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Research in Developmental Disabilities 36 (2015) 620–629

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Research in Developmental Disabilities

For fathers raising children with autism, do coping strategies


mediate or moderate the relationship between parenting
stress and quality of life?
Latefa A. Dardas a,*, Muayyad M. Ahmad b,1
a
School of Nursing, Duke University, Durham, NC 27708, United States
b
Faculty of Nursing, The University of Jordan, Amman 11942, Jordan

A R T I C L E I N F O A B S T R A C T

Article history: In response to the dramatic change in the perception of fatherhood and the significant
Received 26 July 2014 expansion in fatherhood research, this study came to fill the gap in literature and examine
Received in revised form 28 October 2014 the possible mediation and moderation effects of coping in the relationship between
Accepted 29 October 2014
fathers’ of children with autism parenting stress and quality of life (QoL). Mediation and
Available online
moderation effects were examined using multiple programs and software which included
hierarchical regression, structural equation modeling and special Macros added to the
Keywords:
analysis programs to confirm the findings. None of the investigated coping strategies could
Mediation
Moderation mediate or moderate the stress–QoL relationship among the 101 participating fathers. This
Coping study provides interesting information on how the stress-coping-QoL relationship among
Parenting stress fathers of children with autism can be affected by the nature of their stress provoking
Quality of life situation, their individual characteristics, the environment and its demands and resources,
Fathers and the way fathers perceive and apply their coping responses.
Autism ß 2014 Elsevier Ltd. All rights reserved.

1. Introduction

The birth of a new child is considered a pleasant time for most fathers. Unfortunately, nearly one out of 68 fathers receives
upsetting news that his child will demonstrate delays across all areas of development due to a pervasive chronic disability.
Autism is currently considered the number one occurring developmental disability that can impose significant impacts on
fathers’ ordinary roles and render them despaired, powerless, and at risk for many psychosocial problems (Lyons, Leon, &
Roecker Phelps, 2010). The literature addressing fathers of children with autism suggested that once the child is introduced
into the family, the whole fatherhood experience changes (Donaldson, Elder, Self, & Christie, 2011). Fathers’ chronic
caregiving responsibilities may threaten their emotional, physical, and social well-being. For instance, fathers of children
with autism usually experience higher levels of psychological distress and poorer quality of life (QoL) than fathers of typical
children do (Ericzon, Frazee, & Stahmer, 2005; Mungo, Ruta, Arrigo, & Mazzona, 2007). Further, fathers may feel emotionally
charged because of their inability to protect their children from pain or harm (Pelchat, Levert, & Bourgeois-Guérin, 2009).
Dealing with health services may also be physically strenuous for most fathers. Moreover, some studies report that many

* Corresponding author.
E-mail addresses: Latefa.dardas@duke.edu, l.dardas@ju.edu.jo (L.A. Dardas), mma4@ju.edu.jo, mma4jo@yahoo.com (M.M. Ahmad).
1
Tel.: (919) 684-9198.

http://dx.doi.org/10.1016/j.ridd.2014.10.047
0891-4222/ß 2014 Elsevier Ltd. All rights reserved.
L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629 621

fathers feel strain in building up their social networks either because of their demanding roles as care providers or because of
the lack of public understanding of their unique experiences (Lewis, Skirton, & Jones, 2010).
One of the most commonly searched psychological outcomes for parenting a child with autism is parenting stress. Studies
have long revealed significant high levels of stress among fathers of children with autism (Dardas & Ahmad, 2014a,b; Ericzon,
Frazee, & Stahmer, 2005; Seltzer, Abbeduto, Krauss, Greenberg, & Swe, 2004). Fathers report high stress usually because of
their children daily management, the need to search for and deal with available services and educational programs, and the
potential financial strains (Parish, Seltzer, Greenberg, & Floyd, 2004). Furthermore, fathers’ lack of knowledge about their
children’s disability (Kucuker, 2006), and the lack of active planning for fathers’ engagement in all areas of service delivery
(Premberg, Hellstrom, & Berg, 2008) can lead to high patenting stress. The prolonged nature of parenting stress highlights the
significant short and long term risks to fathers’ mental and physical health. The entire QoL of fathers of children with autism
is believed to be threatened with the presence of a child with autism (Dardas & Ahmad, 2014c,d). Poor QoL reported by those
fathers reflects a multidimensional outcome that incorporates their physical health, psychological state, social relationships,
and relationships with salient features of the environment. Overall, fathers raising children with autism face several
challenges that make their coping and adjustment to the child’s disability an on-going complex task.
Based on the prior findings, it becomes clear that fathers of children with autism are fair much better if they can have
means to cope with their inevitable stressors. In fact, relevant studies reported that the ways fathers of children with autism
cope with stress is more influential to their health and QoL than the stressors themselves (Dabrowska & Pisula, 2010;
Hastings et al., 2005). Several links between the types of coping strategies used by fathers of children with autism and their
levels of stress and QoL have been revealed (Dabrowska & Pisula, 2010; Gray, 2006; Hastings et al., 2005). For instance, the
use of less emotion-focused coping and more problem-focused coping was associated with better QoL (Lyons et al., 2010).
More specifically, King et al. (2006) found that adopting positive meanings to the lived experiences is a popular coping
strategy among fathers experiencing stress. Other adaptive strategies included participating in religious and individual
activities and emphasizing strong moral and religious standards, planful problem solving, and self-control (Sivberg, 2002).
On the other hand, the reliance on passive and avoidant coping strategies was found ineffective with chronic stressors such
as raising a child with autism (Hastings et al., 2005; King et al., 2006).
The application of the stress-coping theories on parenting children with pervasive disabilities has yielded lots of interesting
yet mixed results. In addition, there is a lag in coping research on fathers raising children with autism when compared to
mothers, making it difficult to draw firm conclusions about their coping outcomes (Vacca, 2006). In their extensive review,
Hastings et al. (2005) stated that it was difficult to locate published papers describing coping strategies adopted by fathers of
children with autism. Further, Premberg et al. (2008) have stated that although available studies could clarify some issues for
fathers, a small number of fathers were usually included and their voices were mixed with those of mothers. Therefore, it is of
critical importance to understand the underlying structure of coping used specifically by fathers of children with autism.

1.1. Why this study?

There are compelling practical and theoretical reasons for conducting this study. Research generally suggests that the
way fathers cope with life stressors can significantly affect their children’s, partners’, families’, and ultimately their own
health and well-being (Gray, 2006; King et al., 2006; Sivberg, 2002). Fathers, although labeled by some as the ‘peripheral
parent’, can set the tone for the whole family’s reaction to the child with a disability (Donaldson et al., 2011). When fathers’
coping strategies fall short, it becomes difficult for them to support other family members. To date, many gaps are left
unresolved in the arena of coping behaviors adopted by fathers of children with chronic disabilities in general and autism in
particular. It is not well understood how fathers’ empirically derived coping responses are linked to their psychological
functioning and QoL. Available literature includes an investigation for the concepts of stress, coping and QoL through
bivariate relationships. However, relationships among variables are often considered more complex than simple bivariate
relationships with the presence of potential effects of other variables that may work as mediators or moderators in the
existing relationships (Baron & Kenny, 1986; Bennett, 2000).
A mediator is a third variable that links a cause and an effect. A moderator is a third variable that modifies a causal effect
(Wu & Zumbo, 2008). In other words, mediation explains the process of ‘‘why’’ and ‘‘how’’ a cause-and-effect happens,
whereas moderation postulates ‘‘when’’ or ‘‘for whom’’ an independent variable most strongly (or weakly) causes a
dependent variable (Frazier, Tix, & Baron, 2004). Investigating the role of such variables in psychology not only verifies
researchers’ substantive theories around a phenomenon but also answers practical questions about whether an intervention
or treatment program has the expected effect (Wu & Zumbo, 2008). Nevertheless, experts in this field claim that studying
mediation and moderation causal nature effect is often overlooked or simply misunderstood leading to misapplication and
misinterpretation in much of applied research (Frazier et al., 2004; Rose, Holmbeck, Coakley, & Franks, 2004). In this study,
we aimed at investigating eight coping strategies as possible mediators or moderators in the relationship between fathers’ of
children with autism parenting stress and QoL.

1.2. Theoretical framework and hypothetical model

This study was guided by the Lazarus and Folkman’s Transactional Model of Stress and Coping (1984). The model
addresses the concepts of stress and coping. Stress is perceived as ‘‘a relationship between the person and the environment
622 L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629

that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being’’ (Lazarus &
Folkman, 1984, p. 21). Coping is defined as the cognitive and behavioral efforts that are constantly changing to master,
reduce, or tolerate a specific stressor appraised as exceeding one’s available resources and abilities. Thus, stressful
experiences are perceived in this model as dynamic and reciprocal person–environment transactions. A striking point in
the model is that coping strategies are the intermediate process between stressors and health outcome. Lazarus and
Folkman (1984) suggested that the process of coping can change the relationship between life stressors and health.
Generally, ineffective coping strategies can generate negative emotions, harmful long-term effects, and calls for additional
and/or different coping efforts. On the other hand, effective coping leads to positive emotions and beneficial long-term
effects. We assumed that the style of coping fathers of children with autism use to address their stressors can significantly
affect their parenting experience outcomes (QoL) by working as mediators or moderators in an existing stress–QoL
relationship.

2. Methods

2.1. Participants

Participants consisted of 101 fathers aged 25–69 years, with a mean of 39.3 years (SD = 6.9). Almost all were married (98%,
n = 99), and the majority had a secondary school or higher. Family income levels for the total sample ranged from 150 to
3800 JD (1 JD = 1.4 US Dollar). Around 84% of the fathers were employed and represented a variety of occupations (e.g.,
laborers, professionals, and government services). The children with autism were 85 boys and 16 girls aged 2–13 years
(M = 5.9; SD = 3.2). The mean number of children fathers had, beside the child with autism, was 3.6 (SD = 1.6).

2.2. Measures

A demographic questionnaire designed for the present study was used along with three other measures; the Parent Stress
Index-Short Form (PSI-SF), The Revised Ways of Coping Checklist (WCC-R), and the World Health Organization Quality of Life
Assessment-BREF (WHOQOL-BREF).

2.2.1. The Parenting Stress Index-Short Form (Abidin, 1995)

‘‘Parenting stress is a complex construct that involves behavioral, cognitive, and affective components and is a
combination of child and parent characteristics, as well as family situational components as they relate to the person‘s
appraisal of his or her role as a parent’’ (Whiteside-Mansell et al., 2007, p. 27). Based on this notion, we selected the PSI-SF
scale for this study to assess fathers’ perceptions of parenting stress. The PSI-SF is a widely used measure with parents of
children up to 13 years of age and is considered a robust diagnostic measure for parenting stress. The PSI-SF contains
questions derived from the 102-item original PSI full-length that could be administered within a limited amount of time
(Abidin, 1995). Respondents were instructed to select an answer questions on a 5-point Likert-type scale ranging from
‘‘strongly agree’’ to ‘‘strongly disagree’’. We used a validated version for the PSI-SF with parents of children with autism
(Dardas & Ahmad, 2014e). Cronbach’s alpha for the total stress score revealed reliable results (.92). According to Abidin
(1995), parents who obtain a total stress score above a raw score of 90 (at or above the 90th percentile) are experiencing
clinically significant levels of stress. In this study, the mean score for the total stress score was 94.35 (SD = 19.28).

2.2.2. The Ways of Coping Checklist-Revised (WCC-R) (Folkman & Lazarus, 1988)

The WCC-R is an empirically derived inventory composed of 66-item coping strategies that people use to deal with the
internal and/or external demands of specific stressful encounters (Folkman & Lazarus, 1988). The measure was adapted to
provide a clear description for coping through deriving eight classifications, including: positive reappraisal, confrontive
coping, planful problem-solving, seeking social support, distancing, self-controlling, escape-avoidance, and accepting
responsibility. Those categories provide a clear description for the thoughts and actions an individual uses to cope with a
specific stressful encounter. This study had one of its strengths in utilizing the eight coping subscales rather than the general
two-classification model (problem versus emotion-focused coping) that was used in previous relevant research. Indeed,
Folkman and Moskowitz (2004) have argued that relying on the two classifications for the synthesis of findings across
studies may run the risk of distorting important differences within categories.
Fathers were required to respond to a specific stressor (raising a child with autism) and subsequently respond to each
statement in the scale by expressing the extent to which they used the strategy in coping with that stressful situation on a
4-point scale from 0 (not used) to 3 (used a great deal). Scores are additively derived from individual items and divided by
a total score to provide relative scores for a total of eight scales. The WCC-R is considered one of the most widely used
comprehensive and psychometrically robust measures of coping (Lundqvist & Ahlström, 2006). Table 1 describes fathers’
coping responses. The internal consistency ranges from 0.68 to 0.79 for the eight subscales (Folkman & Lazarus, 1988). In this
sample, Cronbach’s alphas for the eight subscales ranged from moderate to high.
L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629 623

Table 1
Description for the eight coping subscales.

Coping subscales (number of items) Mean Percentage Standard deviation Range

Positive reappraisal (7) 20.13 72 3.29 12–27


Confrontive coping (6) 12.96 54 3.07 7–21
Planful problem solving (6) 15.95 66 3.48 6–24
Seeking social support (6) 16.34 68 3.88 8–24
Distancing (6) 13.85 58 3.17 8–23
Self-control (7) 17.56 63 3.40 9–25
Escape avoidance (8) 17.74 55 4.76 10–29
Accepting responsibility (4) 9.04 57 2.57 4–16

2.2.3. The World Health Organization Quality of Life Assessment-BREF Self-administered Instrument (WHO, 1996)

The WHOQOL-BREF assessment instrument was developed by the WHOQOL Group with fifteen international field centers
in an attempt to develop a QoL assessment that would be applicable cross-culturally (WHO, 1996). The instrument has been
developed to provide a short form QoL assessment that looks at domain level profiles, using data from the WHOQOL-100. The
WHOQOL-BREF contains a total of 26 questions inquiring about respondents’ overall perception of QoL and health beside
their physical, psychological, social, and environmental health. The measure scores are scaled in a positive direction, with
higher scores denoting higher levels of QoL. The score 60 out of 100 is considered as the midpoint where QoL is judged on the
WHOQOL-BREF measure to be neither good nor poor (Skevington, Lotfy, & O’Connell, 2004). The mean score for the total QoL
score in this study was 74.17. A validated Arabic version of the WHOQOL-BREF by Dardas and Ahmad (2014f) was used in this
study. Cronbach’s alpha for the total QoL score was .91.

2.3. Analyses

Prior to conducting any type of analyses, we performed basic data screening activities to ensure the accuracy and
legibility of data entry and assess the normality of the continuous variables. Missing data were replaced in accordance with
their manuals’ scoring procedure that allows for calculating missing data. That is, the mean of the items from the subscale
from which the item was missing was calculated and then rounded to the nearest whole number, and assigned to the missing
item. However, there were only seven cases with few items unanswered. The data were also inspected for outliers, defined as
values greater than 3.5 standard deviation units from the sample mean for a given variable. Univariate outlier analysis using
box plots indicated the absence of univariate outliers for all the continuous variables. Descriptive and inferential analyses
were applied to the cleaned data set to describe the sample and to address the research hypotheses using the Statistical
Package for Social Sciences (IBM, SPSS, 21).
We conducted moderation and mediation tests using multiple programs and software which included SEM, SPSS, AMOS,
SOBEL test, and PROCESS Macros for SPSS. In order to confirm if a variable is making a moderation effect in the relationship
between an independent variable and a dependent variable, the nature of this relationship must change once the moderator
variable changes. The inclusion of the interaction in the model should lead to a significant explanation in the outcome
variance better than without. The following two steps were followed to examine the moderation effect: in step one of the
regression model, we entered the predictor and the moderator. Both effects as well as the explained variance (R2) of the
model should be significant. In step two of the regression model, we entered the interaction effect and checked if it was
significant as well as the change in R2 of the model. Moderation is considered to occur if previous results were significant. In
other words, moderation occurs when the direction, strength, or both of the relation between an independent and a
dependent variable are affected by a third variable, which is termed a moderator (Baron & Kenny, 1986; Wu & Zumbo, 2008).
We evaluated the accuracy of the mediation effect using several types of tests. We conducted the traditional
hypothesized method using SPSS regression analysis (Baron & Kenny, 1986) and then, we did the analysis with bootstrap
resampling. In addition, SPSS macros for computing mediated effects with Sobel test was performed (Preacher & Hayes,
2004). Structural equation modeling using AMOS was also used. Furthermore, the Sobel test was used to test the
significance of a mediation effect. The Sobel test provides means to determine whether the reduction in the effect of the
independent variable, after including the mediator, is a significant reduction and therefore whether the mediation effect is
statistically significant (Sobel, 1982).
It is important to report here that the literature on the process of testing moderation effect still ambiguous. Some
researchers hypothesized that a regression model is designed to predict the outcome variable from both the predictor
variable and the moderator variable in first step and then adding the interaction variable in the second step. The effects of the
variables as well as the model in general (R2) should be significant (Aiken & West, 1991; ORSP, 2013). However, Bennett
(2000) stated that in the first step of the regression, the independent variables and the moderator are entered into the model
as predictors. Bennett claimed that the independent variables are not necessary to be significant predictors of the outcome
variable in order to test for an interaction effect. In the next step, if the interaction outcome explains a significant amount of
variance in the dependent variable, then the moderator effect exists (Bennett, 2000).
624 L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629

2.4. Study protocol

The population (fathers) for this study was drawn from public and private Jordanian centers that provide specialized
diagnostic, remedial, and teaching services in the field of disabilities (including autism). The Jordanian Ministry of Social
Development and the Higher Council for the Affairs of Persons with Disabilities provided the researchers with the names of
the licensed centers. Prior to collecting the data, the study received ethics approval from the University and Faculty of
Nursing and the participating centers. The first author personally contacted the head of each center in order to gain approval
for obtaining participants. The study was described to center officials and they were asked for their approval for fathers’
participation. The head of each center was then asked to invite eligible fathers to meet the first author in their children’s
centers. In addition, we sent an invitation letter to the fathers including all the information regarding the researchers and the
study objectives, inclusion criteria, and rights of the participant. The letter also confirmed that participation was voluntary
and that the participant could withdraw from the study at any point.
Since the PSI-SF used in this study is standardized and valid for use with parents of children up to 13 years of age, we
invited only fathers of children aged up to 13 years to participate in this study. Fathers also had to have just one child
diagnosed with autism to ensure that fathers would focus on the same child when they completed the questionnaire.
Further, fathers must be living in the same household with the child with autism.
Fathers who agreed to participate met the researcher (first author) at their children’s centers where the researcher
confirmed the study’s protocol and inclusion criteria. Fathers were informed that the researcher will have an access to their
children’s records. They were also assured that this access was only for the purpose of confirming their children’s clinical
diagnosis. The researcher was then responsible for distributing and collecting the study questionnaires, and making sure
they were voluntarily given to eligible fathers. The first author, rather than any other data collector, chose to be responsible
for gathering the data in order to assure that the study purpose was clarified accurately to the fathers, and increase the
number of the participants by allowing them a convenient access to the researcher to answer any question they may raise
regarding the study. Indeed, it was evident in this study that fathers were willing to participate when they were personally
invited and interviewed by the researcher. Data collection was conducted on Saturdays to avoid difficulty in obtaining
responses from fathers due to job obligations.
Some of the eligible centers agreed to participate but did not permit any direct contact with the fathers. For those, the
research materials were sent home by the classroom teacher via the child. Special closed packages were prepared including
the questionnaire set, an empty envelop, and a letter including the following clarification points: (A) the inclusion criteria for
the study (fathers were asked not to complete the questionnaires if they did not meet any of the criteria), (B) completing all
the questionnaires and returning it back in a sealed envelope to the center, and (C) avoiding sharing or discussing responses
with wives or any other person to assure the reliability and validity of the responses. Returning the completed questionnaire
was considered to be the respondent’s consent to participate in the study.
The self-reported questionnaire utilized in this study had its pros over several other data collection methods. For instance,
the questionnaire was properly quick to administer and took into consideration the fathers’ time constraints. Second, the use
of such method permitted fathers who could not attend the meetings with the researcher to examine and complete the
questionnaire in the comfort and familiarity of their own home. Moreover, the questionnaires ensured the confidentiality to
all the participants. Data collecting procedures also ensured that no personally identifiable information would be associated
with the study questionnaires. Only coded data were entered and analyzed.

3. Results

3.1. Mediation models

We conducted the mediation tests using multiple analysis techniques and statistical software to validate the results. We
ran multiple regression analyses to examine the eight coping strategies as mediators between stress and QoL using SPSS
(IBM, 21; 2012) (Table 2). We conducted mediation analyses using the bootstrapping method with 5000 bootstrap resamples
and bias-corrected confidence estimates (MacKinnon, Lockwood, & Williams, 2004; Preacher & Hayes, 2004). We used
structural equation modeling (SEM) with Analysis of Moment Structure (AMOS, version 21.0) because it allows testing all
components of the mediation model simultaneously (SEM) (Arbuckle, 2012). In addition, we used multiple mediation
analyses with special software for testing the significance of the indirect effects and contrasting the strengths of indirect
effects through eight mediators (Preacher & Hayes, 2008). For this analysis, the SPSS macro program developed and updated
by Preacher and Hayes (2008) was used.
In the multiple regression analysis, we assessed all the coping strategies separately for their mediation effect. First, each
mediator was regressed on the independent variable, and each dependent variable was regressed on the suggested mediator.
As shown in Table 2, in each model, one of these equations was not significant. Furthermore, when controlling for mediators
effect, the relationship between the independent variable and the dependent variable remained significant. Thus, results of
the mediation analyses in the eight models confirmed that none of the coping strategies had a full direct mediating effect.
Model fit through SEM was examined using the chi-square statistic, the Comparative Fit Index (CFI), the Tucker–Lewis
Index (TLI), and the root mean square error of approximation (RMSEA). The mediation path model showed a good fit with the
data: x2 (df = 164) = 583, p < .001, CFI = .91, TLI = .90, RMSEA = .06 (CI = .05, .07). Overall model fit ranged from moderate to
L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629 625

Table 2
Testing coping strategies in 8 mediation models between stress and QoL with bootstrapping.

Mediators B t p value 95% CI

Positive reappraisal
A–B .02 .92 .360 .02 to .07
B–C 1.16 3.18 .002
A–C0 .34 5.49 <.001

Confrontive
A–B .05 4.07 <.001 .05 to .04
B–C .05 .09 .923
A–C0 .32 4.57 <.001

Planful problem
A–B .01 .44 .66 .07 to .04
B–C 1.31 3.87 <.001
A–C0 solving .32 5.16 <.001

Seeking social support


A–B .01 .33 .740 .01 to .04
B–C .56 1.75 .083
A–C0 .33 5.01 <.001

Distancing
A–B .01 .25 .903 .02 to .04
B–C .57 1.45 .150
A–C0 .33 5.06 <.001

Self-control
A–B .03 1.53 .128 .01 to .07
B–C .70 1.90 .059
A–C0 .34 5.29 <.001

Escape avoidance
A–B .13 6.25 <.001 .17 to .03
B–C .43 1.40 .165
A–C0 .27 3.51 <.001

Accept responsibility
A–B .05 4.07 <.001 .06 to .04
B–C .05 .09 .92
A–C0 .32 4.57 <.001

A–B = independent variable (IV) to mediator (M); B–C = mediator to dependent variable (DV); A–C0 = IV to DV through M
(indirect effect).

good, and was generally acceptable for each analysis when viewed across the fit indices. None of the proposed mediators
was significantly associated with the outcome, and no other indirect effects were observed. None of the coping strategies
provided evidence of mediation effect between stress and QoL.
Using the SPSS macro program developed by Preacher and Hayes (2008) was necessary because AMOS only provides the
size and significance of the sum of all indirect effects through multiple mediators. AMOS does not allow for testing the
significance of individual indirect effects or comparing the strengths of individual indirect effects. In this study, the indirect
effects were achieved with the 95% confidence interval (Preacher & Hayes, 2008). When the independent variable (stress)
was regressed on the QoL, the direct effect was significant (B = .33, t (df = 99) = 4.99, p < .001). Confirming the above
result, none of the coping strategies revealed mediation effect between stress and QoL.

3.2. Moderation models

When there is a moderating variable, it changes the magnitude or the direction of the relationship between two variables.
A moderation implies an interaction effect which could (a) Increase the effect of the predictor on the outcome; (b) decrease
the effect of the predictor on the outcome; or (c) reverse the effect of the predictor on the outcome. To test the hypothesis
that the QoL is a function of multiple variables, and more specifically whether the coping strategies moderate the
relationship between stress and QoL among fathers of children with autism, we conducted eight hierarchical multiple
regressions analyses. In the first step, we included two variables: stress and one of the coping strategies. In the second step,
we added only the interaction variable. In multiple regression, moderation is represented as a linear by linear interaction
between the independent variable and the moderator variable (Aiken & West, 1991). Furthermore, to avoid potentially
problematic multicollinearity with the interaction term, it is recommended that the continuous variables be centered for
using moderation analysis (Aiken & West, 1991). In our data, all the moderators, independent variables, dependent variable,
and the interaction terms between the independent variables and the dependent variable were at a continuous
measurement scale.
626 L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629

To test for coping strategies moderation effect, we conducted eight hierarchical regression analyses using SPSS. In each
equation and in the first step, the dependent variable QoL was regressed on the independent variable stress and the
moderator. In the second step, the interaction between stress and the moderator was entered to the analysis. The findings of
this study showed that in all equations, the variables in the first step accounted for a significant amount of variance in QoL
which ranged from .20 to .31, p < .001.
In our analyses, there was no moderation effect for any of the coping strategies. The independent variable (stress) and the
tested moderator should produce a significant effect in predicting the outcome variable in step one of the hierarchical
regression. Only when positive reappraisal and planful problem solving were tested as moderators, their effect as well as the
model were significant. After adding the interaction effect for the stress and the potential moderator, none of the R2 changes
were significant. Additionally, following the ‘PROCESS Procedure’ release 2.12 (Hayes, 2013), we added special Macros to the
SPSS program to test moderation effects. None of the interaction effects between stress and each of the eight coping
strategies produced significant outcomes (Table 3).
Plotting the interaction terms was carried out in further analysis to scrutinize the moderation effect. Examination of the
interaction plot showed no interaction between the lines of the variables. Almost, in all examined models for moderation
effect, the interaction plot was very close to the one in the diagram shown in Fig. 1.

4. Discussion

Over the past few decades, great attention has been turned to the role of fathers’ involvement in their children’s
development. A plethora of social, political, and economic issues led to the ‘era of paternal discovery’ where fathers are
considered more nurturing toward their children and more actively involved in parenting and household responsibilities. In
the case of having a child with autism, the father’s roles, reactions, and experiences were found pivotal for the child’s,
mother’s, and whole family’s health and well-being (Donaldson et al., 2011; Hastings et al., 2005). Fathers who are able to
develop effective coping skills tend to report more positive perspective and value from their special parenting experiences
(Lewis et al., 2010; Pelchat et al., 2009). This study went beyond the traditional perspective of describing paternal coping
when raising a child with autism to investigating the role of such coping responses in the relationship between fathers’
parenting stress and QoL. Against the expectation, none of the investigated coping strategies were mediators or moderators
for the stress effects on fathers’ QoL. Such findings, although difficult to defend, may have several possible explanations.
Our first attempt to explain the results of this study goes in line with Strachan (2005) who reported an interesting
relationship between fathers’ of children with disabilities life stressors and the effectiveness of their coping responses. The
presence of greater pile-up of life stressors was associated with lower utilization and less effectiveness of coping strategies

Table 3
Testing moderation effects of coping strategies on the relationship between stress and QoL using bootstrap.

Model Stress coefficient Moderator coefficient Interaction coefficient F

Positive reappraisal
R2 = .276** .34** 1.16** .03 18.68**
R2 change = .015 .24 3.85 13.28**

Confrontive
R2 = .201** .32** .05 .01 12.36**
R2 change = .002 .43* 1.25 8.27**

Planful problem solving


R2 = .307** .32** 1.31** .02 21.73**
R2 change = .015 .09 3.59* 15.35**

Seeking social support


R2 = .226** .33** .56 .01 14.28**
R2 change = .001 .28 .87 9.44**

Distancing
R2 = .22** .33** .57 .01 13.67**
R2 change = .014 .41** .42 9.78**

Self-control
R2 = .230** .35** .70 .03 14.63**
R2 change = .017 .13 3.20 10.58**

Escape avoidance
R2 = .22** .27** .43 .02 13.59**
R2 change = .023 .61** 2.43 10.22**

Accept responsibility
R2 = .201** .32** .05 .01 12.36**
R2 change = .002 .43* 1.25 8.27**

* p.01
** p.001
[(Fig._1)TD$IG] L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629 627

90

80 Self-control
70
high
60

50 med
QoL

40
low
30

20

10

0
low med high

Stress

Fig. 1. Illustration for the absence of moderation effect.

by the fathers. In other words, fathers who experienced more stressful events tended to use less effective individual and
family coping strategies. Therefore, it may be reasonable to assume that fathers who participated in this study were
overwhelmed with several parenting, social, and/or financial stressors that prevented them from effectively utilizing
available coping resources and enhancing their QoL.
Another possible explanation for the lack of coping mediation/moderation effects is based on the study’s theoretical
framework. According to Lazarus and Folkman (1984), the coping process is sensitive both to the environment and its
demands and resources, and to individual characteristics that influence the appraisal of stress and resources for coping. Thus,
it is possible that fathers’ personal characteristics and their surrounding environment had influenced the relationship
between their coping strategies and QoL. Examples of personal characteristics might include fathers’ beliefs, motivation,
goals, values, and recognition of one’s personal resources for coping. Environmental factors could be related to the nature of
the stressor, its intensity and duration, as well as the availability and quality of social support resources. Future research may
benefit from considering these variables in order to have a clear picture for fathers’ of children with autism stress-coping
dynamics. It is also important to highlight here the cultural impacts on individual coping. Indeed, the coping strategies
adopted by parents are often based on the culture they live in. In their cross-cultural study on coping strategies of mothers of
children with intellectual disabilities, McConkey et al. (2008) found that mothers’ stress was not alleviated by access to
formal support nor was there a relationship between maternal well-being and coping strategies. The authors explained these
findings in that mothers’ stress and health outcomes might be influenced by cultural, personal, and family characteristics
rather than their coping responses.
The current study showed that fathers of children with autism had adopted a variety of coping responses nevertheless,
they had no significant effects on their QoL. These findings warrant investigating the actual application and meaning of these
coping strategies for the fathers. Below we present some clarifications on how the way fathers perceive and apply their
coping strategies can alter their potential effects on health outcomes.

4.1. Confrontive coping

Confrontive coping refers to making active efforts to contain the situation. The confrontive coping subscale used in this
study contains convictions like ‘I expressed anger to the person(s) who caused the problem’, ‘I let my feelings out somehow’,
and ‘I took a big chance or did something very risky’. The use of such coping responses may be sometimes associated with
aggression, hostility, and risk taking. It can also be linked to negative psychological outcomes, especially when individuals
lack the skills needed to confront their stressors appropriately.

4.2. Seeking social support

Seeking social support refers to efforts aimed at obtaining informational, tangible and emotional support. Previous
studies have generally concluded that fathers of children with disability were helped in their adjustment process by seeking
help from relatives and health professionals (Dabrowska & Pisula, 2010; Gray, 2006). However, reviewing the studies
conducted specifically on fathers of children with autism yielded different yet interesting results. When fathers of children
with autism contact outside sources, they appear to be less interested in asking for possible assistance. Further, they are less
likely to express their thoughts and share their feelings with professionals. This was mostly related to either their lack of time
to develop productive relationships with professionals, or due to the professionals lack of recognition to fathers’ special
needs and concerns (Keller & Honig, 2004).
628 L.A. Dardas, M.M. Ahmad / Research in Developmental Disabilities 36 (2015) 620–629

The sociocultural context can affect significantly how much benefit individuals perceive and expect when they ask for
social support. Some studies on fathers of children with disabilities (Gray, 2002; Kandel, Morad, Vardi, Press, & Merrick,
2004) have reported concerns about the social stigma associated with caring for children with chronic disabilities and its
negative impact on parents’ willingness to receive informal support from family and friends. Therefore, although fathers
reported using seeking social support as a coping strategy, the quality and types of their social involvements might alter the
role of this strategy in the stress–QoL relationship.

4.3. Distancing

Distancing was defined by Folkman and Lazarus (1988) as undertaking cognitive efforts to detach oneself from a stressful
situation and minimize its significance. The use of such coping response was considered by some researchers (Folkman &
Moskowitz, 2004) as an adaptive strategy, especially with chronic stressors such as those associated with raising a child with
disability. Nevertheless, it was the least reported paternal coping strategy in this study. It could be that fathers perceived the
distancing scale convictions as being not applicable to their lived experiences. Examples of such convictions include ‘went on
as if nothing had happened’; ‘refused to think too much about it’; and ‘tried to forget the whole thing’. Fathers might actually
apply distancing strategies but in other ways like talking about different subjects or be interested in someone else’s life.
To this end, we agree with Gray (2006) that coping with the stressors associated with the lifelong journey of raising a child
with autism is considered a complex and multidimensional process that changes over time and can yield a wide range of
positive and negative outcomes. Overall, further exploration in this arena is needed before claiming any final conclusion.

4.4. Where to go from here?

The results of this study provide research-based data on how to analyze a potential mediation or moderation effect of a
certain variable in an existing relationship. According to Wu and Zumbo (2008), researchers who use the methodology of
mediation and moderation can enhance a deeper and more refined understanding of potential causal relationships between
independent and dependent variables. However, before deciding how far these results can be generalized to the field of
autism, some limitations must be taken into account. In the first place, the cross-sectional data utilized in this study have
limited generalizability due to unknown pre-existing potentially relevant factors. Longitudinal studies are more helpful in
examining factors that may both enhance or hinder fathers’ coping over time. On the other hand, the meaning of coping with
having a child with autism for fathers warrant further research using qualitative designs. A replication of this study with
different designs may increase its generalizability and enhance stakeholders to establish effective programs for promoting
fathers’ coping responses and offsetting long-term stress effects. We agree with Keller and Honig (2004) that health
professionals, educators, counselors, and policy makers must understand the complex coping process of parenting stress in
order to claim the availability of appropriate paternal support services. On the other side, it continues to be important for
fathers of children with autism to find means to survive their lifelong journey.

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgment

The authors acknowledge the partial funding for this study provided by the University of Jordan.

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