Exploring Parental Motivations for and Consequences of Having a Subsequent Child After an Autism Diagnosis in Türkiye

An autism spectrum disorder (ASD) diagnosis in a child may be an important factor influencing parents in choosing whether to have or not to have a subsequent child. In this descriptive observational study, we aimed to investigate parental motivations for and consequences of having a subsequent child after an autism diagnosis. This study was conducted in a university hospital child and adolescent psychiatry department. A total of 91 subjects (male, n = 72) aged 3 to 22 (10.70 ± 4.60 years) diagnosed with ASD having at least one younger sibling were included in the study. Parents were explored for motivations for and consequences of having a subsequent child after autism diagnosis by using detailed interview form developed by the authors for this study. Parents were also asked to fill out Zarit Caregiver Burden Scale. Source of informants were mostly mothers (84.6%, n = 77). Most of the children with diagnosis of ASD were first born (82.4%, n = 75). A significant proportion of parents (79.1%, n = 72) reported that they were aware or suspected of a psychiatric condition in their child with ASD before the subsequent pregnancy. Definitive diagnosis of ASD had already been established or was in the process of being confirmed in 73.6% (n = 67) before the subsequent pregnancy. Of the respondents completed the survey (n = 58/91), 20.7 percent (12/58) reported their subsequent pregnancy as unintended. The most commonly reported motivations in intended pregnancies (n = 46) were: "to make friendship with the affected older sibling" (76.1%, n = 35), "to help care for the sibling with ASD" (54.3%, n = 25) and to have a healthy child (39.1%, n = 18). Among the parents with intended pregnancies, parents with ASD-related motivations (n = 40) were significantly more likely to have a first-born child diagnosed with ASD compared to those with non-ASD-related motivations (n = 18) (95.0% vs. 72.2%, p = 0.014). Parents with ASD-related motivations were more likely to believe their child would require lifelong support (62.5% vs. 33.3%, p = 0.039). Majority of the parents (67%; n = 61) reported perceiving at least some disruption in the overall care of their affected child after having another child. Caregiver burden scores, as measured by the Zarit Caregiver Burden Scale (ZCBS) did not differ significantly between the groups (mean = 38.05 ± 15.14 for ASD-related motivation vs. 42.38 ± 15.56 for non-ASD-related motivation, p = 0.443). Exploring parental motivations, awareness and consequences of having a subsequent child after autism diagnosis may be an important issue in clinical practice. This may have significant implications in decision making of the parents and clinical management of children with ASD and their families.