This pilot DQA of couple crisis and resilience while raising an autistic child examined Skerrett’s (2015) hypothesized characteristics of resilient couples within the Double ABCX (McCubbin & Patterson, 1983) process model of crisis and adaptation. Findings from deductive analysis support the overall utility of the Double ABCX model and Skerrett’s conceptualization of couple resilience to understand the experiences of couples in adversity. Inductive analysis also revealed a few additional elements and adaptations that may better fit the experience of couples raising autistic children specifically. Inductively derived elements included a coping process marked using unconscious psychological avoidance by those in the narrow form of resilience (a strengths-based term modifying the traditional term, “maladaptation”). Inductive critical discourse analysis added key contextual elements to the integrated model portrayal of stressors, meaning making and coping. Specifically, on the surface, couples described autism, and stressors associated with it, as their primary adversity (i.e., “a storm”). However, critical analysis of the “storm” revealed underlying social structures that sanction ableism and privilege neurotypical development that position families, communities, and couples to see autism as the problem. This led us to conclude these underlying neuro-normative social structures act as a root of the adversity experienced by couples. This addition to the Double ABCX model and Skerrett’s conceptualization of resilience was a key inductive finding. The modified, integrative model is further discussed below considering existing literature.

Support for the Double ABCX ModelA—Stressors/Double A—Stressor Pile-Up

Stressors experienced by parents raising autistic children is well documented (e.g., Chan & Leung, 2020; Hartley et al., 2018; Ramisch, 2012; Saini et al., 2015). Research also shows that stress associated with parenting does not typically decline with intervention (Raffaele Mendez et al., 2019), but it can pile up without it. Thematic analysis from a recent study by Lee et al. (2013) used interviews after sessions one through three of EFCT and showed couples with an autistic child experienced a common struggle to remain connected emotionally through caregiving demands, a theme reflected by couples in our study as well. Our results also align with their third thematic finding of couples’ experiences of alienation and isolation (Lee et al., 2013).

B—Resources and the Ability to Use Them/Double B Integrating New Resources

With all 10 partners identifying as Christians, a key theme that emerged in this study was the role of personal spirituality and faith, which provided a helpful resource for several couples. Personal faith often acted as a grounding force, offering comfort, resilience, and a sense of purpose amidst the overwhelming challenges they faced. For example, Couple 3 demonstrated a faith-based acceptance, stating their belief that their children, despite their challenges, were “created in the image of God,” which gave them strength and determination in their caregiving roles. This sense of spiritual meaning helped them persevere despite immense adversity. This aligns with extant literature that has highlighted how a spiritual viewpoint can help people see otherwise unseen aspects of adversity as potentially beneficial and useful for growth (Stewart-Brown, 2018; Walsh, 2021).

However, while personal faith often served as a stabilizing and supportive resource, the broader systems of organized faith communities (e.g., churches) were not always helpful. Instead, church and community faith systems frequently compounded the stress for couples, largely due to a lack of understanding or awareness about autism and the unique challenges neurodiverse families face. For instance, Couple 3 was also forced to pull their children out of Sunday school and ultimately leave their church due to inadequate support for their autistic child’s special needs. This painful experience highlights the discrepancy between the supportive nature of personal spirituality and the barriers posed by religious communities unequipped to meet the needs of families with neurodiverse children, a finding consistent with literature examining autism, Christianity, marriage, and family (Holmes, 2023; Moerschbacher, 2019). In this way, the ability to utilize faith as a resource was dependent on whether it was drawn from personal beliefs or community-based support systems. Other resources couples in our study promoted as important to them included having a shared commitment to their marriage (informed by their faith for many), finding ways to effectively communicate, and using online or in-person couples’ support groups (formal and informal, often through church programs). This echoes findings from research on how couples parenting autistic children maintain their marriage (Ramisch et al., 2013a, 2013b) as well as broader family resilience literature (e.g., Walsh, 2021).

C—Perceptions of Stressors/Double C—Meaning-Making Over Time

Our participants reported not only engaging in meaning-making processes at home but also demonstrated it during research interviews, echoing previous findings (Johnson & Piercy, 2017; Lee et al., 2013; Romney et al., 2020). Couples in Lee et al.’s (2013) study reported engaging in a meaning-making process to redefine what “normal” looks like, Johnson and Piercy (2017) noted cognitive, meaning-making shifts necessary for negotiating intimacy, and Romney et al. (2020) found couples finding meaning through togetherness, religion and faith communities, having an attitude of adaptability, prioritizing marriage, and good communication. However, these studies did not account for the influences of broader social discourse around neurodiversity that shapes meaning-making processes, a contribution unique to our study. Similarly, our analysis revealed neuro-normative assumptions underneath the hidden bias most (i.e., 7 out of 10 partners) held toward autism. These couples often perceived autism through a deficit-based lens, framing it as an issue that disrupts their expectations of “normal” family life. This framing points to a societal tendency to pathologize neurodiversity (Gaddy & Crow, 2023). Such views were not confined to those explicitly critical of autism; even those who expressed acceptance of their child’s diagnosis still adopted language that positioned autism as a challenge to be “managed.” These findings suggest societal pressures to conform to neuro-normative ideals may play an important role in shaping how couples make meaning of their experiences (Gaddy & Crow, 2023).

X—Crises

The study also confirms the stressor pile-up faced by couples, including financial strain, lack of family support, and navigating the complexities of therapies for their autistic children, which is reflected in other studies on autism (e.g., Peacock et al., 2012; Ramisch, 2012) and in family stress literature (e.g., Walsh, 2021). The overlap between stressors related to autism and external pressures, such as the expectations of extended family members, health concerns, or lack of appropriate professional support, all contributed to the perception of being overwhelmed. This pile-up of stressors seemed to exacerbate crises in the couple relationship, as reflected in vivid descriptions from participants, such as “we’re running on empty” or “somebody who fell overboard and is drowning.”

Double X—Adaptation Responses

A key feature of Skerrett’s (2015) conceptualization of couple resilience and an aspect of the positive adaptation response described in the Double ABCX model is the ability to reintegrate relational wisdom gleaned from challenging experiences. In describing this process, Skerrett (2015) said “Resilient reintegration…requires the ability to identify, access and then reinforce adaptive responses-all of which rely on reflective capacities” (p. 14). We saw this form of resilience in Couples 2 and 4, marked by their use of psychological flexibility and mutual awareness of themselves as both individuals and as a couple. This reflets past research where couples parenting autistic children made cognitive shifts as part of their adaptation process (Johnson & Piercy, 2017; Romney et al., 2020). We saw a broadening of reflective abilities in Couples 1 and 3 (and Couple 5 to a limited degree) as the research interview progressed, suggesting a possible secondary benefit of participating in research which provides opportunities for reflection that couples might not otherwise engage in.

Implications for PracticeRecommendations for Faith Communities

Our results concur with existing literature that churches have historically been undertrained and underequipped to support those with relational and mental health needs (e.g., Clinton, 2017; Holmes, 2023; Moerschbacher, 2019). Church leaders could benefit from making use of the resources cited here, starting with Clinton (2017), as they discern how to best support autistic families in their communities. One thing extant literature highlight is the importance integrative systemic care for couples parenting autistic children (Raffaele Mendez et al., 2019). There is especially a need for strengthening community relationships between churches and knowledgeable providers for these families. Our findings support the utility of building more connections between churches and systemic therapists well-trained in autism to help churches meet the needs of these couples and families. Collaborative relationships can support churches in developing a more supportive infrastructure such as by devising personalized plans, like EAPs, to help churches navigate nuanced needs. Other possibilities include providing additional training and compensation to one or a few people, depending on the size of congregations, to serve as individual support for autistic children and adults who require a higher level of support.

Brief, Strength-Based Approaches to Support and Intervention

Our findings suggest couples parenting autistic children may benefit from brief, strengths-based support for their parenting and relationship to build resilience rather than a deficit-based perspective on the family (as supported by Walsh, 2021). One caregiver training program has been examined as a resource for promoting resilience among couples raising autistic children (Raffaele Mendez et al., 2019). In the brief training program consisting of four sessions, participants created a shared mission statement, practiced effective dyadic communication skills, received research-based psychoeducation on coparenting, and learned how to use optimism and humor to combat stress (Raffaele Mendez et al., 2019), elements our participants shared would be helpful to them. Raffaele Mendez and colleagues’ (2019) study also highlights the benefit of group intervention, which can increase couples’ and families’ social systems with others who understand their lived experiences, something our participants also discussed would be supportive.

In terms of couples’ treatment, solution-focused brief couples therapy (SFBCT) has been examined for its effectiveness with couples raising autistic children with good success in a pilot study (Turns et al., 2019, 2022). Using a small-sample research design, Turns et al. (2019) conducted six sessions of SFBCT with couples and interviewed them about their perceptions of the helpfulness of the approach throughout the therapy process (Turns et al., 2022). Findings from the brief treatment intervention (Turns et al., 2019) support SFBCT as an effective approach with couples raising autistic children. Qualitative findings showed the intervention increased couples’ hope for the future of their relationship and for their autistic child and helped couples reimagine solutions that were not about curing their child’s autism but more about accepting and loving the child they have (Turns et al., 2022). These findings align with those of this study that underscore the importance of building hope for the future to combat hopelessness and desperation as well as helping couples revise their perceptions of autism as “the problem.” Together with the literature, our findings suggest treatment that is brief, optimistic, and focused on building resilience, strengths, and hope has great potential to meet the unique needs of couples parenting autistic children.

Finally, constructivism (Gergen, 2009, 2015) suggests how we speak about neurodivergence generally and autism specifically shapes how we experience and navigate the challenging conditions that often come with autism. For couples struggling with the complexities of their child’s autism, constructivism proposes helping them speak and think about neurodivergence in more accepting and strength-based ways can help them cope better with the associated challenges and adapt in more growth-focused ways.

Teletherapy or In-Home Services

Not only is it important to consider brief therapy that builds hope, strength, and resilience, but it is also important to consider what kind of treatment setting gives these couples the best chance of receiving such intervention, especially rural couples. Several participants in our study discussed the difficulty of going to therapy individually or as a couple due to constraints on time and scheduling, finding suitable childcare, and providers who accept their insurance. One way to help mitigate several of these barriers is to provide in-home therapy or teletherapy for the couple or individual partners. When using in-home or tele-therapy, clinicians should keep in mind several considerations. As described by our participants, autistic children and even teenagers may not be able to self-occupy for the entire duration of a session, so the structure of sessions needs to be flexible to accommodate potential interruptions. Clinicians could consider building in breaks.

Some research has examined home-based multi-systemic family therapy (Hammond & Czyszczon, 2014) and, more recently, in-home brief couple therapy (Lenger, et al., 2020) for a general population. In Lenger et al.’s (2020) study, parents were more likely to select home-based intervention than non-parents, and three-level multilevel modeling results suggest that despite the added chaos of a home-based setting, home settings appear to be just as effective as traditional settings for brief interventions. Brief, home-based intervention for socially disadvantaged families raising an autistic child was recently examined in the UK over a four-year period (Mullan et al., 2021). Participants were offered five in-home visits of 90 min each, and intervention took the form of individualized, practical tools and support to manage their children’s behavior. Intervention also involved listening to parents’ concerns. Participants reported high satisfaction with the program and gauged its length (five sessions) to be “just right.” Evaluations of the project suggest brief home-based intervention is a viable and effective means for providing post-diagnostic support to families at periodic intervals.

Only one study could be found specifically attempting in-home couple therapy with couples raising autistic children (Ramisch et al., 2013a, 2013b). These researchers conducted a qualitative study examining the experiences of three couples of at least one autistic child with in-home Emotionally Focused Couple Therapy (EFCT; Ramisch, et al., 2013a, 2013b). They utilized interviews of the participants’ experiences with the study to evaluate EFCT’s strengths and weaknesses. All three couples showed improvement, reported appreciating the in-home therapy sessions, and said they would not have participated if the sessions had been held in a clinic. A more recent pilot study examined the effectiveness of EFCT in a traditional setting over 12 sessions with seven moderately to severely distressed couples raising an autistic child (Lee et al., 2013). Researchers also reported difficulty recruiting enough qualifying participants to have a waitlist control group. Though not explicitly identified in their implications for treatment, participation might have been higher in a more flexible treatment environment such as in-home. Despite the small sample size, results showed a significant decrease in distress at posttreatment and at 6 months follow-up.

Together, this small body of research supports the need for integrative systemic care, in-home intervention, brief intervention, and/or group-based intervention for couples raising autistic children. These could be considered more by practitioners who work with or desire to work with this population. When in-home intervention is not possible for practitioners, they could consider the use of telehealth through videoconferencing (TVC), which can help people who experience barriers to seeking treatment (Gulliver et al., 2010). Before utilizing TVC, practitioners should receive prerequisite training, so they are competently equipped to work with couples and families generally in a virtual setting (Wrape & McGinn, 2019). Pertinent to this population, when in-home TVC sessions are interrupted by autistic children or day-to-day activities, discuss with the family the need to create a space for therapy or attend as if they are “in office” and gently but assertively set boundaries that coincide with the informed consent process (Wrape & McGinn, 2019). As nonverbal cues are more often missed virtually than in-office, recommendations also include using more verbal cues, using names more frequently to signal family members, and gathering more verbal feedback than typical in an in-office setting.

Limitations and Future Research

Small sample research designs with homogenous samples always carry limitations for generalizability (Bates & Appelbaum, 2014). This limitation extends to our pilot study as well. While small sample designs are useful and important for studying issues that impact special populations (Winter et al., 2018), such as couples parenting autistic children in rural towns, our conclusions must remain tentative and localized to the White, heterosexual, Christian married couples who participated in this study. Though we cannot say for certain that our participants’ experiences map onto those of other couples raising autistic children, our analysis does point to important areas for future research. This includes seeking a culturally heterogenous sample and documenting and exploring other relevant factors like SES, insurance type, and racial differences in couples’ experiences (Douglas et al., 2017; Zeleke et al., 2019).

Next is the need to further investigate how language use shapes couples’ experiences of stress in their relationship and in parenting autistic children. Future research can use critical discourse analysis to examine a broader range of dialectical conversations among parents with autistic children for speech/language patterns and meaning making. Taking more care to avoid ableist language and instead use neuro-affirming language in autism and other neurodiversity research is equally important (Bottema-Beutel et al., 2021; Gaddy & Crow, 2023), especially in research written for clinicians who rely on language as a primary tool of intervention (e.g., marriage and family therapists, counselors, social workers, speech-language pathologists; Crow et al., 2021).

Another key area for future research is investigating how to best train systemic practitioners to work with this population vis-a-vis TVC/tele-mental health services. Existing literature, and findings from this study, suggest TVC could remove many barriers to treatment, but as couples in this study pointed out, they need practitioners who are fully equipped to navigate complex family dynamics during sessions and have a deep understanding of autism. Research shows that autistic people communicate well with other autistic people (Gaddy & Crow, 2023), and this supports the need to also train more autistic individuals in the practice of systemic therapies. More research can be done to better understand how to support the training needs of autistic and non-autistic practitioners working with couples raising autistic children.

Finally, while our findings emphasize the importance of strengths-based, resilience-building approaches for couples parenting autistic children, it is equally important to acknowledge that resilience alone cannot resolve the impact of systemic, external barriers. Even the most relationally adaptive couples in our study expressed distress related to factors beyond their control and we want to emphasize that increasing resilient coping should never be a mechanism of bypassing the harm of systemic inequities. As such, we caution against placing the burden of adaptation solely on couples. Clinicians must contextualize distress within these broader structural limitations and adopt a dual focus: helping couples access and cultivate internal strengths while also supporting systemic advocacy and resource navigation (Brewer, 2018; Parker & Killian, 2020). For example, brief interventions might include components focused on building couples’ skills in advocacy, accessing disability services, and boundary setting with uninformed support systems. Therapists working with this population should also be prepared to collaborate with schools, churches, and healthcare providers to reduce external stressors and foster integrative, systemic support. Without addressing these practical constraints, even the most resilience-focused interventions may fall short of reducing distress in a meaningful or sustainable way.