ORIGINAL PAPER

Keeping a Sound Marriage: How Couples with Childrenwith Autism Spectrum Disorders Maintain Their Marriages

Julie L. Ramisch Esther Onaga Su Min Oh

Published online: 1 May 2013

Springer Science+Business Media New York 2013

Abstract This study focused on strengths and variables

that contribute to marital successes for couples with children

with autism spectrum disorders (in this article, referred to as

autism). Particularly, the purpose of this study was to

examine what husbands and wives with children with autism

in contrast to couples with children who are typically

developing identify as helpful to maintaining their mar-

riages. Concept mapping methodology was used for this

research study. Couples with children with autism and cou-

ples with children who are typically developing participated

in telephone interviews and then grouped and rated the

statements generated from their interviews. Groupings were

translated into pictorial maps showing relationships and

patterns. Couples with children with autism shared common

perceptions about factors that help to keep their marriages

strong: communication and shared foundational ideas about

marriage. Communication was a cluster for all groups of

husbands and wives. Only mothers of children with autism

identified time for self-care as a distinct cluster.

Keywords Autism Communication Concept mapping Couples Marriage

Introduction

The prevalence of children diagnosed with autism spec-

trum disorders (in this article, referred to as autism) is

increasing (Centers for Disease Control and Prevention

[CDC] 2012) and parents are reporting that there are many

stressors associated with raising children with autism.

Parental stress can be predicted from a variety of aspects of

raising a child with autism: stress can develop from

struggling to get a correct diagnosis for a child (OBrien

2007; Siklos and Kerns 2007), behaviors of the child that

are difficult (Brobst et al. 2009; Davis and Carter 2008;

Higgins et al. 2005), and from social isolation (Hock et al.

2012; Myers et al. 2009). Many researchers have found that

parents of children with autism are at increased risk for

physical and emotional stress and possible mental health

difficulties (Benson 2006; Gau et al. 2012; Gray 2002;

Hamlyn-Wright et al. 2007; Lecavalier et al. 2006; Little

2002; Sivberg 2002; Woodgate et al. 2008).

If a parent of a child with autism is married, individual

methods of dealing with associated stressors of raising a

child with autism seem to be associated with the quality of

the marital relationship. Kersh et al. (2006) reported that

lower parenting stress and fewer depressive symptoms

were associated with greater marital quality for mothers

and fathers with children with developmental disabilities.

Again, in a study a few years later, Benson and Kersh

(2011) found that marital quality had a negative relation-

ship with maternal depressed mood and a positive rela-

tionship with maternal well-being for mothers with

children with autism. Even though marital quality appears

to have had positive associations with well-being, many

parents of children with autism have reported that they are

stressed (Benson 2006; Gray 2002; Hamlyn-Wright et al.

2007; Lecavalier et al. 2006; Little 2002; Sivberg 2002;

J. L. Ramisch (&)School of Family, Consumer, and Nutrition Sciences,

Northern Illinois University, DeKalb, IL 60115, USA

e-mail: jramisch@niu.edu

E. Onaga

Michigan State University, East Lansing, MI, USA

S. M. Oh

Michigan Department of Community Health, Lansing, MI, USA

123

J Child Fam Stud (2014) 23:975988

DOI 10.1007/s10826-013-9753-y

Woodgate et al. 2008) and that their marriages are strained

(Fletcher et al. 2012; Myers et al. 2009; Phelps et al. 2009).

More specifically, spouses have reported feeling discon-

nected from each other (Woodgate et al. 2008) and expe-

riencing overall decreased marital satisfaction (Brobst et al.

2009; Higgins et al. 2005; Lee 2009).

It is important that researchers investigate ways to help

couples decrease stress levels and increase marital satis-

faction because, in general, spouses who are under signif-

icant stress tend to report lower satisfaction in their

marriages (Neff and Karney 2009). When these stressors

are repeated or prolonged, stress may be a detriment to the

relationship (Neff and Karney 2009). The results of

research on the prevalence of divorce among couples with

a child with autism have not been consistent. While the

mass media has reported divorce rates as high as 80 %,

there is no empirical research to support this. Freedman

et al. (2012) found no evidence to support that children

with autism were at a higher risk of living in a house

without both biological or both adoptive parents than

children without autism. Conversely, Hartley et al. (2010)

reported that the prevalence of divorce is higher for couples

with children with autism as compared with that of couples

with children who were typically developing. About one in

four (24 %) couples with children with autism divorced

during the 6-year study period versus one in seven (14 %)

couples with children who were typically developing.

Couples with children with autism continued to have a high

risk of divorce through their childrens childhood, adoles-

cence, and early adulthood, whereas parents of children

who were typically developing had low divorce rates once

their children left childhood (Hartley et al. 2010).

While the stress of raising a child with autism can lead to

divorce, it certainly does not have to. Rather than focusing on

failures, focusing on parents strengths and variables that

predict marital success in couples who have children with

autism can be helpful (Eddy and Walker 1999). In some

cases, having a child with autism actually can bring the

couple closer together and enrich their marriage (Myers et al.

2009). Additionally, Hock et al. (2012) discussed how the

stress of parenting a child with an autism forced significant

changes within couple relationships that later brought about a

new level of closeness. The authors reported that for married

couples, having children with autism was a crucible to their

relationships. In other words, parenting children with autism

tested relationships and forced changes to be made. If couples

remained together, they developed new and more effective

ways of interacting (Hock et al. 2012).

Differences in managing stress within the couple rela-

tionship can place strain on a couple raising a child with

autism. Despite not having a consistently verified divorce

rate, concentration on the fact that Hartley et al. (2010)

found that 76 % of parents of children with autism remained

married may provide evidence of positive marital outcomes

for couples with children with autism. An investigation into

the strategies used by couples who remain married while

raising children with autism is important. Specific to autism,

there are few researchers who have examined strategies

couples use to strengthen their marriages. Brobst et al.

(2009) found that even though couples with children with

autism had lower relationship satisfaction than comparison

couples, they did not differ from the comparison couples in

terms of perceived spousal support, respect for partners, or

commitment to relationships.

The current study further examines the strategies of

married couples with children with autism to help maintain

their marriages. The research questions for the study were:

(1) What do husbands with children with autism identify as

helpful to stay married? (2) What do wives with children

with autism identify as helpful to stay married? (3) Do wives

and husbands with children with autism have different ideas

of what helps to stay married? (4) How do wives and hus-

bands with children with autism compare to wives and

husbands with children who are typically developing?

Method

Participants

Couples were recruited during two waves, using two list-

servs affiliated with a university in the Midwestern United

States. These listservs are available to staff, faculty, and

students affiliated with the university. In the first wave,

couples with children with autism were recruited using a

listserv for parents of children with special needs. The

initial email included an invitation for married parents with

children with autism between 4 and 12 years old to vol-

unteer via email or phone. To participate, the couple had to

be married for at least 1 year, living together, and parenting

a child with autism. In the second wave, couples with

children who are typically developing were recruited using

a general listserv for parents. The initial email asked

married couples with at least one child between 4 and

12 years old to volunteer via email or phone. These couples

also had to be married for at least 1 year and living toge-

ther, but not parenting any children with disabilities.

At the time that the email was sent out for this research

study, there were about 160 individuals on the listserv for

parents of children with special needs. It was not known how

many individuals had children with autism as compared to

children with other special needs. Eleven married couples

with children with autism participated in the first wave.

There were originally 12 couples who volunteered to par-

ticipate; however, one couple did not complete the struc-

turing stage. The statements of the twelfth couple remained

976 J Child Fam Stud (2014) 23:975988

123

in the list of statements so the structuring stage would not

have to be repeated with all participants, but all demo-

graphic and assessment information was removed.

For the sample in this study, the mean age for men was

41.27 years (SD = 5.33) and 37.91 years (SD = 5.09) for

women; the average length of marriage was 12.20 years

(SD = 3.93) and the average number of children per cou-

ple was two. There were nine male children and two female

children with autism; the mean age of the child was

7.49 years (SD = 2.42). About 36 % of the couples

reported annual household incomes between $40,000 and

$69,999, 27 % between $70,000 and $99,999, and 36 %

reported they earned $100,000 or more per year. About

73 % of the husbands and 55 % of the wives had achieved

at least a four-year college degree.

The listserv used to recruit couples with children who are

typically developing was a listserv designated for parents, in

general, who were staff, faculty, and students affiliated with

the university. At the time that the email was sent out for this

research study, there were about 800 individuals on that

listserv. Ten married couples with children who are typically

developing participated in the second wave. There were

originally 15 couples who volunteered to participate; how-

ever, five couples did not complete the structuring stage. The

statements of these couples remained as part of this study, but

all demographic and assessment information was removed.

The mean age for men was 38.40 years (SD = 4.17) and

37.30 years (SD = 4.35) for women. The average length of

marriage was 10.60 years (SD = 4.43) and the average

number of children per couple was two. About 20 % of the

couples reported annual household incomes between $30,000

and $69,999, 30 % between $70,000 and $99,999, and 50 %

reported they earned $100,000 or more per year. About 70 %

of the husbands and 80 % of the wives had achieved at least

a 4-year college degree.

Measures

Childhood Autism Rating Scale

The Childhood Autism Rating Scale (CARS; Schopler et al.

1980) was used to obtain an assessment of the mothers

perception of the childs level of involvement on the autism

spectrum. The CARS assesses 15 different dimensions of a

childs behavior and gives a total score ranging from 10 to

60. Each dimension is scored on a scale of (1) age-appro-

priate behavior to (4) deviance from age-appropriate

behaviors. According to the CARS manual (Schopler et al.

1980), scores between 10 and 30 suggest that the child is

Non-Autistic, scores between 30 and 36 indicate

Mildly-Moderately Autistic, and scores between 37 and

60 indicate Severely Autistic. For the purposes of this

study, the researcher conducting the phone interview

completed the CARS assessment over the phone with each

mother with a child with autism. Mothers rather than fathers

participated in the phone interview regarding the CARS due

to greater scheduling flexibility for longer interviews.

Kansas Marital Satisfaction Scale

The Kansas Marital Satisfaction Scale (KMSS; Schumm

et al. 1985) is a three-item scale used to measure overall

relationship satisfaction. Participants rate each items on a

seven-point Likert scale that ranges from (1) extremely

dissatisfied to (7) extremely satisfied. Higher scores on the

KMSS indicate greater levels of relationship satisfaction.

Procedure

Concept mapping (Trochim 1989) has been used in a

number of studies (e.g., Brown 2007; Herman et al. 2005;

Johnson et al. 2000). It is a structured process beginning

with participants responding to a question. The ideas or

statements generated are then translated into a pictorial

map showing relationships and patterns. This method was

appropriate to generate ideas from husbands and wives

about factors they felt helped to keep their marriages intact.

See Jackson and Trochim (2002) for a detailed description

about how concept mapping methodology has strengths in

terms of reliability and validity.

Trochim (1989) defined six steps to the cluster mapping

process: preparation, generation of statements, structuring

of statements, representation of statements, interpretation

of maps, and utilization of maps. The first five steps were

utilized in this study.

Preparation

The preparation step involves the development of the focal

question and the selection of participants (Trochim 1989).

The researchers determined that the main focal question

should be: In your opinion, what has helped you to

maintain a strong marital relationship with your spouse?

It was also during this stage that the researchers determined

that couples with children with autism and couples with

children who are typically developing should participate.

The researchers developed the question and selected the

two groups of participants in order to help identify ideas,

beliefs, or actions regarding how couples with children

with autism maintained their marriages.

Generation of Statements

To generate a list of statements to start the conceptual

mapping process (Trochim 1989), separate telephone

interviews for each member of each couple were

J Child Fam Stud (2014) 23:975988 977

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conducted. After the participant agreed to the informed

consent, the researcher posed the focal question. Partici-

pants were allowed to have as much time as they needed to

provide an unlimited number of statements. The interviews

were audio recorded, and each statement was added to one

of four lists (men or women by children with autism or

children who are typically developing). Statements that

were identical were not entered multiple times to a par-

ticular list of unique statements (see Appendix).

Structuring of Statements

According to Trochim (1989), the structuring stage consists

of sorting the different statements to help identify state-

ments that were related. In order to increase the reliability

of this data analysis, the original participants were asked to

sort the statements into groups. Following the telephone

interviews, the list of statements for each group was sent

back only to participants in that group. That is, husbands

were given a list of statements compiled from the husbands

in their respective wave, and wives were given a list of

statements compiled from the wives in their respective

wave. Each individual was asked to group statements

together into similar concepts. Participants were given

three rules: (1) Each statement can only be used once; (2)

Do not put all statements into one group; and (3) Do not

create a miscellaneous pile. They were given a work-

sheet to list groups of statements and they were also asked

to assign a title to describe each group. Finally, participants

were asked to rate each statement on a scale of (1) not at all

to (5) very much in terms of how much the statement

related to how he or she maintained a strong marriage with

his or her spouse. Each participant who grouped and rated

the statements received a $10 gift certificate.

Representation of Statements

Based on Trochims (1989) method, four concept maps

were created: husbands with children with autism, wives

with children with autism, husbands with children who are

typically developing, and wives with children who are

typically developing, using multidimensional scaling

analysis following the structuring stage. The results (i.e.

groups of statements) from the Structuring of Statements

stage were put into a binary square, symmetric matrix

(SN9N, where N equals the total number of statements) for

each participant. The value for a pair of statements (Sij)

was assigned either 0 or 1 in the matrix, based on whether

the statements were grouped together (i.e., Sij = 1 if a

participant placed statement i and statement j together,

otherwise Sij = 0). The number of individual matrices was

different for each of the four groups of individuals

depending on how many people participated in this step.

Individual matrices were aggregated into a group matrix

for each group of individuals. The group matrices indicated

how the participants in each group of individuals sorted the

statements. Higher values of Sij in the group matrix indi-

cate people put together statements i and j in the same

group, which implies that the statements were conceptually

in the same domain. The group matrix then was used as

data for ALSCAL (SPSS), which was used to analyze each

matrix into two dimensions and provide a plot of each

statement. The distances between two points on a map

indicate how they were similar or dissimilar in the group

matrix generated in the previous step. In other words,

points further apart were grouped together less frequently

than points closer together.

Hierarchical cluster analysis using Wards algorithm

was completed to help generate clusters based on results

from the two-dimensional scaling map. Wards method is

regarded as efficient, because it keeps the sum of squares as

small as possible each time any two clusters are merged

(Everitt et al. 2011). Wards algorithm produces a list of

the statements with values that indicate how statements are

related to each other, or how often they were grouped

together by participants. The algorithm also produces a

dendrogram (a cluster tree) to help researchers determine

the final clusters. The information from Wards method

was used to guide the research team in defining the final

clusters that are visually distinct on the map and concep-

tually make sense for the statements. In the current study,

the researchers reviewed the maps and drew lines delin-

eating clusters that conceptually made sense. When cases

were located close together, the researchers made a deci-

sion about which cluster was the best fit.

Interpretation of Maps

Trochim (1989) suggested that the participants or a focus

group could be involved in the interpretation of the maps

and the labeling of the clusters. Because participants in this

study did not live in close proximity to one another, the

research team (a faculty member and a graduate student)

determined the group labels based upon conceptual themes

as well as the labels participants gave for their own groups.

The team met and discussed the labels until consensus was

reached for each cluster.

Results

Childhood Autism Rating Scale

All mothers with children with autism indicated that their

children had been diagnosed with autism prior to their

participation in this study. The purpose for using the CARS

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assessment was to give the researchers the mothers own

assessment of the severity of autism for her child. The

CARS scores ranged from 23.50 to 50.00. The mean CARS

score, on a scale from 10 to 60, was 34.14 (SD = 7.25).

Three of the children diagnosed with autism had scores that

indicated that they were Severely Autistic, four children

had scores that indicated that they were Mildly-Moder-

ately Autistic, and four children had scores that indicated

that they were Non-Autistic. Again, this assessment was

used to gather information about mothers perceptions of

the level of autism of their children, and was not intended

to challenge diagnoses given by other professionals.

Kansas Marital Satisfaction Scale

According to Crane et al. (2000), a score on the KMSS of

17 or above indicates that the individual sees their rela-

tionship as nondistressed. A score of 16 or below indicates

some degree of marital distress. Of the 20 parents with

children who are typically developing, only one mother

reported a score below 17. Of the 22 parents of children

with autism, six parents reported scores below 17. To test

for differences between the two groups, the non-parametric

MannWhitney U test was chosen because the assumptions

for an analysis of variance (ANOVA) were not met.

Results yielded no significant differences in KMSS scores

between parents with children who are typically develop-

ing (Mdn = 18) and parents with children with autism

(Mdn = 18), U = 163.50, ns, r = -.19. So, while past

research indicates that parents of children with autism have

lower marital satisfaction compared with parents of chil-

dren who are typically developing (Brobst et al. 2009;

Higgins et al. 2005; Lee 2009), this was not the case in the

current study.

Generation of Statements

Both the husbands and the wives from all couples who

responded to the invitation to participate completed this

stage. The Generation of Statements stage yielded 57

unique statements from wives and 43 unique statements

from husbands with children with autism. There were 69

unique statements from wives and 62 unique statements

from husbands with children who are typically developing.

See the Appendix for a list of all of the statements.

Structuring of Statements

Eleven out of 12 couples with children with autism and 10

out of 15 parents of children who are typically developing

completed the structuring stage. Each participant who

completed this step of the process correctly followed the

instructions for grouping and rating of the statements.

Every couple returned their lists together in the same

packet or email so there were no instances where data was

collected for only one partner of a couple.

Representation of Statements

Husbands with Children with Autism

For parents of children with autism, the husbands concept

map yielded four clusters (See Fig. 1): (1) We communi-

cate, (2) We work out our differences, (3) We care for and

love each other, and (4) We have foundational expectations.

Wives with Children with Autism

The wives concept map yielded five clusters (See Fig. 2): (1)

We communicate, (2) We spend time to be a couple, (3) We do

Fig. 1 Cluster map for husbands with children with autism

Fig. 2 Cluster map for wives with children with autism

J Child Fam Stud (2014) 23:975988 979

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things for ourselves, (4) We have foundational expectations,

and (5) We encourage positive qualities for the marriage.

Husbands with Children Who Are Typically Developing

For parents of children who are typically developing, the

husbands concept map yielded six clusters (See Fig. 3):

(1) We care for and love each other, (2) We have com-

mitment to each other, (3) We share religion and faith, (4)

We have foundational expectations, (5) We communicate,

and (6) We work as a team and share responsibilities.

Wives with Children Who Are Typically Developing

The wives concept map yielded four clusters (See Fig. 4):

(1) We communicate, (2) We encourage positive qualities

for the marriage, (3) We share religion and faith, (4) We

parent in the context of strong family values and support.

Comparisons Within and Between Couples

Comparison of Couples with Children with Autism

Similarities and differences between wives and husbands

with children with autism were examined by comparing

Figs. 1 and 2. Both husbands and wives mentioned com-

munication and having foundational expectations as

important to their marriage. Items in the communication

cluster include talking about anything and having open

communication. The cluster labeled We have founda-

tional expectations is less straightforward. Grouped in this

cluster are statements about expectations held before the

couple was married or before having children. For exam-

ple, husbands mentioned statements such as We knew

what we wanted from a partner, and We were prepared

for cost of children. Wives mentioned statements such as

We knew marriages were not easy when we got married,

and We both have a strong belief in commitment of

marriage and raising our family together.

Husbands and wives with children with autism did have

unique clusters with respect to their genders. For example,

two clusters are unique to husbands: We work out our

differences and We care for and love each other.

Working out differences includes statements about working

through problems or talking about differences. The cluster

about care and love includes statements about how hus-

bands love and trust their wives. Wives in this group did

not mention any significant statements about working out

problems, love, or trust. Wives have three unique clusters:

We spend time to be a couple, We do things for our-

selves, and We encourage positive qualities for the

marriage. The wives cluster about spending time to be a

couple includes statements regarding going out just as a

couple without the children, as well as sharing common

interests. On the other hand, in the cluster We do things

for ourselves, wives discussed the importance of going

out and spending time alone. In this cluster there are two

statements that do not seem to conceptually fit within that

group (V35 and V29). It is important to acknowledge that

the method of concept mapping is exploratory in nature and

does not always lead to distinct concepts. Sometimes there

is overlap between the clusters as seen here. Even though

this cluster contains statements that do not seem to con-

ceptually fit, the titled was selected to identify the three

statements that did fit together. Finally, wives discussed

positive qualities for the marriage such as Friendship,

Passion, and Having his support with everything.

Husbands did not talk about going out alone or with their

wives.

Fig. 3 Cluster map for husbands with children who are typicallydeveloping

Fig. 4 Cluster map for wives with children who are typicallydeveloping

980 J Child Fam Stud (2014) 23:975988

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Comparison Between the Groups of Wives

Wives with and without children with autism mentioned

communication as important. They also both mentioned

encouraging positive qualities in the marriage. Wives with

children who are typically developing had about twice as

many statements in this cluster as did wives with children

with autism; however, the statements seemed to be quali-

tatively similar. Additionally, wives with children who are

typically developing included statements about spending

time with their husbands as a couple without children in

their We encourage positive qualities for the marriage

cluster, whereas for wives with children with autism had a

separate cluster titled We spend time to be a couple.

The two clusters, We have foundational expectations

(wives with children with autism) and We parent in the

context of strong family values and support (wives with

children who are typically developing), are similar in that

statements about family values are present in both clusters.

What makes the two clusters different is that wives with

children who are typically developing included many more

statements about the present supports, such as family, in

addition to foundational ideas about the relationship. For

example, in this cluster are statements such as Other

couples are a support system and Extended family plays

a large role in our relationship.

Uniquely, wives with children who are typically devel-

oping had a separate cluster about religion and faith. Wives

with children with autism also mentioned statements about

God and faith, but these statements were grouped within

other clusters and not separated into a distinct cluster.

Finally, wives with children with autism had a unique

cluster about doing things for themselves. Wives with

children who are typically developing did not mention any

statements about spending time alone.

Comparison Between the Groups of Husbands

Like other between-group comparisons, a common cluster

between the two groups of husbands is about communi-

cation. Other common clusters include: We have foun-

dational expectations and We care for and love each

other. Distinctly different, husbands with children with

autism included statements that were clustered into We

work out our differences. Husbands with children who are

typically developing did not mention any statements about

working through problems with their wives. Additionally,

husbands with children who are typically developing have

clusters such as We have a commitment to each other,

We share religion and faith, and We work as a team to

share responsibilities. As in the comparison between the

two groups of wives, husbands with children with autism

do mention commitment, God, and faith, but these

statements are fewer in number, and they are included

within other clusters. Husbands with children with autism

do not mention any statements in terms of sharing

responsibilities.

Correlations of Assessments

The CARS assessment did not correlate significantly with

the KMSS scores nor did the CARS significantly correlate

with the clusters for either the husbands or wives with

children with autism. The KMSS scores did significantly

correlate with the mean ratings of statements for wives and

husbands with children with autism, but not for wives and

husbands with children who are typically developing (See

Table 1). We communicate was a husbands cluster that

significantly correlated with the KMSS score. We com-

municate, We encourage positive qualities for the mar-

riage, and We spend time to be a couple were clusters

that significantly correlated with KMSS scores for the

wives with children with autism.

Discussion

A core research question for this study sought to discover

how husbands with children with autism compare to their

wives regarding how they keep their marriages strong. In

the current study, common perceptions about the factors

that help to maintain marriages emerged: communication

and foundational expectations. Communication was a sig-

nificant factor for intact marriages for these husbands and

wives, as mean ratings for these statements within these

clusters (the cluster for husbands and the cluster for wives

pertaining to communication) positively correlated with

scores on the KMSS. Higher participant ratings of the

statements (i.e., how much that statement related to how he

or she maintained a strong marriage with his or her spouse)

were associated with higher scores on the KMSS. Com-

munication for these couples means that they can openly

discuss topics related to their children as well as other

feelings and concerns. Spouses indicated that they are able

to work things out and make decisions together as a couple.

It also appears that shared ideas about marriage, established

prior to having a child with autism, helped couples to

develop strong foundations for their relationships. Partici-

pants mentioned the commitment that they made to their

spouses when they got married and that they were prepared

to take on the responsibility of children when that time

came. How the statements found within the clusters are

used in the relationship is unknown, but husbands and

wives could use these tenets to balance negative thoughts

or perceptions in the relationship in times of stress.

J Child Fam Stud (2014) 23:975988 981

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Within the group of husbands with children with autism,

being able to work out differences and having love for their

wives also appear to be important factors for keeping the

marriage intact. The statements in the We work out our

differences cluster echo statements about communication,

but the husbands seemed to have conceptualized these

statements differently from those in the communication

cluster (as indicated by a separate cluster). With their

statements, husbands imply that resolving problems and

being able to tolerate disagreement through the resolution

process are what helps them in their marriages. The

absence of parallel statements from wives is noteworthy.

The wives did not mention in their communication cluster,

or elsewhere, statements that pertain to working out

problems or resolving differences.

The husbands with children with autism also had a

distinct cluster about having love for their wives. Husbands

indicated that love, trust, and a willingness to meet the

needs of their wives are important to them. They desire to

support their wives and be there for them emotionally. How

well these husbands are able to communicate these desires

and positive affirmations in their marital relationships,

however, is unknown. The wives mentioned two parallel

statements: We lean on each other and Having his

support with everything, which are grouped within the

cluster We encourage positive qualities for the marriage,

but one or two statements does not nearly compare to an

entire cluster of positive emotional affirmations.

The wives with children with autism had three unique

clusters, We spend time to be a couple, We do things for

ourselves, and We encourage positive qualities for the

marriage, which include many action-focused statements.

These statements imply that wives enjoy spending time

alone with their husbands as well as time alone with their

girlfriends or just out alone. Within the cluster about

spending time to be a couple are statements about friendship

with their husbands, having a solid relationship prior to

children, and taking time to spend with each other without

the children. We do things for ourselves is a much smaller

cluster, and statements do not fit together conceptually as

well as the statements in the cluster about doing things as a

couple. Therefore, for these wives, it appears that spending

time with their husbands and recognizing the importance of

that dyad is a critical factor, more so than spending time

alone. Although spending time alone or with friends is

important, these activities may not be as impactful to the

maintenance of their marriages. Finally, statements within

We encourage positive qualities for the marriage, which

seem not to fit together conceptually, are associated with

higher scores on the KMSS. Higher participant ratings of the

Table 1 Correlations ofstatement ratings with KMSS

scores

* Significant at the 0.05 level

(2-tailed)

** Significant at the 0.01 level

(2-tailed)

Cluster name Participant ratings Correlation of

ratings w/KMSSMean SD

Husbands with children who were typically developing

We care for and love each other 4.41 .25 .36

We have commitment to each other 3.98 .38 .11

We share religion and faith 4.25 .33 .09

We have foundational expectations 4.12 .32 .19

We communicate 4.00 1.10 -.30

We work as a team and share responsibilities 4.44 .33 .19

Wives with children who were typically developing

We parent in the context of strong family values and support 4.13 .30 -.50

We share religion and faith 3.50 1.43 .20

We communicate 3.65 .50 .26

We encourage positive qualities for the marriage 3.74 .58 -.09

Husbands with children with autism

We have foundational expectations 3.75 .81 .01

We communicate 3.83 .68 .83**

We work out our differences 3.98 .72 .59

We care for and love each other 3.94 .59 .54

Wives with children with autism

We have foundational expectations 4.01 .90 .37

We communicate 3.95 .83 .83**

We encourage positive qualities for the marriage 3.88 .96 .95**

We spend time to be a couple 3.54 .51 .73*

We do things for ourselves 3.74 .70 .42

982 J Child Fam Stud (2014) 23:975988

123

statements in terms of how much that statement related to

maintenance of a strong marriage with a spouse were asso-

ciated with higher scores on the KMSS. Interestingly, hus-

bands do not mention going out with their wives or spending

time away from their families in any of their clusters. Per-

haps this indicates that husbands do not see such activities as

essential to maintaining their marriages. The fact that wives

view these acts as important, however, may be indicative of

ways to help individuals with children with autism battle

social isolation (Hock et al. 2012; Myers et al. 2009).

Overall, it appears as though the statements given by the

wives were much more action-focused and were centered

on things that were done by each person to preserve the

marriage. Statements by the husbands seem more focused on

positive feelings that they have directed towards their wives.

This finding provides insight into some differences between

husbands and wives raising children with autism in terms of

their preferences for their marriages.

When comparing the wives with children with autism to

wives with children who are typically developing, the

clusters about communication and encouraging positive

qualities in the relationship were similar. It is noteworthy

that while wives with children with autism made statements

about spending time to be a couple and time alone, wives

with children who are typically developing did not mention

any statements about spending time alone. Spending time

alone, or making sure to reserve time to spend with friends,

may be a strategy that wives with children with autism have

developed that is particularly salient in their marital rela-

tionships. While wives with children who are typically

developing may do this as well, they do not code it as salient

to keeping their marriage together.

Another difference between the two groups of wives was

that wives with children who are typically developing

mentioned more statements about social and family support.

They also had a separate cluster about religion and faith.

Wives with children with autism had statements about reli-

gion and faith, but they were spread throughout other clus-

ters. This difference between the two groups needs to be

considered when identifying factors to stay married. Per-

haps, wives with children with autism did not mention family

or social support because they do not find extended family or

their social network to be contributing positively to their

marital relationship. This result would be in alignment with

research indicating that parents feel isolated from family

members who do not understand autism (Woodgate et al.

2008). In terms of family and friends, parents interviewed by

Myers et al. (2009) reported that a loss of family and friends

was related to negative responses to the childs autism.

Husbands with children with autism and husbands with

children who are typically developing were very similar in

their statements. They both mentioned communication,

common foundations, and care and love as important to

keeping a marriage intact. Again, there are more statements

about feelings directed toward their wives from husbands

with children with autism. Also, compared to husbands

with children who are typically developing, husbands with

children with autism had more statements about sharing

responsibilities in the relationship.

Limitations

Participants in both waves reported high incomes and

educational status; the results might have been different if

the participants were more diverse with respect to financial

and educational resources. Another limitation was that the

sample size for this study was small. Future studies should

aim to have a larger, more diverse sample.

Jackson and Trochim (2002) discussed that having

respondents help determine the final clusters would help to

increase the validity of a study. Ideally, the participants

themselves would provide member checking and cluster

labeling in a face-to-face meeting. Unfortunately, for this

particular project, participants were spread out geographi-

cally and such a meeting was not possible. Instead, the

researchers constructed the labels of the clusters while

allowing influence from the names that the participants

suggested for their groupings.

Future Research

It would be interesting to explore how some of the statements

and ideas are used within the marital relationship to maintain

the relationships of couples with children with autism. In

other words, through this study communication emerged as a

key aspect of maintaining a marriage for both husbands and

wives with children with autism, and it might be helpful for

future research studies to explore the idea of effective

communication for couples with children with autism.

Future research studies might also investigate how state-

ments within the cluster about foundational expectations are

used within the relationship. For example, do such thoughts

and ideas help to balance stress or negative thoughts?

Additionally, husbands had a cluster about the love that they

have for their wives including statements about love and

trust. A logical next step might be to explore how the hus-

bands communicate these concepts to their wives and why

wives did not include any of these types of statements in any

of their clusters. For wives with children with autism,

spending time with their husbands was mentioned; however,

husbands did not mention spending time alone with their

wives. It might be helpful to further explore whether hus-

bands perceive spending time alone with their wives relates

to maintaining their marriage.

J Child Fam Stud (2014) 23:975988 983

123

Practice Implications

It is clear that the couples in this study valued commu-

nication between partners. It is important for profes-

sionals working with such couples to be prepared to offer

training in communication and to aid couples in devel-

oping adequate communication skills. The provider also

can help couples explore foundational expectations for

their relationships. If such foundational expectations are

found to be similar within dyads, they can be used to

build a united front in times of stress. Finally, providers

can work with couples and extended family members to

develop networks of support. The informal social support

of extended family members, family friends, and neigh-

bors has been demonstrated by researchers to be very

helpful for families with children with autism (Altiere

and von Kluge 2009). Researchers have demonstrated

that informal social support can help lessen depression of

parents (Benson 2006).

Appendix: Clusters and Statements

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

Husbands with children with autism

We communicate (9)

V18 We communicate about anything

V20 We have open communication for the

good, bad, or otherwise

V26 Communication

V3 Were not territorial and we work

together

V30 Talking to her

V7 Work things out as they come up

V43 Communicating about changes of

what is a priority in life

V1 We work together to care for our child

V27 Staying on the same page

We work out our differences (5)

V16 We try to look forward

V35 Our verbal combats result in talking

about our differences

V15 We work through the problems

V23 We work it out when we dont agree

V2 We have mutual support instead of

his/her jobs

We care for and love each other (18)

V12 There is lots of caring between

partners

V34 Both of us are sympathetic with each

other

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

V32 Being there for each other

V38 Willingness to meet the others need

V5 Willingness to commit to the marriage

and make time to spend together

V21 We know that we will annoy each

other

V13 I have a strong and loving wife

V17 My wife is my best friend

V19 I love my wife

V31 Love

V14 My wife puts up with me

V42 Avoid situations with other people

that can promote infidelity

V36 Having trust in each other

V22 We recognize that we are different but

that is not bad

V41 Putting others need first; I do it for her

and she does for me

V29 I try to support her

V37 Having a commitment to each other

V6 We love each other

We have foundational expectations (11)

V4 We share a faith in God

V11 We were prepared for cost of children

V40 Desire to not to live the same life like

our parents

V24 We had a good foundation

V28 Faith

V39 Involvement in church, which is a

common interest of ours

V9 We had a strong foundation

V33 Knowing what the negative

experiences of people who have

divorced are like

V8 We were older when we got married

V10 We knew what we wanted from a

partner

V25 We took a year to just be a couple

before having kids

Wives with children with autism

We communicate (17)

V9 Talk everything over

V32 We talk a lot

V18 Communication

V47 Open communication with each

other

V23 Open communication

V37 We communicate a lot about our

childs needs and how we can meet

those needs

984 J Child Fam Stud (2014) 23:975988

123

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

V24 We talk about our concerns

V38 We communicate about our own

feelings

V25 We talk about all decisions affecting

our child

V40 Compassion

V41 Compromise

V20 We have to talk to one another before

making any decisions or believing

any doctor

V48 We talk things out

V39 Honesty

V56 Listening to him about what is

important to him

V3 We have similar beliefs in how handle

autism and our child

V51 We agree about parenting

We spend time to be a couple (14)

V7 We were friends for many years

V50 We try to spend time with each other

V34 We make time to be just a couple

V55 Taking time to spend with each other

V49 Giving each other breaks

V6 We dont have any time now to spend

together alone so it was important to

have a good foundation to start

V26 Have someone to watch the kids

overnight

V5 We had a really solid relationship to

begin with

V27 We find time for us without kids

V14 We share common interests

V28 Be friends with each other

V8 We share everything and do

everything together

V15 We enjoy traveling and exploring

together

V52 My husband takes my child out to do

things

We do things for ourselves (5)

V36 Mom goes out with girlfriends every

week

V33 We make time for ourselves

V43 We have things that we do together

but also we have things we do

separately

V35 Being a couple is very important

V29 We started out on a good foundation

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

We have foundational expectations (14)

V17 We stand strong together so not to be

divided and conquered by children

V31 We knew we had to work everything

out

V13 We have to work it out the best we can

V53 Faith

V10 Our family values come before

difficulties that come up

V30 Divorce was taken off the table when

we got married

V11 We knew marriages were not easy

when we got married

V4 We both believe in God

V54 Priority of marriage first

V57 Looking into the family unit and not

only the autism

V9 We both have a strong belief in

commitment of marriage and raising

our family together

V12 We made a commitment

V2 We want to make marriage work and

we have faith that it can work

V1 We have a commitment to the

marriage and to each other

We encourage positive qualities for the marriage (7)

V42 Friendship

V44 Passion

V21 A sense of humor

V22 Staying on the same page

V46 We lean on each other

V16 There is teamwork in terms of sharing

responsibilities

V45 Having his support with everything

Husbands with children who are typically developing

We care for and love each other (13)

S32 Honesty

S40 Approach everyday with respect and

common sense towards your partner

S23 We try to meet each others needs

S34 Understanding

S22 I try to think of what my wife needs

and give that to her

S24 We attended a marriage conference

that helped us

S25 I accept who she is-the good and the

bad

S2 No secrets

J Child Fam Stud (2014) 23:975988 985

123

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

S3 We have a personal investment in

each other

S38 We love each other

S48 We like each other

S50 We are pretty good friends.

S8 We love each other

We have commitment to each other (6)

S35 We make time to spend with each

other

S37 Trust

S15 We have a commitment to each other

S21 I express my commitment level on a

daily basis

S9 Our love means commitment

S53 We have a lot of similarities in what

we like

We share religion and faith (3)

S19 Faith

S20 Christianity influences my life and my

commitment to my wife

S10 Our marriage involves God

We have foundational expectations (9)

S13 We have common interests and values

S56 We have common values

S55 We have a common sense of family

S58 We share similar values in teams of

family and kids

S59 Being children of divorced parents

you dont want your children to go

through that

S60 We want our family to be stable

S49 Shes very easy to get along with

S54 We have a lot of mutual friends

S14 Our kids help to unify us and remind

us that we are a family

We communicate (19)

S11 We have a willingness to compromise

S45 It is important to be able to concede

when necessary

S47 We are able to negotiate

S7 You have to communicate with each

other

S16 We go out without the kids

S5 I am willing and open to talk about

things

S44 Neither of us are afraid to tell each

other no and why

S31 There is nothing we wont talk about

S51 We talk a lot

S17 Communication

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

S27 You cant ignore things

S43 Bouncing ideas off each other

S30 Open communication

S46 Knowing somebody long enough

S36 We are straightforward with each

other

S61 We communicate more than any other

couple we know

S18 We check in about what is going on

S6 You have to know the needs of the

other person

S12 We know and understand each other

and accept each others faults

We work as a team and share responsibilities (12)

S1 My wife and I have a unified approach

to everything

S2 We do best when we work as a team

S29 We share responsibilities

S52 We know we are on the same team

S62 We have an ability to work together

S28 I know that we are a team and have to

work together

S26 Patience

S39 I have a sense of responsibility

S4 Willingness to be a team player and

act for the good of the whole family

S33 We work as a team

S41 Raising our kids together

S57 We both enjoy spending time with the

family during our free times

Wives with children who are typically developing

We communicate (22)

S52 Communication is the key

S53 We talk about whatever we think is

important

S43 Open communication

S27 We talk a lot and everything

S28 Were good at communicating

S30 We try to communicate as much as

possible

S14 We talk about and address problem

when they come up

S18 Communication

S57 You cant read each others minds

S64 Flexibility

S6 We like to take a time out when things

get rough

S29 We pick our battles

S7 Time away from each other helps us to

appreciate each other

986 J Child Fam Stud (2014) 23:975988

123

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

S35 We rarely go to bed angry

S2 We talk about things besides the kids.

S41 We have our own activities that we

like to do

S25 We try to take extra time to make sure

we communicate clearly

S44 We have realistic expectations for our

marriage

S46 We are understanding with each other

S58 We support one another in decision-

making

S66 Letting go of the responsibility from

before the kids

S67 Understanding that we were raised

differently

We encourage positive qualities for the marriage (25)

S13 We have a strong relationship

S55 Having fun with friends

S4 When we took those vows, it was until

death do us part

S38 We are really good friends as well as

husband and wife

S40 We try to make a little time each day

to check in with each other

S68 We were older when we got married

S20 We go out with and without the kids

S26 We dont get to see each other much

S48 We use a babysitter to go out.

S23 I think about my husband and try to

look out for his interests

S36 We didnt have kids right away

S1 Making sure we prioritize time with

each other

S10 We were good friends for year before

dating each other

S37 We both have a sense of humor

S49 We share a sense of humor

S50 We are always joking with each other

S65 We laugh a lot

S33 We dated for a long time before we

got married

S54 Spending time together

S51 We try to not take things too seriously

S11 We share a lot of common interests

S19 Our marriage is a priority

S24 I try to make my husband feel loved

Appendix continued

Cluster title

(number

of statements)

Statement

# in

cluster

Statement

S34 Whenever we get a few minutes with

each other, it is always beneficial

S56 Being together

We share religion and faith (4)

S5 I talk to God

S9 We have a central spiritual center

S22 We have a commitment before Jesus

Christ

S42 Our Christian faith

We parent in the context of strong family values and support (18)

S8 Other couples are a support system

S16 We are on the same page with our kids

S17 We present a united front with our

kids

S31 We want to see our children do better

than we did

S61 We have the same ideas about raising

our kids

S62 Our cultural traditions bound us

together

S3 We ask for help from each other and

friends and family when we need it

S15 We back each other up in terms of

parenting

S32 We try to present a united front

S69 We work together as a team

S39 We love our kids

S47 Hes a great dad with the kids

S45 We had good examples of strong

marriages

S60 We have a strong marriage because

we have a strong family

S63 Extended family plays a large role in

our relationship

S21 We surround ourselves with friends

and family that are family oriented

like we are

S12 We have similar values

S59 We have the same family values

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Keeping a Sound Marriage: How Couples with Children with Autism Spectrum Disorders Maintain Their MarriagesAbstractIntroductionMethodParticipantsMeasuresChildhood Autism Rating ScaleKansas Marital Satisfaction Scale

ProcedurePreparationGeneration of StatementsStructuring of StatementsRepresentation of StatementsInterpretation of Maps

ResultsChildhood Autism Rating ScaleKansas Marital Satisfaction ScaleGeneration of StatementsStructuring of StatementsRepresentation of StatementsHusbands with Children with AutismWives with Children with AutismHusbands with Children Who Are Typically DevelopingWives with Children Who Are Typically Developing

Comparisons Within and Between CouplesComparison of Couples with Children with AutismComparison Between the Groups of WivesComparison Between the Groups of Husbands

Correlations of Assessments

DiscussionLimitationsFuture ResearchPractice ImplicationsAppendix: Clusters and Statements References