Critical Article Review Paper

Introduction
The article, Age-Related Differences in the Association between Autistic Sons’
Challenging Behaviour and Maternal Anxiety and Depression: Implications for Counsellors by
Bitsika & Sharpley (2020) explored challenging behavior (CB) among autistic sons and its
impact on their mother’s mental health. The study aimed to investigate the possible relationship
between the autistic child’s CB and depression and anxiety symptoms in the parents. The authors
hypothesized that a significant relationship exists between the observed Aberrant Behavior
Checklist (ABC) and the mother’s depression and anxiety.
Method
The researchers advertised local parent support groups in Australia, inviting families with
at least one child with autism spectrum disorder (ASD) to participate in the study. A sample of
49 mothers was selected for the study (Bitsika & Sharpley, 2020). Each of the mothers had sons
aged six to nine years. The boys were grouped into four categories based on their age to allow
researchers to compare the different ages. All the boys had been clinically diagnosed with ASD.
However, the researchers also confirmed the diagnosis using the Autism Diagnostic and
Observation Schedule (ADOS-2).
The researchers then used the Generalized Anxiety Disorder 7 (GAD7) to assess self-
reports made by the mothers. The Patient Health Questionnaire (PHQ9) was also used; the two
instruments helped measure anxiety and depression, respectively. Further, the researchers used
an ABC, a 58-item scale, to assess the boys’ CB. The scale rated the boy’s behavior based on
five subscales: inappropriate speech, hyperactivity, stereotypy, lethargy, and irritability (Bitsika

3
& Sharpley, 2020). The scales looked at categories of behavior that are relevant to ASD. The
mothers who took part in the study signed consent forms. They were also given an information
statement and a questionnaire booklet to complete during the four-week period when the data
was collected.
In analyzing data, the researchers used SPSS 23, where they started with descriptive data.
The correlation between the mothers’ PHQ9 and GAD7 scores and the boys’ ABC and IQ
subscale and total scores were tested using the Pearson bivariate correlation. Any significant
differences between the scores were tested using MANOVA and ANOVA. The researchers then
represented the data visually to see the trendlines and correlation coefficients in the data and
determine whether the variables differed across the boys’ different age groups.
Results and Conclusion
The results of the study confirmed that the CB of boys with autism is associated with
their mothers’ mental health. The results showed that the level of anxiety and depression in the
mothers increased with decreasing IQ levels of the boys. The researchers also observed that the
mothers’ depression (PHQ9) scores ad anxiety (GAD7) scores remained relatively constant
across the four groups(Bitsika & Sharpley, 2020). This meant that the scores did not have any
significant differences across the different ages of the boys. The implication was that as the boys
grew older, their mothers’ anxiety and depression moved away from their CB.
The researchers found that there could have been an “experience effect” whereby as the
mothers parented the ASD boys across the years, they developed a certain level of resilience.
However, this explanation was challenged by the fact that the results did not show any
significant relationship between the time of diagnosis and the PHQ9 and GAD7 scores. The

4
“experience effect” could therefore not have been a linear event. The researchers then concluded
that the result could have signaled an age-related variable instead of a time-since-diagnosis
variable that allowed mothers to cope better and not be overly anxious or depressed as their ASD
sons advanced in age. The researchers alluded to the possibility of improved communication as
the boys interacted with their peers in school as the possible cause for the changes in anxiety and
depression scores. However, they agreed that the area should be further investigated in future
studies to allow for a conclusion supported by evidence.
Overall, the results acquired enabled the researchers to provide answers to their research
questions. They found that when the link between boys’ CB and maternal anxiety and depression
is most powerful when the boys are six and seven years. Also, mothers’ resilience to cope with
their sons’ CB increases over time even though the level of anxiety and depression remains
relatively constant over the years. The researchers concluded that raising a child with ASD is
quite demanding and may affect a parent’s emotional well-being. Therefore, psychosocial
support for such parents is necessary to help them live quality lives and cope with the challenges
presented with raising such children.
Notably, the sample was collected from one community, Gold Coast, Queensland,
Australia. The cultural and ethnic limitations of the sample could potentially impact the
generalizability of the research findings. Besides, the mothers who took part in the study
voluntarily responded after the advertisement was made. It is possible that the mothers whose
anxiety and depression levels were very high did not respond, making the sample
unrepresentative of the general population of mothers raising children with ASD. Also, the link
between mothers’ declining levels of anxiety and the boys’ advancing age could imply that
mothers accessed external sources of emotional support over the years, consequently helping

5
them become more resilient. Such possibilities necessitate further studies in the future that will
explore the topic more exhaustively while considering all these variables and their possible
influence on the final findings.
Takeaway
Overall, the researchers conducted the study comprehensively and in a satisfactory
manner. The researchers were objective and refrained from making assumptions. For instance,
they made a precaution when they introduced the possibility of an “experience effect” in the
correlation between boys’ age and the level of maternal anxiety and depression. They advised
that this finding be considered cautiously as the study entailed a rather homogenous sample
given the nature of the boys’ IQ and age. Thus, this opens up a discussion in the scholarly space
and a study gap for future researchers to explore. The work is thus quite impressive. However,
when selecting the sample, the researchers could have specified whether they needed mothers
that have never sought counseling or any psychosocial support for their emotional distress,
specifically linked to raising their ASD sons.
Further, the study has implications for the field of counseling psychology. From the
findings, it is evident that mothers raising children with ASD are vulnerable emotionally. They
may experience emotional distress associated with their children’s CB. Even after several years
of parenting sons with ASD, the maternal levels of anxiety and depression remained significantly
high. These findings demand attention in clinical settings. They necessitate parental assessment
for anxiety and depression for individuals whose children are diagnosed with ASD. Without such
an analysis, the parent’s need for psychosocial support may go unnoticed.

6

References

Bitsika, V., & Sharpley, C. F. (2020). Age-Related Differences in the Association between
Autistic Sons’ Challenging Behaviour and Maternal Anxiety and Depression:
Implications for Counsellors. British Journal of Guidance & Counselling, 48(3),
406–417.