = −.022, p = .031) but not for fathers (b = .014, p > .05; see Figure 3). There was also a significant interaction between social support and parent gender (γ₄₁ = .04, p = .033). Probing this interaction effect revealed that the positive effect of daily social support on parental life satisfaction was significant for mothers (b = .060, p < .001) but not for fathers (b = .016, p > .05; see Figure 4).

Figure 3.

The interaction of daily child-related stress and parent gender in predicting same-day levels of parental life satisfaction.

Figure 4.

The interaction of daily social support and parent gender in predicting same-day levels of parental life satisfaction.

Next-day associations between stress, coping, social support, and well-being

As shown in Table 3, positive coping positively predicted next-day life satisfaction (γ₂₀ = .16, p = .030) after controlling for prior-day life satisfaction. However, the main effects of child-related stress, negative coping, and social support, or the moderation effect of parent gender on parental next-day well-being were not significant.

Table 3.

Multilevel models predicting next-day positive and negative affect and life satisfaction.

Variable	Negative affect		Positive affect		Life satisfaction
	Coefficient (SE)	t ratio	Coefficient (SE)	t ratio	Coefficient (SE)	t ratio
Intercept, γ₀₀	14.00 (.56)	25.01***	19.90 (1.30)	15.35***	3.62 (.09)	38.98***
Average child-related stress, γ₀₁	0.35 (.08)	4.20***	0.12 (.13)	0.88	−0.03 (.01)	−1.91
Average positive coping, γ₀₂	−0.50 (.53)	−0.94	3.33 (1.03)	3.22**	0.41 (.12)	3.55***
Average negative coping, γ₀₃	0.56 (.58)	0.98	−0.44 (.99)	−0.45	−0.01 (.11)	−0.04
Average social support, γ₀₄	0.13 (.10)	1.26	0.33 (.16)	2.06*	0.06 (.02)	3.41***
Parent gender, γ₀₅	0.35 (.64)	0.54	0.05 (1.43)	0.03	−0.05 (.10)	−0.53
Prior-day child-related stress, γ₁₀	−0.04 (.09)	−0.49	0.01 (.11)	0.14	0.02 (.03)	0.76
Parent gender, γ₁₁	−.11 (.10)	1.14	0.01 (.12)	0.03	−0.01 (.03)	−0.32
Prior-day positive coping, γ₂₀	0.11 (0.25)	0.44	0.14 (.25)	0.57	0.16 (.07)	2.21*
Parent gender, γ₂₁	0.05 (.30)	0.17	−0.57 (.33)	−1.73	−0.12 (.08)	−1.44
Prior-day avoidant coping, γ₃₀	−0.22 (.19)	−1.17	−0.04 (.17)	−0.22	0.07 (.07)	1.04
Parent gender, γ₃₁	0.30 (.24)	1.27	−0.03 (.25)	−0.11	−0.06 (.08)	−0.71
Prior-day social support, γ₄₀	0.07 (.06)	1.09	0.03 (.08)	0.39	0.02 (.02)	0.86
Parent gender, γ₄₁	−0.09 (.07)	−1.17	0.12 (.11)	1.10	−0.01 (.02)	−0.36
Prior-day affect/satisfaction, γ₅₀	0.12 (.04)	2.66*	0.12 (.04)	3.13**	−.05 (.05)	1.11
Day of study, γ₆₀	−0.08 (.02)	−3.53***	−0.14 (.03)	−4.01***	0.01 (.01)	0.31

SE; standard error.

Day 1 of study was coded as 0.

p < .05, **p < .01, ***p < .001.

Discussion

In their everyday lives, parents of children with ASD may encounter varying levels of stress and employ different coping and social support-seeking behaviors that have important implications for their well-being (Hartley et al., 2017; Pottie et al., 2009). The current study adopted the double ABCX model as a framework for understanding factors associated with daily affect and life satisfaction in Chinese parents of autistic children. Results showed that higher child-related stress and lower social support on a given day were related to mothers’ (but not fathers’) lower life satisfaction that day. Higher levels of avoidant coping were related to mothers’ and fathers’ higher negative affect and lower positive affect on the same day but not the next day. Moreover, daily positive coping was positively related to both mothers’ and fathers’ life satisfaction on the same day and the following day, and positively correlated with same-day positive affect. The applicability of the double ABCX model in explaining family adaptation for parents raising a child with autism has been confirmed by previous cross-sectional studies that relied on global measures, and the studies were mainly conducted in Western cultures (e.g. McStay et al., 2014; Meleady et al., 2020; Pozo et al., 2014). Findings of this study expand this model to diary studies to investigate day-to-day dynamics of parental well-being and to other cultural groups (i.e. Chinese).

We found that the impact of daily child-related stress (labeled A in the model) on life satisfaction was moderated by parent gender, with these same-day associations being significant only among Chinese mothers. This is consistent with previous studies in other cultural groups (McStay et al., 2014; Vernhet et al., 2019) that have discussed the greater impact of child stress and related social support on mothers’ well-being than on fathers’ well-being when parenting a child with ASD. This could be due to the fact that mothers are usually more involved in taking care of children with ASD (Dardas & Ahmad, 2014) and therefore more vulnerable to child-related stress than fathers (Allen et al., 2013; Ang & Loh, 2019). This is especially so in China, where the traditional cultural ideas hold that mothers should take on multiple family responsibilities, such as housekeeper and caregiver of the child (Gau et al., 2010). This cultural stereotype about motherhood roles puts more pressure on Chinese mothers, making the daily stress of parenting an autistic child even more pronounced on them (Lin, 2015). Therefore, on days of above average child stress, Chinese mothers experienced poorer life satisfaction than usual.

Similarly, the daily relationship between same-day social support (labeled B in the model) and parental life satisfaction was only significant among mothers. Social support can be an important resource that helps parents of autistic children counteract the daily demands of childrearing by providing instrumental or emotional support (Meleady et al., 2020; Paynter et al., 2013). It is particularly important in countries such as China, where formal services and support systems have yet well-established and parents of children with disabilities commonly report a lack of sufficient formal support (Su et al., 2018). Thus, Chinese mothers, as the primary caregivers, may be more reliant on support from family and friends to fill the caregiving needs in informal ways. On days when mothers receive adequate social support to cope with the challenges of caring for their autistic children, they were more likely to report greater life satisfaction that day. The results of the current study are consistent with prior diary studies in other cultural groups (e.g. White American, African American; Pottie et al., 2009), suggesting that social support can serve as a protective factor in helping Chinese mothers of children with ASD reduce stress and promote life satisfaction in their daily lives.

As expected, higher avoidant coping (labeled C in the model) on a particular day was correlated with lower positive affect and higher negative affect on the same day. This finding is in line with previous cross-sectional and longitudinal studies (Hastings et al., 2005; Yu et al., 2018), suggesting avoidance is unhelpful for parents of children with ASD when coping with the demands of childcare. Based on the stress and coping model (Lazarus & Folkman, 1984), avoidant coping may lead to increased negative outcomes on parents because neither the stressors originating from parenting a child with autism nor their emotional reaction to caregiving burdens is addressed. Furthermore, Chinese parents may actively use avoidant coping due to their concerns about the potential stigma attached to their ASD children and themselves (Ji et al., 2014; Tait et al., 2016). In the day-to-day process of raising children with ASD, the detrimental impact of avoidant coping may be more salient for Chinese parents of ASD children.

The most consistent predictor of daily well-being was positive coping (labeled C in the model). Specifically, higher levels of positive coping on a particular day were related to higher positive affect that day as well as greater life satisfaction both on the same-day and on the next day. Given that parents of children with ASD confront daunting challenges in their daily life when dealing with the demands of raising their children, positive coping, such as reframing the situation in a positive light, may be more effective in dealing with daily hassles and restoring balance in family functioning (Lai & Oei, 2014; Meleady et al., 2020). On days when parents report greater use of positive coping than usual, they tend to view the daily challenges associated with having a child with ASD in a more positive light and experience more positive affect.

To the best of our knowledge, the only study examining the impact of daily coping strategies on well-being in parents of children with autism was conducted in White American families (Pottie & Ingram, 2008). The researchers found that higher positive emotion-focused coping was associated with more daily positive mood. The findings from this study support Pottie and Ingram’s (2008) research on daily coping and extend their findings to the Chinese cultural context. Our results highlighted that daily positive coping is particularly important and has a lingering protective effect on reducing stress and thus promoting positive affect and life satisfaction both concurrently and with a 1-day lag among Chinese parents of children with ASD.

We also expected to observe next-day effects of child-related stress, avoidant coping, and social support, however none of these variables influenced positive or negative affect or life satisfaction on the flowing day. Such findings are novel yet consistent with the view that same-day associations between daily experiences and well-being would be more notable than lagged associations (Kiang & Buchanan, 2014). Since the degree of perceived well-being is dynamic and changes on a daily basis (Heller et al., 2006), it appears to be more susceptible to immediate factors; thus, the effects of stress and social support would be attenuated over time and do not carry over to the next day (Obeid & Daou, 2015). Another possibility is that parents of children with ASD in the current sample have demonstrated resilience that promotes better recovery from the negative impacts of children’s ASD symptoms observed on the previous day (Ekas & Whitman, 2011). The results of this study provide an important first glimpse into the daily lives of Chinese parents of a child with ASD. More research in different cultural contexts is needed in which daily measures of various factors are included within the double ABCX model, in order to further elucidate how daily child-related stress, coping, and social support influence parents’ subjective well-being from one day to the next.

The results of this study have important implications for programs and interventions aimed at improving the daily well-being of parents of children with ASD. First, we found that among all the factors included in this daily diary study, positive coping was the most associated with parents’ daily well-being. This finding emphasizes the importance of supporting families to develop and use positive coping strategies. Indeed, researchers have developed various forms of positive coping interventions that have repeatedly shown to improve subjective well-being and reduce parenting stress for parents of autistic children (Pickard & Ingersoll, 2017). For example, Hidayah and Lestari (2019) demonstrated that self-help groups intervention on coping strategies can promote positive coping skills such as problem-focused coping and support seeking to help parents of ASD children cope with stress in their daily life. Other interventions, such as the Positive Reappraisal Coping Intervention (PRCI) have been shown to enhance positive reinterpretation and individual growth to prompt parents to view the difficult situations of caring for a child with autism in a more positive way (Lancastle et al., 2022). It is therefore to help parents ameliorate the negative effects of caregiving and promote positive well-being outcomes.

In addition, the findings that the same-day associations between child-related stress, social support, and life satisfaction were only significant in mothers (but not in fathers) highlight intervention efforts for Chinese mothers of children with ASD. Supportive services focused on providing respite to mothers and increasing paternal involvement are highly encouraged to foster mothers’ resilience and further promote health and well-being of the whole family (Rankin et al., 2019).

The present study has some limitations. First, this study relied solely on parent-report data, which increases the potential for biased results due to shared method variance and social desirability. It is recommended that future studies include multiple informants (e.g. children and other parents) or more objective measures of daily experiences (e.g. observations) to replicate the current findings. Second, only 19 fathers participated in this study and the small sample of fathers limited the statistical power to detect gender differences in daily associations. Moreover, given that this study did not include comparison groups, it is unclear whether the current findings are unique to parents of children with ASD. Future studies with larger sample sizes should incorporate comparison groups to better test how daily experiences are linked to parental well-being. Finally, since the overall severity of autism symptoms, behavior problems, and vocal and non-vocal skills in children can influence parental stress (e.g. Dieleman et al., 2019), future research could collect this information during baseline data collection and control for their impact on parents’ daily stress and well-being.

Utilizing the double ABCX Model as a guiding framework, the current study examined the concurrent and lagged effects of child-related stress, social support, and coping on daily well-being among Chinese parents of children with ASD. We found that parental positive coping on a given day was related to not only higher positive affect and higher life satisfaction on the same day but also higher life satisfaction on the following day. In addition, the same-day associations between child-related stress, social support and life satisfaction were only significant in mothers, not in fathers. Previous cross-sectional studies in Western cultural contexts have consistently demonstrated that the double ABCX model is useful in identifying factors related to overall family adaptation to children’s ASD by measuring the global or aggregated levels of variables at one-time point. Our results extend this model to a daily diary study and to a non-Western culture (i.e. Chinese) and suggest that it can also provide a useful framework for understanding the links between parenting experiences and well-being outcomes at the daily level in Chinese families of children with autism. The findings of this study emphasize mothering vulnerability and the salient role of positive coping in raising children with ASD and shed new light on intervention programs for Chinese parents of children with ASD.

Footnotes

Declaration of conflicting interests

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

Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Beijing Social Science Fund Project (grant no. 21DTR030).

ORCID iDs

Hui Wang

Sihan Liu

Zhuo Rachel Han

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