Tuesday, 21 June 2011

D-I-V-O-R-C-E and autism

D-I-V-O-R-C-E went the song from Dolly Parton. Dolly herself has little reason to sing such a song with her pretty long-lasting marriage to her husband Carl Dean - and good luck to them too. When it comes the general population however, many people are not as lucky as Dolly and Carl, with current divorce rates hovering around the 10.5 per 1,000 marriages in the UK (2009) and 3.4 per 1,000 marriages in the USA (2010).

I have to say I was surprised at the UK and US figures. Like many people in the UK, I was always under the impression that divorce was much more common in the States than here in Blighty given the media portrayal and the almost constant references to things like the pre-nuptial. I would therefore like to apologise to our American cousins for my tainted view of the divorce statistics.

Before I go on, I would perhaps mention that whilst divorce is often (always?) a stressful and difficult time for parents, it can be equally, if not more distressing for any off-spring who might also be caught up in the middle, also dependent on their age and understanding of the implications. There are for example, quite a few studies which have confirmed the detrimental effects of divorce in terms of the longer-term outcome including the child's subsequent self-esteem, identity and skills and abilities to form long-lasting relationships. Even childhood bed-wetting may be tied into the experience of divorce.

When it comes to autism spectrum conditions, there is quite a lot of speculation as to whether the divorce rate may be different amongst parents who have a child with autism compared with the general population. As you would imagine this is a very delicate area to discuss given the implications of divorcing where autism 'might' be a factor and what light this potentially puts autism in. I would add that I am not judging, merely reviewing the available data.

This paper suggested that there was a significant difference in divorce rates among parents of children with autism and controls (23.5% vs. 13.8%). Interestingly, the authors also found that whereas divorce rates in the control group tended to drop off after a child had emerged from infancy, the divorce rate amongst the autism parent group did not. The explanation was that the continuing 'dependency' demands of children with autism on their parents may have had an effect.

The collected data is however not unanimous in postulating that having a child with autism is a risk factor for divorce. This recent paper found no increased risk of divorce (or as they put it 'living in a household not comprised of their two biological or adoptive parents'). The same data was also presented at the 2010 IMFAR conference.

I found this recent article which provides some qualitative data on the possible effect of autism on cases of parental divorce; the report data suggesting that half of all divorces where autism was involved, cited autism as 'one' reason for the divorce. It is interesting that stress in one form or another was listed as a factor related to autism and the breakdown of the marriage. There are often considerable stresses and strains which have been experimentally shown to occur when raising a child/children with autism; indeed beyond those of raising a child with an intellectual disability such as Down syndrome for example. The types of strain which can occur are numerous and include relatively simple things like just getting enough sleep (those of you that read my post on sleep and autism might get a flavour of this issue). The impact of stress (whether connected to autism or for other reasons) on the effectiveness of intervention has also been examined and a possible relationship found.

I don't quite know what conclusion to draw from this combined data. Yes, there does some to be some connection between having a child with autism and divorce. I don't however think that we can say that every parent who has a child with autism is likely to divorce because divorce is a very complicated thing, and the reasons behind it are pretty personal and numerous. Take for example, this recent analysis which suggested that husbands playing video games to the detriment of talking to their wives was suggested as a factor in up to 15% of cases of divorce.

There are also a couple of aspects missing from the evidence base. Things like whether the 'type' of autism has any impact and whether also co-morbidity such as intellectual disability or epilepsy or other things might also be contributory to or protective against divorce. I would also like to see further research on how things like coping mechanisms, the impact of other children and extended family support, finance and monetary issues and faith and religion might also affect a parental decision to stay together or not. Such data could also be useful when it comes to mediation before any final decisions are made.

I would finally point out that divorce is an agreement between two people - 'the final termination of a marital union' to put it into cold, hard words. Unless one or both of those persons have autism themselves, the decision to divorce or not, is ultimately about those two individuals and their relationship, everything else including the house, the kids, the possessions and yes, autism, is secondary.

How about a more up-beat song from Dolly?