The workshop aims to develop an understanding of the challenges, skills, and issues for autistic mothers.
It will consider evaluative points and module themes around interventions.
Participants will plan a hypothetical intervention for an autistic mother, modifying intervention and communication strategies.
The session will include a mid-term evaluation and global classroom peer and teacher feedback on infographics.
Initial Questions for Consideration
In what ways is parenting a stressful job?
Based on essential readings, what factors could make motherhood difficult for autistic people?
What strengths might autistic mothers have?
Importance of Studying Maternal Autism
Autistic individuals often have unmet healthcare needs and lower healthcare self-efficacy (Nicolaidis et al., 2013).
They may experience increased anxiety while accessing healthcare services (Lum et al., 2014).
Increasing Recognition but Lagging Support
There's an increase in autistic women (and those assigned female at birth) being diagnosed, with a <150% increase among women over 35 years (Underwood et al., 2021).
However, 80% of autistic females remain undiagnosed at age 18 (McCrossin, 2022).
Improved diagnostic rates do not translate to quality, long-term post-diagnostic support (Bargiela et al., 2016).
There is even less support for autistic mothers due to a lack of clinical understanding and research in this area (McDonnell et al., 2021).
Almost a quarter of mothers of autistic children identify as having autistic traits (Pruitt et al., 2016).
Challenges Faced by Autistic Mothers
Autistic mothers face challenges throughout motherhood, including prenatal and postnatal periods.
Pregnancy and birth can lead to additional sensory processing challenges (Samuel et al., 2022).
They are more likely to experience additional psychiatric conditions, including pre- or post-partum depression, and report greater difficulties in areas such as multi-tasking, coping with domestic responsibilities, and creating social opportunities for their child (Pohl et al., 2020).
They are more likely than non-autistic mothers to feel stigmatized and misunderstood by health professionals (Pohl et al., 2020).
Stigma presents a major barrier to accessing services or seeking support from friends and family.
Prenatal Challenges
Communication challenges between patients and providers, sensory overload from the healthcare environment, and issues related to understanding information such as memory and processing speed during appointments (Mason et al., 2019).
Prenatal depression/anxiety, not autistic traits by themselves, are challenges for autistic women during and after pregnancy (Lum et al., 2014).
Autistic women are at an increased risk of adverse pregnancy outcomes compared to non-autistic women (Sundelin et al., 2018).
Unmet healthcare needs for autistic mothers lead to increased anxiety while accessing healthcare services (Lum et al., 2014).
Autistic people may not feel pain in the same way as neurotypical people and may find it difficult to describe pain in a way that the average health professional understands (Grant et al., 2022), potentially due to interoception challenges.
Postnatal Challenges
Grant (2022) systematic review found:
Low understanding of autism and lack of acceptance of autistic needs among maternity staff.
Autistic mothers felt they were not heard or believed by health professionals, judged, and reluctant to disclose their diagnosis.
Services not tailored towards autistic needs.
Difficulties transitioning to becoming a parent – exhaustion, control, and routine.
Felt unable to assert their needs.
Pohl et al. (2020) found that autistic women were more likely to self-report experiencing post-partum depression compared to non-autistic women.
64% of 306 autistic women reported difficulty breastfeeding their first child compared to 58% of 118 non-autistic women (Pohl et al., 2020).
Postnatal (Parenthood Outcomes)
Dugdale et al. (2021) conducted semi-structured interviews with nine autistic mothers to children aged 5–15 years on parenting experiences.
Autism fundamentally impacts parenting.
Mothers face a battle for the right support.
Development and acceptance are key themes.
Parenting involves ups and downs.
Feelings of intense connection and closeness were experienced by mothers but often interrupted through having to manage the child’s daily needs.
Shared understanding of autism can be a positive factor.
Strategies for Autistic Mothers
Focus on building on strengths, reducing stress, anxiety, & rigidity.
Intervention must be very sensitively delivered – no parent likes criticism nor to feel judged.
Active listening.
Rapport building.
Emotional support.
Psychoeducation.
Peer support.
Positive Psychology Coaching.
Mindful emotion coaching.
Cognitive behavioral coaching.
Signposting.
Interventions
Interventions should not try to hide or suppress autistic traits to make autistic mothers become ‘neurotypical’ mothers.
Masking could lead to further mental health issues.
Autistic parents with autistic children are able to create a neurodiversity-affirming home environment (Attwood, 2022).
Interventions should assist with managing daily tasks, boosting self-esteem, and providing a peer support network of other autistic mothers.
Not all interventions work for all autistic mothers, and there is no single intervention for autism.
Group Activity Instructions
Each group is given a case study scenario to read.
Create a paper plan: Plan which intervention strategies you may use to help reduce stress for the autistic mother.
Justify why you would use your chosen strategies.
Using your knowledge of autism from the module so far, plan how you would tailor communication strategies with the autistic mother.
Present your plan to your peers.
FISS-ASC Psychoeducation Workshops
Understanding autism.
Sensory & communication.
Managing anxiety.
Demand Avoidance.
Bonds & boundaries.
Compulsions & rituals.
Individual personalized psycho-education.
Positive Behavior Support (PBS)
Based on Behaviorism (Classical & Operant Conditioning).
Focus on reinforcing positive behavior, however minor.
Aims to reduce challenging behavior by reinforcing positive behavior.
Reduces stress and anxiety-provoking situations.
Reinforcement by therapist, parents, educators.
Parents are trained in PBS techniques.
The UK Government endorses the PBS approach (2014).
A controversial form of PBS is ABA (Applied Behavior Analysis) therapy – USA (Devita-Raburn, 2016).
PBS in Practice
Step 1 – understand the function of a challenging behavior.
Step 2 – Identify slow & fast triggers.
Step 3 – Identify strengths.
Step 4 – Intervene at the slow trigger stage using strengths positive reinforcement.
Evaluation of PBS (ABA): refer to Milton (2014).
Positive Psychology Coaching
Seeks to identify strengths.
Positive problem-solving using optimism, resilience, humor, self-efficacy, and kindness are key traits at the core of positive psychology.
Krata (2013) identified how PPC can be used with autism.
Positive Psychology Coaching Details
Over a series of 3-6 sessions, the client learns about positive psychology and is asked to create experiments as ‘homework’ to try out between sessions (Groden et al., 2011).
Aim to:
Reinforce a mindset of ‘positive attitude’.
Increase resilience.
Reduce anxiety & stress.
Increase self-esteem.
Increase feelings of happiness.
Mindful Emotion Coaching
Emotion coaching relates to parents’ skills in accepting, labeling, & validating their own & their children’s emotional experiences and expression (Temple & Holly, 2010).
It involves helping to understand & regulate emotional arousal & display, & problem solve about the source of those emotions (Snyder et al., 2013).
Hand model of the brain with children (Siegal, 2010).
It addresses anxiety, depression, behavioral difficulties, and emotional regulation.
Additional Strategies to Modify for Autistic Mothers
Ensuring the therapy room is autism-friendly – environmental tweaking.
Appointments with a friend to support.
Appointments in the home.
Modify instructions to allow for executive functioning difficulties.
Repetition.
Written summary of intervention.
Awareness that she may have difficulty communicating her concerns clearly.
Additional emotional support – via phone check-ins.
Support with strategies around rigidity.
Movement breaks within long appointments (initial assessment).
Outdoors coaching – reduces pressure of eye contact.
Cognitive Behavioral Coaching (CBC)
S.P.A.C.E. (Edgerton & Palmer, 2005).
Roots in cognitive behavioral therapy.
Focus on stress management, anxiety, and conflict management.
Evaluation and Consideration of ‘Interventions’
Issues of personal agency and double empathy.
Diversity in autism – is it helpful to create a single clinical intervention for autistic mothers?
Do mothers need help, support, or ‘intervening’ with? (c.f. Milton, 2014).
To what extent does the system have to change/adapt to autistic mothers?
Post-Lecture Tasks
Take a photo of your ‘intervention’ so you have a record of your work to use for the exam.
Portfolio Task 7: Write up your intervention and add further points.
Work on your infographics!
Include reading on sensory reactivity in autism for your infographics (otherwise no extra reading prep for this week).
Mid-Term Module Evaluation
Survey for Feedback, Rating, Comments, Responses, Advice.
Global Classroom Activities
Get into your GC groups.
Make sure you have uploaded your infographic (whatever state it is in!) - onto your individual group discussion on the Canvas GC module.
Peer review another group’s work: Group 1 review Group 2, Group 2 review Group 3, and so on… Group 10 review Group 1.
Please provide feedback on:
Clarity – is it easy to follow and understand?
Visual and verbal content?
Style – is it pleasing, colors, spacing, photographs, visuals?
Content – is this valid, robust, informative?
Evidence – are there accurate references/evidence for the main points?
Inclusion of names (students), logos, institutions (universities), and community partner.