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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: [email protected]
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
123
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
978 J Child Fam Stud (2014) 23:975988
123
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
123
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
123
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
123
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