Doctoral Qualitative Case Study Method

In the recent years, there has been an increase in the prevalence of Autism Spectrum Disorder (ASD). When parents receive an educational determination of autism for their child, both parents have the potential to be asymmetrically influenced. The “opportunity cost” to families of children with autism are defined as the alternatives experiences that foregone in terms of personal, social, and economical stressors (Amendah, Grosse, Peacock, & Mandell, 2011). A child diagnosed with an ASD can exhibit behaviors or actions that are overwhelming for a parent. Children with an autism spectrum disorder (ASD) have many exacerbated behaviors that can increase a parent’s frustration.

A notable collection of research exists that reveals that overexertion can often occur when parenting a child with an ASD (Laxman, McBride, Jeans, Dyer, Santos, Kern, Sugimura, Curtiss, & Weglarz-Ward, 2014). There are a number of studies, on parental stressors in mothers and fathers of children with ASD (Laxman et al., 2014). However, there is very little research on how parents manage the education of their child with an Autism Spectrum Disorder. This qualitative study will employ the use of a set of in-depth case studies, conceptualized within the social theory of symbolic interaction, to generate a solid narrative around familial factors related to parenting a child on the Autism Spectrum (Frieden, Joffe, Cono, Richards, & Iademarco, 2014).

Today’s educators report feeling unprepared to face the demanding task of teaching children with autism spectrum disorder (ASD). It is not unexpected that parents and other stakeholders verbalize low levels of confidence in the capabilities of special education teachers (Tincani, Cucchiarra, Thurman, Snyder, & McCarthy, 2014). Research on the state of education and educator training programs has been going on for the past three decades (Buchanan, 2012; Gujarati, 2012; Gujarati, 2012), and has consistently displayed that teachers feel unready to work with parents. Regrettably, the results of the research have not manifested in substantial improvements in the circumstances.

Discovering methods of dealing with the educational process is dire. As stated, the number of children with ASD is on the rise (Frieden, Joffe, Cono, Richards, & Iademarco, 2014), and school officials and teachers will be challenged to adequately serve this growing population. Since current research does not provide an adequate response to the issue, this study will serve to explore this essential feature. One source of expertise, and also anxiety, may be parental involvement.

Autism spectrum disorder (ASD) is a combination of multiple neurodevelopmental disorders that is comprised of autism, Asperger disorder, and pervasive developmental disorder not otherwise defined (American Psychiatric Association, 2013). Infants who have ASD exhibit moderate to rigorous impairments in social synergy and communication along with limited, repetitive behaviors, and defined peculiar kind of behaviors, activities, and interests typically unfolding before a child reaches three years old. Diagnoses of ASD should be precipitated by elaborate behavioral appraisals, making diagnostic evaluation tedious and time-consuming. This assemblage of signs characterizes autism from moderate autism spectrum disorders (ASD) such as Asperger syndrome (Boyle, Boulet, Schieve, Cohen, Blumberg, & Yeargin-Allsopp, 2011; Dingfelder, & Mandell, 2011; Delmolino, & Harris, 2012).

Although the heredity of autism is complicated, and it is unclear if ASD is defined more by multigene reciprocal action or by occasional mutations (Center for Disease Control, 2012). In exceptional instances, autism is heavily associated with factors that produce birth deficiency. Other researchers’ suggest that circumstances, such as infancy vaccines, may contribute to the disorder, but these are questionable and the vaccine hypotheses lacks reliable scientific confirmation (Luckhaupt et al., 2013).

Most current reports approximate a prevalence of one to two incidents per thousand people for autism, and about six per thousand for ASD, with ASD averaging a 4.3:1 male-to-female proportion (Leventhal et al., 2011). The number of people perceived to have autism has grown astronomically since the 1980s, at minimum partially owing to differences in diagnostic method; the issue of whether real pervasiveness has risen is incomplete (Centers for Disease Control, 2012). A new government survey of parents suggests that 1 in 45 children, ages 3 through 17, have been diagnosed with autism spectrum disorder (ASD). This is notably higher than the official government estimate of 1 in 68 American children with autism, by the Centers for Disease Control and Prevention (CDC, 2014). The report is based on based on an analysis of the medical and school records of 8-year-old children at 11 monitoring sites across the country. As such, it can miss children who are not receiving medical or special education services related to autism. (Centers for Disease Control, 2014).

The current methods of how parents manage the education of their child with ASD is due to the lack of intensity of services, and training (Dingfelder, & Mandell, 2011; Delmolino, & Harris, 2012). All individuals diagnosed with ASDs have some social, communication, and behavioral difficulties, there is significant variability in the number, severity, and type of impairments presented. Individuals also exhibit unique strengths and needs in other areas that can be impacted by ASDs. Because ASD interventions target specific needs or skills, rather than treating ASDs in general, whether

an intervention is likely to be effective depends on the specific strengths and needs of the individual. Research data are reviewed to identify ASD interventions that have been demonstrated to be effective in addressing a target need or skill in individuals with similar characteristics. Individual characteristics that often are central to intervention selection include the individual’s age, level of cognitive functioning, level of functional communication, nature and extent of social impairment, any intrusive stereotypic preoccupations, and any co-occurring psychiatric symptoms. (Ingersoll, & Berger, 2015).

These are many factors that contribute to the educational malfunctioning that exists, but altering these features would enhance the potential aliments for parents in the academic realm. The past measures to nurture ASD children have yielded minimal results in this field and have perpetuated the stressful nature of parent and child interaction. The development of ASD harbors considerable insight into the issue.

It is not known how parents manage the education of their children with an autism spectrum disorder. Children with ASD have extraordinary demanding task in socialization and interaction with others (Alquraini, & Gut, 2012) due to gross neurological dysfunction which impairs the functioning of their brains. It is not known how parents manage the education of their children with an autism spectrum disorder. Corresponding to American Psychiatric Association (2013), Autism Spectrum Disorders (ASD) or Pervasive Developmental Disorders (PDD) is described as uncompromising and pervasive impairment in manifold domains of development: communication skills, reciprocal social interaction skills, or the habitual stereotyped way of life, activities and interests.

It is not known how parents manage the education of their children with an autism spectrum disorder. As a result an in-depth case study, conceptualized within the idiographic approach will be used. Case study is an in-depth investigations of a single person, group, event or community. Typically, data are gathered from a variety of sources and by using several different methods (e.g. observations & interviews). Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

The purpose of this qualitative case study is to explore and define how parents manage the education of their children with an autism spectrum disorder in North West region of ProjectAutism.org in Houston Texas. The case study approach is useful to this research because there is a need to obtain an in-depth appreciation of the issue, event or phenomenon of interest, in its natural real-life context in “how parents manage the education of their child with ASD” over time (Yin, 2013).

In order to achieve the intended purpose of this research, the researcher will be guided by the following questions: Phenomenon. Curricula decisions made by parents.

R1: How do parents mange the education of their child with Autism Spectrum Disorder?

R2: How does parental participation support the education of their child with Autism Spectrum? The research will guide the interpretation and understanding of the circumstances encountered by parents striving to teach, help, and inform parents, guide children or both on better ways to handle their special needs’ children.

Parental Stress

The behavioral components of ASD that significantly correlate to parental stress levels involve temperament, child responsiveness, repetitious behaviors, and supplementary care needs (Cappe, Wolff, Bobet, & Adrien, 2011). The everyday demanding task of raising a child with additional variables can produce stress in fathers, mothers, and other caregivers when parenting a child with ASD. Coming to terms with the disability can be a challenge in and of itself; nevertheless, other circumstances can create pressure and anxiety in parents. The elements that contribute to lofty stress levels in parents with a child on the autism spectrum are oftentimes mentioned as lack of sufficient professional assistance, adverse social reactions towards persons with ASD, and certain behaviors of the child (Pisula, 2011).

Since many children with autism exhibit behavior that is seen as ”unusual,” at times even “creepy,” parents may agonize about social criticism from other parents. Social reactions to the disorder can leave parents feeling agitated or worrisome. With a lack of knowledge of ASDs, there is imperceptible approval of people with this disability than many others. With this broad lack of awareness of the dysfunction, parents may also anguish over their child being teased or bullied at school (Foody, James, & Leader, 2014).

Ultimately, stress is similarly connected with the child’s capacity to communicate or regulate in social circumstances. Communication deficiencies are seen across a spectrum of nonverbal and verbal skills such as rhythm, gestures, melody, demeanor, facial appearances. Self-injury and aggression are also prevalent in children with ASD. Aggressive and contrarily disruptive behavior are the greatest predictors of parental stress. Not surprisingly, these stress constituents can lead to reduced health consequences for parents. These brand of provocations are normally the fundamental reason parents solicit professional guidance.

Child behavioral difficulties, in particular, and not the severity of the disorder, have been observed to contribute to parental depressive symptoms. According to Rezendes & Scarpa (2011), a child's lack of prosocial behaviors donates greatly to parental stress.

Concurring to a study administered by Foody, James, & Leader, (2014), 74 mothers parenting children on the autism spectrum put on an ambulatory blood pressure monitor that obtained diastolic and systolic blood pressure and heart movement over a 24-hour span. The study recorded high levels of anxiety and parenting stress, and fairly high levels of depression in participants (Foody, James, & Leader, 2014).

The amount of stress in parents of children with developmental disabilities emerges strongly correlated with increases in their depressive manifestations and reductions in their emotional well-being (Cappe et al., 2011; Neece, Green, & Baker, 2012)

Parenting Self-Efficacy

Prior study implies that parental constituents may affect the relationship between child behavior problems and parenting depression and stress, adding the role of parenting self-efficacy within the parenting experience. Giallo, Wood, Jellett, and Porter, (2013) studies found that self-efficacy is negatively correlated with parental psychopathology. Rezendes and Scarpa, (2011) investigated the relationship between parental cognitionsperceptions and maternal self-efficacy and found that parental depression, guilt, and stress all accounted for unprecedented variance in self-efficacy. Mothers who recorded higher levels of self-efficacy were similarly more efficient in supporting the growth of their children, implying that self-efficacy may also play a role in parenting behaviors.

Karst, and Van Hecke, (2012) observed that self-efficacy arbitrated the effects of child behavior problems on the mother's anxiety and depression. Parents of children with autism report both increases in parenting stress and decreases in parental competency (Rezendes, & Scarpa, 2011). Also, mothers who reported feeling more guilt about their child's state of health were found to have profound parental self-efficacy (Gardiner, & Iarocci, 2012). Prevailing research hints that parenting self-efficacy may underlie the association between child behavior problems and maternal anxiety/depression.

This research will guide the interpretation and understanding of the circumstances encountered by parents striving to teach, help, and inform, and guide parents on better ways to manage their special needs’ children. The delving into the matter will provide more insight into the situation and provide potential avenues to venture that could aid in the familial temperament.

Purpose of the Study

The purpose of this study is to develop substantive theory about how parents manage the education of their child diagnosed with an Autism Spectrum Disorder. An in-depth case study, conceptualized within the social theory of symbolic interaction, will use to generate thick description and explanation. Case study in psychology refers to the use of a descriptive research approach to obtain an in-depth analysis of a person, group, or phenomenon. A variety of techniques may be employed including personal interviews, direct-observation, psychometric tests, and archival records. The distinctive topics for applying the case study method arise from at least two situations. First and most important (e.g., Yin, 2013), the case study method is pertinent when your research addresses either a descriptive question ( what happened?) or an explanatory question ( how or why did something happen?); in contrast, a well-designed experiment is needed to begin inferring causal relationships (e.g., whether a new IEP curriculum had improved the student performance), and a survey may be better at telling you how often something has happened. Second, you may want to illuminate a particular situation, to get a close (i.e., in-depth and first-hand) understanding of it. The case study method helps you to make direct observations and collect data in natural settings, compared to relying on “derived” data (Yin, 2013) such as test results. Case studies are generally a single-case design, but can also be a multiple-case design, where replication instead of sampling is the criterion for inclusion. Like other research methodologies within psychology, the case study must produce valid and reliable results in order to be useful for the development of future research. 

Symbolic Interactionism focus on the subjective aspects of social life, rather than on objective, macro-structural aspects of social systems. One reason for this focus is that interactionists base their theoretical perspective on their image of humans, rather than on their image of society. Segalman, (2014) contends humans are pragmatic actors who continually must adjust their behavior to the actions of other actors. We can adjust to these actions only because we are able to interpret them, i.e., to denote them symbolically and treat the actions and those who perform them as symbolic objects. This process of adjustment is aided by our ability to imaginatively rehearse alternative lines of action before we act. Social Interactionism lens may shed light on interventions to improve ASD communication Symbolic Interactionism.

Highly structured, intensive early intervention may lead to significant developmental gains for many children with autism. However, a clear understanding of early intervention effects may currently be hampered by a lack of precision in outcome measurement. To improve the precision and sensitivity of outcome assessment it may be useful to integrate research on the nature of the social disturbance of autism with how parents manage the education of their child diagnosed with ASD (Thiemann-Bourque, Brady, and Fleming, (2012) at ProjectAutism.org in North West region of Houston Texas.

The purpose of this case study is to understand, describe, develop, and discover the central phenomenon of the study for the participants at ProjectAutism.org in Houston Texas. The researcher will ask two central questions as stated below R1 and R2 followed by no more than ten sub questions. A few sub questions succeed each general central question; the sub questions narrow the focal point of the research but leave open the questioning. This method is well within the limits set by Miles, Huberman and Saldana (2014), who recommended that investigators write no more than a dozen qualitative research questions in all (central and sub questions).

In order to achieve the intended purpose of this research, the researcher will be guided by the following questions:

Phenomenon. Curricula decisions made by parents

R1: How do parents mange the education of their child with Autism Spectrum Disorder?

R2: How does parental participation support the education of their child with Autism Spectrum?

Phenomenon to be studied.

The research will study how parents manage the education of their child with autism spectrum disorder. An empirical inquiry that investigates the phenomenon within its real-life context. In the human sphere this normally translates into gathering ‘deep’ information and perceptions through inductive interviews, discussions and participant observation, and representing it from the perspective of the research participant(s).

Alignment:

Alignment is an important issue in this research project because how parents manage the education of their child with autism spectrum disorder questions are derived from the research purpose. R1: How do parents mange the education of their child with Autism Spectrum Disorder further distill the purpose by more clearly focusing the research purpose, and the purpose provides clues to the type of research design (Miles, Huberman & Saldana 2014). The research questions, will be further narrowed as the project moves forward, to be clearly related to the research design. R1 and R2, are clearly aligned to sustain the research.

Advancing Scientific Knowledge

The current knowledge on this topic recognizes the various issues that exist, but fail to harbor comprehension on all matters. Considerable research has been employed in order to discover the factors and features of the spectrum. Further detailed research investigates the varied aspects of familial incidents that occur when a child is on the Autism Disorder Spectrum. A study in 2012 investigated perspectives of parents whose children have received outpatient therapy in community mental health clinics (Brookman-Frazee, Baker-Ericzén, Nicole Stadnick, & Taylor, 2012). This type of examination has been the focus of the research, which does not serve to explore the facets of this issue. Participation of parents of children with autism is commonplace in most comprehensive intervention programs, yet, there is limited research relating to the best practices in this area (Steiner, Koegel, Koegel, & Ence, 2012). The varied evaluations into children with autism do extend into interactive measures with parents, but does not acquiesce the maintenance features for parents in order to limit stress.

The research that has been executed thus far serves to engage an initialization into the issue, but is limited in its angled comprehensive framework. Due to increasing prevalence rates of Autism Spectrum Disorders in recent years, there is a strong need for efficient, cost-effective, and Empirically Supported Treatments for this population” (Steiner, Koegel, Koegel, & Ence, 2012). The conception of parental anxiety and stress in relation to a child with an ASD is well documented, but the most effective means of thwarting the frustration have not emerged. This research will aid in delving into the topic and obtaining insight into the potential paths to enter in order to gain some relief from the stress. The contribution will provide vision for educational features of ASD children and allow for parents of these children to gain recognition into methods of application.

The proposed study will make several substantial and original contributions to knowledge. This study will develop substantive theory in an area where no such theory presently exists. The theory will lead to an understanding and explanation of the situation faced by parents trying to educate their child or children with an ASD. The theory will be relevant to the development of policies concerning parents trying to educate their child with an ASD in United States of America. This study will provide a unique exploratory analysis, in-depth perspective of the situation faced when trying to educate a child with ASD in United States of America.

Case studies can provide very detailed information about a particular subject that would not be possible to acquire through another type of experimentation to investigate cases in-depth and to apply multiple sources of evidence making them a beneficial tool for descriptive research studies where the focal point is on a specific situation (Yin, 2013). Case studies provide very specific information about a distinct case that would not be feasible to procure through some other type of experimentation to examine cases in-depth and to employ multiple sources of evidence making them a useful vehicle for descriptive research studies where the focal point is in a particular circumstance (Yin, 2013).

This research will contribute to a better understanding of how parents manage the education of their child with Autism Spectrum Disorders (ASD. An in-depth case study, conceptualized within the idiographic approach will contribute to the literature by utilizing an in-depth investigations into the parent’s educational management of their child through data collection from a variety of sources and by using several different methods (e.g. observations & interviews).

How parents manage the education of their child with Autism Spectrum Disorders (ASD) relates to other studies in the background and problem statement because the recent public debate has focused on relatively few questions - almost exclusively on the hypothesized links between the combined measles, mumps and rubella (MMR) vaccination of bowel disorders and autism. Because of the important public health implications of any such link, several expert groups and reports have considered these particular issues in detail (Jain, Marshall, Buikema, Bancroft, Kelly, & Craig, 2015). While they acknowledge that there are interesting findings, they have found no persuasive evidence for such links. The broader question “What are the causes of autism?” therefore remains, as does of the question of how parents manage the education of their child with ASD? It was in the light of these uncertainties’ that the Department of Health asked the Medical Research Council (MRC) to review research on the causes and epidemiology of autism (American Psychiatric Association 2013).

Parents need specific training in autism education, so that children on the spectrum are able get the best help out of his or her classroom experiences (Todd, Beamer, & Goodreau, 2014). The research will contribute to the conceptual framework in the context of the strengths, concerns, values, and preferences of the child with an ASD and his or her support network. This network includes the family, the professional team, and available community resources. The project will play an important role in summarizing and synthesizing the knowledge base on ASD interventions providing parents with the most current evidence to guide intervention planning and implementation. A parent needs to become familiar with what will work best with that particular child. As Pajareya, and Nopmaneejumruslers, (2011) suggests, every child is going to be different and parents have to be able to adjust with every one of them.

The proposed research will offer information on different effective mechanism that can be useful to parents managing the education of their autistic children. It will offer an in-depth perspective and understanding of the circumstances encountered by parents attempting to manage the education their children with ASD. The outcome of this research will be very relevant to the advancement of policies concerning parents trying to educate their child with ASD in United States of America.

Rationale for Methodology

The central goal of the qualitative methodology for this research is to gather an in-depth understanding of human behavior and the reasons that govern such behavior. Qualitative methods examine the why and how of decision making, not just what, where, when, or "who" (Saladana, 2012). A popular method of qualitative research is the case study (Yin, 2013) which examines in-depth purposive samples to better understand a phenomenon (e.g., family well-being and children with intellectual disability; Glidden, (2012) hence, smaller but focused samples are more often used than large samples which may also be conducted by the same or related researchers.

On the other hand quantitative research is the systematic empirical investigation of observable phenomena via statistical, mathematical or computational techniques (Salkind, 2013). The objective of quantitative research is to develop and employ mathematical models, theories and/or hypotheses pertaining to phenomena. Salkind, (2013) contends the process of measurement is central to quantitative research because it provides the fundamental connection between empirical observation and mathematical expression of quantitative relationships.

Qualitative research gathers information that is not in numerical form. For example, diary accounts, open-ended questionnaires, unstructured interviews and unstructured observations. Qualitative data is typically descriptive data and as such is harder to analyze than quantitative data. Qualitative research is useful for studies at the individual level, and to find out, in depth, the ways in which people think or feel (e.g. case studies Yin, 2013). Case studies are in-depth investigations of a single person, group, event or community. Typically, data are gathered from a variety of sources and by using several different methods (e.g. observations & interviews). This method assists you to make immediate data collection and observations in natural environments, matched to relying on acquired data (Denzin & Lincoln, 2011)—e.g., school, test results and other statistics supported by government agencies, and responses to questionnaires.

This qualitative study will use a case study research design. This is an approach to research that facilitates exploration of a phenomenon within its context using a variety of data sources. This ensures that the issue is not explored through one lens, but rather a variety of lenses which allows for multiple facets of the phenomenon to be revealed and understood. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions (Hancock, & Algozzine, 2011).

Good, rigorous case studies require a strong methodological justification (Yazan, B. 2015) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011). Case study research empowers the researcher to investigate relevant topics not readily covered by other designs. Conversely, other designs cover many issues better than does case study research. The overall concept is that several research approaches serve equivalent functions. The study might even utilize multiple methods that involve the case study (Yin, 2013). Denzin and Lincoln, (2011) argue that human learning is best researched by using qualitative data. In selecting a case study research methodology, (Yin, 2013) suggests that it is proper to select that paradigm whose assumptions are best met by phenomenon being investigated. This study is about human learning in its natural environment and the effective use of emerging technology in facilitating it. Qualitative case study is concerned with processes rather than simply the outcomes or products. When the understanding of an event is a function of personal interaction and perception of those in that event, and the description of the processes that characterize the event, qualitative approaches are more appropriate than quantitative designs to provide the insight necessary to understand the participants’ role in the event, and their perceptions of the experience.

The ethnographic method is not appropriate for this study because it is different from other ways of conducting case study approach due to the following reasons. Ethnography means trying to understand behavior and culture by going out and talking to and observing people wherever they are, while they’re doing whatever it is they do (Weber, & Cheng, 2013). It means entering someone’s world for a while, be it a couple of hours or a couple of days, or a couple of years. A major difference between ethnography and case study research is the depth and intimacy of the work. Getting up close and personal with the research participants. By spending time with participants as they go about their daily lives, and develop a better understanding of the cultural significance of various products, services, or medical conditions and treatments, and get a first-hand look at how people respond to, and are affected by, their social surroundings (Weber, & Cheng, 2013).

Grounded theory is also not conducive for this research on the ground of its misunderstood status as theory (is what is produced really 'theory'?). Thornberg, and Charmaz, (2012) suggest that it is impossible to free oneself of preconceptions in the collection and analysis of data in the way that Glaser and Strauss say is necessary. They also point to the formulaic nature of grounded theory method and the lack of congruence of this with open and creative interpretation – which ought to be the hallmark of qualitative inquiry. They suggest that the one element of grounded theory worth keeping is constant comparative method. In grounded theory, researchers engage in excessive conceptualization and defend this as "sensitivity to context." Because of this, convergent conceptualization becomes impossible (Thornberg, & Charmaz, 2012).

The following are the operational definitions of terms used in this research:

Autism

As defined by American Psychiatric Association, (2013), autism is a broad term for a collection of heterogeneous disorders of brain development. These disorders are portrayed, at varying levels, by challenges in social interaction, verbal and nonverbal communication and repetitive behaviors.

Prevalence

Center for Disease Control, (2012). Refers to prevalence as the cumulative amount of cases of a disease in a given population at a particular time which includes autistic disorder, Asperger's disorder, childhood disintegrative disorder, and Pervasive Developmental Disorder-Not Otherwise Specified. (PDD-NOS)

Etiology

As defined by Yu, T.W., Chahrour, M.H., et al. (2013), etiology means the set of causes, cause, or manner of causation of a disease or condition.

Antisocial disruptive behaviors

As defined by Minshawi, Hurwitz, Fodstad, Biebl, Morriss, & McDougle, (2014), antisocial disruptive behaviors refer to disruptive acts characterized by covert and overt hostility and intentional aggression toward others.

Intervention

Charman, (2011), defines intervention: as the act of intervening, interfering or interceding with the intent of modifying the outcome.

An inclusionary Classroom

As defined by Ruggs, and Hebl, (2012), an inclusionary Classroom is the act of placing children with disabilities sitting next to ones who have been deemed "gifted and talented." The mixing is performed quietly, and carefully. Students do not fundamentally know who is working at what level.

Assumptions, Limitations, Delimitations

There are several limitations to the current study that should be mentioned and taken into account when interpreting and disseminating the findings.

1. This study represents findings from a relatively small sample.

2. Given the sampling efforts, this could potentially represent a selection bias, meaning that those who participated are more likely than others to participate in research more generally.

3. Families whose children are more severely affected by ASD were unable to participate given their time and energy limitations.

4. This study uses data from intact couples and findings may not be applicable for single parents or separated or divorced parents.

The following are assumptions to this study:

1. Parents provide accurate information regarding their child‘s specific diagnosis.

2. There was a wide range of ages among children with Autism used in the study.

The number of epidemiological studies of autism has increased in recent years, one of the most controversial topics with respect to this population is the prevalence of this spectrum of disorders. The number of cases has risen dramatically, (Amendah, Grosse, Peacock, and Mandell, 2011) and various hypotheses have been put forward to explain this phenomenon. Among the most frequently addressed possibilities are expanded diagnostic criteria, more awareness of the disorder, diagnosis at earlier ages, and the recognition that ASD is a lifelong condition.

Infants who have ASD exhibit moderate to rigorous impairments in social synergy and communication along with limited, repetitive behaviors, and defined peculiar kind of behaviors, activities, and interests typically unfolding before a child reaches three years old. Diagnoses of ASD should be precipitated by elaborate behavioral appraisals, making diagnostic evaluation tedious and time-consuming. This assemblage of signs characterizes autism from moderate autism spectrum disorders (ASD) such as Asperger syndrome (Boyle, Boulet, Schieve, Cohen, Blumberg, & Yeargin-Allsopp, 2011; Dingfelder, & Mandell, 2011; Delmolino, & Harris, 2012).

The current methods of how parents manage the education of their child with ASD is due to the lack of intensity of services, and training (Dingfelder, & Mandell, 2011; Delmolino, & Harris, 2012). Individuals also exhibit unique strengths and needs in other areas that can be impacted by ASDs. Because ASD interventions target specific needs or skills, rather than treating ASDs in general, whether an intervention is likely to be effective depends on the specific strengths and needs of the individual.

It is not known how parents manage the education of their children with an autism spectrum disorder. Children with ASD have extraordinary demanding task in socialization and interaction with others (Alquraini, & Gut, 2012) due to gross neurological dysfunction which impairs the functioning of their brains. The purpose of this qualitative case study is to explore and define how parents manage the education of their children with an autism spectrum disorder in North West region of ProjectAutism.org in Houston Texas. The behavioral components of ASD that significantly correlate to parental stress levels involve temperament, child responsiveness, repetitious behaviors, and supplementary care needs (Cappe, Wolff, Bobet, & Adrien, 2011). The amount of stress in parents of children with developmental disabilities emerges strongly correlated with increases in their depressive manifestations and reductions in their emotional well-being (Cappe et al., 2011; Neece, Green, & Baker, 2012)

The purpose of this study is to develop substantive theory about how parents manage the education of their child diagnosed with an Autism Spectrum Disorder. An in-depth case study, conceptualized within the social theory of symbolic interaction, will use to generate thick description and explanation. The case study method is pertinent when your research addresses either a descriptive question (what happened?) or an explanatory question (how or why did something happen?); in contrast, a well-designed experiment is needed to begin inferring causal relationships (e.g., whether a new IEP curriculum had improved the student performance), and a survey may be better at telling you how often something has happened (Yin, 2013).

The researcher will ask two central questions as stated below R1 and R2 followed by no more than ten sub questions. A few sub questions succeed each general central question; the sub questions narrow the focal point of the research but leave open the questioning. This method is well within the limits set by Miles, Huberman and Saldana (2014), who recommended that investigators write no more than a dozen qualitative research questions in all (central and sub questions). Considerable research has been employed in order to discover the factors and features of the spectrum. Further detailed research investigates the varied aspects of familial incidents that occur when a child is on the Autism Disorder Spectrum. A study in 2012 investigated perspectives of parents whose children have received outpatient therapy in community mental health clinics (Brookman-Frazee, Baker-Ericzén, Nicole Stadnick, & Taylor, 2012). This type of examination has been the focus of the research, which does not serve to explore the facets of this issue. This study will provide a unique exploratory analysis, in-depth perspective of the situation faced when trying to educate a child with ASD in United States of America.

Case studies can provide very detailed information about a particular subject that would not be possible to acquire through another type of experimentation to investigate cases in-depth and to apply multiple sources of evidence making them a beneficial tool for descriptive research studies where the focal point is on a specific situation (Yin, 2013). An in-depth case study, conceptualized within the idiographic approach will contribute to the literature by utilizing an in-depth investigations into the parent’s educational management of their child through data collection from a variety of sources and by using several different methods (e.g. observations & interviews).

The central goal of the qualitative methodology for this research is to gather an in-depth understanding of human behavior and the reasons that govern such behavior. Qualitative methods examine the why and how of decision making, not just what, where, when, or "who" (Saladana, 2012). This qualitative study will use a case study research design. This is an approach to research that facilitates exploration of a phenomenon within its context using a variety of data sources. This ensures that the issue is not explored through one lens, but rather a variety of lenses which allows for multiple facets of the phenomenon to be revealed and understood. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions (Hancock, & Algozzine, 2011).

There are several limitations to the current study that should be mentioned and taken into account when interpreting and disseminating the findings. (a) One cannot generalize from a single case; (b) the case study is most useful for generating hypotheses, whereas other methods are more suitable for hypotheses testing and theory building; (c) the case study contains a bias toward verification; and (d) This study uses data from intact couples and findings may not be applicable for single parents or separated or divorced parents. The following are assumptions to this study: (1) Parents provide accurate information regarding their child‘s specific diagnosis. (2) There was a wide range of ages among children with Autism used in the study.

Organization of the Remainder of the Study

This case study will present a concrete narrative detail of actual, or at least realistic events of how parents manage the education of their child with ASD, it will have a plot, exposition, characters, and sometimes even dialogue" (Yin, 2013). The reports will be extensively descriptive, the right combination of description and analysis" (2013). The researcher will address each step of the research process, and attempt to give the reader as much context as possible for the decisions made in the research design and for the conclusions drawn.

This contextualization will include a detailed explanation of the researchers' theoretical positions, of how those theories drove the inquiry or led to the guiding research questions, of the participants' backgrounds, of the processes of data collection, of the training and limitations of the coders, along with a strong attempt to make connections between the data and the conclusions evident.

The researcher will identify significant variables that emerged during the research and suggest studies related to these, and will suggest further general questions that the case study generated ending with implications for further study.

TEACCH program as well as semi-structured interviews and approved data aggregation technique will be collected (Andres, 2012). Chapter 2 contains a review of literature. Chapter 3 contains the description of the research design, sampling procedures, and the statistical methods that will be used. The following chapter contains the review of literature for the study.

This chapter will review the pertinent literature in harmony with the relative to the research questions defined in the first chapter. The research questions will act as guiding tools for conducting the literature review. This meta-analytical method will offer insight into the issue and allow for an in depth investigation into all crevices of the disorder. To better understand the problem and its context, it is appropriate to provide a theoretical framework for the study and an overview of how parents deal with the education of their child with an Autism Spectrum Disorder. Gathering evidence and research will provide a background of information that will serve to reveal the gaps in the understanding of the issue. There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and educational systems; as a result there is a growing need for parental intervention of how parents deal with the education of their child with ASD due to lack of intensity of services and training of staff (Dingfelder, & Mandell, 2011). The literature review will reveal the necessary direction that needs to be pursued in order to gain a better comprehension of ASD.

Autism spectrum disorder (ASD) is a combination of multiple neurodevelopment disorders that is comprised of autism, Asperger disorder, and pervasive developmental disorder not otherwise defined (American Psychiatric Association, 2013). These varied disorders have in recent years been incorporated into ASD due to the connectivity of the symptoms involved in the behavior of people afflicted with the disorder. The inclusion was highly debated due to the expansive scope that would then exist for people diagnosed with ASD. Infants who have ASD exhibit moderate to rigorous impairments in social synergy and communication along with limited, repetitive, and defined models of comportments, activities and interests all springing developing before a child is three years old. Due to the age of diagnosis, children may begin intervention at a young age and best practices suggest that parent involvement is essential both for more rapid gains and for consistency across the child’s waking hours (Steiner, Koegel, Koegel, & Ence, 2012). The focused method of acquiring a diagnosis of ASD depending on very specific features that is among a long list of potential factors. Diagnosis of ASD should be precipitated on elaborate behavioral appraisals, making diagnostic evaluation tedious and time-consuming. This assemblage of signs characterizes autism from moderate autism spectrum disorders (ASD) such as Asperger syndrome (Boyle, Boulet, Schieve, Cohen, Blumberg, & Yeargin-Allsopp, 2011).

Autism has a solid generative foundation, although the heredity of autism is complicated, and it is unclear if ASD is defined more by multi-gene reciprocal action or by occasional mutations (Center for Disease Control, 2012). In exceptional instances, autism is heavily associated with factors that produce birth deficiency. Other researchers suggested circumstances, such as infancy vaccines, are questionable and the vaccine hypotheses needs reliable scientific confirmation (Luckhaupt et al., 2013). Most current reports approximate a prevalence of one to two incidents per thousand people for autism, and about six per thousand for ASD, with ASD averaging a 4.3:1 male-to-female proportion (Blumberg, Bramlett, Kogan, et al. (2013; Coo, Ouellette-Kuntz, Lam et al., 2012). The number of people perceived to have autism has grown astronomically since the 1980s, at minimal partially owing to differences in diagnostic method; the issue of whether real pervasiveness has risen is incomplete (Centers for Disease Control, 2012).

Impact of ASD on Parents and Families

The effects of begetting a child with an ASD on parents and families are, like the disorder itself, multifaceted and pervasive. Nearly 85 % of individuals with ASD present with cognitive and/or adaptive constraints that restrict their capacity to live autonomously, leading to the likelihood that they will need some degree of assistance or care from their parents and families through life span (Beer, Ward, and Moar, 2013). In Seltzer et al. (2001) longitudinal study of parents of children with developmental disabilities, over 50 % of parents aged 50 or older showed that they still reside with their child, compared with a rate of 17 % for typically developing children. The permanent weary load often placed on parents and siblings of children with ASD probably exacerbates the challenges faced by families of children with ASD, may change caregivers’ understanding of parenting, and possibly decreases enthusiasm about their own fate, as well as the prospect of their afflicted child. In summation, the perception and conceptualization of ASD are quickly and continuously evolving (Rutter, 2011; Ritzema, & Sladeczek 2011). In consequence, families of children with ASD are confronted with a disorder for which etiology is unclear and optimal treatment is disputed. These families are therefore usually left navigating a heterogeneous and ever-changing direction, all the while grasping that impediments in accessing services could lead to worse treatment outcomes.

Family and caregiver distress linked to ASD typically occurs long before an official diagnosis is given. Parents of children later diagnosed with an ASD rumor early concerns regarding variations in communication, social behavior, play, and motor abilities within the first 6 months of life, with most parents recounting specific anxiety about ASD at around 18 months (Bolton, Golding, Emond, & Steer, 2012). Nonetheless, the real time parents are notified of an Autistic Disorder diagnosis for their child usually comes much later, when the child is roughly 3.1 years of age, with an average of 7.2 years of age for a determination of Asperger Syndrome (Center for Disease Control, 2012). Parents of children with ASD frequently show relief following the diagnosis, which can assist them better comprehend their child’s challenges (Midence and O’neill 1999). Nonetheless, Chamak et al. (2011) stated that roughly 63 % of parents revealed discontent with the way the diagnosis was reported. The experience of the diagnosis itself probably contributes to the way in which parents make sense of their child’s disability, and Shyu et al. (2010) observed that the way in which parents described their child’s deficiencies affected their personal well-being, their child’s functioning, and the treatment programs chosen by the family. Parental knowledge and analysis of deficiencies is probably correlated profoundly with the way ASD is told to them by treatment professionals (e.g., Psychologists or Pediatricians). Nevertheless, no study to date has investigated how specific explanatory techniques or processes at the time of diagnosis affected parent and family functioning or coping from that point onward. Assessing these measures appears expressly important given the extensive and ever-changing views within the scientific community on the etiology of ASD and optimal treatment methods for children with ASD (Kim et al., 2011).

Supporting and raising a child with an ASD seems to have adverse effects on parents and families regardless of the rigor of symptomatology or the time since diagnosis of the disorder (Rezendes & Scarpa (2011). Ekas et al. (2010) remarked that core manifestations, correlated symptoms, and behavior difficulties linked with ASD all added significantly to negative parental well-being, with roughly 12 % of the fluctuations in well-being explained by children’s ASD deficiencies. Presented the variability in ASD exhibition, it is necessary to traverse specific areas affected by having a child with ASD to gain broader knowledge of what behaviors/deficits add to each particular domain of impact.

Effects of ASD on Parents

Parental Self-Efficacy

It seems important to understand caregivers’ mental conviction in their ability to parent effectively their child, or parenting self-efficacy (PSE), notwithstanding of the appearance of a disability. In part, this construct may affect actual parenting behaviors, as a study of PSE in parents of typically developing children by Karst, and Van Hecke, (2012) proposed that PSE predicts the level of parenting proficiency. These authors further stated that parents with higher PSE tend subsequently to demonstrate more efficient parenting even in the face of challenging child behavior (Karst, and Van Hecke, (2012). The importance of PSE discussed in Karst, and Van Hecke review warrants consideration of how this construct is affected by having a child with an ASD. If adverse effects exist, it is crucial to understand how they impact children with ASD and the services they receive, as well as how they contribute to further difficulties for parents, as PSE has been associated with increased levels of parenting stress in parents of children with disabilities (Giallo, Wood, Jellett, & Porter, 2011). Parenting self-efficacy may be uniquely influenced by having a child with ASD for various reasons. Parents with larger autism phenotype (BAP) or sub-threshold components of autism often seen in parents of children with ASD (Sasson, Lam, Parlier, Daniels, and Piven, 2013) may require self-confidence in assisting their child address challenges that they too encounter (e.g., social anxiety or distress with nonverbal communication). Besides, the discussion over ASD etiology and description, in combination with the plethora of mediations available for ASD, usually leaves parents feeling confused and unsure about the optimal direction of treatment for their child (Mackintosh et al. 2012). In addition, Sofronoff and Farbotko (2002) remarked that the delay in diagnosis (which, with Asperger syndrome, can continue into the teenage years) oftentimes means parents of children with ASD have been utilizing ineffective parenting strategies for long periods, leaving themselves frustrated and unsure of their parenting capabilities. Ultimately, PSE may be uniquely affected by parents of children with ASD due to the child’s deprivation of mutual social communication, a trademark deficiency of autism. Parents may feel less equipped to meet the passionate needs and wants of their children with ASD, who are usually incapable of expressing amply such needs due to impairments in both verbal and nonverbal communication.

Sofronoff and Farbotko (2002) underscored the significance of targeting PSE in parents of children with ASD in their study of a parent management training program intended to enhance parents’ self-efficacy. They observed that parents in a 1-day seminar and parents attending individual treatment sessions both recount improved self-efficacy compared with control groups, with significantly elevated improvement detected in maternal caregivers (Sofronoff and Farbotko 2002). Besides, Keen et al. (2010) stated that a parent-focused intervention led to higher growth in PSE pertinent to a self-directed intervention. These conclusions imply that PSE in parents of children with ASD is flexible and responsive to brief, targeted intervention. Sofronoff and Farbotko (2002) also discovered that parents reported less child behavior problems post intervention, implying that improvements in PSE in parents of children with ASD can have an immediate impact on the diagnosed child. Hastings and Brown 2002) proposed that parents of children with developmental delays displayed increased parenting competence comparison with parents of typically developing children, but did not relate competence to perception of efficacy.

In a research of mothers of children with ASD, Kuhn and Carter (2006) observed that diminished sense of agency and heightened feelings of guilt in parents were both correlated with profound PSE. Parental agency was imagined as the degree to which a mother assumes an active role in her child’s development, engages in communications with her child, and continues in recognizing strategies that reduce maladaptive child behaviors and maximize adaptive behaviors (Kuhn and Carter 2006). Kuhn and Carter noted that agency and guilt donated significantly diminished PSE beyond other circumstances such as parenting stress, depression, the amount of time since the child’s diagnosis, and whether another child in the family had a disability. It also seems that there are discrepancies between parental and maternal caregivers of children with ASD with regard to parenting ability. Hastings and Brown (2002) observed that PSE served as a medium for mothers between child misconduct and maternal distress and despair, while for fathers, PSE was observed to reduce the relationship between child behavior difficulties and maternal anxiety. The association between parental awareness about ASD and PSE seems significant given the complexity of the disorder, but a study in this area has been limited. Kuhn and Carter (2006) detected that autism-related knowledge was not significantly associated with maternal self-efficacy, although they showed that limitations in their measure of autism knowledge, along with a homogenous representation, provided inadequate variance to confirm the lack of a correlation between these constructs. These researchers saw a positive relationship between autism-related knowledge and time since diagnosis, suggesting that parents continued to enhance their own knowledge about ASD after diagnosis. Mackintosh et al. (2012) noted that parents continue relying massively on the internet for information about their child’s disorder. Nevertheless, it is unclear what impact, if any, enrollment in any kind intervention had parent's knowledge of ASD. Taken in aggregate, there are several reasons to believe that parents of children with ASD suffer from diminished PSE though no longitudinal studies to date have validated this hypothesis. Nevertheless, given that increases in PSE through interventions such as that by Sofronoff and Farbotko (2002) seem to impact positively parents and their children with ASD, it seems important to take this variable into account in understanding the overall effect of having a child with ASD on parents and families.

One of the most extensively researched areas of impact considering parents of children with ASD is parenting stress, broadly imagined as pressure, strain, and tension revolving particularly around the task of rearing (Rao & Beidel 2009). Parents of children with ASD encounter higher levels of parenting stress than parents of normally developing children as well as parents of children with other kinds of developmental delay or special health care demands (Schieve et al. 2011). Circumstances donating to parenting stress in caregivers of children with ASD include the child’s cognitive impairment, externalizing behavior difficulties and internalized mental agony, depressed mood or anger, functional dependency, hyperactivity, dissent, lack of self-care facilities and profound adaptive functioning, language deficiencies, learning disability, inflicted limits on family opportunities, demand for care across the lifespan, improper eating, toileting, and sexual expression, comprehensive social difficulties, and great likelihood of living in the house (Brown et al. 2011; Hall & Graff 2011). Although cognitive impairment was once recognized as one of the biggest patrons to lofty parenting stress (Ingersoll & Hambrick 2011). Davis & Carter (2008) observed that cognitive deficits did not add uniquely to variation in parenting stress when evaluated along with other child characteristics. Further, Rao and Beidel (2009) noted that higher intellectual functioning in high-functioning children with ASD did not ameliorate high levels of stress in parents. Davis and Carter (2008) suggested that neither deficits in language and communication nor stereotyped behavior contributed significantly to parenting stress, despite these two categories representing two of the core deficits of ASD. These verdicts grant support to the idea that the novel combination of emotional, functional, and behavioral difficulties common in children with ASD, in conjunction with the pervasive and usually critical impact of the disorder, affect parents more than the ‘‘core symptoms of autism, per se. Therefore, the objectives of ASD interventions (i.e., functional difficulties vs. symptoms) may be vital to consider when evaluating how treatments influence parenting stress.

With reverence to parent gender, mothers of children with ASD seem to suffer from heightened levels of parenting stress correlated with fathers (Davis and Carter 2008; Cappe, Wolff, Bobet, & Adrien, 2011) were found to perceive greater levels of stress for other specific family members and for their family as a whole (Little 2002). Intercommunication influences between parent gender and child age, with mothers of older siblings with ASD manifesting lower stress levels while father’s stress stayed constant throughout childhood (Bebko et al. 1987). These researchers recommended that this reduction in stress might depict a relationship between parenting stress and the acceptance of ASD deficits, at minimum in parental caregivers. Hastings (2003) showed that parental stress was linked not only to child challenges but also paternal mental well-being (i.e., the mental health of the other caregiver), while fathers’ stress did not seem to be immediately affected by parental mental health. However, Tehee, Honan, & Hevey, (2009).observed that mothers of children with ASD exhibited heightened levels of parental engagement compared with fathers. The amount of parental engagement displayed by caregivers was associated with parenting stress, and it has been suggested that parenting engagement may somewhat or wholly reconcile the relationship between parent gender and stress (Tehee et al. 2009). These conclusions imply a demand for more comprehensive understanding of how parents divide care obligations for their children with ASD and how this division of caregiver assignments influences parent mental health. Fathers and mothers may also vary in terms what child features donated most to their parenting stress, with regard to both etiology and rigor (Davis & Carter 2008). Davis and Carter (2008) observed that emotional child dysregulation donates significantly to parental stress, whereas fathers were affected by their child’s maladaptive externalizing behaviors. Deficits in social relatedness added significantly to both maternal and paternal stress (Davis & Carter 2008).

The findings suggest that for problems that are ongoing and difficult to address, such as ASDs, psychological acceptance may be an important factor in coping for parents. A study on the well-being of parents of children with autism by Baer, Lykins, and Peters, (2012) found that parents who received more social support, had lower scores of depression, anxiety and anger. Also parents with older children, females and larger families reported lower scores of anger.

Autism Spectrum Disorders such as autism and Asperger's syndrome cause issues in crucial areas of development: Verbal and nonverbal communication, Social interaction, Imaginative or creative play, and Sensory processing (Taddei & Contena, 2013). Children on the autism spectrum may have trouble understanding or communicating their needs to teachers and fellow students. They can have difficulty understanding some classroom directions and instruction, along with subtle vocal and facial cues of teachers. Inappropriate social interaction can lead to challenging behaviors, bullying, and ostracizing (Center for Disease Control, 2014). Difficulties with imaginative or creative play hamper interactions with other children and mean that many teaching strategies will not be effective. Sensory issues mean a student may not cope with noisy environments, being touched by others, or maintaining eye contact. This inability to fully decipher the world around them often makes education stressful for the child, and teachers often report that they find it difficult to meet the needs of students on the autism spectrum. Parents and teachers, ideally should have specific training in autism education, so that they are able to help the student get the best out of his or her classroom experiences (Center for Disease Control, 2014).

Why do challenging behaviors occur?

Every child is born perceiving themselves at the center of their universe. As they grow, they realize that other people exist separately to themselves. In turn, they realize these other people have needs and wants that may conflict with their own, you can’t always get what you wanted. In a sense, the process of becoming an adult is learning to respect other people’s needs and balancing them with your own. Children with autism have great difficulties in this area, as the disorders involve problems with seeing the world from another person’s perspective (Hutchins, Prelock, & Bonazinga, 2012). A child with autism is not willfully engaging in challenging behavior more than any other child would. They simply have much more trouble in developing this awareness of others that modifies and refines our behavior.

The parent as 'behavior detective'

A common principle in behavior management is looking for what the child is communicating through their behavior. The young boy screaming in the supermarket trolley may have wanted that yogurt, may be overcome by all the noise, or finds the hard seat in the trolley uncomfortable. The parent of an autistic child need to be a 'behavior detective' - investigating the cause of a behavior and forming appropriate responses, particularly if it occurs regularly.

Parental Involvement

An important issue in identifying points of leverage in improving students’ academic achievement is determining how and to what degree parental involvement (PI) affects their child with ASD achievement. Such knowledge might inform parenting practices as well as school-based policies, practices, and interventions that involve working with parents. For example, such research might help in the design and development of interventions that maximize parental involvement, where it has been shown to have the most positive and powerful effect. Shute, Hansen, Underwood, and Razzouk, (2011) found that the literature on PI is quite complex and sometimes contradictory. The idea that parental involvement engenders students’ academic achievement is intuitively appealing to the point that society in general, and educators in particular, have considered PI an important ingredient for the remedy of many ills in special education today. Legislation was enacted, such as the Goals 2000 (Report of the Ready for School Goal Team (2000). Educate America Act and the reauthorized Elementary and Secondary Education Act (ESEA) in the United States, which has made parents’ involvement in their children’s education a national priority (Baker, & Soden, 1998; Beyer, & Johnson, 2014). Schools have been encouraged to reexamine their parental involvement policies and programs and to demonstrate innovative approaches in order to obtain PI. For example, eligibility for Title I funding is now contingent on the development of agreements where families and schools assume mutual responsibility for children's learning.

A collaborative parent-school relationship is based on parents and teachers understanding each other’s perspectives and realities. It is important for parents to have a clear understanding of their child’s school program, the roles of staff members and how individual classrooms meet the diverse needs of all the students. It is equally important for teachers and school staff to have an understanding of the experiences families go through in living with children with ASD, the interventions they access and the important role that schools play in families’ lives. With these understandings and a commitment to collaboration, parents and teachers can work together to create positive and effective educational programs for students. Each family is unique and has different experiences obtaining a diagnosis, and planning for and adapting to meet the needs of a child with ASD.

There is no particular best satisfied efficacious educational method for all children with an ASD. The Models of Best Practice is based on common strengths and core deficits among individuals with ASD. Despite some similarities, there will be much variation among students’ abilities and needs. Study has determined that the best programs are those that consolidate a mixture of accurately verified methods and are intended to address and promote the requirements of individual students and the experts and families with whom they are connected (Wong, C., Odom, S. L., Hume, Cox, Fettig, Kucharczyk, & Schultz, (2014). This places relatives, and primarily parents, in very severe conditions regarding the selection of suitable and effective educational methods regarding their individual child with an ASD. Consequently, there is a long-standing attitude by parents of children with an ASD of receiving instructional strategies and methods that lack effectiveness and proven efficacy (Bergen, 2013). The challenge then is how parents deal with the education of their child with an Autism Spectrum Disorder.

Defining Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are a group of neurodevelopmental disabilities defined by significant impairments in social interaction, deficits in communication, and the presence of rigid behaviors and restricted interests. Persistent deficits in social communication and social interaction across context, not accounted for by general developmental delays, and manifested by social-emotional reciprocity, nonverbal communicative behaviors, and developing and maintaining relationships (Lohr & Le, 2012; Maenner, Schieve, Rice, et al. 2013).

The thinking and learning abilities of people with ASDs can vary – from gifted to severely limited. ASD typically begins before the age of 3 and can create challenges throughout a person's life. Additionally, people with ASD will have restricted, repetitive patterns of behavior, interests, or activities as manifested by stereotyped or repetitive speech, excessive adherence to routines or ritualized patters, highly restricted or fixated interests, and hyper- or hyperactivity to sensory input or unusual interest in sensory aspects of environment (Lohr & Le, 2012; Maenner, Schieve, Rice, et al. 2013). ASD occurs in all racial, ethnic, and socioeconomic groups and is at least four times more likely to occur in males than females.

The primary ASDs are Autistic Disorder (or “autism”), Asperger’s Disorder, and Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS). These conditions share many of the same behaviors, but they differ in terms of when the behaviors start, how severe they are, and the precise pattern of problems. Other disorders often listed as a PDD include Rett’s Disorder and Childhood Disintegrative Disorder, although these disorders may no longer be included on the “spectrum” as new diagnostic criteria for ASD are developed.

Autistic Disorder

Autistic Disorder or “autism” is defined by qualitative impairments in three areas of function: (1) social interaction, (2) communication, and (3) restricted repetitive and stereotyped patterns of behavior, interests, and activities. Common symptoms include poor eye contact, poor “reading” of social cues, failure to develop peer relationships, lack of social or emotional reciprocity, delayed speech development, difficulty sustaining conversation, lack of make-believe play, repetitive motor mannerisms, and rigid adherence to routines (National Institute of Mental Health. 2010). Symptoms are present before 3 years of age. As many as 60- 75% of children with Autistic Disorder also have intellectual disabilities, but some children with Autistic Disorder can develop average or even superior intellectual abilities. Even in children with intellectual disabilities, there may be isolated skills that are highly developed such as in music, math, or memory (Center for Disease Control, 2014).

A revision to autism spectrum disorder (ASD) was submitted in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), (American Psychiatric Association. 2013). The new diagnosis encircles previous diagnoses of autistic disorder, Asperger's disorder, childhood disintegrative disorder, and PDD-NOS. In preference to categorizing these diagnoses, the DSM-5 embraced a dimensional method to diagnosing disorders that fall underneath the autism spectrum umbrella. It is contemplated that persons with ASDs are best portrayed as a single diagnostic category because they manifest similar types of symptoms and are best differentiated by clinical specifiers (i.e., dimensions of severity) and associated salient qualities (i.e., known genetic disorders, epilepsy and intellectual disability). An additional change to the DSM involves communication and collapsing social deficits into one domain. Thus, a person with an ASD diagnosis will be described in terms of severity of social communication symptoms, severity of fixated or restricted behaviors or interests and associated features. The restriction of onset age has also been loosened from 3 years old to early developmental period, with a note that symptoms may manifest later when demands exceed capabilities. Autism forms the core of the autism spectrum disorders. Asperger syndrome is closest to autism in signs and likely causes (Meyer-Lindenberg, 2012) unlike autism, people with Asperger syndrome have no significant delay in language development (American Psychiatric Association. 2013). PDD-NOS is diagnosed when the criteria are not met for a more specific disorder. Some sources also include Rett syndrome and childhood disintegrative disorder, which share several signs with autism but may have unrelated causes; other sources differentiate them from ASD, but group all of the above conditions into the pervasive developmental disorders (Lohr & Le, 2012; Maenner, Schieve, Rice, et al. 2013). Autism, Asperger syndrome, and PDD-NOS are sometimes called the autistic disorders instead of ASD (Lohr & Le, 2012) whereas autism itself is often called autistic disorder, childhood autism, or infantile autism (Helverschou, Bakken, Martinsen, 2011). Although the older term pervasive developmental disorder and the newer term autism spectrum disorder largely or entirely overlap, (National Institute of Mental Health. 2010) the former was intended to describe a particular set of diagnostic labels, whereas the latter refers to a postulated spectrum disorder linking various conditions (American Psychiatric Association. 2013). ASD, in turn, is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact (American Psychiatric Association. 2013).

Asperger’s Disorder

Asperger’s Disorder or Asperger Syndrome is defined by impairments in social interaction combined with restricted or repetitive patterns of behavior, interests, and activities. Common symptoms include poor “reading” of social cues, failure to develop typical peer relationships, lack of emotional reciprocity, intense interests or preoccupations, and rigid adherence to routines. Children with Asperger Syndrome do not show general impairments in language or overall cognitive development, although impairments in visual-motor skills and pragmatic (social) language are common. Children with Asperger’s syndrome have better fluid reasoning abilities even than children with typical development and better visual attention than children with an autistic disorder (Taddei & Contena, 2013).

This aspect serves to reveal the levels involved in the spectrum. Asperger’s syndrome provides a separation in the spectrum and the differences aid in the development of effective approaches to treatment. Consistently with what has been shown by some authors, results of different studies are not homogeneous, perhaps because of a difference between the instruments used, theoretical frames, definitions and research methodologies; many different theories to explain autistic disorder have been proposed but delineation of the areas and processes of the brain involved is a topic of much debate (Taddei & Contena, 2013). The image of Asperger’s disorder, however, is much less offensive to family and friends than that of Autism. In a current study the finding that the condition of autism has a greater impact on the child and family than that of Asperger’s disorder is consistent with the concerns raised about the autism label having a more negative connotation attached to it than that of the Asperger’s disorder label (Kite, Gullifer, & Tyson, 2013).

The Asperger’s Disorder Syndrome (ADS) originated to incorporate various disorders into a combination system of diagnosis. There has been much debate about the proposal to remove the diagnostic label of Asperger’s disorder from the new DSM, which has continued, even after the removal (Kite, Gullifer, & Tyson, 2013). Asperger’s Disorder has incurred controversy in the spectrum of the Autistic capacity. Questions have been raised about the distinctiveness of Asperger’s disorder from Autism and the increasing diagnostic rates of pervasive developmental disorders since the introduction of Asperger’s disorder into the DSM and increasing diagnostic rates of pervasive developmental disorder conditions (Kite, Gullifer, & Tyson, 2013).

This has spawned the inclusion of the spectrum with preference offering to the notion of one fluid approach without separation of the disorders. The altered method of evaluation has served to employ a combination system that allows for a collective review. The categorical approach to autism will be combined with a dimensional model, which allows for a spectrum of social communication function appears to be distributed in a continuous fashion across the general population (Lohr & Le, 2012). This fosters an image of cohesiveness amongst the disorders and is applied to the spectrum.

Impact of Asperger’s Disorder to parents

Parents with Asperger’s display either minor and/or notable problems in their parenting. Problems encountered by parents who satisfy most or all of the diagnostic guidelines for Asperger’s are notable. Investigations in the domain of cognition have seen that those on the autistic spectrum have difficulties with updating the range and focus of their attention. (Berger, Aerts, van Spaendonck, Cools. A. R. & Teunisse, 2003). It has been proposed that this singular attentional discrepancy may stem from an inherent disability to reorient attention quickly (Berger et al., 2003). The latter is itself an attentional deficiency of significance when the parent has care and control of young children. Parents need to be able to reorient their attention regularly and usually need to be able to do so under stress. It has also been perceived in the research that various individuals on the spectrum share a deficiency in the sifting and shifting of attention between sensory schemas as well (Bogdashina, 2003). This notable piece also plays out in parenting. The indicated deficits tie in with other neurological abnormalities of Asperger such as sensory hyposensitivity and hypersensitivity. Collectively they impinge directly on the core responsibilities of parenting. Problems in parenting are connected directly to the core neurocognitive clinical characteristics of Asperger’s itself, specifically poor cognitive shifting, weak central coherence, and lack of a theory of mind.

Theory of Mind

The second of The Big Three neurological characteristics that these parents lack is a theory of mind (ToM). ToM is one capacity we have to make sense of the world we live in (it is not the only one). This theory implies that a person's thoughts, experience, ideas, and aspirations make up his or her individual theory of mind. The absence of ToM or mind-blindness is a phrase of art coined by neurocognitive scholar (Baron-Cohen, Leslie, & Frith, 1985). Baron Cohen asserts that a salient core quality of autism is the failure to know (deduce) what others comprehend and what others do not comprehend. Those who are mind blind, Baron-Cohen, Leslie, and Frith, (1985) implies, are incapable of ascribing mental states to others as communication is taking place or from that point forward. Assumedly this is not an either/or condition, with some persons being more and others being less mind blind than non-autistic persons. Mind blind parents with Asperger generally cannot accurately discern the thoughts, intentions, knowledge or aims of their child. It is obvious then that mind blindness or absence of a ToM cannot but play a pivotal function in global parenting capacity.

In this way, the problems encountered by these parents may be characterized as being organic in origin. Hence, these problems have been reported as occasionally presenting as either organic neglect or organic abuse (Berger et al., 2003). A few of these parents display what the author refer to as a parenting-disability (Bogdashina, 2003). That is, they experience significant neurological deficiencies that show up as deficiencies in their parenting toolkit. These shortcomings in turn impact on their global parenting capability.

Parent perceptions of autism and divorce.

Most parents of children with autism are acutely aware of the issues that come with the diagnosis and particularly, how stress affects their marriage. So what does the research say about autism and divorce? One study published by Hartley, Barker, Seltzer, Floyd, Greenberg, Orsmond, et al. (2010) showed that parents who had a child with autism had a higher divorce rate than parents without a child with autism. Their research reveals that the divorce rate for people with Asperger’s is around 80% Why so high? The answer may be found in how the symptoms of Asperger’s affect intimate relationships. People with Asperger’s often find it difficult to understand others and express themselves. They may seem to lose interest in people over time, appear aloof, and are often mistaken as self-centered, vain individuals. A person with Asperger’s may have trouble understanding the emotions of their partner, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. Because of this, a person with Asperger’s might be seen as egotistical, selfish or uncaring. These are unfair labels, because people with Asperger’s find it very difficult to understand other people's emotional states, and they are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate! In another study by Freedman, Kalb, Zablotsky, and Stuart, (2010) found there was no increase in divorce rates. According to their research, "64% of children with autism lived with married or adoptive parents compared to a rate of 65% for children with no autism diagnosis.

The subject of divorce and autism is important in that parents of a newly diagnosed child may read an article about higher divorce rates and assume that their marriage is automatically at risk for divorce. Also, if a couple already has a strained marriage prior to the diagnosis, they may think that divorce is unavoidable. While there are strong emotions resulting from a diagnosis, and there can be significant stress involved with raising a child with autism, do parent who subsequently get divorced primarily divorce because of the autism?

What Do Parents Say?

Fifty-two divorced parents who have a child with autism responded to a survey regarding their perceptions of divorce and autism. While 78% of respondents said, they divorced after their child was diagnosed, and overwhelmingly 76% of the respondents said that autism was not the primary cause of their divorce. Although the majority of respondents did not consider autism a leading cause of divorce, 50% did consider autism to be a contributing factor for the divorce (Freedman, Kalb, Zablotsky, and Stuart, (2010).

Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)

The diagnosis of PDD-NOS is appropriate when there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a more specific disorder. This diagnosis is often used when a child shows several symptoms consistent with an ASD, but does not meet the full criteria for either Autistic Disorder or Asperger’s Disorder. This diagnosis is being eliminated in favor of the spectrum collection. A proposal to combine the conditions of autism, Asperger’s disorder, childhood disintegrative disorder and PDD-NOS into the one diagnostic label of Autistic Disorder (Autism Spectrum Disorder) was first officially circulated by the American Psychiatric Association in 2009 (Kite, Gullifer, & Tyson 2013). This method of diagnosis places PDD-NOS into a section on the spectrum, which is limiting the defined nature of the diagnosis.

Impact to parents.

Parenting adolescent children with pervasive developmental disorder engenders incomparable sustained stresses, which have been coined burden of care (Fisman, & Wolf, 1991). One particular source of stress for mothers and fathers is the children's irregular developmental development, in which accelerations and delays of adaptive functioning may subsist side by side. Though the characteristics and rigor of a handicapping situation are not the sole determinants of family functioning, the appearance of a child with a pervasive developmental disorder has a meaningful impact on family members. Parental mental health suffers, and the resulting distress affects her performance as mother and marriage companion. Unlike other handicapping situations with an apparent physical defect, the invisible handicap of the autistic child and the frequent delay in diagnosis add to the mother's self-doubt about her parental capability. While the impact on maternal psychological health is less, the fathers of autistic children are nonetheless extremely stressed and seem to be especially assailable to the stress caused by these difficult children. Living within this family environment, the prospects for spontaneous and behavioral problems for siblings must be assessed, along with their inherent strengths, to plan defensive interventions for these children. Efficient work with these family’s needs an understanding of the evolution of family system problems and their dynamic and reciprocal interaction over time (Schuntermann, 2002).

Other Pervasive Developmental Disorders

The essential feature of Childhood Disintegrative Disorder is a marked regression in multiple areas of functioning following a period of at least 2 years of apparently normal development. Because the prevalence of pervasive developmental disorders is 11.3 per 1000 children aged 8 years according to a recent report, it is far more prevalent than narrowly defined autistic disorders” (Yamada, Kato, Suzuki, Suzuki, Watanabe, Akechi, & Furukawa, 2012). After the first 2 years of life (but before age 10), the child shows a clinically significant loss of previously acquired skills in at least two of the following areas: expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, play, or motor skills. Rett’s Disorder or Rett Syndrome, which is a genetic disorder that occurs almost exclusively in girls, involves the development of multiple specific deficits following a period of normal early functioning. Between 5 and 48 months of age, the child with Rett Syndrome shows a slowing of head growth, loss of previously acquired purposeful hand skills, the development of stereotyped hand movements (e.g., hand wringing), a loss of social engagement, poorly coordinated gait or trunk movements, and severely impaired language and psychomotor skills.

Parental Impact

Raising a child with other pervasive developmental disorders can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with pervasive developmental disorders are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. Dealing with pervasive developmental disorders can be a difficult venture for any parent. Learning how to best handle your child takes patience and learning (Karst, Van Hecke, 2012).

In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with other pervasive developmental disorders can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for pervasive developmental disorders are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. There are several treatment options available to help make dealing with pervasive developmental disorders a bit easier on the family (Karst, Van Hecke, 2012).

Causes of Autism

Landrigan, Lambertini, and Birnbaum, 2012; Lundstrom, Chang, Rastam, M., et al. 2012; Taylor, Swerdfeger, Eslick, 2014 contends no one knows for sure what causes autism, but scientists believe that both genes and the environment play a role. Research has shown that autism tends to run in families. Among identical twins, if one child has autism, then the other is likely to be affected 75-90% of the time. Parents who have a child with an ASD have a 2-10% chance of having a second child who is also affected. Some parents worry that vaccines cause autism, but the scientific evidence does not support this theory.

There is some evidence that exposure to factors in the environment (such as viruses or infections) may play a role in causing some forms of autism. Several studies interested in executive function implicit in ASD have, in fact, suggested that children with autistic disorder have significant difficulty in global information processing, showing instead a good performance in local information processing. The measure of recognition has been the sole method of diagnosis since the disorder is unable to be identified in any other manner. However, understanding the cognitive functioning of subjects with Asperger’s syndrome compared with those with autistic disorders could suggest a useful way to adopt specific methods of intervention (Taddei & Contena, 2013).

The causes are linked to genetics and environmental measures and the focused view into the actions and behaviors serve to allow for diagnosis without the understanding of why it has emerged. It is important to recognize that autism is a brain-based disorder and is not caused by inadequate parenting; however, parents can play an important role in planning and carrying out interventions after an ASD is identified (Moss, & Howlin, 2009).

How do parents feel about no knowing the cause?

How parents deal with the diagnosis plays an important part in the future of that family and the child with autism. Most mothers and fathers wonder whether something they did or did not do - might have provoked their child's autism. Although it is plausible to nail down the cause of autism in some children, nearly all parents will never find a conclusive answer to their question. Though quite a few unusual genetic disorders and toxic susceptibilities are known to cause autism (or autism-like symptoms that may be misdiagnosed as autism), most incidents of autism are deemed "idiopathic," meaning "without known cause (Taylor, Swerdfeger, Eslick, 2014). Some of the known explicit causes of autism are enumerated above. Approximately all of the leading health organizations including the NIH and the CDC state that there is no correlation between vaccines and autism. Yet several parents are convinced there is more to the story, and reservations about the safety of vaccines linger in their minds.

Prevalence

From the 2010 surveillance year, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71–85), and 46% in the average or above average range of intellectual ability (IQ >85).

The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity (National Institute of Mental Health. 2010; Center for Disease Control (2014).

Estimates of the prevalence of the disorder in the USA and other countries are controversial and have been moving towards an apparent increase in rates; prevalence estimates a range from 0.07% to 1.8% (Neggers, 2014). Many theories have circulated on the cause without offering any proof. “Though it is established that autism is a multifactorial condition involving both genetic and a wide range of environmental risk factors, many recently emerging factors such a de novo gene mutation and potentially modifiable nutritional risk factors have not been studied extensively” (Neggers, 2014). This inclusion of established measures has been studied in order to determine the increasing level of autism.

However, the complex nature of these overlapping disorders and changes in clinical definitions over time has resulted in uncertainty in monitoring the prevalence of ASD (Neggers, 2014). The recognition that the increase is occurring has become evident, but there are no concrete measures to provide definitive numbers based on the altered sectors that have emerged in classification. Furthermore, the developed version for diagnosis and the collective approach to do so have served to reveal an appearance of prevalence for ASD diagnoses. While numerous theories have been formulated regarding the increase in ASD diagnoses, the broadening of the diagnostic criteria, improved assessment methods and a heightened awareness of autism symptoms appear to be primarily responsible for the increased prevalence of ASD diagnoses (Martins, Walker, & Fouche, 2013). The varied discussions regarding the prevalence have yielded as many theories on the increase or more widespread recognition of the disorder.

Lifetime Costs

Amendah, Grosse, Peacock, and Mandell, (2011) asserts, the Autism Society of America estimates that the lifetime cost of caring for a child with an autism spectrum disorder ranges from $3.5 million to $5 million. Based on these estimates, the United States is facing almost $90 billion annually in costs for autism spectrum disorders. These costs include research, insurance costs and non-covered expenses, Medicaid waivers for autism, educational spending, housing, transportation, employment, therapeutic services, and caregiver costs. Lifetime medical costs alone are roughly twice those of a typical American, and lost productivity and caregiving costs for dependent adults with a severe ASD can exceed the costs of childhood care and treatment.

ASD affects many aspects of family life, not only leading to physical and psychological impairment of parents, but also causing great unemployment and financial burdens (Ou, Shi, Xun, Chen, Wu, Luo, Zhang, & Zhao, 2015). There are many aspects that are involved in caring for a child with ASD. Employment and childcare afford considerable financial burdens for parents. In previous studies, 39% of parents of children with ASDs have reported that childcare problems greatly affected their employment decisions, and that the average loss of annual income associated with having a child with ASDs was $6,200 or 14% of their reported income in the United States (Ou et al., 2015).

Furthermore, it is exceptionally difficult to locate adequate care that will address the necessary needs of a child with ASD. This prompts familial issues that further burdens the family financially. A recent study also found that children with ASD are 9% less likely to have both parents employed in the United States, and that family earnings are 21% less than those of families with children who have another health limitation and 28% less than those of families with children who have no health limitation (Ou et al., 2015). These statistics reveal the alarming costs of having a child with ASD. The varied financial matters that occur that range from medical, research, care, and other serve to incur considerable costs, but the lack of funds that are acquired must be factored into the equation. When compared with other childhood diseases, ASD was more likely to be associated with financial problems, a need for additional income to provide for the child’s medical care, a reduction of cessation of work because of the child’s condition, and an investment of 10 or more hours per week providing or coordinating care all combine to reveal the exorbitant costs that exist for parents of children with ASD (Amendah et al., 2011).

High Cost Stress on Parents

The responsibility for families touched by autism is tremendous, contends Autism Speaks President Mark Roithmayr. The extraordinary cost further heightens that burden. The effort and time entailed in organizing the care and treatment plan across a considerable number of providers have decreased the capacity of many families to earn a living. Parents experience productivity losses and medical expenses, including inpatient, outpatient, emergency, home health care, pharmacy and out-of-pocket costs. Also, many parents are still denied insurance coverage for essential treatments and services, and the finances add to the overall emotional strain on families (Buescher, Cidav, Knapp & Mandell, 2014). Research has found that non-medical costs account for the largest proportion of expenses. While direct medical costs, home care, such as outpatient care, and pharmacy, add significantly to overall costs, non-medical costs, comprising intervention services and special education, child daycare, and particularly residential accommodations and care for adults who age out of school and can no longer reside at home with parents account for the largest proportion of autism costs (Buescher, Cidav, Knapp & Mandell, 2014).

Parents experience productivity losses and medical expenses, including inpatient, outpatient, emergency, home health care, pharmacy and out-of-pocket costs. For various families, an autism diagnosis signifies a lifetime of assimilating many of the caregiving and financial strains connected with the disorder, particularly in adulthood when the availability of societal supports dwindles. In their study, David Mandell (2014) concurred that it is imperative that we examine how high-quality intervention can reduce the burden on families. Shattuck, and Roux, (2014) contends for families, an autism diagnosis can likewise mean a lifetime of assimilating many of the financial and caregiving burdens associated with the disability, uniquely in adulthood when the availability of societal support diminishes.

Evaluation

There is no medical test for ASDs and a diagnosis is made after a thorough evaluation. The evaluation might include clinical observations, parent interviews, developmental histories, psychological testing, speech and language assessments, and possibly the use of one or more autism diagnostic tests (Baio, 2012; Butler, Youngs, Roberts, & Hellings, 2012). The method of evaluation focuses on behaviors and history in order to gain exposure into the child’s daily actions. Behavioral measures are the only method for obtaining a diagnosis of ASD. The platform for evaluation stems from the limited knowledge on ASD causes. Furthermore, the minimized understanding on the causes creates inaccuracies in the diagnoses and compartmentalization of the structure.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related disorders. DSM-5 will address autism in a different fashion; the categorical approach to autism will be combined with a dimensional model, which allows for a spectrum of social communication deficits because social communication function appears to be distributed in a continuous fashion across the general population (Lohr & Le, 2012). Under the DSM-5 criteria, individuals with ASD must show symptoms from early childhood, even if those symptoms are not recognized until later. Compared with DSM-IV-TR, the proposed criteria show greater specificity to reduce false-positive diagnoses but slightly lower sensitivity, so more false- negative diagnoses may result, especially with female patients (Lohr & Le, 2012).

The dimensional method approach offers the opportunity to engage in a more formulated system of evaluation. It encourages earlier diagnosis of ASD; but also allows people whose symptoms may not be fully recognized until social demands exceed their capacity to receive the diagnosis. There is a necessity to gain awareness at the earliest point so that the implementing of treatment can occur at an effective time. It is useful in identifying school-aged children with autism-related disorders, as well as diagnosing younger children (APA 2013).

Research suggests that both genes and environment play important roles in causing Autism Spectrum Disorder (ASD), (Johnson, Giarelli, Lewis, & Rice, 2013). The combination of the two offers the potential for future research on the cause. The behaviors off the opportunity to gain vision on the problem but leave limited comprehension on the exact nature of the disorder. With the limited understanding, there are many repercussions that exceed having to provide treatment. Thereby leaving families with autistic children face a multitude of challenges because of the behavioral problems associated with the disorder.

Social Impact

Families having a child with an ASD has shown that the child’s behaviors can be a constant source of stress to both caregivers and siblings (Angell, Meadan,. & Stoner, 2012). The behavioral problems that are prevalent in children with ASD ignite significant impediments in the cohesiveness of a family and serenity of any relationship. These ill manners of interaction are not malicious, but they do incur the same result. Parents, especially mothers, of children with an ASD are more likely to experience serious psychological distress, including depression and anxiety, than parents of children with other developmental disabilities (Russa, Matthews, & Owen-DeSchryver, 2015).

Dealing with children in this spectrum harbor considerable focuses that exceed the normal scene, which serves to alter the average image of interaction. The issues can generate considerable stress if methods of coping are not employed. Extremely antisocial and disruptive behaviors such as self-injurious, tantrum, obsessional, compulsive and violent behaviors can often make normal family life almost impossible (Minshawi et al., 2014). Devising systems of maintenance are essential to handle the difficult lifestyle that emerges when a child falls on the Autistic Disorder Spectrum. The emotional perceptions that are ignited in familial relationships tend to range on negative features due to the frustration and stress. Many families feel isolated (McStay, Dissanayake, Scheeren, , Koot, M., & Begeer, 2013) and the self-confidence and self-esteem of family members are often at risk (Angell, Meadan,. & Stoner, 2012; Minshawi et al., 2014). This results in depression and animosity amongst family members.

There are many arenas for stress generation. These time periods serve to mark milestones in the child and family’s life. They serve to reveal the reality of the situation and cause fear and anger at the resulted information. A number of studies have established that parents of children with autism face higher levels of stress than parents of children with other chronic diseases or intellectual disorders (Yamada et al., 2012). The level of stress has not been investigated to afford a detailed statistic but the realization that the stress exists has been determined. The stress is higher among mothers than fathers, and mothers reported more anxiety or more depression (Yamada et al., 2012). Furthermore, the platform that exists in the educational setting serves to be source of concern for the parents and any alteration causes anxiety as to the future. Research indicates that when compared with parents of typical children and parents of children with other neurodevelopmental disabilities, parents of children with ASD have been found to experience significantly higher levels of parenting stress and psychological distress (Yamamoto, & Nagano, 2015).

Research into appropriate educational choices for parents is complicated by the heterogeneity of the condition and the accompanying comorbid conditions which may also present along with the ASD diagnosis. Several research-based intervention methods aimed at addressing behavioral and psychiatric problems for children with ASD have been developed and tested in controlled laboratory settings (Brookman-Frazee, Baker-Ericzen, Stadnick, & Taylor, 2012). The studies have attempted to discover various features involved in the intervention scene in hopes of employing real-world applications. This type of information can ignite a bastion of hope for families and offer a subsiding image to the previously assumed future. Current research has delved into the notion of inclusion with the general classroom; studies are being conducted to determine if this method will relieve stress for parents due to the potential progress that could emerge.

Intervention

Solomon, Van Egerenm, Mahoney, Quon Huber, and Zimmerman, (2014) contends that there are variety of interventions that have been used to address the disruptive, off-task behaviors displayed by children with ASD such as positive reinforcement, visual schedules, social stories, and self-monitoring. Positive reinforcement in the form of prizes, verbal praise, tokens to purchase desired items, and food has been used as a means of increasing desired behaviors (i.e., academic engaged time), and decreasing problem behaviors (i.e., disruptive, off-task behavior) in children with ASD. Reinforcement is provided by an adult or a peer when the child displays appropriate behavior or refrains from displaying inappropriate behaviors (Lounds-Taylor, Dove, Veenstra-VanderWeele, Sathe, McPheeters, Jerome, et al. 2012; Warren, Veenstra-VanderWeele, Stone, Bruzek, Nahmias, Foss-Feig, et al. 2011; Smith, T. (2012). Visual schedules and Priming have also been used to decrease problem behaviors (Knight, Sartini, & Spriggs, 2015; McCurdy E.E. Cole, C.L. (2014). The interventions are based on the rationale that if the child knows what to expect next, he or she may be less anxious and therefore not engage in disruptive behavior. Alternatively, the child may remain on task to get to the next, more desired, activity. Similar to positive reinforcement, there is empirical evidence to support that visual schedules and priming can successfully reduce problem behaviors in children with ASD (Smith, 2012).Self-monitoring has also been used as a means of behavior change with students with ASD (Koegel & Koegel. 2012). With self-monitoring, the child is taught to observe and record instances of his or her own behavior, with the goal of reducing the disruptive actions. Self-monitoring has demonstrated positive effects in reducing disruptive behaviors in children with ASD and other disabilities (Koegel et al. 2013; Koegel & Koegel. 2012; Stasollaa, Perillib, & Damianic, 2014).

Finally, another intervention strategy that has been used to reduce off-task and disruptive behaviors in students with ASD is Prevent-Teach-Reinforce (Strain, Wilson, & Dunlap, (2011). PTR is a team-based approach that includes conducting a functional behavior assessment (FBA) to determine the function of the behavior, and then creating an intervention plan based on the results of the FBA. Results of multiple studies have shown that PTR increases appropriate social skills and academic engagement as well as reduce problem behaviors (Crosland and Dunlap 2012; Dunlap, & Fox, 2009; Fox, Hemmeter, Snyder, Binder, & Clarke, 2011).

Two comprehensive classes of interventions emerge in the research literature (Smith, 2013) and have classified them as focused intervention practices and comprehensive treatment models. It is crucial to define both in order to differentiate the two.

Parental Impact on Intervention

The programs point out how parent involvement helps ensure the behaviors learned in the structured program can be generalized to the home environment (Ryan et al., 2011). Due to the parents being the child’s earliest teacher, many specialized early intervention programs offer training for parents to continue therapy within the home (National Institute of Mental Health, 2010). Some children attend a structured day treatment program and return home to their involved parents who have training in how to continue the learned behaviors from school to the home environment. Others come home to lack of parental involvement. Lack of parental involvement could be a result of many different variables. Parents of children with ASD experience varying levels of motivation, stress, depression, and different socioeconomic levels, which could impact their availability to resources and education (Cappe, Wolff, Bobet, & Adrien, 2011; Schultz, Schmidt & Stichter, 2011).

Research has shown the importance and effectiveness of parental involvement in early intervention programs. There is lack of research showing the effectiveness of programs when there is lack of parental involvement and the impact it can have on the child’s development within the program. When there is lack of parental involvement and the program is ineffective there is potential for impact on the child. Current research on autism includes topics such as assessment and diagnosis, class and in home services for children with autism, training and support services for parents and families (Lord, 2007; National Institute of Mental Health, 2010). Social Workers are an integral part of the assessment, diagnosis and treatment plan of a child with ASD. They also promote parental involvement and provide training and support to parents of children with ASD. In order for early intervention programs to be effective and the child to make improvements the parents need to be involved, but this responsibility ultimately lies on the parents themselves. Once the child leaves the hands of the social worker and the structured intervention program, it is out of the social workers hands and up to the parent to utilize the services offered (Schultz, Schmidt & Stichter, 2011).

Comprehensive Treatment Models

Comprehensive treatment models (CTMs) consist of a collection of practices intended to obtain an extensive learning or developmental effect on the core deficiencies of ASD. In their study of education programs for children with autism, the National Academy of Science Committee on Educational Interventions for Children with Autism (Hume, Boyd, McBee, Coman, Gutierrez, Shaw, Sperry, Alessandri, & Odom, S. 2011) classified 10 CTMs. They embraced the TEACCH program developed by Schopler and colleagues (Marcus, Schopler, & Lord, 2000), the LEAP model (Strain & Hoyson, 2000; Strain, & Bovey, 2011). the UCLA Young Autism Program by Lovaas and colleagues (Smith, Groen, & Winn, 2000), as well as the Denver model designed by Rogers and colleagues (Rogers, Hall, Osaki, Reaven, & Herbison, 2000).

In a follow-up to the National Academy study, Odom, Boyd, Hall, and Hume (2010) classified 30 CTM programs operating within the U.S. These programs were recognized by organization (i.e., around a conceptual framework), operationalization (i.e., procedures manualized), intensity (i.e., substantial number of hours per week), longevity (i.e., occur across one or more years), and breadth of outcome focus (i.e., multiple outcomes such as behavior, communication, social competence targeted) (Odom, Thompson, Boyd, Dykstra, Duda, Hedges, Szidon, Smith, & Bord, 2013).

Focused Intervention Practices (FIP's)

In opposition, focused intervention practices are meant to discuss a particular goal or skill of a student with ASD (Odom et al., 2010). These practices are operationally described, address explicit learner outcomes and tend to transpire over a smaller time period than CTMs (i.e. until the individual intent is attained). Models include pivotal response training, discrete trial teaching, video modeling, and prompting. FIP's could be deemed the hub of educational programs for youth and children with ASD, and they are profoundly remarkable features of the CTMs just explained. For instance, peer-mediated intervention and instruction (Sperry, Neitzel, & Engelhardt-Wells, 2010), is a fundamental characteristic of the LEAP model (Strain & Bovey, 2011).

The goal of the prevailing review is to distinguish focused intervention practices that have proof of effectiveness in fostering concrete outcomes for learners with ASD. Teachers and other parents may choose these methods when creating an individualized education or intervention program because of the proof that they produce consequences comparable to the goals set for youth and children with ASD. Odom, Hume, Boyd, and Stabel (2012) explained this as a technical eclectic approach and the National Professional Development Center on ASD has created a means through which these methods could be orderly applied in school-based programs and early intervention.

Inclusion in the General Education Classroom

The most recent revision of the Individuals with Disabilities Education Improvement Act (IDEA 2004) mandates that children with disabilities be educated in general education classrooms with their typical peers to the maximum extent possible. Additionally, the law states that children with disabilities may only be removed from regular education and placed in special education when, due to the nature or severity of the disability and with the appropriate supports and services, they cannot receive a satisfactory education in the general education classroom (IDEA 2004).

The incorporation of students into the general classroom has been shown to be effective. However, behaviors exhibited by students with ASD frequently lead to their return to segregated special education settings (McCurdy & Cole, 2014). The importance of providing effective education is dire in the outcomes of these children regardless of the awareness into the post-secondary lifespan.

Inclusive education has become a particularly important issue in the education of children with autism spectrum disorders (ASD). ASD is a developmental disorder characterized by difficulties in communication and social behavior, and the presence of restricted and repetitive/ challenging behaviors and interests (Rodríguez, Saldaña, & Moreno, 2012). Inclusion is viewed by many as an appropriate practice for educating children with ASD because of the potential benefits including the increased opportunity for social interactions with nondisabled peers, the possibility of developing friendships, the gains in communication, social, and adaptive behavior skills, and the participation in age-appropriate activities that may enhance social competence and ultimately lead to successful post-school adjustment (Segal, & Campbell, 2012).

Viewed by many as an appropriate practice for educating children with ASD because of the potential benefits including the increased opportunity for social interactions with nondisabled peers, the possibility of developing friendships, the gains in communication, social, and adaptive behavior skills, and the participation in age-appropriate activities that may enhance social competence and ultimately lead to successful post-school adjustment (McCurdy & Cole, 2014).

The inclusion of new educational measures offers potential aid and expansion on the level of quality care that is acquirable. New methods of education serve to provide a framework for development in a child diagnosed with ASD. There is more limited research concerning inclusion of students with an ASD in mainstream education. Despite the benefits of inclusion, there are also barriers that arise during the implementation of inclusive practices (McCurdy & Cole, 2014). The research regarding inclusion has yielded considerable results but has not offered a defined state of the best method of application. One of the initial barriers is gaining support of the school administration and staff (McCurdy & Cole, 2014). The notion of inclusion frightens many school administrators due to the behavioral issues that accompany children on the AD spectrum.

Many schools never consider placing students with ASD in general population because of the provision in IDEA 2004 that allows for the removal of children with disabilities from general education setting if the nature of severity of the child’s disability inhibits his or her learning (McCurdy & Cole, 2014). The debate on the location of the educational setting is commonplace in the ASD circles. Both positions offer research and evidence; the outcomes these students attain in the early years after leaving high school serve as a leading measure of the effectiveness of the educational services and supports provided during secondary school (Kucharczyk, Reutebuch, Carter, Hedges, El Zein, Fan & Gustafson, 2015). It is essential that these students receive the most effective approach in the educational setting to ensure they are able to reach their full potential once reaching adulthood. Some schools may require the child to earn his or her way into general education, thereby refusing to allow the child access to the general classroom” (McCurdy & Cole, 2014). This method of obtaining inclusion is, for the most part, eliminating any potential to achieve inclusion.

Post-Secondary Outcomes

Although social-related challenges are among the defining features of ASD, the needs of adolescents with ASD are often more global as they prepare to pursue goals in the areas of postsecondary education, careers, community participation, and independent living (Kucharczyk et al., 2015). There are many additional components that exist that extend past the notion of socialization and communication that must be tended too prior to a child with ASD progressing in life. In other words, interventions addressing just one dimension of students’ lives may be far too narrow to produce substantial improvements in the post-school outcomes of graduates with ASD (Kucharczyk et al., 2015). Students are appearing ill prepared to handle the stress of independence. These new adults with ASD have moved through the system without acquiring the necessary skills to adjust to the new title. Although literature is replete with evaluations of interventions addressing individual educational domains (e.g., social interactions, reading, self-management) for elementary and preschool students, far less attention has focused on adolescents (Kucharczyk et al., 2015). There are various components that are potentially involved in the results that are emerging.

Reflection on these post-school outcomes is driving the field to consider how secondary and transition services might be optimally designed and delivered to meet the needs of these adolescents. The continued review of the situation is suggesting a desperate need to ascertain measures to employ in order to prevent the current outcomes of the post-secondary environment. It is therefore timely for this researcher to produce longitudinal ethnographic research, which provides an insider perspective and theory to explain how parents deal with the education of their child or children with an ASD over time.

Autism Spectrum Disorder Perception

Autism is a core disorder of the pervasive developmental disorders (PDDs) (World Health Organization 2014; American Psychiatric Association (2013), and manifest before the age of three years. The word Autism is derived from the Greek word ‘autos,’ meaning ‘self’; the term describes a condition in which a person withdraws from social interaction; hence, living in a world confined to ‘self’ (Duff & Flattery, 2014).

Autism is, nevertheless, a dimension rather than a distinct class and is commonly recognized as a spectrum, along which children encounter differing degrees of complexity in the domains of social interaction, communication, and a leaning toward repetitive behaviors and lack of vision and creativity. Children with autism spectrum disorder (ASD) lack comprehension of how to start and respond to joint attention with other individual, have challenges in social timing of communication, and may not comprehend other people’s aims as displayed through gestures and language, even though they may look affectionate and want to be with other individual socially. In a sample of children with ASD ages 8-17, participants were more likely to initiate a social interaction than respond to a social interaction (McMahon, Vismara, & Solomon, 2013).

They have trouble with coordinating their responses, and with inhibition of repetitive behaviors and interests. An important function of educators may be to facilitate a more tangible and/or positive construct of self, before any increase in functional life skills, activities of daily life, or social interaction and communication skills can be realized in students with autism spectrum disorders (Duff & Flattery, 2014). The reason for the step approach suggestion stems from the notion of disconnection with the “self”. Social engagements stem from the desire to form connections with others, and without a “self”, there is nothing to connect. These claims venture towards the image of self-awareness and understanding on the spectrum of empathy and sympathy, which are emotional connections that are largely difficult for children with ASDs.

Social interaction, language, and theory of mind are all developmentally linked and positively correlated with an individual’s ability to engage in joint attention; consequently, deficits in joint attention and in developing theory of mind, are now recognized as a descriptors of individuals with autism (Duff & Flattery, 2014). Children with core autism have more serious challenges and are more prone to have associated learning difficulties, than those who have other diagnoses within the Autism spectrum.

As a result, aggressive behaviors in children with autism spectrum disorders (ASD) often cause a great deal of difficulty for families. Frustration that emerges from the limitations and lack of comprehension results in various behavioral actions. Hitting, kicking, biting, and throwing objects, and other behaviors common during a temper tantrum or meltdown can greatly increase parent stress (Sikora et al., 2013). The dangerous nature of the violent behaviors serves to incur concern and patterns of fear for the self and for those surrounding the child, which adds to stress levels. To make things worse, a vicious cycle can begin so that behavior problems increase stress and increased stress (together with fraying nerves and poorer parental responses to the behavior) result in even worse behavior problems.

Many parents feel detached and the self-esteem of immediate family members of children with ADS has the potential to withdraw emotionally (Sikora et al,. 2013). The generation of these behaviors and the consequent behaviors has been largely untreated due to the lack of research and result on the most effective approaches to subside the actions. The mental state that exists within the realm of ASD does not comprehend the full weight of the malfunctions and results in an inability or a view of unnecessary with respect to change (Boulter, Freeston, South, & Rodgers, 2014). Even with the patterned stress that emerges throughout the path, the initial knowledge of the diagnosis serves to generate the most fear based on the mysterious nature of the disorder. Researchers commonly report that families of children with autism spectrum disorder experience more parenting stress than families of typically developing children or those diagnosed with other disabilities [e.g., Down syndrome, cerebral palsy, intellectual disability] (Hayes & Watson, 2013). The emergence of stress in a landslide against other disabilities can be contributed to various factors. One potential cause could be the behavioral factor that is the dominating component to the disorder; it translates into many actions that are destructive and occasionally cruel. Additionally, this disorder, while commonly discussed and known, is not thoroughly understood and the lack of knowledge generates a fear of the unknown (Hayes & Watson, 2013). The continued focus in the research could aid in relieving some manner of stress for parents if there are defined and proven methods of treatment or successful implementations.

Parental Impact

The stress that emerges in families with a child or children with ASD is highly individualized. There are many factors that contribute to the potential levels of frustration and anxiety and every family measure is unique. It is evident that the level of stress experienced is subject to individual differences; this difference can be partly accounted to factors like how parents comprehend their lives, and partly to the kind of strategies they employ when distributed or distressed (Pareek & Jindal, 2014). The development of coping measures would aid in the minimization or limited nature of stress, but effective methods have not been fully explored.

These students frequently display a paucity of comprehension of their personal education requirements, inadequate self-advocacy, abilities and appear uncomfortable about revealing their circumstances because of potential stigmatization; all of which conflict with their capacity to solicit assistance (Steinbrenner, 2015). As a result, it is appropriate for this researcher to produce exploratory analysis of the effects of stress on specific quantifiable variables of research, that is, parents’ ways of dealing with the education of their child with an Autism Spectrum Disorder. This will thus present an insider perspective in illustrating how parents deal with the education of their children with an ASD over time.

Advancing Scientific Knowledge

The current knowledge on this topic recognizes the various issues that exist, but fail to harbor comprehension on all matters. Considerable research has been employed in order to discover the factors and features of the spectrum. Further detailed research investigates the varied aspects of familial incidents that occur when a child is on the Autism Disorder Spectrum. A study in 2012 investigated perspectives of parents whose children have received outpatient therapy in community mental health clinics (Brookman-Frazee et al., 2012). This type of examination has been the focus of the research, which does not serve to explore the facets of this issue. Participation of parents of children with autism is commonplace in most comprehensive intervention programs, yet, there is limited research relating to the best practices in this area (Steiner et al., 2012). The varied evaluations into children with autism do extend into interactive measures with parents, but does not acquiesce the maintenance features for parents in order to limit stress.

The research that has been executed thus far serves to engage an initialization into the issue, but is limited in its angled comprehensive framework. Due to increasing prevalence rates of Autism Spectrum Disorders in recent years, there is a strong need for efficient, cost-effective, and Empirically Supported Treatments for this population (Steiner et al., 2012). The conception of parental anxiety and stress in relation to a child with ASD is well documented, but the most effective means of thwarting the frustration have not emerged. This research will aid in delving into the topic and obtaining insight into the potential paths to enter in order to gain some relief from the stress. The contribution will provide vision for educational features of ASD children and allow for parents of these children to gain recognition into methods of application.

The proposed study will make several substantial and original contributions to knowledge. This study will develop substantive theory in an area where no such theory presently exists. The theory will lead to an understanding and explanation of the situation faced by parents trying to educate their child or children with an ASD. The theory will be relevant to the development of policies concerning parents trying to educate their child with an ASD in United States. The directional approach to the research will yield specific results that will provide a sectional image for application. The information obtained in this research will have an immediate use and afford relief and aid to parents with children that have ASD. The inclusion of the research will offer insight into the situation that exists in the educational realm and provide angles of effective imparting of knowledge to students with ASD.

Gaining access to another component of this disorder will provide considerable relief on various levels for parents, educators, and adolescents afflicted with the disorder. Discovering more facets to the disorder serves to develop hope and generate acceptance for the situation on all levels. Educators become better equipped to handle children that have ASD and parents are more educated in methods to support their child or children in the academic setting. Employing an in depth investigation into this crevice will incur an increase in comprehension and an initialization in the elimination of the mysterious nature of the disorder as it pertains to treatment and application. This research will be essential to the perpetuation of future research regarding discovery of treatment and correlational causes.

The investigation into the previous research and literature on the topic has yielded considerable insight into various facets of ASD. The examination led to a more fluid understanding of the disorder and provided an image of the gaps in the current bane of knowledge. The literature review allowed for the opportunity to gain a detailed account of the gaps in the current research and devise potential areas for future dissection. ASD is the new format for all contributions to the autism sectors, which encompass various social and behavioral disorders.

The combinational approach to evaluation offers a collective image of the needs involved in the academic setting and the emotional toll incurred by families with a child or children with ASD. The focused approach to the research revealed a framework for components of the familial and educational arena that is lacking. Analysis into these sectors revealed initial features for inclusion that aid in effective application. These features also foster an image of the emotional stress that accompanies families that have a child or children with autism. The literature provided extensive fodder towards the proposed measure of research. The next phase serves to offer explanatory components to the methodology of the current study. In the Rationale for Methodology an in depth review of the path of research will be presented.

The review of literature has yielded reoccurring themes underscoring the importance of how parents deal with the education of their child with Autism Spectrum Disorder (ASD) (Boyle et al., 2011; Dingfelder, & Mandell, 2011; Alquraini, & Gut, 2012; American Psychiatric Association, 2013).

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