In a recent Household Survey conducted in 2019 – 2020, the Census and Statistics Department in Hong Kong estimated that 1.4% of its local children under 15 years old have ASD. The numbers are close to the worldwide prevalence rate of 1%. Despite efforts to create an inclusive school environment, there is still much stigma and discrimination against families with children with ASD.
Children with autism spectrum disorder (ASD) exhibit behavioural patterns that appear restricted and repetitive; they also have atypical development in social communication and social interaction. This neurodevelopmental disease is so diverse that every child experiences it differently, and its symptoms are often noticeable in early childhood.
Chinese Culture and discrimination
Children with ASD behave and interact very differently from neurotypical children. One of the apparent differences may be in speech and communication. They may be very picky with their food and may also be non-compliant for various reasons, such as sensory overload or are less inclined to pay attention to people. In the collectivist Chinese culture, these differences stand out. These children are seen to be causing trouble and not behaving in the best way for society. Since families play a central role in the child’s life, the child’s defiance is the parents’ fault.
Furthermore, children with ASD and their families are seen as inferior; as a result, they are treated poorly compared to neurotypical children and their families. The parents strongly feel the discriminatory effects of ableism. Parents of children with ASD often feel judged and blamed for their children’s disruptive behaviours; they are stigmatised by the community and are perceived as incompetent parents. As such, parents of children with ASD feel socially isolated and humiliated.
Impact of Parent Discrimination
From the Family Systems perspective, there are connections and interdependencies between the psychological experiences of children and their parents. Parents’ social stressors and negative emotions may significantly impact children’s mental and behavioural health. In fact, social rejection is a strong predictor of psychological discomfort. When society and the community perceive children with ASD as abnormal, they may also discredit their parents. As such, parents of children with ASD are on the receiving end of stigmatising attitudes and behaviours from others around them.
Discrimination will likely intensify parents’ psychological strain, raising their agitation and hostility toward their partners and children. As a result, it can lead to unhealthy family environments that exacerbate the children’s mental and behavioural health symptoms. Conversely, when parents of children with ASD have strong peer support and professional guidance, it can result in a virtuous circle of progress.
Discrimination Leads to Parental Depression
Parental depression is characterised by the parents’ enduring unhappiness and significantly decreased interest or enjoyment in all or almost all activities. In a longitudinal study, Chan et al. found that parents of children with ASD who face discrimination can form negative beliefs about themselves over time. Not only do they have lower self-esteem and self-efficacy, but they also feel inferior to others and do not find life meaningful. The cumulative effects of negative self-beliefs and emotional discomfort may lead to depressive symptoms. As a result, parents’ negative emotions may worsen their children’s mental and behavioural health (2022b).
Discrimination Leads to Harsh Parenting
Chinese culture highly regards the values of obedience, integrity, and diligence. Physical punishment to promote these virtues in children is an accepted form of discipline and parenting strategy. Parents who view a child’s ASD symptoms as disobedience may use physical punishment as a form of discipline. In addition, when parents feel more burdened and stressed, they may become more hostile and harsh with their children. The intensifying aggressiveness and hostility may lead to increased physical discipline.
Discrimination Leads to Co-Parenting Conflicts
When parents disagree about parenting strategies, co-parenting conflict can arise. Although it is common to have differing views, parents of children with ASD can experience more aggression and agitation when fueled by discrimination. Discrimination can increase the psychological burden, causing parents to be in a bad mood or easily irritable. While trying to find a suitable parenting strategy, they may criticise each other’s style or argue about practices. The more parents engage aggressively with one another, the less secure the child feels, leading to more adjustment problems. Other research shows us that parental stress can exacerbate a child’s emotional and behavioural issues.
Discrimination Leads to Increase in ASD Symptoms
Chan et al. discovered a relationship between parents’ experiences of discrimination and their child’s symptoms through three pathways: parental depression, harsh parenting, and co-parenting conflicts. In fact, the children’s symptoms were predicted by parents’ experiences with discrimination. The study also found a correlation between discriminatory experiences and parental depressive symptoms. Children who witness their parents’ unhappy moods may experience detrimental effects on their mental health as a result of contagion, imitation, and social referencing. (2022b).
Parents’ discrimination experiences can adversely impact their children, reflecting how negative social experiences can impact different family subsystems, leading to psychological issues for family members. As such, researchers suggest a family-based approach to understanding and supporting parents of children with ASD. Another study from Scarpa et al. also indicated that the detrimental impact of discrimination might be regulated by internal psychological resilience in both parents and children and by external support systems. These findings imply that focusing on parental discipline strategies may reduce child disruptive behaviours.
Chan et al. proposed using evidence-based programs such as Cognitive Behavioural Therapy (CBT) and Mindfulness-based CBT to build resilience and reduce parental depressive symptoms. Additionally, they suggest that parents learn how to manage their anger and emotions better and how to manage and resolve conflicts (2022b).
Besides the professional services and support offered by various community groups, Hong Kong also works on improving the social acceptance of children with ASD by encouraging schools to provide inclusive education through the “whole school participation model of inclusive education” program. Based on diagnosis and assessment, children with ASD may be enrolled into regular schools. The program operates based on five basic principles – early identification, early support, whole-school participation, home-school cooperation, and cross-sector collaboration, to promote inclusive education in schools. Furthermore, schools will form support groups to help children with ASD develop their potential and overcome difficulties.
From Discrimination to Compassion
Discriminatory attitudes and practices against children with ASD and their families are prevalent in a Chinese society like Hong Kong. Such discrimination brings additional stress to the caregivers, resulting in issues like parental depression, harsh parenting, and co-parenting conflicts. All of these, in turn, adversely impact children with ASD, causing an increase in disruptive symptoms and affecting their psychosocial development.
Despite the Education Bureau’s efforts to integrate special needs education into regular schools, it may still take some time for discriminatory attitudes and practices to shift towards inclusiveness and compassion. Families can turn to evidence-based interventions like CBT or parent training programs to improve emotional well-being and learn positive parenting strategies.
Understand more about Children with ASD and Autism in Asia:
- Benefits of Exercise on Sleep and Behaviour
- How Music Affects Speech
- How Face Perception Affects Social Skills
- Food and Nutrition Matters
- Autism in Asia: Parent Training Program in China
Chan, K. K. S., Leung, D. C. K., & Fung, W. T. W. (2022). Longitudinal impact of parents’ discrimination experiences on children’s internalizing and externalizing symptoms: A 2-year study of families of autistic children. Autism, 0(0). https://doi.org/10.1177/13623613221093110
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). (n.d.). American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm
Fang, Z., Barlow, J., & Zhang, C. (2022). Parenting Programs That Address Physical Abuse in Childhood for Families of Children With Developmental Disabilities in Mainland China: Systematic Review and Meta-Regression. Trauma, Violence, & Abuse, 23(2), 457–475. https://doi.org/10.1177/1524838020915599
Fang, Z., Lachman, J. M., Zhang, C., Qiao, D., & Barlow, J. (2022). A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China. Autism, 26(8), 1973–1986. https://doi.org/10.1177/13623613211070869
McCabe, H. (2007). Parent Advocacy in the Face of Adversity: Autism and Families in the People’s Republic of China. Focus on Autism and Other Developmental Disabilities, 22(1), 39–50. https://doi.org/10.1177/10883576070220010501
SAGE Reference – The SAGE Encyclopedia of Lifespan Human Development. (2018, March 26). https://sk.sagepub.com/reference/the-sage-encyclopedia-of-lifespan-human-development/i11021.xml
Scarpa, A., Swain, D. M., Factor, R. S., Dahiya, A. V., & Bertollo, J. R. (2021). Enhancing Flexibility: A Biosocial Model for Resilience to Adversity in Youth With Autism. SAGE Open, 11(3). https://doi.org/10.1177/21582440211037997
Shawler, P. M., & Sullivan, M. A. (2017). Parental Stress, Discipline Strategies, and Child Behavior Problems in Families With Young Children With Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 32(2), 142–151. https://doi.org/10.1177/1088357615610114