الفهرس 
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Abstract
Summary
Autism spectrum disorder (ASD) is a
neurodevelopmental disorder characterized by impaired
social communication and social interactions with unusual
responses to stimuli, restricted interests, and repetitive
behaviors. Children with ASD have complex care needs
and require a range of integrated services, including health
promotion, personalized care, rehabilitation services, and
collaboration with other sectors, such as the educational,
occupational, and social sectors (Costa, Steffgen &
Ferring, 2017).
Caregivers of children with ASD reported more
negative impact and poor psychological wellbeing. They
appear to be at great risk for depression, stress, anxiety and
distress. Also, Family caregivers of these children have to
spend much energy and patience in managing the child’s
behavioral, emotional and health problems. They face
different challenges arising from necessity of dealing with
social consequences of the disabilities like potential threat
of stigmatization (Townsend, 2015).
Expressed emotion (EE) is a construct used to
measure the emotional climate within families. EE is of
interest to researchers in the field of autism spectrum
disorder (ASD) because of its putative implications for
child development (Ayilara, Ogunwale & Babalola,
2017).
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102
Hence, it’s important to examine EE because
negative dimensions of EE have been associated with the
behavior problems of children with ASD, and expressions
of warmth were associated with reductions in behavior
problems and increase social interaction and
communication over time (Romero-Gonzalez, Chandler
& Simonoff, 2018).
A nurse can be a competent care-provider for an
autistic child, an instructor for the family members, and
counselor of the people about autism. The nurse can also be
a partner with the physician, psychologist, therapist, and
school teachers, and a researcher conducting studies on
autism. Also, the nurse has significant role in improving
quality of the family- child relationship (Benger, Kinali &
Mazarakis, 2018).
Aim of the study:
This study aims at assessing expressed emotions
among family caregivers of children with autism.
Research Question: -
This study is based on answering the following question:
What are the levels expressed emotions of the family
caregivers of children with autism?
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103
What are the attitudes of family caregivers toward their
children with autism?
What is the relation between family attitude and levels
of expressed emotions among family caregivers of
children with autism?
Subjects and Methods:
The study will be portrayed under four main designs as
following:
Technical design:
The technical design includes research design,
setting, subjects and tools of data collection.
A. Research design: A descriptive explanatory design was
used in this study to assess expressed emotions among
family caregivers of children with autism.
B. Setting: This study was conducted in the outpatient
clinic of the Institute of Psychiatry affiliated to Ain
Shams University.
C. Subjects of the study:
A purposive sample of 100 family caregivers of children
with autism was selected according to certain inclusion
criteria.
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104
Inclusion criteria for children with autism:
Child diagnosed with autism.
Age: Preschool and school age children (3-12years).
Gender: Both sex (males and females).
Free from other neurological or psychiatric diseases or
handicapped.
Attended the previously mentioned setting regularly.
Inclusion criteria for the family caregiver of children
with autism:
Family member who give direct care to the child and
stay within the same home.
Sex: from both sex (males and females).
Free from any psychiatric disorders.
Educational level: all educational level and different
socioeconomic status.
Willing to participate in the study.
Tools of data collection:
I. Socio-demographic sheet: (Appendix I)
It was designed by the researcher after reviewing
related literature to assess socio-demographic data of both
family caregivers and children with autism and it was
divided into two parts:-
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105
A. First part: (Socio Demographic Data of children with
autism): included data related to socio demographic
characteristics of children with autism such as; age, sex,
education, rank and duration of the disease.
B. Second part (Socio Demographic Data of Family
Caregivers of children with autism): included data
related to socio- demographic characteristics of family
caregivers such as; age, sex, address, level of education,
occupation, monthly income, relation to child, and
history of autistic disorder within the family
II. The expressed emotions scale EES “Appendix II”:
It was developed by Cole & Kazarian (1988) and
adapted by the researcher to assess the level of expressed
emotion among family caregivers of children with autism.
It is consisted of three parts including: (Hostility, criticism,
and over involvement), which are represented at 36
statement the hostility composed of 13 items, criticism
composed of 9 items and over involvement composed of 14
items.
III.The family attitude scale (FAS) “Appendix III”:
It was originally developed by Kavanagh et al,
(1997) and adapted by the researcher to assess family
attitude among family caregivers of children with autism.
After adaptation of this scale, it was divided to 13 items
based on at three points (always - sometimes - never).
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106
The findings of the study can be summarized in the
followings:
Concerning socio-demographics data of children with
autism, shows that, nearly half (49%) of children with
autism their age ranged between 3 - <8years with mean
age of studied children was 6.99±3.78 year. As regard to
gender, two thirds (67%) of the studied children were
male. nearly two thirds (62%) of them were neither read
nor write and didn’t attending training course about
behavior modification
Concerning socio-demographic data, the study revealed
that more than half (57%) of the studied caregivers of
child with autism were the mothers &the majority of
them (82%) were married and more than half (57%) of
them were not working. Regarding to their monthly
income, it was found more than half (52%) of them were
having inadequate income.
As regards total levels of EE, the majority (81%) of the
studied caregivers had high levels of expressed
emotions. While, less than one fifth (18%) of them had
low levels of expressed emotions.
The majority (83%) of the studied caregivers always
represents a real burden on them. While, four fifth
(80%) of the studied caregivers always have difficulty
dealing with their children.
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Nearly three quarters (72%) of the studied caregivers
had negative attitude towards their children with autism.
While, only (28%) of them had positive attitude toward
their children with autism.
It was found that there was a high statistically
significant relation between total level of expressed
emotion of the studied caregivers and their age, marital
status and educational level.
High statistically correlation between attitude of the
studied caregivers of children with autism and their
total expressed emotions levels.
Conclusion
The result of the present study concluded that, nearly
half of children with autism their age ranged between 3 -
<8years and two thirds of them were male. Also, more than
half of the studied caregivers of children with autism were
their mother &the majority of them were married. Regards
caregivers age it was found that more than half were in age
ranged between 20-<35years. The total levels of expressed
emotions among the majority of the family caregivers of
children with autism under study were high and the most
affected component of EE is over involvement followed by
hostility and criticism. Nearly three quarters of them had
negative attitude toward their children with autism. Also, this
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108
study concluded that there is a highly statistical correlation
between attitude of the studied caregivers of children with
autism and their total expressed emotions levels.
Recommendations
Based on the findings of the study, the following
recommendations are suggested:
Utilization of our study results in designing and
implementing counseling program for family
caregivers of children with autism to management of
high expressed emotion.
Future research should be focus on the effect of family
expressed emotion on the children behavior and their
progress.
It is necessary to increase family caregivers’ awareness
regarding autism, through media to remove stigma,
misconception, fear and anxiety which surrounding it.
Establishment of counseling clinics for family
caregivers of children with ASD to improve their
expressed emotions.
Educational program should be provided for nurses
about how to enhance EE among family caregivers of
having children with AS