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The Experiences of Parents for Emotional Interaction with Children with Autism: A Systemic Approach | OMICS International
ISSN: 2378-5756
Journal of Psychiatry
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The Experiences of Parents for Emotional Interaction with Children with Autism: A Systemic Approach

Doui Irene*

Mental Health Counselor, Greece

*Corresponding Author:
Doui Irene
Mental Health Counselor, Greece
Tel: 30 698 99 52 5
E-mail: [email protected]

Received Date: March 26, 2015; Accepted Date: July 29, 2015; Published Date: August 03, 2015

Citation: Irene D (2015) The Experiences of Parents for Emotional Interaction with Children with Autism: A Systemic Approach. J Psychiatry 18:310 doi: 10.4172/2378-5756.1000310

Copyright: © 2015 Irene D. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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Abstract

The present research aimed to explore, through the experiences of parents, the way in which the feelings of parents of children with autism affect children's feelings. Also, a second purpose was to investigate the way, by which the behavior of the child is modified whenever the parents interact emotionally with them, and how children’s behavior is able to modify parents’ behavior. It is known that one’s behavior affects the behavior of another, which in return affects the behavior of the first person and so on. We hypothesized that children with autism are able to perceive and react to emotions. Also, we assumed that parents feelings affect the children's feelings and that these feelings affect children’s’ behavior, considering that it comes to people who have a completely different understanding in relation to their communicative ways. Another assumption was that positive emotions function as depressants and create a climate of security. Similarly, negative feelings toward the child, once again are expressed to both feelings and behavior of the child. We expected that children's behavior can modify the behavior of their parents because of circular causality. Our sample was consisted of eight mothers of children with autism. For data collection we used the qualitative method and specific the semi - structured interview. The thematic analysis revealed the existence of feelings in children with autism and how they interact with their parents. It also revealed the differential effect between positive and negative emotions; finally we noticed the effect of all these on parents’ behavior.

Keywords

Autism; Emotions; Parents; Behavior; Emotional interaction

Introduction

Family as well as other social groups is conceived as a group of individuals that interact within a system, according to the theory of systems [1,2]. The family system usually consists of parents and children. Each person does not behave as an isolated entity within the system. Instead, follows a cyclical pattern in which no single behavior is the cause or the result of some events. In this way we see that the relationship and interaction between all members of the family is bidirectional. The behavior of each person influences the behavior of the other, which in return influences the behavior of the first person and so forth. In a family we behold that the parents’ behavior affects their children, whose behavior inevitably affects the parents’ behavior and so on. This research will focus specifically on families with children with autism. Also aims to explore the parents’ experiences of children with autism, and specific the way by which parents’ feelings influence children's emotions and how these emotions affect children's behavior. The reason this issue was selected has to do with my personal interest around family people with autism, as well as the fact that this is a subject that has not been sufficiently explored. Having worked with families in the context of family therapy and counseling, but also with people with autism at an individual level I have concluded that autism can teach us important lessons about concepts such as compassion, communication, intimacy, love; if we just pay more attention to the wake of the behavior of people with autism through their interaction with the relevant ones, especially through emotional interaction with family members.

Background

Autism

Since, autism was not always so easy to define, if we had a look at the past we would see too many descriptions that all concluded to what we know today as the triad of deficits, inadequate in some skills related to socialization, communication and creative imagination [3]. Until 2013, autism, according to the Manual of Diagnostic Criteria DSM IV (1994. 2000) of the American Psychiatric Association (APA), was in the category of Pervasive Developmental Disorders. According to the latest American Classification Manual (DSM - V, 2013) there have been some revisions due to the names of pervasive developmental disorders as well as the diagnostic criteria. From now on we refer to it as the category of autism spectrum disorders. The classification is based on the severity of the disability of the child in levels (i.e. level 1, level 2, and level 3). There are changes even in the diagnostic criteria. . In DSM-V the diagnosis is based on seven diagnostic criteria divided into two groups: the persistent deficits in social communication and social interaction between the frames and the limited and repetitive patterns of behavior, interests or activities [4]. It is also clarified that the symptoms must have occurred in the early developmental period, causing clinical deficits in the functionality of the child and not accurately explained by cognitive impairment (Developmental Disorder Intellect) or generalized developmental delay [2] the new criteria were needed for a better diagnosis and therapeutic intervention [5].

The influence of the presence of children with autism to parents’ emotional status

The chronicity and severity of autism may adversely affect the emotional state of parents and siblings [6]. Problems such as lack of language, the bizarre anti-social behaviors and tantrums are likely to generate high levels of anxiety. Apart from the symptoms, stress is also caused during the length of the treatment, knowing that there is no treatment which can "cure" autism [7]. It is said that parents of children with autism have higher levels of anxiety [8] and the reason lies in the three stressors in the upbringing of a child with autism of who spoke.

1. Concern about the permanence of the situation.

2. Refusal of society or even family members of the child's autistic behaviors.

3. Low levels of social support.

For these reasons, stress experienced by parents can significantly affect their adaptation to the world of autism and in the care of a child with special needs. According to Bluth [9] it has been observed that parents of children with autistic spectrum autism indicate lower levels of satisfaction in their between relationship [10]. Also according to Sivberg’s survey, it is observed that parents of children with autism, compared to the control group, had more psychological stress, worry and emotional burnout, physical health burden, isolation from the rest of the family and friends. In comparison though, mothers of children in the autism spectrum tend to be affected to a greater extent on the existence of autism in the family, and have higher levels of stress and depression, worse physical health, psycho-emotional lower resistance, less life satisfaction and more guilt [7]. Based on these data we can see that growing a child with Autistic Spectrum Disorders is a stressful experience, however, as demonstrated in the investigation of, there are benefits and these are increasing the estimate towards life, health and people in general, to achieve intellectual and personal progress because of the experience of autism. We just need parents to recognize the positive aspects of the child and draw satisfaction from them.

Something that should be mentioned is that in 1995 Estrada and Pins of, according to, reported that family theory regarded the autistic disorders as a result of dysfunctional families, as well as a result of poor relations between parents and children. Although the etiology of autism is not entirely clear, the aforementioned cause of autism is now rejected.

Emotions influence of parents on the behavior of children with autism

During the literature review no sufficient data was found about the influence of parental behavior in children with autism. Something that has been examined in the light of the influence of parental feelings is the social development of children with autism. It is known that children with pervasive developmental disorders acquire difficulties in developing social skills [11]. However, Haven et al. observed that the quality of interaction between parents and children appears to have long-term implications for the social development of children with developmental difficulties and children with typical development [12,13]. Furthermore, studies have come to conclusion that the emotional support of parents towards children indirectly affects the development of children's social skills by encouraging emotional competence. Indeed, it has been shown that, when parents are synchronized (e.g. via response) with children's behavior during interaction games, this can result over time in language development in children with Autistic Spectrum Disorders [14].

Emotional perception of children with autism

A key question is why everyone considers lack of empathy as one of the key features of pervasive developmental disorders. It is initially legitimate to define what we mean by empathy. Empathy is defined as an emotional reaction, which stems from the emotional state or mood of another man [15]. Weare tells us that experiencing our own emotions enables us to feel empathy and to imagine how others feel [16]. According to Harris there are cases in which we understand the emotion someone feels but we do not feel the same feeling. It is also important to mention that in order to be able to appreciate a feeling, one needs not only to imagine what the other feels, but also what he thinks and wants [17]. Thus, we conclude to what Eisenberg and Strayer reported that there is not right or wrong definition of empathy, but different definitions [15]. Ultimately, it is not clear which aspects of empathy are common and which are separated in Autistic Spectrum Disorders.

According to Baron-Cohen and Golan literature, it is documented that the emotion recognition and the recognition of mental state is the core difficulty in subjects of autism spectrum [18,19]. Drossinou says: "The management of emotions in autism spectrum disorders refers to the effortless expression of emotion, which is also the main difficulty of autistic children [20]. For them it’s hard to express with words what is that bother them, what's confusing, what is it that makes them self-inflicted or beat others." Children with autism, some less and others more, fail to understand or respond adequately to the emotions expressed by others, while when they do, their responses can sometimes or often be strange, unusual and lacks empathy (empathy), e.g. someone’s cry of pain may seem strange, striking fact to the child and to impress or make him laugh [21].

Hamilton and Ujarevic report that, the first investigations carried out relatively to the emotions in autism have shown that individuals with autism face some difficulties to match the emotional facial expressions with emotional expressions of the body and the context [22]. Hobson, in a detailed investigation did not find any evidence for the recognition of basic emotions. The investigation led to the idea that people with autism may have some difficulties in identifying some basic emotions, despite a general lack of recognition [23,24]. Baron-Cohen concluded that the difficulties on the theory of mind can cause some difficulties in selective recognition of the emotion of surprise. Nevertheless, future studies failed to show that several subsequent studies have dealt with both the negative feelings and the positive. Specifically, Ashwin reported they have difficulties in negative emotions such as anger and fear [25,26]. Difficulties have been also observed with respect and the recognition of sadness [27,28]. Certainly there are studies [29,30] which have found deficiencies in recognizing negative emotions, unlike other studies which found shortcomings in the recognition of positive emotions [22]. Therefore, we observe that until now the general idea that exists on the recognition of emotions in autism is very confusing, there are no clear answers on the recognition of emotions. It is unclear whether they have reduced ability to recognize emotions, and in case there is, such a reduced ability whether it equally affects all the emotions.

Recent research data investigate the existence of empathy in children with autism; children with autism face some understanding and performance difficulties of personal meaning in what is perceived [31]. According to the theory of mind children with autism develop the cognitive part of empathy at a later age than children of typical development. This was demonstrated by the experiment with the puppets (known as "Sally-Ann Test"). The procedure is the following: asking the children to watch the puppets. Sally gets a candy and puts into a pushcart and then leaves the room. As Sally is out of the room, Ann gets the candy and puts it in a box. Then children are asked the following question: where will Sally look for the candy when she enters the room? The results showed that 80% of children with autism failed to assess the misconception of Sally. So according to this, people with autism do not have the ability to think about ideas and cannot understand the other's perspective Baron- Cohen Markram conducted a pioneering study of autism in which people with Autistic Spectrum Disorders are not without empathy; rather feel the feelings of others too strongly to withstand them. So keeping in mind Nota’s example above concerning the response of a child with autism to a cry of pain, this reaction could be built as is flooded by feelings, i.e. an excess of empathy, not a lack of it. Indeed Markram indicate that this theory ("Intense World Syndrome") proposes that a fundamental problem in autism spectrum disorders is not a social failure, but rather a hypersensitivity experience, which includes an excessive reaction. For this hypersensitivity, according to Preston and De Waal the Phoebe Caldwell writer for pervasive developmental disorders, writes: "It is clear that, while people on the spectrum cannot easily respond to external gestures/sounds, respond more easily if the initiative of which they are witnesses is already part of their repertoire [31]. This indicates the selective use of incoming information and not absent. It seems that people with autism are really quite good in recognition and imitation, if the action perceived is somewhat meaningful and relevant to their brains. What concerns the failure of the empathic response, it appears that at least some people with autism are hypersensitive to the feelings of others and not "alexithymikoi", but cannot manage the painful feedback that it starts in the body, and therefore have learned to suppress this capability. "

The Purpose of Research

Generally is assumed that children with autism exhibit a peculiar emotional response: usually unexpressed and uninvolved in the emotional state of others, even of their own parents [32]. On the other hand we have Markram theory which relates to an emotional hyper function of individuals with autism. The question that arises, at this point is, which of the two is true? We must remember that people with autism are not just people who have a developmental disorder but they are much more, they are people who care about others, do things, are interesting and are part not only of the family whose living system they follow but also are part of wider social context in which they grow.

My experience of people with autism has shown me, that although it is difficult for them to recognize facial expressions and body language, as well as through these expressions to recognize the feelings and attitudes of others; once they understand one’s feelings (anger, fear, joy, etc.), they feel them and even greatly. Based on my own experience and the above literature data this research attempts to investigate how the feelings of the parents of children with autism affect their children’s feelings, and therefore how they possibly modify the behavior of children, which as a consequence may modify the behavior of parents.

Research Questions

Our cases examine the emotional interaction of parents and children with autism. Our first hypothesis is that children with autism perceive and react to feelings. Secondly we assume that the feelings of parents affect the children's feelings and that these feelings affect the behavior of children, always considering that these are people who have a completely different understanding as to their communicative ways. When parents e.g. express joy, that changes the behavior of children. A third assumption, once more, is that positive emotions function soothingly and create a climate of security. Also if parents express negative feelings toward the child, such as anger, again these are reflected in both emotions and the child's behavior. And finally, because of the circular causality, we expect that the children's behavior will also change the behavior of their parents.

Methodology

Sample

One of the key features of qualitative research is that the sample size consists of a small number of cases. The sample selection criteria are the cases selected to bring a wealth of information concerning the investigation. Basically it is a collective case study [33], which is used to collect data from a number of individuals, to a better understanding of this phenomenon [34]. The sample is appropriate sampling, i.e. selected parents who believe that they have useful material to offer us. Our sample size is 8 people (8 parents of children with autism). Initially, it was aimed the sample to be consisted by 4 mothers and 4 fathers of children with autism. However due to the fact there were difficulties to find fathers of children with autism willing to participate in the research, our sample consists solely of mothers. The size of the sample meets the needs of this research. The sample comes from two prefectures of Greece, Corfu and Thessaloniki. Samples’ age is in the range from 34 years to 73 years. Half of the mothers interviewed are still working either in public structures or homemakers. In all cases children were diagnosed at an early age (2-3 years on average) with the exception of a child whose diagnosis was made when he was 7 years old. The diagnosis ranged from slight to moderate form of autism in the presence of mild mental retardation. The occurrence of mental retardation in individuals with autism supports complex organic nature of the disorder. It has been found that 23% of people with autism have an IQ higher than normal. The remaining 77% have mental retardation: 50% of people with autism have moderate to mild mental retardation and 27% had severe mental retardation. Children were all male which confirms the evidence that male are 34 times more likely to develop autism than females. Most children undergoing puberty, except one who is 6 years old. Even throw the difficulties in finding people willing to participate in our survey involved and two parents, who were in the family adults with autism, specifically traveled the 30s.

Method

To investigate the experiences of parents of children with autism and specifically the way in which the feelings of parental influence on children's emotions and how these emotions affect the behavior of children, we will use the qualitative method. This method was chosen due to the fact that, for the investigator is an adventure [35] and according to the Ball the researcher himself is the research tool. This means that the researcher is able through his attitude and the way he handles the research to influence the process and outcome of the investigation. The inquiry relates to the cases of parents with emotional interaction towards children so through qualitative method one can penetrate what it means for the participants experiencing what they can speak, i.e. to deepen the topic that interests us. The qualitative method has much to offer us when you need to explore the feelings of people or when we ask the participants to talk to us openly about their experiences [36]. And as felicity Kyriazi points out: "As the depth study involved qualitative research leading to gather detailed data on multiple aspects of cases under investigation, and thus facilitate the development process and clarify the conceptual categories [37]". The qualitative method has much to offer when it comes to exploring the feelings or experiences of the participants. Indeed, the qualitative method, in this investigation, is considered necessary and justified, as there are few data on this subject, thus collecting quantitative data does not make sense bearing in mind that the relevant dimensions and categories of the matter is not clear [38].

Once the investigation is moving around the views of parents experiences for emotional interaction parents - children with autism only the qualitative study and the choice of semi - structured interviews are the most appropriate means to conduct it with. Specifically, we have had interviews with parents of children with autism, which lasted on average 20 minutes. The interview process was the same in all cases. Before starting the interview we discussed the purpose of the investigation and inform every participant about the rights. We referred to ensuring the confidentiality, and assuring that if they want they have the right to be informed about the results of the investigation when it is completed. Most of participants were interested in the feedback. Yet, it became clear that each participant would have the opportunity to withdraw from the research, and finally got the written consent of everyone for participating in our survey [39].

Followed questions were concerning the topic of research, as well as the recording of demographics. The data collection method was through a written record of participants' responses and through recording. Almost all participants agreed to be tape-recorded during the interview.

According to Kyriazi, this method promotes free expression of respondents they respond by putting their own limits while giving emphasis where they think they have to give in relation to the matter under investigation [40]. According to Patton this method seeks personal conceptual shapes of participants and through them, the researcher’s introduction in the world of their personal experience. Also prevents the researcher from one’s own prejudices and by changing the process helping to keep a specific procedure, which would be identical hence the researcher is as impartial as possible.

Data analysis

The data gathered from the interviews were analyzed by the content analysis method, namely the method of thematic analysis, a method that is widely used as a tool in the analysis of qualitative research in psychology [41]. The above mentioned method is very useful in identifying, analyzing and recording the patterns (themes) through the data. More specifically, the analysis of our data was done in five phases. Initially, we had to deal with the ownership of our data, making frequent and repeated readings of the data we have collected. This phase is very important part as it was the basis of my research. The second phase of the analysis had to do with the creation of important codes, something that was achieved in various ways such as for example using fluorescent markers and circling keywords. We proceede then, to checking the relations between our issues and clarifying them, the creation of the first patterns in order to create the categories and subcategories of our data. The fourth phase had to do with the control of the categories we created. We answer questions such as: Do we have sufficient data in our every category? Are all the categories we built useful for our research or not necessary? Once we had answered these questions and decided which issues will keep, we continued to the next phase which had to do with the final definition of our issues. At this stage we gave a name to each pattern that we have decided to keep for each topic on which we wrote a detailed analysis. It should be noted that each issue was examined at an individual level as well as in relation to the rest, for this reason some phases of analysis were reversible, several times we came back to an earlier stage of our analysis, and we went back and front. Finally, we proceeded to the full writing of our report. The reason why this method has been chosen was because it is a flexible and because the researcher is able to produce unexpected results, reasons which, in the Braun and Clarke contribute to the advantages of this method.

Results

The present chapter will introduce the four thematic categories of the main issues that rose by participants during the interviews.

In summary, our subject categories are:

• Existence of emotions in children with autism

• Effect of emotional interaction between parents and children

• Positive Emotions

• Negative Emotions

• Parents' Behavior

• Siblings of children with autism

Existence of Emotions in Children with Autism

One mother told us: "Yes, of course they have emotions that show and can understand the feelings of others. But the process by which they do is somehow different. That’s what I've seen from my child." Parents of children with autism through their experiences from their daily routine recognized the ability of children with autism to react and perceive emotions.

Influence of Emotional Interaction between Parents and Children

"What I want to say before we move on is that generally children are affected by their parents and in some cases, as in our own family, influenced mainly by mom! I notice that my own attitude and behavior affects his. So if I am calm and relaxed and I behave with a calm way then he is calm." This was the observation of a mother at the beginning of our interview regarding feelings. So we see how the quality of relationship between parents and children affects this emotional interaction. The majority of survey participants espoused the same view as the above mother quoted. Also, through the findings is noted that positive emotions differ when expressed in comparison to the negative. There was a slight distinction regarding the emotional expression to children from some parents. Some parents choose to limit the expression of negative emotions or even not to express them at all in front of their children: "In general I try to avoid negative emotions; I do not want him to receive it. The calmness generally helps in relationships, not only children like my son, but also in normal children. Anything negative I do not want him to feel it; I treat him like a prince.”

Positive Emotions

It was observed that positive emotions (joy, peace, love) were more easily understood by children and there was a greater variety in their expression. "When I'm happy I usually tell him, when e.g. will go for a walk, then I see him react to what I say and enjoy himself. Expresses his delight, rejoicing, rubbing his hands and laughing and he” MA. In all cases, the reaction of children to positive feelings expressed mainly with physical reactions such as shaking hands, with songs, hugs, kisses, dancing and laughing.

Negative Emotions

But what about negative emotions? Sadness, anger and fear are emotions whose reactions are immediately apparent. The first reaction to a number of children was to remain stationary and observe the words and deeds of their parents: "I express my anger a lot when doing something bad in order to understand. Then he, usually, looks at me, in my eyes. Perhaps that moment he feels a bit scared, he’s timid and cringes a little bit, makes some steps back as I talk to him. "PA

Parents’ Behavior

As varied are the reactions of children when their parents express different emotions, in the same way the parents are affected. We noticed that the behavior of parents affects children's behavior and the behavior of children in turn affects the behavior of parents [1]. The parents' reactions are divided according to the emotions. The majority of participants when they talked about how they are affected by the change of behavior in the expression of positive emotions responded positively comments that reinforce existing positive emotions: "Of course affected when I see him feel well and react. I feel joyful and happy. At that moment I get strength and courage to go on. I feel calm and optimism. "CC.

As positive emotions help foster a positive attitude and generate positive image, negative emotions lead to corresponding strengthening of a negative attitude and image for both the parent and the child: "At times when I see him approaching and trying to calm me, I feel sorry for him. I think of what I do and how I can help him, it’s an ugly feeling. Other times when there is anger, when I see him react I get upset, sad and then try to calm down myself, counting to ten to calm down so he does the same. "KM

Siblings of Children with Autism

In a family the brotherly subsystem interacts continuously. But how this interaction functions when one of the brothers has autism? "It was difficult for his sister to grow up and understand what was happening to her brother. Mainly she observed engaging us with her brother and his reactions where sometimes she found them strange and sometimes frustrating. For a long time she did not want to deal with him and she felt bad if she had to stay alone with him." But there is a positive side of the interaction between the brothers. A mother told us: "They have a wonderful relationship with her brother. Indeed have developed their own communication code. They spend much time together. Little seems to constantly monitor. I think that through her brother she matures faster, perhaps sometimes with 'violent' way.

Conclusions

The present study was undertaken to study the experiences of parents of children with autism and specific way in which the feelings of parental influence on children's emotions and how these emotions affect children's behavior. The analysis of the interviews of parents on the three research questions raised in this study has concluded that the physical and mental development of each child’s can be understood only in relation to their parents and family. The relationship between the child and the family is interactive and circular: the parents affect the child which in turn affects their parents [42]. Regarding the mental development of the child, what's more important than the emotional interaction with their parents? Joy, peace, love, sadness, anger, fear are defined as feelings but the feeling as an abstract concept is difficult to define. As difficult as it is to define it, so important it is in our lives since man as a social being is overwhelmed by feelings that define and shape the life and evolution [43].

The first finding regarding empathy, found that children with autism perceive the feelings of others and even react to them, not in a common way for all children but keeping each child their own personal information. We say that there is a variety in the reactions characterized by "a qualitative difference in the expression and understanding of emotions in relation to the way typically developing person expresses and understands the feelings" Whether it is a cry, or a strong hand movements actually we see what Sacks said, describing the feeling of people with autism "An autistic person may feel violent passions, intensely charged obsessions or an almost uncontrollable tenderness and concern for certain sectors [44]. Autism is not the feeling generally is deficient but the feeling in relation to complex human experiences, social mainly but perhaps some relevance to them-aesthetic, quality, etc. symbolic." But what should we mind in relation to empathy is that it requires more than a simple understanding of the feelings of another person. According to Harris there are cases in which we understand the emotion the other person feels, but we do not feel the same feeling. It is also important to mention that, in order to be able to appreciate and recognize a feeling, one needs not only to be able to imagine what the other feels, but also what he thinks and wants. For it is legitimate to keep in mind that there is no right or wrong definition of empathy, but different definitions [45].

Through the findings of our research it was revealed what Hamilton and Ujarevic mention that the first investigations carried out with reference to the emotions in autism have shown that individuals with autism face some difficulties to match the emotional expressions to the facial emotional expressions of the body and the context. Indeed in some children it was observed that it was difficult to equate the feelings expressed by parents with emotional facial expressions. Consistent with the Tsigganou, neuroanatomical data have shown that there are some problems in both the control and the regulation of emotions and this is why people with autism sometimes give the impression that they are impulsive and without inhibitions. On the second and third question of this research almost all participants confirmed our initial premise that the feelings of parents influence the children's feelings and that these feelings affect in turn their children's behavior, as well as in a manner that operates in different types of emotions.

Specifically positive emotions are easier to identify, as observed by Hamilton and Ujarevic recognition of happiness is marginally reduced in autism. Based on our data from the interviews, it is proved that the feelings of joy were very quickly understood by children and even express it by them. We observed that when parents were happy and expressed this feeling to the children, the children were cheerful and this could be presumed by their special position and the attitude towards parents. Calmness as an emotion can be considered highly contagious. When parents were calm during their interaction with their children, it was noticed that the children seemed more relaxed and calm. Indeed, they did calmer movements and listened more to their parents. Of course, when we talk about positive emotions, we cannot fail to mention love. Love is a feeling that is spread to family members and features more than anything the relationship between parents and children. Through research we concluded that love expressed by parents daily with very small acts and in particular situations mainly with physical reactions such as a hug, a caress and a kiss. All participants reported that children understood all forms of love their parents expressed. The children felt joy, happiness and usually expressing affection with various acts. They were asking for hugs, kisses, some other kids started to sing and dance. We note that our findings for positive emotions refute studies like that of Humphreys et al. who found shortcomings in the recognition of positive emotions.

Notas states, that "children generally take example from their parents and imitate them. Often react in the same way that their parents react in anger, in solving problems and dealing with difficult emotional situations " It seemed, indeed, that anger was one of the negative feelings which were readily understood by children something that contradicts some of the existing research supporting that people with autism have difficulties in recognizing anger. Even the feeling of anger had a great impact on children's behavior. We have seen several examples of children that when perceived anger of parents got angry themselves as well. Indeed in many cases some children were in a state of disarray which was expressed with wild movements of their hands, shouting and there were some cases in which a violent behavior would be adopted. According to Hamilton and Ujarevic, regarding the feeling of the sadness with the people of autism we have an unclear picture. There are studies that support that it is difficult for children to recognize the feeling of regret (Boroston et al,. Gorden et al,. Wallace et al., and others which indicate that there were shortcomings in the recognition of sadness and other negative emotions. With those agree our own findings regarding the feeling of sadness. With only one exception, the participants we confirmed that when children conceived the sadness they feel, and then they feel sad, depressed and often respond by being physically gathered to observe and in some cases they made mollifying movements towards the sad person as a hug or a caress. Notable are the results of our investigation concerning the emotion of fear. All participants reported that from their experience that children do not realize when they themselves feel frightened, which was as a consequence that there is no effect on either the way the child feels, nor in the way the child behaves towards his parents. What our finding is confirmed by previous reports is that the recognition of fear is the most difficult for individuals with autism [46].

Any type of interaction has an impact on both individuals that interact. Until now we talked about how children are affected by their emotional interaction with their parents. But what about the parents? How they are affected and what they observed in their behavior? Because of the circular causality, just as we assumed, the children's behavior changed also the behavior of their parents. Specifically we can talk about the behavior of parents in the presence of positive and negative emotions as well as attitudes of children. Regarding the positive feelings we concluded to the following: Any positive attitude of children has led parents to feel happy, excited and calmer. The pleasure the parents got by the way their children acted, helped them to maintain an optimistic attitude towards the development of the child and specifically on how the child reacts. All this of course affects parents on a personal level. All participants reported that they felt happy about how children reacted, and this gave them strength and courage to continue to do the best they can. If a positive attitude creates a new positive attitude and positive emotions, respectively to the negative emotions result new negative emotions and negative attitudes. What does it mean for parents when their children feel anger and express it? How parents are affected by fear and grief of children? All these feelings create explosive behaviors and parents feel bad. The first reaction is sadness and fear for children considering what they have to endure and how they can help themselves. There were many cases where some parents felt sorrow for the emotional state of the children something that affected them a lot and sometimes lived idly and felt ready to give up their efforts. They had feelings of anxiety; parents of children with autism have higher levels of stress as it has been observed. Diffuse was also the feeling of guilt, as mentioned by Notas: But very rarely encounter parents who do not have wondered: "my fault?" "Could it something I did or did not I?", "Could it heredity?”. In connection with guilt it has been observed that is one of the basic emotions experienced by the parents of children with autism and is present from the beginning of the diagnosis of the child. Guilt exists due to uncontrollable 'biological reactions", which are created by the state of their child turning towards themselves and accusing him [47]. They experience feelings of guilt because they feel responsible for the situation of the child or because they reject or overprotect their child, as well as feelings of hopelessness along with guilt because they feel unable to rise, train and protect the child.

As we observe these findings about how parents feel we notice that they are in an emotional spiral similar to that experienced when learning about the diagnosis of autism. Many studies have dealt with these feelings. Especially the feeling of guilt is very common from parents and has to do with the tendency of parents to blame them for the situation of the child. Of course with the exception of a mother, where the child's negative attitude helps her realize that now has to focus on reality and when difficult things she remains calm. Indeed, as she said: "There was never rainbow without the rain before. This is sometimes also the situation at home. It may be difficult raising a child with autism, but believe me; you gain a lot on a personal level." It seems that the way in which the behavior of the child modifies the behavior of the mother is reinforcing and has positive results for the child itself. For this he had spoken and Bayat, through the survey found that there are benefits through the experience of one of autism [48]. All our parents confirmed that regardless of the difficulties they experience daily at the end of the day always remains a pleasant sensation of what children have achieved, a sense of gratitude for what they have in their lives and what they accomplished daily themselves. It is also important, as the Callias states that parents recognize the positive of the children and draw satisfaction from them. This satisfaction they feel will feed themselves, preventing the negative emotions that can be experienced in their daily lives on the presence of autism in the family [49].

So far the majority of research has dealt with negative impacts from the presence of a child with disabilities to parents regarding the increased levels of anxiety and the creation a feeling of non-equilibrium within the family system [50]. This is a finding which is confirmed by our own research. Features a mother at the beginning of the interview she said " This is a difficult situation at home when you have a child like that.” The family, being a system consists of other smaller systems. An equally important subsystem is that of brothers. The presence of autism has negative effects on emotional state not only the parents but also the siblings. Even in families where there were brothers was very strong this hypothesis: "It was difficult for his sister to grow up and understand what was happening to her brother. Mainly observed engaging us with her brother and his reactions to sometimes find the strange and sometimes frustrating. For a long time he did not want to deal with it and he felt bad if I had to stay alone with him”. As expected, the siblings of children on the autism spectrum are affected by the presence of the disorder in the family and overwhelmed by a variety of negative emotions such as sadness, fear, jealousy, anger, and often all the attention of parents is centered on their brother [51]. According to Bagenholm and Gillberg [52] siblings of children on the autism spectrum express more concerns about the future and often treat their brother with autism as a "package" that causes problems and bring additional difficulties in family life. "My eldest son constantly complains when he has to take care of his brother for a while. He says it is not his responsibility, he cannot do it, that the constantly burden him and ends to argue. "They address many of the effect s of children with autism in siblings. It has been observed that the siblings of children with autism experience more emotional difficulties, behavioral problems and psychological problems compared with siblings of children with mental retardation and other disorders [53,54]. The problems, in fact, related to behavior may relate to the way they feel the children themselves (anxiety, depression, social isolation), but also the way in which they react to the surrounding (aggression, temper tantrums) [55,56]. The Cassel observed that siblings of children on the autism spectrum tend to smile less compared with siblings of children without autism [57]. We can confidently say that everything siblings do together can be used to build a special relationship and however difficult it seems to be, it will always leave something positive and reinforcing to the individual. So as we confirmed the investigation of Mandleco et al. when the family there is a child with autism could be a positive influence to the siblings with typical development [58]. Several studies have even dealt with the effect of the existence of autism in siblings of children who have autism and the results were positive. Specifically Rivers and Stoneman spoke of the satisfaction felt by children with normal development by brotherly relationship [58]. There are fewer conflicts and competition between siblings [59]. Even through the brotherly relationship there are developing some positive emotions such as affection, understanding, cooperation and accountability, positive self-image and the easiest social adjustment and higher levels of self-esteem.

Important was also the observation made regarding the quality of parent-child interaction and the way they develop their social skills over time. Features one of the participants told us: "I noticed that my decision always to treat him with calmness and patience , not be carried away by my own thoughts and being negative towards him, helped him be more calm and receptive to us his family, but also with other people around him.", confirming what Haven et al. observed, namely that the quality of parent-child interaction appears to have long-term effects on social development of children with developmental difficulties precisely and children with typical development [60].

These results exceed the recent literature, providing a rich description of the efforts of both children with autism to regulate their emotions when feeling them and their parents to engage more deeply with the way they interact towards their children.

Reflexivity

It was the first time in which I tried to make a qualitative interview survey. The topic I chose always fascinated me because of my experience with children with autism. I eager to designate, through my research what I was experiencing myself every day by working with both the families of the children as well as the children themselves. I enjoyed every minute of the investigation. The interviews were a constructive part and helped to discover even more about the world of autism. My contact with parents was very pleasant and I was very pleased with the willingness of parents to open up and discuss a sensitive issue such as their relationship with their children. Of course equally interesting was the part of the interpretation of the findings of the investigation as itwas here as would say Holsti: The so-called" reading between the lines "where the researcher is free to use all his imagination and intuition to extract the appropriate conclusions elements [61]. Highly productive and charming piece of analysis and interpretation of research, undoubtedly the satisfaction of completing the survey is the greatest joy.

The present investigation is an attempt to explore and capture the experiences of parents regarding the emotional interaction with children with autism, especially in Greece, where the field of autism needs to be further research. It may not be possible to generalize the results of research and lead to universal conclusions, but I strongly believe that this effort actively contributes in this direction and that in the future could be used for further research.

Annexes

Interview Questions

Introductory Question:

You think that people with autism perceive and react to feelings?

1st Theme: Positive Emotions: Joy, calmness, love Questions:

-Describe me an experience where you felt joy and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

-If so, how did this change affected you?

-Describe me an experience where you felt calmness and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

- If so, how affected you this change?

-Describe me an experience where you felt love and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

- If so, how did this change affected you?

2nd Theme: Negative Emotions: Sadness, anger, fear

-Describe me an experience where you felt sadness and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

If So, how did this change affected you?

-Describe me an experience where you felt anger and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

If so, how did this change affected you?

-Describe me an experience where you felt fear and your child was present?

-What Felt your child while expressing that feeling?

-Did you notice any change in the child's behavior?

- If So, how did this change affected you?

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