Abstract
Autism spectrum disorders have adverse effects on family life. Based on this, this research was conducted with the aim of investigating the Effectiveness of Reality Therapy Based on Unconditional Positive Self-Acceptance on the Attitude towards Childbearing in Mothers of Children with Autism Spectrum Disorders. The present study was an experiment with a pretest-posttest design with a control group. The statistical population of the research was made up of all mothers of children with autism in Sari City in 2021-2022, from which a sample of 30 people was selected using the available sampling method and randomly divided into two groups (15 people in the experimental group and 15 people were placed in the control group. The people in the experimental group received reality therapy intervention based on unconditional positive acceptance for two months in 8 sessions of 60 minutes. The questionnaire used in this research included Soderberg et al.'s (2013) attitude scale towards fertility and childbearing. The results of the test showed that reality therapy based on unconditional positive self-acceptance has a significant effect on the attitude towards fertility and childbearing of mothers of children with autism spectrum disorders. Based on the findings of the present research, it can be concluded that reality therapy training based on unconditional positive self-acceptance, with the benefit of teaching appropriate methods for accepting reality and making moral and responsible choices, can be used as an efficient method to improve the attitude towards fertility and childbearing.
Keywords: Reality Therapy, Attitude to Fertility and Childbearing, Mothers, Autism Spectrum Disorders.
 
 
Extended Abstract

Introduction

Autism spectrum disorder is one of the neurodevelopmental disorders that leads to many problems in children's interactions and social behaviors in many fields (Diagnostic Guide, Statistics of Mental Disorders, 2020). Children with autism have major problems in social, communication, and language interactions (Morais, Major, Davlantis, Frantz, & Harris, 2018). In Iran, the prevalence of autism spectrum disorder in Iranian children is reported to be 10 per 10,000 people (Mohammadi, Ahmadi, Khaleghi, Zarafshan, & Mostafavi, 2019). Autism spectrum disorder, due to having several characteristics, such as having a diverse range of linguistic, communication, behavioral, and social abnormalities, as well as late diagnosis, can impose various psychological pressures on the child's family and relatives (Khoger, Nejad Farid, Ranjbar, Lotfi & Hakim Shushtri, 2019). Many parents, especially mothers, feel guilty about their autistic child, and accepting the reality is very difficult for parents (Zarafshan, Hakim Shushtari, Mohammadian, Zarei, Karimi, & Hoshangi, 2019). Research on parents of children with autism spectrum disorder shows that parents and especially mothers of these children experience high levels of stress compared to children with normal development and are at high risk of physical and mental problems (Barros, Mendez, Graziano, and Bagner, 2018). Mothers of a child with autism experience a complicated and very challenging life compared to fathers and mothers of other normal and exceptional children, and are less satisfied with their lives (Gabriel, 2018). A review of studies related to fertility decline in Iran shows that fertility decline in recent decades is closely related to structural and modernization factors, family developments, changing the value of children, changing childbearing patterns, producing and expanding family planning programs, improving women's status and increasing women's independence, economic factors, individual characteristics such as age, educational progress, etc. However, no research has been done on mothers with children with an autism spectrum disorder. Looking at different treatment methods, it can be said that Glaser's reality therapy is an approach that can be used for a wide range of subjects and people (Mason, 2016). Reality therapy is one type of therapy that increases responsibility and resilience (Glaser, 2000).
Research Question
Is reality therapy based on unconditional positive self-acceptance effective on the attitude towards childbearing of mothers with children with autism spectrum disorders?

Literature Review

In this regard, Ebrahimi and Ebrahimi (2020) found that reality therapy is effective in reducing rumination and anxiety in mothers of autistic children, and also increases the tolerance of mothers of autistic children. The results of studies by Alami et al. (2020) showed that educational intervention based on the theory of planned behavior can have an effect on the fertility intention of single-child women. Emamdoost et al. (2019) found that reality therapy is effective for the parent-child attitude of mothers of children with autism spectrum disorder. The research of Jamasian and Dukanei Fard (2017) showed that group reality therapy is effective in increasing life expectancy and improving the quality of life of infertile women. The results of the research of Popov, Radanovich, and Biro (2016) showed that there is a relationship between self-acceptance and mental health.

Methodology

The design of the current research was an experimental type with a pretest-posttest design with a control group. The statistical population of the study was made up of all mothers of children with autism in Sari City in 2021-2022. After obtaining the necessary permits to conduct the research, by referring to the specialized treatment and educational center for children with the autism spectrum in the city of Sari, 35 mothers with children with autism spectrum disorders were selected according to the entry and exit criteria. They were randomly placed in two experimental and control Groups (15 people in each group). First, all sample subjects in both groups responded to the fertility and childbearing attitude scale by Soderberg et al. (2013) in the pretest stage, and in the next stage, the experimental group underwent 8 sessions of 60 minutes (1 time per week) of reality therapy intervention based on positive acceptance. They received their unconditional support in the meeting hall of the Nik Andishan Center, and the control group did not receive any intervention. At the end of both groups, a posttest was performed. The intervention was also carried out by a psychologist. The inclusion criteria included mothers with single children with autism spectrum disorders and confirmed according to the records, files, and diagnostic opinion of a psychiatrist or psychologist, at least a diploma education, no use of psychotherapeutic drugs, or substance abuse. Also, the exclusion criteria included: the absence of more than two sessions.

Results

The results of data analysis showed that there is a significant difference between the two groups in the variables of child as a pillar of life, child as an obstacle, postponing fertility to the future, and fertility requiring the fulfillment of prerequisites. This means that the reality therapy package based on acceptance and commitment has been able to have a significant impact on the components of the child as the pillar of life, the child as an obstacle, postponing fertility to the future, and fertility requires the fulfillment of the prerequisites of mothers of children with autism spectrum disorders. The amount of effect of the reality therapy package is based on acceptance and commitment to the amount of child as a pillar of life, child as an obstacle, postponing fertility to the future, and fertility requires the fulfillment of the prerequisites of mothers of children with autism spectrum disorders, respectively 0.612, 694. 0, 0.718, and 0.736. This means that 61, 70, 72, and 74 percent of the changes in the variables of a child as a pillar of life, child as an obstacle, postponing fertility to the future, and fertility require the realization of the backgrounds of mothers of children with autism spectrum disorders by presenting the independent variable (closed reality therapy based on acceptance and commitment).
 
 
Table 1. The results of covariance analysis of the effect of reality therapy package based on acceptance and commitment on the attitude towards fertility and childbearing of mothers of children with autism spectrum disorders




Effect size


P


F


Mean squared value


df


sum of squares


Source of change






0.852


<0.001


90.540


5785.961


2


11571.922


Modified pattern




0.728


0.123


7.888


1


7.888


Pre-test effect




<0.001


154.857


9896.170


1


9896.170


The effect of the independent variable




 


 


63.905


27


1725.445


error




 


 


 


30


118555


Total





Discussion

 The present study was conducted with the aim of the effectiveness of reality therapy based on unconditional positive self-acceptance on the attitude towards childbearing of mothers with children with autism spectrum disorders. The results showed that reality therapy based on unconditional positive self-acceptance has a significant effect on the attitude towards fertility and childbearing of mothers of children with autism spectrum disorders. This means that this education can lead to improving the attitude towards having children.

Conclusion

Reality therapy is based on control theory and assumes that people are responsible for their own lives and their actions, feelings, and behavior. This can certainly lead to a reduction in negative emotions among women who have children with neurodevelopmental disorders (Jamasian and Dukanei Fard, 2017). In the present study, it was tried to encourage women to express their feelings and share their experiences in the group, while helping to release emotions and discover dysfunctional beliefs by giving correct information to improve cognition and correct cognitive errors, and to provide strategies to manage emotions and conditions, and introducing the available options with informational and social support to improve the ability and awareness and to find a better attitude towards fertility and childbearing.
Acknowledgments
The current research is taken from the doctoral thesis of the first author of the research with a code of ethics (IR.IAU.SHAHROOD.REC.1401.075); we hereby express our gratitude to all the mothers present in the research who cooperated fully in the implementation of the research.