This section will give an overview of autism spectrum disorders. It seeks to explore affects of autism disorder on the parent-child relationship. It will define the symptoms of autism disorder, taking into account the issues surrounding social interaction and communicative development, as well as looking at behaviours typical to autism. The developmental stages of a child will be looked at in terms of the milestones that should be reached by a typically developing child and the delays in these milestones in a child with autism disorder will then be reviewed. Since many children with autism have difficulties with social interaction and communication skills, factors associated with attachment behaviour and styles, the study will explore attachment in children and will discuss the different attachment styles. Attachment in children with autism will then be discussed. Bonding between the parent and child will be looked at, paying particular attention to factors likely to impact the bonding relationship between a parent and the child with autism and how these can affect the attachment style and behaviour of the child. The importance of the support from social care workers in facilitating these attachments and bonding processes will also be addressed.
Autism Spectrum Disorders Defined:
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Autism spectrum disorder (ASD) refers to a wide range of developmental disorders affecting the social, communicative and imaginative abilities of those it affects (Wall, 2004). It "...is highly complex and variable in its clinical presentations and manifestations" (Zager, 2005, p.3). It is unique from other neuro-developmental conditions because of its defining feature which is a difficulty with social and communicative development (Zager, 2005). The disorders of ASD can be classified as Autism Disorder, Pervasive Developmental Disorder, Rett's syndrome, Asperger syndrome, and Childhood Disintegrative Disorder (American Psychiatric Association, 2000).
For the purpose of this study, only Autism Disorder will be focused on. Although the disorder can be distinguished from other forms of ASD, the terms autism and ASD are often used interchangeably (O'Brien & Daggett, 2006). The term autism will be used to describe Autism Disorder within this study.
Approximately three quarters of those diagnosed with autism have an intellectual disability (van Ijzendoorn, 2007). It is estimated that 1 in every 166 people have autism in Ireland, but international research points to a higher prevalence (Major Autism Research, 2009). The prevalence of autism varies in terms of gender, with boys being four times more likely to have it than girls (Kay, 2007). The symptoms of autism will now be discussed.
Symptoms of Autism Spectrum Disorder:
The symptoms of autism change according to the age and maturity level of the person. The behavioural issues associated with autism can range from mild to severe impairments (DSM-IV-TR, 2000).
Kanner (cited in Aarons & Gittens, 1999) described nine characteristics associated with autism. These are:
problematic relationship building
a delay in language development, or no development at all
difficulty with using spoken language to communicate meaningfully
a delay in the development of echolalia; repetition of words, phrases and sounds that a child has heard
pronominal reversal; substituting 'you' for 'I' e.g. instead of the child saying "I want a drink", they say "you want a drink"
repetitive play; a lack of imaginative play and a constant systematic play
an issue with change and a constant need for a routine to be in place
good rote memory; an ability to remember a lot through repetitive learning
normal physical appearance, which led Kanner to believe that people with autism spectrum disorder could be of normal intelligence.
Kanner (cited in Aarons & Gittens, 1999) later grouped these points together into two essential features; the repetitive nature and sameness of routines and the onset of extreme aloneness within the first two years of life.
In order for a diagnosis to be given a child must display symptoms from one or more of the categories as defined by the DSM-IV-TR before the age of three (American Psychiatric Association, 2000). The DSM-IV-TR (American Psychiatric Association, 2000) outlines the diagnostic criteria for autism disorder as follows:
A. six or more symptoms from the lists (1), (2), and (3), with two or more from (1) and at least one each from (2) and (3):
Impairments in social interaction:
Always on Time
Marked to Standard
(a) Inability to form relationships with peers that match their developmental level
(b) Impairment with non-verbal behaviours such as gestures to regulate social interaction, eye contact, body postures.
(c) Marked impairment in social or emotional reciprocity
(d) Failure to seek enjoyment with others through shared interests or joint achievements
Impairments in communication:
(a) Repetitive use of language
(b) Inability to partake in imaginative play consistent with their developmental level
(c) A delay in or inability to develop spoken language with no effort shown in using an alternative method of communication such as mime
(d) A hindrance in the individual's ability to begin or maintain a conversation, even with adequate speech
3. Repetitive behaviours, interests and activities:
(a) Preoccupation with parts of objects
(b) Repetitive motor movements such as hand flapping and rocking
(c) Apparent need or desire to perform particularised, non-functional routines
(d) Preoccupation with one or more restrictive patterns that is abnormal in intensity or focus
B. Delay or abnormal functioning in at least one of the following areas, prior to the age 3 years: (1) social functioning, (2) language as used in social communication, or (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Childhood Disintegrative Disorder or Rett's Disorder.
The symptoms and characteristics of autism are not always clear cut and every individual differs in terms of the symptoms they present with (Aarons & Gittens 1999). Having said this, most definitions include a triad of factors. The first factor involves child's development of communication. The second involves the child's development of social interaction. The third factor relates to the "restricted, repetitive, and stereotyped patterns of behaviour, interests and activities" seen in people with autism (American Psychiatric Association, 2000).
Impairment of Social Interaction:
There are a number of differences that can be noted when discussing social interaction issues. A child portraying typical development begins to relate to their environment in the early months of life, through touch, taste, sound, sight and hearing (Wall, 2004). They can also begin to interpret facial expressions and respond to the feelings their parents express (Wall, 2004). A child with autism has difficulty with interpreting facial expressions, emotions and feelings or intonation of verbal interactions and therefore their social interaction is restricted (Wall, 2004). As a result they may not interact with others and may form a rigid structure of play that excludes others (Wall, 2004; Zager, 2005). By excluding others and hence physical contact, issues with the feeling of touch can arise (Wall, 2005). Due to the lack of contact with others children with autism often avoid eye contact, which complicates their ability to relate to others further (Wall, 2004; Zager, 2005).
Impairment of Communication
Children with autism have marked difficulties with communication. These difficulties impact on both their verbal and non-verbal skills. Acquired speech tends to be delayed (Wall, 2004). Some acquire the full ability to speak, some only partially and others may not acquire any form of speech (Wall, 2004; Zager, 2005). Some children may develop the ability to sign while others may not (Wall, 2004). In some cases a regression in the child's acquired speech can occur, resulting in them losing the speech they have learned (Wall, 2004). Because of the inability to connect with others socially, a child with autism may not find the need to communicate in a verbal manner (Wall, 2004). When speech does develop it can often be repetitive and have an unusual tone or intonation (Wall, 2004). Echolalia is also a symptom affecting the development of communication in children with autism. This refers to the automatic repetition of vocalisation, words, phrases or sentences made by another person (Wall, 2004).
There may be issues with understanding the context of the conversation or the conversation process (Wall, 2004). The fact that children with autism tend to interpret everything that is said in a conversation literally can add to this difficulty (Wall, 2004; Zager, 2005). They can also have issues with misinterpreting non-verbal communication (Kay, 2007).
Restricted, repetitive, and stereotyped patterns of behaviour:
Children with autism can often struggle with their imaginative abilities to interact. They can display repetitive play and a narrower range of interests than a typically developing child (Aarons & Gittens, 2004; Zager, 2005). They may be preoccupied with one or more restricted pattern of interest that is abnormal either in intensity or focus (American Psychiatric Association, 2000). Such patterns include "...an inflexible adherence to specific, non-functional routines... repetitive motor mannerisms... or a persistent preoccupation with parts of objects" (American Psychiatric Association, 2000, p.71). This can be related to the need for them to have repetition and structure in their lives, when their world seems so chaotic to them (Wall, 2004).
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Children with autism may exhibit stereotyped body movements such as flapping their hands, clapping, rocking or swaying (American Psychiatric Association, 2000). Abnormalities of posture may also be present.
Children with autism also tend to have issues with understanding other people's perspectives (Wall, 2004). This is related to them only being able to deal with issues that make sense to them (Wall, 2004).
The symptoms of autism can be noted throughout the developmental stages of a child (Greenspan & Wieder, 2006). These stages will now be looked at.
Greenspan & Wieder (2006) suggest six milestones essential for healthy emotional and intellectual growth. These milestones are generally reached by your typically developing child. However, delays in reaching these milestones are often noted in children with autism.
The first milestone is "shared attention and regulation" which deals with the processing of sights, sounds and touch (Greenspan & Wieder, 2006, p.30). It also deals with the child's ability to self regulate. This milestone begins at zero to three months. It has been noted when studying children with autism that there is a "lack of sustained attention to different sights and sounds" (Greenspan & Wieder, 2006, p. 30). An example of this can be seen when a parent holds their child and the child avoids eye contact with the parent. This can occur as a result of the child being overwhelmed by the number of stimuli, hence preventing the child's ability to regulate themselves. These symptoms would relate to the difficulties with social interactions that a child with autism has.
The second milestone has to do with "engagement and relating", which deals with the trust and the love between the child and the parent(s), or the person working with the child (Greenspan & Wieder, 2006, p.30). This begins at two to five months. This milestone can be seen to be lacking in a child with autism. The child with autism tends not to engage at length with others and their expressions of joy when engaged tend to be fleeting. This affects their abilities to interact socially.
The third milestone is "purposeful emotional interaction", which deals with two-way interaction between the child and the person interacting with them (Greenspan & Wieder, 2006, p.30). This milestone begins at four to ten months. Children with autism tend not to interact with others as often as a typically developing child. They do not tend to initiate interactions and when they are relating with someone it tends to be in response to the other persons actions.
The forth milestone is called "social problem solving", where the child opens and closes circles of communication (Greenspan & Wieder, 2006, p.30). This is where a child displays a number of social and emotional interactions in a row in order to problem solve. It begins from ten to eighteen months. The child masters this milestone by opening and closing circles of communication with an individual, such as their parent. An example of this would be where the child opens a circle of communication by initiating play, such as rolling a ball to their parent. The child closes the circle of communication by responding to the parent when they pass the ball back. A child with autism has difficulty with sustaining a number of interactions with a person and rarely displays emotional exchanges or cues as seen in the child playing with the ball.
The fifth milestone is "creating ideas" which deals with pretend play through the use of meaningful words and phrases (Greenspan & Wieder, 2006, p.30). It begins at one and a half to two and a half years. Children with autism often have issues with language development and so this milestone can be affected through the child being unable to express themselves. They may also just repeat what is heard, which is known as echolalia. This behaviour relates to the symptoms affecting communication in a child with autism.
The sixth milestone has to do with "connecting ideas together" and thinking logically (Greenspan & Wieder, 2006, p.30). This milestone deals with connecting ideas and reality. It begins at around the age of two and a half to three and a half years. It is noted that children in autism struggle with this milestone due to language delays, echolalia, and an inability to use words and phrases logically. An example of this would be where a child with autism asks for a drink but instead of saying "I want a drink", they request it by saying "you want a drink".
Children with autism have issues with all of these milestones (Greenspan & Wieder, 2006). They have issues with relating to others. This in turn impacts on their ability to socialise. Children with autism have particular difficulty with the fifth and sixth milestones. They rarely part take in imaginative play and find it hard to connect ideas together.
Greenspan & Wieder (2006) gave a developmental span of zero months to three and a half years. Kanner (cited in Aarons & Gittens, 1999) suggested that symptoms of autism may arise at this stage. Attachment occurs at this stage too; within the first year of a child's life (Ainsworth et al., 1978). For this reason, attachment will be discussed with reference to the impact of the symptoms and developmental delays on it.
Attachment can be defined as "an affectionate bond between two individuals that endures through space and time and serves to join them emotionally" (Klaus & Kennell cited in Fahlberg, 2003, p.14).
Attachment allows for a number of self defining characteristics to occur in a child. These include a child's ability to reach their full intellectual potential, to sort out what he or she perceives, to think sensibly and rationally, to develop social emotions, to develop a conscience, to trust others, to cope better with stress and frustration, to overcome fears and worries and to increase self worth (Fahlberg, 2003).
Bowlby (1982) outlined four phases that a child progresses through during their attachment development. The first phase occurs from birth to approximately twelve weeks. Within this period the baby shows signs of orientation towards an individual and signals them but they have trouble discriminating between individuals. They rely solely on their auditory and olfactory abilities to do so. The second phase can be seen to occur from twelve weeks up until six months. The child exhibits behaviours highlighted within the first phase but the behaviours become more intense and are more readily directed at a distinctive individual such as a parent. They also signal their parent through the use of attachment behaviours. The third phase occurs when the child is approximately six or seven months and continues into their third year of life. It can be delayed until after their first birthday if the attachment figure is not consistently present. In this phase the child maintains proximity to their attachment figure by crawling or walking towards them. The fourth phase is known as the goal corrected partnership. It occurs from the age of four onwards but can occur as early as three. During this phase the child becomes aware that the caregiver has goals and interests separate to their own and the child takes them into account. These phases provide the basis for three key attachment characteristics that Bowlby (1982) outlined.
The first attachment characteristic defined by Bowlby (cited in Howe, 1999) is proximity seeking to a distinctive figure or small group of people. This involves the child actively seeking out their caregiver in order to have their needs met. The second is the development of a secure base. A secure base refers to the primary care giver acting as a place of safety, comfort and warmth when anxiety levels rise (Ainsworth & Wittig cited in Howe, 1995). The third is separation distress. Proximity seeking relates to the desire of a child to be near the person they are attached to. A secure base refers to the attachment figure acting as a base of security from which the child can explore the surrounding environment. Separation distress refers to the anxiety that is felt by the child when the carer is not present. The materialisation of these characteristics depends on parental sensitivity.
Parental sensitivity is one of the commonly recognized determinants of attachment (van Ijzendoorn et al., 2007). Fahlberg (2003) describes how the arousal-relaxation cycle works to form attachments between children and their parents. The cycle begins with the child expressing a discomfort as a result of need that is not being met. This leads to the parent responding to the child's discomfort in a comforting and sensitive manner, leading to the child reaching a state of calm and the cycle being completed (Fahlberg, 2003). Successful completion of this cycle on a regular basis leads to a secure attachment being formed (Fahlberg, 2003). When this cycle is disrupted, by the parents not responding to the child for example, problems with attachment can arise (Fahlberg, 2003). Therefore parenting styles play a huge role in the development of attachment.
Ainsworth, Blehar, Waters & Wall (1978) expanded on Bowlby's research on attachment and created an experiment known as "The Strange Situation". This experiment looked at characteristics such as those described by Bowlby (cited in Howe, 1999); the creation of a secure base, proximity seeking and separation distress. Ainsworth et al. (1978) set up a situation where a child and their parent were alone in a room. They looked at the extent to which the child explored the room. They then sent a stranger into the room who approached the parent and talked to them and following on from that approached the child. The parent was then asked to quietly leave the room. The parent eventually returned to the room to comfort the child. Through these steps, Ainsworth et al. (1978) could distinguish a pattern emerging in the types of proximity seeking and separation distress different children presented with. The research led Ainsworth to define three types of attachment styles. These were secure attachment, insecure-ambivalent attachment and insecure-avoidant attachment. Main and Solomon (cited in Solomon & George, 1999) defined a fourth attachment style known as disorganized-insecure attachment.
Secure attachment occurs when a child's arousal-relaxation cycle is repeatedly completed by the parent (Fahlberg, 2003). This leads to the child connecting with the parent in such a way that they become a secure base for the child (Ainsworth et al., 1978). They can feel independent enough to explore their environment and seek their attachment figure when a threat is posed or they feel anxious (Ainsworth et al., 1978). They display distress when the attachment figure leaves but are not overly distressed. Children that are securely attached tend to seek out their parents in preference to strangers (Ainsworth et al., 1978).
Insecure ambivalent attachment:
Children who are ambivalently attached tend to display considerable distress when separated from a parent or caregiver, but do not seem reassured or comforted by the return of the parent. The child can be clingy and over-dependant (Ainsworth et al., 1978). This attachment occurs in children, whose parents are inconsistent with their care giving (Graham, 2006). They may provide the child with some basic needs such as food and shelter but they are inconsistent in their responses to the child's signals for attention.
Insecure avoidant attachment:
Insecure-avoidant attachment styles can be seen in children that tend to avoid their parent (Ainsworth et al., 1978). This avoidance often becomes more noticeable after a period of absence (Ainsworth et al., 1978). A parent's attention may not be rejected but insecure-avoidant children do not tend to seek it. Insecure avoidant children do not show a preference towards their parent over a stranger (Ainsworth et al., 1978). This style of attachment generally occurs when the primary caregiver does not fulfil the arousal-relaxation cycle proposed by Fahlberg (2003). The child's signals for attention from the parent are not fulfilled and so the child eventually fails to display those behaviours (Graham, 2006).
Insecure disorganised attachment:
Main and Solomon (cited in) coined the parental strategy of insecure disorganized attachment. Children with an insecure disorganised attachment style show a lack of clear attachment behavior. Their actions and responses to caregivers are often a mix of behaviors, including avoidance and/or preoccupation . These children are described as displaying dazed behaviour, sometimes seeming either confused or apprehensive in the presence of their parent(s).
Due to the disruptions in the development of communication and social interaction the question might arise of whether a child with autism can form secure attachments (van Izjendoorn et al., 2007). Attachment in children with autism will now be discussed.
Attachment in Children with Autism Disorder:
Kanner (cited in Rutgers et al, 2004) was the first to define autism as a developmental disorder, whose defining feature was the inability to form affective connections with others. According to studies completed in the area of attachment in children with autism, children with autism can form secure attachments (van Ijzendoorn et al., 2007; Rutgers et al., 2007; Dissanayake and Crossley, 1997). Studies have shown that children with autism may display less contact with their caregiver but they do show preference for their mother over a stranger (van Ijzendoorn et al., 2007). In a study undertaken by Dissanayake and Crossley in 1994, they found that children with autism decreased their exploratory behaviour and increased their attachment behaviours to their mothers when a stranger entered the room (Dissanayake & Crossley, 1997).
Van Ijzendoorn et al. (2007) hypothesised that there is a biological limitation on the intergenerational transmission of attachment in children with autism. Sigman and Capps (cited in van Ijzendoorn et al., 2007) state that a secure working model of attachment comes later in those with autism and may not come at all, unless the attachment figures appreciation and understanding of the child's perspective is present.
Rutgers et al. (2007) found that children with autism appeared to be less securely attached than children with normal development and those with developmental disorders such as mental retardation. In a study undertaken in 1994, Capps et al. (cited in van Ijzendoorn et al., 2007) found that out of the fifteen participant children with autism, all showed signs of disorganised attachment. This suggests that children with autism may be able to form normative attachments within their attachment strategy but that they may not fall into the category of what Ainsworth et al. (1978) defined as the secure pattern. It is important, therefore, to look at the bonding process between the parent and child and the child's attachment behaviours to clarify what attachment strategy the child relates to.
Bonding between Parents and their Autistic Child and Attachment Behaviours Displayed by Children with Autism:
It is well documented that "...the resources that parents bring to their families satisfy a number of needs in the family, one of them being support for the development of children."(Lugo-Gil & Tamis-LaMonda, 2008, p.1082). Fahlberg (2003) refers to bonding as the parent's link to the child.
According to Grossmann, Grossmann and Kindler (cited in Grossmann, Grossmann & Waters, 2006), there are three influential factors that impact whether or not bonding occurs. The first involves the interactions and responses an individual has with attachment figures early on in life. Whether the child receives positive or negative responses from the parent will impact on how they attach with the parent. The second factor relates to an individual's mental models of close relationships with others. This internal model will influence how they will experience future relationships. The final factor involves the parent's respect for the child's attachment needs and their need to explore their surrounding environment. The child can build on their ability to be independent through the exploration of their environment. Fahlberg (2003) insists that if a parent is responsive and sensitive to their child's needs attachment can occur (Fahlberg, 2003).
The attachment behaviours shown by a child are crucial when forming an attachment with their parent (Bowlby, 1982). Humans are unique in their attachment behaviour due to the lack of an instantaneous attachment that can be seen in non-human primates (Bowlby, 1982). Bowlby (1982) states that there is evidence that babies as young as three months exhibit attachment behaviours such as smiling and vocalisations when in the presence of their mother. However Bowlby states that a child's awareness of their parent can only really be measured when they can actively seek out their parent once they are mobile, which usually occurs from eleven months onwards (Bowlby 1982; Hayes, 2005).
Bowlby (1982) defined thirteen types of attachment behaviour displayed by young children. All of the behaviours relate to the child's reaction towards their parent. Bowlby focused on the mother as the indicator for such behaviours. One such behaviour is variation in vocalisations. Babies tended to vocalise more when near a parent. Another behaviour that has been noted is the tendency of a child to cease crying once held by their mother. Another is when a baby starts crying when the mother departs from them. An increase in the child smiling in the presence of their mother is another form of attachment behaviour. Other behaviours include the way the child greets their parent in comparison to others, the constant stare at the parent when held by another person, the way in which they approach their parent, their constant following of the parent, climbing on and exploring their parent, burying their face into their parents lap, using their parent as a secure base, hurrying to the parent for safety and clinging to the parent.
Ainsworth et al. (1978) recorded all of these behaviours in the Strange Situation experiment. These included the child crying when their mother left the room and greeting the mother when they returned by raising their arms, smiling and cooing in delight.
Ainsworth et al. (1978) found that these behaviours are present at the age of six months and are exhibited more regularly and vigorously as the child reached the age of nine months. These behaviours continue as the child reached the age of one and throughout their second year of life.
It is not until children are about three years of age that they come to terms with short absences from their parents; around the age that they attend pre-school (Bowlby, 1982). Attachment to parents is still shown at this stage, however. Children may cry when their parent leaves them and then request attention from their teacher (Bowlby, 1982). This attachment behaviour tends not to last as long as a younger child's.
These behaviours can be present in children with autism but tend not to be as frequent (van Ijzendoorn, 2007). Certain attachment behaviours have been seen to be lacking in children with autism. These behaviours include the child not raising their arms in an anticipation of being picked up, a lack of eye contact, an indifference to or dislike of being touched or cuddled, the child not reacting to voices or noises but showing good hearing in other situations, the child appearing deaf and the child showing more of an interest in objects as opposed to human faces (Ives & Munro, 2002).
Attachment plays a huge part in how the parent child relationship develops. Another factor that impacts on this relationship is the developmental delays that can be seen in children with autism disorder. The issues surrounding the developmental delays and difficulty an autistic child has with expressing attachment behaviours can impact on their relationship with their parent (O'Brien & Daggett, 2006). The effect of these factors on the child-parent relationship will now be discussed.
The affects of Autism Spectrum Disorder on the parent-child relationship:
"You didn't lose a child to autism. You lost a child because the child you waited for never came into existence. That isn't the fault of the autistic child who does exist, and it shouldn't be our burden. We need and deserve families who can see us and value us for ourselves, not families whose vision of us is obscured by the ghosts of children who never lived. Grieve if you must, for your own lost dreams. But don't mourn for us. We are alive. We are real. And we're here waiting for you"
(Jim Sinclair, 1993).
A child with autism can have problems with relating to their parents due to issues with communication and socialisation (Fahlberg, 2008). The perception of normal parental behaviours may be more threatening to a child with autism than a child of normal development, due to the disorientation caused by changing environments and their difficulty with read emotional expressions on their parents' faces (van Ijzendoorn et al., 2007). When the symptoms of autism become apparent to the parent, it can cause them to question their capability as parents (McConachie & Diggle, 2005).
Rogers, Ozonoff & Maslin-Cole (cited in van Ijzendoorn et al., 2007) state that children with autism show clear preference towards their mother over a stranger. It is also noted that they increase proximity seeking when they reunite with their mother. Dissanayake & Crossley (cited in Dissanayake & Crossley, 1997) stated that children with autism portrayed attachment behaviours similar to normal and Down's syndrome children, increasing their proximity levels to their mother when a stranger was near to them and therefore decreased their exploratory behaviour.
Rutgers study (as cited in van Ijzendoorn et al., 2007) showed that autism does not jeopardise the development of secure or insecure attachments. However, it can impact on the relationship between parenting styles and attachment development.
It is clear that a normative attachment can occur between a child with autism disorder and their parents. The issue that presents itself is the effect of attachment behaviours and developmental delays on the parent-child relationship. This is where the role of the social care worker is essential. Fraiberg (cited in Fahlberg, 2003) states that when a child is unattached they cannot easily make attachments with others, even if the most favourable conditions for bonding are provided. For this reason it is important that social care workers help parents maximise their responses to the attachment behaviour shown by their child. By facilitating a parent throughout the arousal-relaxation cycle the social care worker can help the parent strengthen the bond between themselves and their child. The promotion of the positive interaction cycle is also important. The social care worker can facilitate interactions between the parent and child. These interactions can result in positive behaviour from the parent leading to positive responses from the child, hence strengthening their attachments.
Most of the studies completed in the area of autism, attachment and bonding focus on the types of attachment in children with autism. They do not to look at the impact the disorder has on the parent-child relationship and how the parent-child relationship is affected. For this reason this study will focus on the parent- child attachment and bonding process in children with autism and aim to put specific emphasis on how the disorder affects this relationship. In this way, the information gathered can help professionals working with autism to facilitate the attachments between parents and their autistic child. The next chapter will cover the methods used for collecting data necessary to evaluate the effects of autism on the parent-child relationship.