Parental separation in the context of offspring autism or ADHD

It's been quite a few years since I've approached the topic of parental separation/divorce in the context of an offspring diagnosis of autism or attention-deficit hyperactivity disorder (ADHD) (see here). The net result of that discussion was that the (peer-reviewed) evidence base, at the time, was a little mixed when it came to whether parental separation was more or less likely in the context of offspring autism for example. Indeed, whilst family parenting pressures no doubt contribute to parental relationship 'anxiety', there are a myriad of other factors to take into consideration too...

Fast forward to recent times and the study results published by Sabrina Just Kousgaard and colleagues [1] make for the blogging fodder, with their conclusion that: "Parents of children diagnosed with ADHD or ASD [autism spectrum disorder] were more likely to separate than control parents."

From a cold, objective science view the Kousgaard study is a well-powered one, insofar as including "the parents of 12,916 children with ADHD, 7496 children with ASD and 18,423 controls." With those sorts of participant numbers, you probably won't be surprised to hear that the source country was Denmark and yet again, the use of one of those fabulous Scandinavian population registries. Indeed: "all children with ADHD or ASD born between 1990 and 1998 in Denmark" were studied and followed-up "until the child's 25th birthday, parental separation or December 31, 2015, whichever came first."

Authors acknowledge that although there was a higher rate of parental separation in those families with a child with autism or ADHD it wasn't as straight-forward as 'blaming' offspring diagnostic status or not. So: "Other factors associated with parental separation were parental imprisonment, parental psychopathology, low parental education level, low household income and living in a larger city." What this finding does is reiterate that family circumstances are universally 'weird and wonderful' and that just because there is a child or children in the family diagnosed with autism or ADHD (or both) does not mean that families are any more or less 'weird and wonderful'.

Then to the big questions: (i) why was the parental separation rate elevated when autism or ADHD is diagnosed in the family, and (ii) what can be done to help families 'stay together'? Well, without getting too high-and-mighty about this (acknowledging for example, that in some circumstances parental separation is actually a better option than a continued 'toxic' family environment) there are other clues in the research literature (see here).

So, first of all let's acknowledge that parenting is tough. That's a universal issue, irrespective of whether children are diagnosed with this, that or t'other. Having a child with a developmental disorder/label/diagnosis does seem to make things tougher insofar as the additional 'things' that need to be catered for, and the almost constant battles that follow trying to get those additional 'things' catered for. I say this not only from the perspective of the parent-child relationship but also the additional strains related to schooling and education and navigating often complicated social welfare systems for example. It's little wonder that some parents voice sentiments like 'why I can never die' in this context (see here). The research literature is also pretty much unanimous that quality of life for parents with a child with a developmental diagnosis is reduced compared with families without that diagnosis (see here). This also highlights how such pressures take their toll both psychologically and physically. There is no malice intended in that last sentence and no blame to be apportioned; I'm just guided by what the research in this area is telling us.

From the perspective of parents and their relationship with each other, it's not difficult to see how diverting energy into a family and their welfare often means diverting energy away from each other. The words 'emotional roller-coaster' have probably been used more than once to describe parenting a child with a behavioural and/or developmental diagnosis, and minus any psychobabble, such a roller-coaster can be emotionally draining. Yes, there are ups, but also there are downs; and in the context that various types of 'energy' (psychological and physical) are often finite in amount, so when such energies and time are focused on a child or children, there is logically, less for the other significant partner. Simple physics. Throw in the dwindling resources devoted to something like respite care for example (see here) and, well, you can see how this might quite severely affect the family dynamic. And results also tend to be cumulative...

I don't doubt that the issue of parental separation in the context of an offspring developmental and/or behavioural diagnosis is a complicated one. People split up all the time and, more often that not, it's more about the people (parents) themselves and their relationship than anything else. It would be foolish however to disregard data such as that generated by Kousgaard and colleagues showing how context and environment can also play a (variable) role when it comes to family break-up.

And on the back of the Kousgaard results, it's perhaps also time to start thinking about how parental break-up / separation might affect said offspring, particularly when a diagnosis of autism and/or ADHD is part of the clinical picture...

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[1] Kousgaard SJ. et al. The effect of having a child with ADHD or ASD on family separation. Soc Psychiatry Psychiatr Epidemiol. 2018 Aug 28.

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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?