Understanding Strengths and Needs of Families Affected by Autism Spectrum Disorder: The Role of Risk and Resilience Factors in Family Adjustment

Background: Autism spectrum disorder (ASD) affects not only a diagnosed child but the entire family system. Researchers have continuously documented challenges and negative consequences of ASD on families (e.g., Baker-Ericzen et al., 2005; Estes et al., 2009; Hoffman et al., 2009; Myers et al., 2009; Phetrasuwan & Shandor Miles, 2009). However, raising a child with ASD also is associated with positive impacts on the family system, though these are infrequently studied. The Resiliency Model of Stress, Adaptation, and Adjustment (McCubbin & McCubbin, 1996) outlines both positive and negative processes involved in a family’s response to a stressor (i.e., child’s diagnosis of ASD). This theory posits that a family achieves successful or positive adjustment by utilizing resiliency factors to balance demands and risk factors. The Family Adjustment Measure (FAM; Daire et al., 2014) has been validated to assess both risk and resilience factors among families of children with a range of disabilities. Recently, the FAM was used to predict families of children with ASD who may experience clinically significant stress (McKee et al., 2020). Such findings suggest clinical utility of the FAM, but additional study with ASD-affected families is necessary. Purpose: The overarching aim of this study was to further explore validity of the FAM when used with families of children with ASD and thereby to enhance understanding of family adjustment in families of autistic children by examining latent structures of family adjustment regarding both risk and resilience factors. Methods: Data collected as part of a larger study examining parent perceptions, stress, family adjustment, and treatments sought amongst parents of youths with confirmed diagnoses of ASD were analyzed. The final sample size for the current study included 359 parents (319 mothers/female guardians, 40 fathers/male guardians). The 30-item FAM was fully completed by all participating parents. The FAM subscales include Parental Distress, Family Based Support, Social Support, and Positive Coping. To examine the factor structure of family adjustment in families of children with ASD, as measured by the FAM: a confirmatory factor analysis (CFA) was completed to determine relationships between the factors and the theorized underlying latent constructs. Results: The CFA utilizing the original four-factor model yielded a significant x2 (p < .001), rejecting that the model perfectly fit to the data. Some model fit indices indicated adequate fit (RMSEA = .07), while others suggested poor fit (CFI = .83, TLI = .85). Due to some model misspecification, relationships within the model were respecified. This was done using case-by-case analysis with review of model fit after each covariance was added. The resulting, final four-factor model indicated adequate and improved fit to the data across all modification indices (RMSEA = .06, CFI = .90, TLI = .92). Conclusion: The FAM’s original four-factor structure was verified in a sample of parents of children and adolescents with confirmed clinical diagnoses of ASD, though additional complexity was added to the model to account for differences within this data set. Future studies should include further study of the FAM for this population, including consideration of a structural equation model (SEM) to account for family, child, and individual characteristics that may influence the risk and resilience factors contributing to overall family adjustment, as improved understanding of family adjustment can lead to improved treatment outcomes for children and their families.