Annals of Psychiatry and Treatment

Shahrokh Amiri*, Fatemeh Ranjbar, Research Article

Roshanak Hatami, Habibeh Barzegar,
Salman Abdi and Ali Baharigharehgoz
Research Center of Psychiatry and Behavioral
Psychopathology of the Parents
Sciences, Tabriz University of Medical Sciences,
Tabriz, Iran of Autistic Children Based on the
Dates: Received: 25 June, 2016; Accepted: 08
August, 2016; Published: 11 August, 2016 Clinical Personality Disorders
*Corresponding author: Dr. Shahrokh Amiri,
Department of Psychiatry, Razi University Hospital,
Elgoli Road, Tabriz 51677, East Azerbaijan, Iran, Abstract
E-mail: Objective: The aim of this study was to investigate the psychopathology of parents of autistic
www.peertechz.com children based on clinical personality disorders.

Keywords: Psychopathology; Parents; Autistic Methodology: In this is a cross-sectional study,130 parents of autistic children were selected from
disorder; Prevalence; Personality disorders autism community rehabilitation centers in Tabriz, Iran and 154 parents of the mentally healthy children
were selected as controls. Diagnostic interview based on DSM-IV-TR criteria was used to diagnose
ISSN: 2640-8031 autism by two child and adolescent psychiatrists. The Millon Clinical Multiaxial Inventory-III (MCMI-III)
was used to evaluate parents’ personality profiles.

Results: The frequency of having personality disorders was higher in the parents of autistic
children than controls (p<0.01).The most common psychiatric conditions among parents of autistic
children were melancholic personality, persistent depression and negativism (44.6%, 29.2% and
25.4% respectively). Alcohol and substance use and antisocial personality were the least prevalent.
Clinical patterns of personality disorders (avoidance, depressed, sadist, negativist, masochist), severe
personality pathology (schizotypal, borderline, paranoid), clinical syndromes (generalized anxiety,
somatoform, bipolar, persistent depression, PTSD), and severe clinical syndrome (thought disorder,
delusional disorder) were higher in parents of autistic children than controls (p<0.05) and prevalence of
histrionic personality disorder was lower (p<0.01).

Conclusion: Parents of autistic children have higher rate of psychopathology.

Introduction developmental disorders (PDD) in Japan indicated that they have

experienced higher level of stress than mothers in general population.
Autism may be defined as child’s inability to communicate with
Mothers’ emotional stress was associated with the specific personality
people or situations. The term “Autistic” refers to the children in whom
traits such as neuroticism and agreeableness, perceived control by
a set of developmental disorders is observed pertaining mostly to the
the husband and the severity of widespread developmental disorder
central nervous system. Impairment in social and communicational
scores [10]. Gary et al. [11], reported that mothers of children
interactions, as well as limited and repeated interests are considered
with PDD are more vulnerable than the fathers while dealing with
the triple most important deficits of autism [1]. The prevalence
problems and use different strategies to get on with the child’s
of autism spectrum disorders at the age of eight is estimated to be
inability. Konstantareas et al. [12], reported that anger and call for
between 5.7 and 21.9 per 1000 [2]. This rate is estimated to be 6.26 per
10000 in Iranian children [3]. the help of a spouse are more observed in mothers of autistic children
than mothers of normal children.
According to the systematic family theories, the behavior of each
family member (especially parents) influence the behavior of other A study conducted on 2 to 5 years old children with PDD, indicated
members (especially children); therefore, presence of a psychiatric that their behavioral and emotional problems have a considerable
disorder in a family member affect the behavior of others and might impact on increasing stress in the mother, parents’ mental health
even cause psychiatric problems [4]. On the other hand, it should problems and family performance [13]. Another study comparing
not be ignored that the genetic similarity of parents and children can parents of autistic children’s with parents of disturbed non-autistic
make them both prone to have psychiatric disorders to a great extent. children indicated that mothers of autistic children suffered from
This is reflected in higher prevalence of psychiatric conditions in neurotic personality based on Eysenck scale and had a higher score
parents of children with psychiatric disorders [5-7], as well as higher of extraversion. Moreover, there was a positive correlation between
level of stress before birth of the child [8]. neuroticism and the severity of autism among children [14].

Considering the fact that personality represents a general Another report showed that mothers of autistic children
outline of each individual’s mental state, character recognition helps experienced higher stress and broader autism phenotype in
understanding and predicting an individual’s future behavior [9]. comparison with the mothers of children without autism disorder.
In this regard, evaluating clinical personality disorders in parents of Controlling the severity of autism in children, parental stress
autistic children may give valuable information. There are few reports and broader autism phenotype were the predictors of depressive
is this issue. A study conducted on parents of children with pervasive symptoms in mothers [15].

Citation: Amiri S, Ranjbar F, Hatami R, Barzegar H, Abdi S, et al. (2016) Psychopathology of the Parents of Autistic Children Based on the Clinical
Personality Disorders. Ann Psychiatry Treatm 1(1): 001-005.
001
Amiri, et al. (2016)

Most of available studies on personality of parents are based A) eleven personality clinical scales: Schizoid, Avoidant,
on dimensional theories and few studies are available about Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Sadistic,
psychopathology based on clinical symptoms. The current study was Compulsive, Negativistic, Masochistic; B) Three severe personality
conducted to determine the psychopathology of parents of autistic pathology scales: Schizotypal, Borderline, Paranoid; C) Seven Clinical
children with respect to the clinical personality disorders. Syndrome Scales: Anxiety, Somatoform, Bipolar, Dysthymia, Alcohol
Dependence, Drug Dependence, Posttraumatic Stress Disorder; D)
Materials and Methods Three Severe Clinical Syndrome scales: Thought Disorder, Major
This cross-sectional study was conducted during 2015. This study Depression, and Delusional Disorder.
was approved by regional ethnic committee, Tabriz University of It also has 3 modifier scales used to identify disclosure, desirability
medical sciences. All of participants gave written informed consent. and debasement. Each item was scored in proportion with the
Privacy and autonomy for leaving the research were compiled for all symptoms of each clinical scale. The Farsi version of MCMI-III has
of participants. acceptable validity and reliability like the original version. In an
Using the convenience sampling method, 130 parents of autistic Iranian study, the diagnostic validity of Farsi version was reported to
children were selected from the autism community rehabilitation be between 0.58 and 0.83 for all the scales of MCMI-III [18]. In the
centers in Tabriz, Iran. The diagnostic interviews were conducted current study, Cronbach’s alpha coefficient for reliability of subscales
was between 0.68 and 0.86.
by two child and adolescent psychiatrists to diagnose autism based
on DSM-IV-TR criteria. A total of 154 parents of normal children Statistical analysis
who visited the university clinics for minor general health problems
Data were analyzed by SPSS version 21. The descriptive statistical
(such as common cold and gastrointestinal complaints) were selected
methods (frequency, percentage, mean, standard deviation) were
as controls. The Strengths and Difficulties Questionnaire (SDQ)
used to describe the variables.
was used to screen the control group regarding developmental and
psychiatric problems. The inclusion criteria were the diagnosis Results of MCMI were interpreted based on defined cut-off for
of autism based on DSM-IV-TR criteria for the parents of autistic each subscale. Then chi-square and Fisher’s exact tests were employed
children (AD group) and scoring normal on SDQ (controls), age to compare the characteristics and frequencies of disorders between
of the child under18, and parental literacy. Adoption was the only the two groups. A logistic regression model was also employed
exclusion criteria in this study. to evaluate prognostic value of psychopathology of parents about
presence of autism in their child. The p values less than 0.05 was
Parents willing to participate were evaluated by Millon Clinical considered significant.
Multiaxial Inventory-III (MCMI-III) for personality profile.
Results
Instruments
A total of 130 parents of autistic children (AD group) and 154
Kiddie Schedule for Affective Disorders and Schizophrenia- parents of normal-control children completed the study. Mean age of
Present and Lifetime Version (K-SADS-PL): This questionnaire is a parents and children in the two groups was not different.
semi-structured diagnostic interview designed according to DSM-VI
Mean age of children in AD group and controls was 6.87±4.98
criteria. The test-retest and inter-rater reliability of Farsi version of
and 8.24±4.98 in that order (t=1.86, df=282, p=0.06). Mean age of
K-SADS diagnostic interview is reported to be 0.81 and 0.69 in that
parents in AD group and controls was not statistically different either
order [16].
and was 35.68±5.95 and 37.05±7.002 respectively (t=1.75, df=282,
The Strengths and Difficulties Questionnaire (SDQ) – Parent p=0.08).
Version: SDQ (Goodman, 17) includes 25 items and it is used to
Table 1 describes the demographic characteristics of parents and
evaluate children’s problem in four areas (emotional symptoms,
children. There was not a significant statistical difference between the
behavioral problems, hyperactivity/inattention and peer relationship two groups in terms of the gender distribution, number of children,
problems) and one skill (prosocial behavior). SDQ scoring is scored families living place or parents’ psychiatric history. However parents
with a three-degree format (not true=0, somewhat true=1, certainly in the AD group had lower educational level and mostly low-paid
true=2). The psychometric properties of Farsi version of SDQ in jobs (p<0.001).
Iranian children aged 3 to 17 were reported by Ghanizadeh et al. [17].
The reliability is reported to be 0.73. Psychopathologies of parents are described in Table 2. Most of
subscales of MCMI were higher in AD group. The most prevalent
Millon Clinical Multiaxial Inventory-III (MCMI-III) disorders in AD group were melancholic personality, persistent
MCMI-III was used to evaluate the personality profiles of the depression, and negativism (44.6%, 29.2%, and 25.4% respectively).
study sample. MCMI-III is a self-report tool for adults with 175 items Alcohol and substance dependence and anti-social personality
which are answered with a yes/no format. MCMI-III is considered disorder had the lowest prevalence.
one of the most important objective tools for detecting clinical The most common disorders in controls were histrionic,
symptoms which are coded on axis I and II (personality disorders) compulsive, and melancholic personality (24%, 22.7%, and 18.2%
based on DSM-IV diagnostic criteria. MCMI-III has 24 clinical scales in that order). Alcohol dependence, substance use and anti-social
divided in four classes as follows: personality disorders had the lowest rates.

Citation: Amiri S, Ranjbar F, Hatami R, Barzegar H, Abdi S, et al. (2016) Psychopathology of the Parents of Autistic Children Based on the Clinical
Personality Disorders. Ann Psychiatry Treatm 1(1): 001-005.
002
Amiri, et al. (2016)

Table 1: Demographic characteristics of the study sample. schizoid personality disorder and might include a restricted number
Autism Control Chi-Square but more accurate diagnosis.
Variables Group
N % N % χ²  p
Our results showed that more severe clinical syndromes (e.g.
Female 22 16.9 39 25.3
Child’s Gender 2.95 0.11 thought disorder and delusional disorder) were observed in parents
Male 108 83.1 115 74.7
Mother 75 577 103 66.9
of AD children in comparison with controls. There have been
Parent’s Gender
Father 55 42.3 51 33.1
2.54 0.13 contradictory reports about this issue [22]. However, these results are
1 61 46.9 64 41.6 in line with evidences that support a relationship between autism and
Number of Children 2 55 42.3 81 52.6 4.13 0.12 schizophrenia at the level of clinical and cognitive symptoms [23,24].
3 14 10.9 9 5.8 This study revealed the higher frequency of bipolar disorder and
Below
33 25.4 30 19.5 PTSD and the lower prevalence of histrionic personality disorder in
Diploma
Diploma 58 44.6 39 25.3
parents of autistic children. This may represent a shared vulnerability
Parent’s Educational
level Associate’s 8 6.2 11 7.1
23.83 <0.001 to autism and PTSD and bipolar disorder within a family. High impact
Bachelor’s 20 15.4 60 39 of having a child with autism might also play a role in precipitation
Master’s/PhD 11 8.5 14 9.1 of PTSD and mania. Moreover social behaviors of family members
Unemployed 6 4.6 4 2.6 would be influenced by having autistic children, and parents would
Worker 13 10 6 3.9 probably decrease their dramatic behaviors to prevent others from
Clerk 21 16.2 69 44.8 paying attention to them.
Parent’s job 29.10 <0.001
Housewife 57 43.8 53 34.4
Our results showed that parents of autistic children have not only
Self-
Employed
33 25.4 22 14.3 higher rate of personality disorder but higher rate of comorbidity
Rural 117 90 140 90.9 as well. This finding is reflected in studies with a more narrow
Residence 0.06 0.84 definition of personality disorders. As a study conducted by Piven
Urban 13 10 14 9.1
Positive psychiatric history of parent 117 90 142 92.2 0.42 0.53 et al. [25], showed that personality traits such as aloof, untactful,
undemonstrative, and unresponsive were more observed in parents
There was a statistically significant difference between the groups of AD children in comparison with the parents of children with
in terms of number of disorders. It means that 22 parents on AD Down syndrome. Furthermore, another study indicated that the
group (26.2%) had one personality disorder, 25 (29.8%) had two/ scores of obsessive-compulsive symptoms, interpersonal sensitivity,
three disorders, and 37 (44%) had four/more disorders. In the control depression, anxiety, paranoia, psychotic symptoms, hostility and
group, 36 parents (54.5%) had one personality disorder, 17 (25.8%) sleep/diet problems were higher in the mothers of autistic children
had two/three disorders, and 13 (19.7%) had four/more personality than mothers of healthy children [26].
disorders (χ2=14.47, df=2, p<0.01). Researchers commonly report that families of children with
As indicated in Table 3, a binary logistic regression was conducted autism spectrum disorder experience more parenting stress than
by entering 16 character attributes which were significant by Fisher’s families of typically developing children or those diagnosed with
exact test. Results showed that two traits of bipolar disorder and post- other disabilities [27]. There is a multifaceted relation between
traumatic stress in parents can predict autism in their children while parental mental health and parent-child relation. The fact that
histrionic personality disorder has a negative impact. parents of autistic children have higher psychological problems
might reflect the higher psychological burden of autism on parents
Discussion [19,25]. Improvement of their mental health after reduction of
This cross-sectional study was conducted to determine the autistic symptoms in their children strengthens this relationship [28].
psychopathology of parents with autistic children with a focus on Quality of emotional, social and supportive aspects of mother-child
personality problems. Results of the present study indicated high relationship influences their children’s behavior [29], as well as both
prevalence of pathological traits attributable to personality problems parents [30]. Their lower self-efficacy could have a negative impact on
especially depressed mood disorders and dysthymia. children’s growth [31-33].

The research findings regarding psychological trauma pertaining The findings of this study have some limitations. Study sample
to anxiety and depression in parents of autistic children are consistent was enrolled from a specialized center and might not fully reflect
the population. Autism community rehabilitation centers provide
with previous reports. The psychological burden, depression and
the care to majority of children with AD, but this sample might
anxiety were reported to be higher in parents of AD children in
miss children with undiagnosed AD who might have higher
comparison with the parents of normal children [19,20].
parental psychopathology. Moreover, the intensity of autism was
In contrast to the previous report, there was no difference not controlled, and a self-report (though standard) tool was used to
between prevalence of schizoid personality between parents of AD evaluate personality disorders.
and mentally healthy children [21]. Different method of study may
explain this difference. Parents with more severe schizoid personality
Conclusion
disorder might refuse to participate for a self-report. Moreover, the Parents of autistic children have higher rate of psychopathology.
current study used the cut-off point to make the definite diagnosis of The highest frequency of personality problems in these parents belong

Citation: Amiri S, Ranjbar F, Hatami R, Barzegar H, Abdi S, et al. (2016) Psychopathology of the Parents of Autistic Children Based on the Clinical
Personality Disorders. Ann Psychiatry Treatm 1(1): 001-005.
003
Amiri, et al. (2016)

Table 2: Psychopathology in Parents of Autistic and Normal Children.

Control Autism Fisher’s Exact Test P OR(95% CI)
Schizoid 8(5.2) 16(12.3) 4.61 0.052
Avoidant 10(6.5) 22(16.9) 7.66 0.008 2.93(1.33-6.45)
Melancholic 28(18.2) 58(44.6) 23.33 <0.001 3.62(2.12-6.19)
Clinical Personality Patterns

Dependent 14(9.1) 19(14.6) 2.09 0.19

Histrionic 37(24) 11(8.5) 12.15 <0.001 0.29(.014-0.60)
Narcissistic 4(2.6) 8(6.2) 2.20 0.15
Antisocial 0 3(2.3) 3.59 0.09
Sadistic 3(1.9) 14(10.8) 9.74 0.002 6.07(1.70-21.63)
Compulsive 35(22.7) 21(16.2) 1.92 0.18
Negativistic 13(8.4) 33(25.4) 14.90 <0.001 3.68(1.84-7.81)
Masochistic 11(7.1) 29(22.3) 13.39 <0.001 3.73(1.78-7.81)
Schizotypal 3(1.9) 12(9.2) 7.47 0.007 5.11(1.41-18.55)
Severe Personality pathology Borderline 4(2.6) 11(8.5) 4.84 0.03 3.46(1.07-11.16)
Paranoid 3(1.9) 13(10) 8.59 0.004 5.59(1.55-20.08)
Generalized anxiety 5(3.2) 19(14.6) 11.77 0.001 5.10(1.84-14.07)
Somatic symptoms 4(2.6) 13(10) 6.86 0.01 4.16(1.33-13.11)
Clinical Symptoms

Bipolar disorder 1(0.6) 13(10) 13.15 <0.001 17(2.19-131.81)

Persistent depression 17(11) 38(29.2) 14.93 <0.001 3.32(1.77-6.24)
Alcohol use 0 0
Drugs use 0 1(0.08) 1.18 0.45
PTSD 4(2.6) 20(15.4) 14.89 <0.001 6.81(2.26-20.51)
Thought Disorder 6(3.9) 20(15.4) 11.18 0.001 4.48(1.74-11.53)
Severe clinical symptoms Major Depression 2(1.3) 5(3.8) 1.90 0.25
Delusional Disorder 1.(0.6) 13(10) 13.15 0.001 17(2.19-131.81)

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Citation: Amiri S, Ranjbar F, Hatami R, Barzegar H, Abdi S, et al. (2016) Psychopathology of the Parents of Autistic Children Based on the Clinical
Personality Disorders. Ann Psychiatry Treatm 1(1): 001-005.
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Copyright: © 2016 Amiri S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Amiri S, Ranjbar F, Hatami R, Barzegar H, Abdi S, et al. (2016) Psychopathology of the Parents of Autistic Children Based on the Clinical
Personality Disorders. Ann Psychiatry Treatm 1(1): 001-005.
005