Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

25-12-2022 | Autism Spectrum Disorder | Original Paper

Self-compassion mitigates the cognitive, affective, and social impact of courtesy stigma on parents of autistic children

Authors: Kevin Ka Shing Chan, Winnie Tsz Wa Fung, Donald Chi Kin Leung

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 11/2023

Abstract

Purpose

Due to the courtesy stigma of autism spectrum disorder, many parents of autistic children are devaluated and discriminated against by the public. Despite the high prevalence of this courtesy stigma, very few studies have examined its negative effects on parents of autistic children and explored the factors that may protect the parents from these negative effects. The present study utilized a 2-year, two-wave prospective longitudinal design to examine the associations of courtesy stigma with adverse cognitive (self-stigma), affective (depressive and anxiety symptoms), and social (parent–child and inter-parental conflicts) consequences for parents of autistic children and to test whether these associations would be moderated and mitigated by self-compassion.

Methods

A total of 381 parents of autistic children completed questionnaires about courtesy stigma, self-compassion, self-stigma, depressive and anxiety symptoms, and parent–child and inter-parental conflicts at time 1 (T1) and time 2 (T2).

Results

Courtesy stigma interacted with self-compassion at T1 in predicting self-stigma, depressive and anxiety symptoms, and parent–child and inter-parental conflicts at T2. Specifically, the associations of courtesy stigma with the adverse psychological consequences were weaker for parents with high self-compassion than for those with low self-compassion.

Conclusion

Our results demonstrate the prospective associations of courtesy stigma with adverse cognitive, affective, and social consequences for parents of autistic children, as well as the protective effects of self-compassion against such associations. These results highlight the importance of increasing parents’ self-compassion to help them cope with courtesy stigma and improve their psychological well-being.

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DCCrossRef

Goldin RL, Matson JL, Cervantes PE (2014) The effect of intellectual disability on the presence of comorbid symptoms in children and adolescents with autism spectrum disorder. Res Autism Spectr Disord 8(11):1552–1556. https://doi.org/10.1016/j.rasd.2014.08.006CrossRef

Romero M, Aguilar JM, Del-Rey-Mejías Á, Mayoral F, Rapado M, Peciña M, Barbancho MÁ, Ruiz-Veguilla M, Lara JP (2016) Psychiatric comorbidities in autism spectrum disorder: a comparative study between DSM-IV-TR and DSM-5 diagnosis. Int J Clin Health Psychol 16(3):266–275. https://doi.org/10.1016/j.ijchp.2016.03.001CrossRefPubMedPubMedCentral

Stevens T, Peng L, Barnard-Brak L (2016) The comorbidity of ADHD in children diagnosed with autism spectrum disorder. Res Autism Spectr Disord 31:11–18. https://doi.org/10.1016/j.rasd.2016.07.003CrossRef

Cappadocia MC, Weiss JA, Pepler D (2012) Bullying experiences among children and youth with autism spectrum disorders. J Autism Dev Disord 42(2):266–277. https://doi.org/10.1007/s10803-011-1241-xCrossRefPubMed

Yu L, Stronach S, Harrison AJ (2020) Public knowledge and stigma of autism spectrum disorder: comparing China with the United States. Autism 24(6):1531–1545. https://doi.org/10.1177/1362361319900839CrossRefPubMed

Mitter N, Ali A, Scior K (2019) Stigma experienced by families of individuals with intellectual disabilities and autism: a systematic review. Res Dev Disabil 89:10–21. https://doi.org/10.1016/j.ridd.2019.03.001CrossRefPubMed

World Health Organization (2019) Autism spectrum disorders: fact sheet. https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders. Accessed 15 June 2022

Ling CYM, Mak WWS, Cheng JNS (2010) Attribution model of stigma towards children with autism in Hong Kong. J Appl Res Intellect Disabil 23(3):237–249. https://doi.org/10.1111/j.1468-3148.2008.00456.xCrossRef

10.

Gray DE (1993) Perceptions of stigma: the parents of autistic children. Sociol Health Illn 15(1):102–120. https://doi.org/10.1111/1467-9566.ep11343802CrossRef

11.

Schroeder JH, Cappadocia MC, Bebko JM, Pepler DJ, Weiss JA (2014) Shedding light on a pervasive problem: a review of research on bullying experiences among children with autism spectrum disorders. J Autism Dev Disord 44(7):1520–1534. https://doi.org/10.1007/s10803-013-2011-8CrossRefPubMed

12.

Chan KKS, Lam CB (2017) Trait mindfulness attenuates the adverse psychological impact of stigma on parents of children with autism spectrum disorder. Mindfulness 8(4):984–994. https://doi.org/10.1007/s12671-016-0675-9CrossRef

13.

Chan KKS, Leung DCK (2021) Linking child autism to parental depression and anxiety: the mediating roles of enacted and felt stigma. J Autism Dev Disord 51(2):527–537. https://doi.org/10.1007/s10803-020-04557-6CrossRefPubMed

14.

Yip CCH, Chan KKS (2022) Longitudinal impact of public stigma and courtesy stigma on parents of children with autism spectrum disorder: the moderating role of trait mindfulness. Res Dev Disabil 127:104243. https://doi.org/10.1016/j.ridd.2022.104243CrossRefPubMed

15.

Goffman E (1963) Stigma: notes on the management of spoiled identity. Simon and Schuster, New York

16.

Kinnear SH, Link BG, Ballan MS, Fischbach RL (2016) Understanding the experience of stigma for parents of children with autism spectrum disorder and the role stigma plays in families’ lives. J Autism Dev Disord 46(3):942–953. https://doi.org/10.1007/s10803-015-2637-9CrossRefPubMed

17.

Mak WWS, Kwok YTY (2010) Internalization of stigma for parents of children with autism spectrum disorder in Hong Kong. Soc Sci Med 70(12):2045–2051. https://doi.org/10.1016/j.socscimed.2010.02.023CrossRefPubMed

18.

Chan KKS, Leung DCK, Fung WTW (2022) Longitudinal impact of parents’ discrimination experiences on children’s internalizing and externalizing symptoms: a 2 year study of families of autistic children. Autism. https://doi.org/10.1177/13623613221093110CrossRefPubMed

19.

Chan KKS, Yip CCH, Wang Z (2022) Nonattachment alleviates the longitudinal impact of experienced and anticipated discrimination on parents of children with autism spectrum disorder. Mindfulness 13(7):1733–1744. https://doi.org/10.1007/s12671-022-01911-wCrossRef

20.

Chan KKS, Lam CB (2018) Self-stigma among parents of children with autism spectrum disorder. Res Autism Spectr Disord 48:44–52. https://doi.org/10.1016/j.rasd.2018.01.001CrossRef

21.

Chan KKS, Yip CCH, Leung DCK (2022) Longitudinal impact of self-stigma content and process on parental warmth and hostility among parents of children with autism spectrum disorder. J Autism Dev Disord. https://doi.org/10.1007/s10803-022-05529-8CrossRefPubMedPubMedCentral

22.

Mak WWS, Cheung RYM (2008) Affiliate stigma among caregivers of people with intellectual disability or mental illness. J Appl Res Intellect Disabil 21(6):532–545. https://doi.org/10.1111/j.1468-3148.2008.00426.xCrossRef

23.

Green SE (2007) “We’re tired, not sad”: benefits and burdens of mothering a child with a disability. Soc Sci Med 64(1):150–163. https://doi.org/10.1016/j.socscimed.2006.08.025CrossRefPubMed

24.

Chan KKS, Lam CB (2016) Parental maltreatment of children with autism spectrum disorder: a developmental-ecological analysis. Res Autism Spectr Disord 32:106–114. https://doi.org/10.1016/j.rasd.2016.09.006CrossRef

25.

Chan KKS, Leung DCK (2020) The impact of child autistic symptoms on parental marital relationship: parenting and coparenting processes as mediating mechanisms. Autism Res 13(9):1516–1526. https://doi.org/10.1002/aur.2297CrossRefPubMed

26.

Hou Y, Kim SY, Hazen N, Benner AD (2017) Parents’ perceived discrimination and adolescent adjustment in Chinese American families: mediating family processes. Child Dev 88(1):317–331. https://doi.org/10.1111/cdev.12603CrossRefPubMed

27.

Riina EM, McHale SM (2010) Parents’ experiences of discrimination and family relationship qualities: the role of gender. Fam Relat 59(3):283–296. https://doi.org/10.1111/j.1741-3729.2010.00602.xCrossRefPubMedPubMedCentral

28.

Wong CCY, Knee CR, Neighbors C, Zvolensky MJ (2019) Hacking stigma by loving yourself: a mediated-moderation model of self-compassion and stigma. Mindfulness 10(3):415–433. https://doi.org/10.1007/s12671-018-0984-2CrossRef

29.

Neff KD (2003) Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity 2(2):85–101. https://doi.org/10.1080/15298860309032CrossRef

30.

Neff KD (2016) The self-compassion scale is a valid and theoretically coherent measure of self-compassion. Mindfulness 7(1):264–274. https://doi.org/10.1007/s12671-015-0479-3CrossRef

31.

Chan KKS, Lee CWL, Mak WWS (2018) Mindfulness model of stigma resistance among individuals with psychiatric disorders. Mindfulness 9(5):1433–1442. https://doi.org/10.1007/s12671-018-0887-2CrossRef

32.

Chan KKS, Yung CSW, Nie GM (2020) Self-compassion buffers the negative psychological impact of stigma stress on sexual minorities. Mindfulness 11(10):2338–2348. https://doi.org/10.1007/s12671-020-01451-1CrossRef

33.

Lathren CR, Rao SS, Park J, Bluth K (2021) Self-compassion and current close interpersonal relationships: a scoping literature review. Mindfulness 12(5):1078–1093. https://doi.org/10.1007/s12671-020-01566-5CrossRefPubMedPubMedCentral

34.

Wang H, Lou X (2022) A meta-analysis on the social relationship outcome of being compassionate towards oneself: the moderating role of individualism-collectivism. Pers Individ Differ 184:111162. https://doi.org/10.1016/j.paid.2021.111162CrossRef

35.

Anjum MA, Liang D, Durrani DK, Parvez A (2022) Workplace mistreatment and emotional exhaustion: the interaction effects of self-compassion. Curr Psychol 41(3):1460–1471. https://doi.org/10.1007/s12144-020-00673-9CrossRef

36.

Beekman JB, Stock ML, Howe GW (2017) Stomaching rejection: Self-compassion and self-esteem moderate the impact of daily social rejection on restrictive eating behaviours among college women. Psychol Health 32(11):1348–1370. https://doi.org/10.1080/08870446.2017.1324972CrossRefPubMed

37.

Koch EJ (2020) Remembering that “everybody hurts”: the role of self-compassion in responses to rejection. Basic Appl Soc Psych 42(3):167–175. https://doi.org/10.1080/01973533.2020.1726748CrossRef

38.

Ma J, Liu C, Bao H, Gu X (2022) How to ward off the threat of workplace ostracism? The merit of self-compassion. Pers Individ Differ 187:111396. https://doi.org/10.1016/j.paid.2021.111396CrossRef

39.

Wong CCY, Mak WWS, Liao KYH (2016) Self-compassion: a potential buffer against affiliate stigma experienced by parents of children with autism spectrum disorders. Mindfulness 7(6):1385–1395. https://doi.org/10.1007/s12671-016-0580-2CrossRef

40.

Chan BSM, Deng J, Li Y, Li T, Shen Y, Wang Y, Yi L (2020) The role of self-compassion in the relationship between post-traumatic growth and psychological distress in caregivers of children with autism. J Child Fam Stud 29(6):1692–1700. https://doi.org/10.1007/s10826-019-01694-0CrossRef

41.

Torbet S, Proeve M, Roberts RM (2019) Self-compassion: a protective factor for parents of children with autism spectrum disorder. Mindfulness 10(12):2492–2506. https://doi.org/10.1007/s12671-019-01224-5CrossRef

42.

Bohadana G, Morrissey S, Paynter J (2019) Self-compassion: a novel predictor of stress and quality of life in parents of children with autism spectrum disorder. J Autism Dev Disord 49(10):4039–4052. https://doi.org/10.1007/s10803-019-04121-xCrossRefPubMed

43.

Neff KD, Faso DJ (2015) Self-compassion and well-being in parents of children with autism. Mindfulness 6(4):938–947. https://doi.org/10.1007/s12671-014-0359-2CrossRef

44.

Liao X, Lei X, Li Y (2019) Stigma among parents of children with autism: a literature review. Asian J Psychiatr 45:88–94. https://doi.org/10.1016/j.ajp.2019.09.007CrossRefPubMed

45.

Papadopoulos C, Lodder A, Constantinou G, Randhawa G (2019) Systematic review of the relationship between autism stigma and informal caregiver mental health. J Autism Dev Disord 49(4):1665–1685. https://doi.org/10.1007/s10803-018-3835-zCrossRefPubMed

46.

Salleh NS, Abdullah KL, Yoong TL, Jayanath S, Husain M (2020) Parents’ experiences of affiliate stigma when caring for a child with autism spectrum disorder (ASD): a meta-synthesis of qualitative studies. J Pediatr Nurs 55:174–183. https://doi.org/10.1016/j.pedn.2020.09.002CrossRefPubMed

47.

Mickelson KD, Wroble M, Helgeson VS (1999) “Why my child?”: parental attributions for children’s special needs. J Appl Soc Psychol 29(6):1263–1291. https://doi.org/10.1111/j.1559-1816.1999.tb02039.xCrossRef

48.

Raes F, Pommier E, Neff KD, Van Gucht D (2011) Construction and factorial validation of a short form of the self-compassion scale. Clin Psychol Psychother 18(3):250–255. https://doi.org/10.1002/cpp.702CrossRefPubMed

49.

Eaton K, Ohan JL, Stritzke WGK, Corrigan PW (2019) The parents’ self-stigma scale: development, factor analysis, reliability, and validity. Child Psychiatry Hum Dev 50(1):83–94. https://doi.org/10.1007/s10578-018-0822-8CrossRefPubMed

50.

Serchuk MD, Corrigan PW, Reed S, Ohan JL (2021) Vicarious stigma and self-stigma experienced by parents of children with mental health and/or neurodevelopmental disorders. Community Ment Health J 57(8):1537–1546. https://doi.org/10.1007/s10597-021-00774-0CrossRefPubMedPubMedCentral

51.

Eaton K, Stritzke WGK, Corrigan PW, Ohan JL (2020) Pathways to self-stigma in parents of children with a mental health disorder. J Child Fam Stud 29(6):1732–1744. https://doi.org/10.1007/s10826-019-01579-2CrossRef

52.

Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.xCrossRefPubMedPubMedCentral

53.

Chan KKS, Lam CB, Law NCW, Cheung RYM (2018) From child autistic symptoms to parental affective symptoms: a family process model. Res Dev Disabil 75:22–31. https://doi.org/10.1016/j.ridd.2018.02.005CrossRefPubMed

54.

Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097. https://doi.org/10.1001/archinte.166.10.1092CrossRefPubMed

55.

Aquilino WS (1997) From adolescent to young adult: a prospective study of parent-child relations during the transition to adulthood. J Marriage Fam 59(3):670–686. https://doi.org/10.2307/353953CrossRef

56.

Chan KKS, Wang Z, Li H (2022) Longitudinal impact of mindful parenting on internalizing and externalizing symptoms among children with autism spectrum disorder. Mindfulness 13(8):1984–1993. https://doi.org/10.1007/s12671-022-01933-4CrossRef

57.

Aquilino WS, Supple AJ (2001) Long-term effects of parenting practices during adolescence on well-being outcomes in young adulthood. J Fam Issues 22(3):289–308. https://doi.org/10.1177/019251301022003002CrossRef

58.

Margolin G, Gordis EB, John RS (2001) Coparenting: a link between marital conflict and parenting in two-parent families. J Fam Psychol 15(1):3–21. https://doi.org/10.1037/0893-3200.15.1.3CrossRefPubMed

59.

Krieger T, Hermann H, Zimmermann J, Holtforth MG (2015) Associations of self-compassion and global self-esteem with positive and negative affect and stress reactivity in daily life: findings from a smart phone study. Pers Individ Differ 87:288–292. https://doi.org/10.1016/j.paid.2015.08.009CrossRef

60.

Morley RH (2019) The effect of self-compassion on impulsivity provoked by a reduction in self-esteem. Curr Psychol 38(6):1662–1667. https://doi.org/10.1007/s12144-017-9704-7CrossRef

61.

Jazaieri H, Jinpa GT, McGonigal K, Rosenberg EL, Finkelstein J, Simon-Thomas E, Cullen M, Doty JR, Gross JJ, Goldin PR (2013) Enhancing compassion: a randomized controlled trial of a compassion cultivation training program. J Happiness Stud 14(4):1113–1126. https://doi.org/10.1007/s10902-012-9373-zCrossRef

62.

Gilbert P (2014) The origins and nature of compassion focused therapy. Br J Clin Psychol 53(1):6–41. https://doi.org/10.1111/bjc.12043CrossRefPubMed

63.

Pace TWW, Negi LT, Dodson-Lavelle B, Ozawa-de Silva B, Reddy SD, Cole SP, Danese A, Craighead LW, Raison CL (2013) Engagement with cognitively-based compassion training is associated with reduced salivary C-reactive protein from before to after training in foster care program adolescents. Psychoneuroendocrinology 38(2):294–299. https://doi.org/10.1016/j.psyneuen.2012.05.019CrossRefPubMed

64.

Neff KD, Germer CK (2013) A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol 69(1):28–44. https://doi.org/10.1002/jclp.21923CrossRefPubMed

65.

Schuling R, Huijbers M, Jansen H, Metzemaekers R, Van Den Brink E, Koster F, Van Ravesteijn H, Speckens A (2018) The co-creation and feasibility of a compassion training as a follow-up to mindfulness-based cognitive therapy in patients with recurrent depression. Mindfulness 9(2):412–422. https://doi.org/10.1007/s12671-017-0783-1CrossRefPubMed

66.

Ali A, Hassiotis A, Strydom A, King M (2012) Self stigma in people with intellectual disabilities and courtesy stigma in family carers: a systematic review. Res Dev Disabil 33(6):2122–2140. https://doi.org/10.1016/j.ridd.2012.06.013CrossRefPubMed

67.

Özaslan A, Yıldırım M (2021) Internalized stigma and self-esteem of mothers of children diagnosed with attention deficit hyperactivity disorder. Child Health Care 50(3):312–324. https://doi.org/10.1080/02739615.2021.1891071CrossRef

Title: Self-compassion mitigates the cognitive, affective, and social impact of courtesy stigma on parents of autistic children
Authors: Kevin Ka Shing Chan
Winnie Tsz Wa Fung
Donald Chi Kin Leung
Publication date: 25-12-2022
Publisher: Springer Berlin Heidelberg
Keywords: Autism Spectrum Disorder
Anxiety
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 11/2023
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-022-02413-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Self-compassion mitigates the cognitive, affective, and social impact of courtesy stigma on parents of autistic children

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

Young adults with intellectual and developmental disabilities who participate in Special Olympics are less likely to be diagnosed with depression

Correction to: Prevalence and correlates of perinatal depression

Prevalence and correlates of perinatal depression

Does the peer-led Honest, Open, Proud program reduce stigma’s impact for everyone? An individual participant data meta-regression analysis

Pilot study of a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK: ON TRAC project

A bibliometric analysis of media coverage of mental disorders between 2002 and 2022