نوع مقاله : مقاله پژوهشی
عنوان مقاله English
نویسندگان English
Abstract
Autism is one of the most pervasive neurodevelopmental disorders, significantly impacting both patients and their caregivers. When a child is diagnosed with autism, it can lead to numerous challenges and emotional struggles for caregivers, particularly mothers, making it difficult to accept the child's condition. However, some mothers manage to accept their children with these challenging conditions and remain committed to their care. This research is a qualitative phenomenological study using thematic analysis to investigate the worldview of mothers who exhibit high acceptance of their autistic children. Data was collected through semi-structured interviews with nine mothers of autistic children. These mothers were selected through purposeful sampling, and the sampling continued until the responses reached saturation. The findings revealed that the worldview of the participating mothers encompasses three dimensions: a finite world, infinite life, and death anxiety. This type of worldview involves grappling with concepts such as fear of the future, the transience of life, and preparation for death. These factors significantly influence how these mothers accept and adapt to their children's condition.
Introduction
Autism Spectrum Disorder (ASD) is one of the most pervasive neurodevelopmental disorders, significantly impacting both patients and their caregivers. When a child is diagnosed with autism, it can lead to numerous challenges and emotional struggles for caregivers, particularly mothers, making it difficult to accept the child's condition. Families, as the primary environment where members influence one another, experience significant changes in family structure when a child with autism is born, creating new responsibilities and challenges (Jassim, Baron-Cohen, & Suckling, 2021). Parents of autistic children face numerous challenges and experience significant psychological distress, including anxiety, confusion, and worry, placing them in states of uncertainty and helplessness (Sato et al., 2022).
Acceptance represents a coping strategy for mothers of children with autism (Caletti et al., 2022). Acceptance of conditions and living alongside them plays a significant role in increasing the resilience of these parents. In Acceptance and Commitment Therapy (ACT), acceptance is defined as "actively embracing a person's experience of a situation or event without attempting to control ineffective behaviors" (Graaf et al., 2021). Acceptance occurs when emotions are experienced as they are, without attempts to change the process or form of those experiences (Zhao et al., 2020). In therapy based on acceptance and commitment, the function of psychological experiences such as thoughts, feelings, memories, and emotions is targeted, and individuals pursue meaningful life activities aligned with their values. Individuals accept what is beyond their control and commit to actions that enrich their lives (Xu, O'Brien, & Chen, 2020).
A critical question concerns the factors that contribute to acceptance and commitment. What causes some individuals to demonstrate greater acceptance and commitment to difficult life events than others? One determining factor is the individual's worldview—their general perspective on existence and life. Worldview represents an individual's overall outlook on existence, encompassing fundamental questions about humanity's place in the universe, the nature of being, and ultimate reality (Afkari, 2020). Each person possesses a set of mental structures organized into beliefs, values, knowledge, traditions, and habits. The subsets of thought related to a particular idea reveal a person's worldview (Kourti, 2021). For instance, the concept of worldview in philosophy addresses questions such as whether the world is a random phenomenon or governed by causality, what kind of laws it follows, whether the world has a purpose, and whether it is finite or infinite (Afkari, 2020).
Acceptance serves as the core of ACT and achieving a desirable life requires precise identification of changeable and unchangeable aspects of individuals' existential lives. When individuals cease their futile efforts to combat or escape undesirable and inevitable aspects of life, the path for fundamental change in changeable matters becomes smoother (Ahmadian & Tehranchi, 2025). In the Islamic worldview, suffering has specific philosophical purposes. Some sufferings are direct consequences of human errors and can be resolved through behavioral correction, while others serve as expiation for sins (Mohammadi, 2009). However, given the importance of existential themes in enhancing the concept of acceptance among mothers of autistic children, this therapy can transform mothers' worldview through understanding suffering as part of human existence. One of ACT's core concepts is identifying values as worldview—values consciously and purposefully chosen by individuals, which have relative stability in their worldview and enhance their capacity to solve problems when they act according to them (Hayes et al., 2006). Despite the importance of acceptance and the need to understand its mechanisms in mothers of autistic children, very limited research has examined the factors contributing to acceptance. Most studies have quantitatively examined the effectiveness of conventional ACT interventions, while acceptance and commitment may differ in these mothers. Additionally, quantitative studies are unable to deeply explore this phenomenon, and qualitative studies can better investigate this process. This research aims to qualitatively examine the worldview of mothers of autistic children with high acceptance.
Research Methodology
This qualitative descriptive phenomenological study utilized Colaizzi's seven-step method. The research focused on mothers of children with autism, selected through purposive sampling based on inclusion criteria including high acceptance levels (scores above average on the Acceptance and Action Questionnaire-II; Bond et al., 2011), minimum education level of high school diploma, and having a child with autism over 35 years of age. Exclusion criteria included history of specific physical-mental illnesses and having more than one child with special needs. The minimum education level was set to ensure mothers could adequately understand and respond to interview questions. Sample size was determined by data saturation, achieved after interviews with nine participants. Data were collected through semi-structured interviews lasting approximately 45 minutes each, conducted in a secure therapeutic setting at an autism rehabilitation clinic in Abadan, Iran. Interviews were audio-recorded with participants' written consent.
Interview questions explored various aspects of worldview, including acceptance of the child's condition, understanding of acceptance and commitment, attitudes toward life, purpose of the world, and perceptions of finiteness and infiniteness. A pilot study with three participants led to question revisions. The interview guide consisted of 12 questions validated by eight experts in relevant fields (content validity ratio > 0.75). Data were analyzed using thematic analysis through open, axial, and selective coding following Strauss and Corbin's (1990) grounded theory approach. For trustworthiness, member checking was conducted with participants, expert review by specialists in clinical psychology, qualitative research, and Islamic studies was performed, and the research process was audited by knowledgeable supervisors to ensure credibility and dependability.
Discussion
Finite World
The worldview of mothers with high acceptance encompassed the concept of a finite world. This theme included four sub-themes: the transience of the world, the world as a passageway, the insatiability of worldly greed, and the existence of suffering in life. Participants expressed a deep understanding of the temporary nature of worldly life. One participant stated: "I think this world is smaller than what could fulfill human desires. As people get older, they realize many things in this world are fleeting and not worth running after" (Participant 2). Another noted: "This life is a test and has no eternity; the world is a transient thing" (Participant 8). This understanding helped mothers view their children's difficult conditions as a bridge toward growth and self-improvement. The recognition that the world is a passageway to the afterlife allowed mothers to see their hardships as meaningful and purposeful. One participant shared: "Since my child was diagnosed with autism, even though my pain has increased, my trust in God has also increased. I tell myself that God must love me because He gave me this child to get closer to Him" (Participant 1).
The concept of insatiability of worldly greed highlighted how mothers recognized that excessive attachment to worldly desires prevents spiritual growth and acceptance. Participants expressed that greed leads to distance from God and feelings of emptiness. The presence of suffering in life was understood through Quranic teachings, particularly the verse "We have certainly created man in hardship" (Quran, 90:4). This understanding enabled mothers to develop greater resilience and acceptance of their circumstances. One participant explained: "Everyone has difficulties in life. I think these hardships make me a better mother" (Participant 4). This perspective aligns with existential psychology, which emphasizes that meaning-making through suffering is essential for psychological well-being (Frankl, 2017; Yalom, 2016). The mothers' worldview reflects a religiously grounded existential framework that transforms suffering from meaningless pain into purposeful growth opportunity.
Infinite Life
The second major theme was infinite life, encompassing seven concepts: acceptance of death, true life after death, seeing beyond the afterlife world, death as eternal peace, receiving feedback from actions and behaviors, preparation for death, and death as a healing force. Participants demonstrated acceptance of death as an undeniable reality. One participant stated: "Death is a truth, just like eating and being born. We didn't come to this world by our own will, and we don't know when we will leave" (Participant 5). This acceptance enabled them to focus on making the most of their present circumstances with their children.
The concept of true life after death provided mothers with existential motivation and meaning. A participant expressed: "When a person thinks about their relationship with God and realizes that the real place is elsewhere, that eventually we will die and meet God, it gives them motivation in this world to try to show their best self" (Participant 2). The understanding that death is not an end but a transition to a more expansive existence helped mothers reframe their current difficulties as temporary. Another participant noted: "Death is like sleep, eternal peace. When you sleep, how comfortable you become. Sleep is a temporary death. Death is the same; when you die, you become free from all life's worries" (Participant 5).
The belief in receiving feedback from actions and behaviors created a sense of accountability and purpose. Participants recognized that how they treated their children and others would have consequences beyond this life. One participant explained: "Life is planting and harvesting. Others plant and we harvest, and we plant and after us, others harvest. Our parents worked hard for us, now we must work hard for our children" (Participant 5). This understanding motivated them to invest meaningfully in their relationships and caregiving. Preparation for death was viewed as an ongoing process of moral and spiritual readiness. A participant described: "Death is a journey from this world. We are just guests here. Just like when you temporarily go to someone's house, you maintain respect and dignity because you will return to your own home. A person's real home is their grave, so we should be good guests in this world" (Participant 7). This perspective transformed death from a feared endpoint to a meaningful transition that gives purpose to present actions.
Death Anxiety
The third major theme was death anxiety, encompassing three concepts: fear of death, worry about the future, and feelings of guilt. While mothers had generally accepted death as a reality, they experienced anxiety related to specific concerns. Fear of death was present but not debilitating. One participant stated: "One of my fears, like other mothers, is what will happen to my child after my death. But when I think about God's mercy, I'm confident He won't abandon my child" (Participant 1). The primary source of death anxiety was worry about the future of their children, particularly their autistic child's well-being and care after the mother's death. Another participant expressed: "I don't fear death; I only fear my children being alone. Only my children's loneliness worries me" (Participant 6). This concern reflects the profound attachment and responsibility mothers feel toward their vulnerable children. Additionally, some participants expressed guilt about past actions and the potential consequences after death. One participant noted: "My fear of death is about what I've done that I'll have to answer for. I'm afraid of the rights of others that remain on my shoulders" (Participant 9).
The findings demonstrate that death anxiety in these mothers was primarily other-oriented (concern for dependents) rather than self-oriented (fear of personal extinction). This pattern aligns with Yalom's (2016) existential psychotherapy framework, which identifies death anxiety as a fundamental human concern. The mothers' ability to accept death while maintaining appropriate anxiety about their children's future reflects a balanced and functional worldview. The existential challenges these mothers face—including the finitude of life, the inevitability of death, and the responsibility toward dependents—are processed through a religiously grounded worldview that provides meaning, purpose, and coping resources. Their acceptance of their children's condition appears to be supported by a coherent belief system that integrates suffering, mortality, and meaning into a framework that enables adaptive coping and psychological resilience.
Conclusion
This qualitative study examined the worldview of mothers of children with autism who demonstrate high acceptance. The findings revealed that their worldview encompasses three main themes: finite world, infinite life, and death anxiety. The finite world theme included concepts of transience, the world as a passage, insatiable greed, and the existence of suffering. The infinite life theme included acceptance of death, true life after death, seeing beyond the afterlife, death as eternal peace, receiving feedback from actions, preparation for death, and death as a healing force. The death anxiety theme included fear of death, worry about the future, and feelings of guilt.
The findings highlight that worldview significantly influences how mothers perceive and cope with hardships and challenges. The mothers' religiously grounded worldview enabled them to find meaning in suffering, accept their children's conditions, and commit to their care. The integration of existential and spiritual perspectives provided a framework for understanding suffering as purposeful, death as a transition, and life as meaningful within a broader cosmic context. This worldview, characterized by the recognition of worldly transience combined with belief in eternal life, appears to facilitate acceptance and psychological adaptation.
The findings have implications for therapeutic interventions. Interventions based on ACT, when integrated with attention to individuals' worldviews and spiritual beliefs, may be particularly effective for mothers of children with autism. Understanding and addressing existential concerns, including death anxiety and the search for meaning, should be incorporated into therapeutic approaches for this population. The study's limitations include the limited geographic scope, the lack of control for variables such as spousal support and child autism severity, and the exclusion of mothers with lower education levels. Future research should examine worldview in mothers of children with other neurodevelopmental disorders, compare findings across different cultural contexts, and develop and evaluate interventions targeting worldview-related factors to enhance acceptance and well-being in mothers of autistic children. Additionally, quantitative instrument development based on the identified worldview components could facilitate larger-scale research and clinical assessment in this population.
کلیدواژهها English