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Mona Khayal, PhD, is a 2026 graduate of the PhD program in Counselor Education & Supervision, Antioch University, Seattle.

Najla Hrustanovic, PhD, Committee Chair

Katie Schmitz, PhD, Committee Member

Briana Trageser, PhD, Committee Member

Keywords

autism spectrum disorder, caregiver burden, quality of life, anxiety, comparative study

Document Type

Dissertation

Publication Date

2026

Abstract

This comparative cross-sectional study investigated caregiving burden, quality of life, and anxiety among primary caregivers of children with autism spectrum disorder compared to caregivers of typically developing children. Using Bronfenbrenner’s Ecological Systems Theory, 66 caregivers (31 autism, 35 comparison) of children aged 6-18 completed the Zarit Burden Interview-12, WHO Quality of Life-BREF, and GAD-7. According to the results, autism caregivers reported substantially higher burden (M = 31.26 vs. 13.23, d = 2.42) and anxiety (M = 9.13 vs. 4.63, d = 1.04), with 90% exceeding clinical burden thresholds compared to 26% of comparison caregivers. Quality of life was lower across all four WHO domains, with environmental resources showing the largest impairment (d = -1.38). Nearly half (45%) of autism caregivers experienced clinically significant anxiety compared to 14% of comparison caregivers. Results support multilevel interventions targeting individual coping, family support, service coordination, and policy reform. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

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Mona Khayal, PhD, 2026
ORCiD 0009-0003-4089-6518

Mona Khayal, PhD, NCC, LMHC, LPC, SUDP is a mental health counselor, substance use counselor, National Certified Counselor, counselor educator, and consultant based in the greater Seattle, Washington area. She holds a PhD in Counselor Education and Supervision from Antioch University, a Master's in Clinical Mental Health Counseling, and a Bachelor's in Business Administration. Bilingual, she brings an added layer of cultural connection and accessibility to her work with diverse populations. Drawing on extensive experience in both corporate leadership and clinical mental health, her work bridges two worlds in a way few practitioners can. Her expertise spans trauma healing and resilience, autism and neurodivergence, and supporting immigrant and low-income communities facing adversity. Through consultation, curriculum development, and scholarly work, she designs interventions that make mental health care more accessible and effective. At the heart of everything she does is a commitment to building inclusive spaces where healing and growth are possible for individuals, families, organizations, and communities across borders.  

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