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Predictors of Parenting Stress in Children Referred for an Autism Spectrum Disorder Diagnostic Evaluation

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Abstract

Parents of children with autism spectrum disorder (ASD) report significantly higher stress than parents of children with other developmental disorders. Symptoms that overlap with the autism spectrum are often present in other developmental disorders, which could significantly increase parenting stress. Additionally, the severity of ASD symptoms within a group of children with ASD can greatly vary. In the present study, problem behaviors, cognitive and adaptive functioning, and parenting stress were examined in a group of 40 children aged 2–5 years who were referred for an autism evaluation. The children presented with varying levels of symptoms often associated with ASD, and some met criteria for an autism spectrum disorder diagnosis. This approach allowed for both categorical and dimensional consideration of ASD-associated symptoms and the relation to parenting stress in children with and without autism. When examined based on ultimate clinical diagnosis of ASD or non-ASD, child behavior problems and parenting stress were similar across groups. Clinician-based autism severity ratings (based on the Autism Diagnostic Observation Schedule) did not significantly predict parenting stress; however, parental report of the severity of ASD-associated symptoms (from the Social Responsiveness Scale) showed a significant relation to stress. Cognitive ability did not uniquely contribute to stress. Problem behaviors as assessed by the Child Behavior Checklist accounted for the largest proportion of the variance in parenting stress; adaptive behaviors and severity of parent- or clinician-rated autism-associated symptoms did not uniquely contribute above and beyond problem behaviors. Parents who reported more behavior problems or more autism-associated symptoms reported higher parenting stress. Clinical applications and the need for more research on parenting stress and problem behaviors in children displaying autism symptomatology are highlighted.

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References

  • Abidin, R. A. (1995). Parenting stress index: Short form (PSI-SF) (3rd ed.). Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont: Research Center for Children, Youth, and Families.

    Google Scholar 

  • Aman, M. G., & Singh, N. N. (1986). Aberrant behavior checklist (ABC). East Aurora: Slosson.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington: Author.

  • American Psychiatric Association. (2012). Frequently asked questions. Retrieved 12/17, 2012, from http://www.dsm5.org/about/Pages/faq.aspx#3.

  • Baker, B. L., McIntyre, L. L., Blacher, J., Crnic, K., Edelbrock, C., & Low, C. (2003). Pre-school children with and without developmental delay: behaviour problems and parenting stress over time. Journal of Intellectual Disability Research, 47(4), 217–230. doi:10.1046/j.1365-2788.2003.00484.x.

    Article  PubMed  Google Scholar 

  • Bishop, S., Gahagan, S., & Lord, C. (2007). Re-examining the core features of autism: a comparison of autism spectrum disorder and fetal alcohol spectrum disorder. Journal of Child Psychology and Psychiatry, 48(11), 1111–1121.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years. Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010.

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (secondth ed.). Hillsdale: Lawrence Erlbaum Associates.

    Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2005). The social responsiveness scale (SRS) manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Dąbrowska, A., & Pisula, E. (2010). Parenting stress and coping styles in mothers and fathers of pre-school children with autism and down syndrome. Journal of Intellectual Disability Research, 54(3), 266–280. doi:10.1111/j.1365-2788.2010.01258.x.

    Article  PubMed  Google Scholar 

  • Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics. Journal of Autism and Developmental Disorders, 38(7), 1278–1291. doi:10.1007/s10803-007-0512-z.

    Article  PubMed  Google Scholar 

  • Dyches, T. T., Wilder, L. K., Sudweeks, R. R., Obiakor, F. E., & Algozzine, B. (2004). Multicultural issues in autism. Journal of Autism and Developmental Disorders, 34(2), 211–222.

    Article  PubMed  Google Scholar 

  • Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014). Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics, 134(2), 454–463. doi:10.1542/peds.2013-3164.

    Article  Google Scholar 

  • Eisenhower, A. S., Baker, B. L., & Blacher, J. (2005). Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being. Journal of Intellectual Disability Research, 49(9), 657–671. doi:10.1111/j.1365-2788.2005.00699.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism: The International Journal of Research & Practice, 13(4), 375–387. doi:10.1177/1362361309105658.

    Article  Google Scholar 

  • Everett, J. R. (2001). The role of child, family and intervention characteristics in predicting stress in parents of children with autism spectrum disorders. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62(6-B), 2972.

    Google Scholar 

  • Gallagher, S., Phillips, A., Drayson, M., & Carroll, D. (2009). Parental caregivers of children with developmental disabilities mount a poor antibody response to pneumococcal vaccination. Brain, Behavior, and Immunity, 23(3), 338–346.

  • Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627. doi:10.1007/s10803-006-0280-1.

    Article  PubMed  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. doi:10.1007/s10803-008-0674-3.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hall, H. R., & Graff, J. C. (2011). The relationships among adaptive behaviors of children with autism, family support, parenting stress, and coping. Issues in Comprehensive Pediatric Nursing, 34(1), 4–25. doi:10.3109/01460862.2011.555270.

    Article  PubMed  Google Scholar 

  • Hastings, R. P. (2002). Parental stress and behaviour problems of children with developmental disability. Journal of Intellectual & Developmental Disability, 27(3), 149–160. doi:10.1080/1366825021000008657.

    Article  Google Scholar 

  • Hepburn, S., Philofsky, A., Fidler, D. J., & Rogers, S. (2008). Autism symptoms in toddlers with Down syndrome: a descriptive study. Journal of Applied Research in Intellectual Disabilities, 21(1), 48–57. doi:10.1111/j.1468-3148.2007.00368.x.

  • Hus, V., Bishop, S., Gotham, K., Huerta, M., & Lord, C. (2013). Factors influencing scores on the Social Responsiveness Scale. Journal of Child Psychology and Psychiatry, 54(2), 216–224.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hutton, A., & Caron, S. (2005). Experiences of families with children with autism in rural New England. Focus on Autism and Other Developmental Disabilities, 20(3), 180–189. doi:10.1177/10883576050200030601. http://dx.doi.org.ezproxy.lib.uwm.edu/.

    Article  Google Scholar 

  • Johnson, N., Frenn, M., Feetham, S., & Simpson, P. (2011). Autism spectrum disorder: parenting stress, family functioning and health-related quality of life. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 29(3), 232–252. doi:10.1037/a0025341.

    Article  Google Scholar 

  • Johnston, C., Hessl, D., Blasey, C., Eliez, S., Erba, H., Dyer-Friedman, J., & Reiss, A. L. (2003). Factors associated with parenting stress in mothers of children with fragile X syndrome. Journal of Developmental and Behavioral Pediatrics, 24(4), 267–275. doi:10.1097/00004703-200308000-00008.

    Article  PubMed  Google Scholar 

  • Kaat, A. J., Lecavalier, L., & Aman, M. G. (2014). Validity of the aberrant behavior checklist in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1103–1116.

    Article  PubMed  Google Scholar 

  • Klein-Tasman, B., Phillips, K. D., Lord, C., Mervis, C. B., & Gallo, F. J. (2009). Overlap with the autism spectrum in young children with Williams syndrome. Journal of Developmental and Behavioral Pediatrics, 30(4), 289–299. doi:10.1097/DBP.0b013e3181ad1f9a.

    Article  PubMed Central  PubMed  Google Scholar 

  • Konstantareas, M., Homatidis, S., & Plowright, C. (1992). Assessing resources and stress in parents of severely dysfunctional children through the Clarke modification of Holroyd’s Questionnaire on Resources and Stress. Journal of Autism and Developmental Disorders, 22(2), 217–234.

  • Lecavalier, L., Aman, M. G., Scahill, L., McDougle, C., McCracken, J. T., Vitiello, B., et al. (2006). Validity of the autism diagnostic interview-revised. American Journal on Mental Retardation, 111, 199–215.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule (ADOS) manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Somer, B. (2012). Autism diagnostic observation schedule manual (2nd ed.). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Maxted, A. E., Dickstein, S., Miller-Loncar, C., High, P., Spritz, B., Liu, J., & Lester, B. M. (2005). Infant colic and maternal depression. Infant Mental Health Journal, 26(1), 56–68. doi:10.1002/imhj.20035.

    Article  Google Scholar 

  • McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120–129. doi:10.1111/j.1365-2753.2006.00674.x. http://dx.doi.org.ezproxy.lib.uwm.edu/.

    Article  PubMed  Google Scholar 

  • Miodrag, N., & Hodapp, R. M. (2010). Chronic stress and health among parents of children with intellectual and developmental disabilities. Current Opinion in Psychiatry, 23(5), 407–411.

    Article  PubMed  Google Scholar 

  • Mori, K., Ujiie, T., Smith, A., & Howlin, P. (2009). Parental stress associated with caring for children with Asperger’s syndrome or autism. Pediatrics International, 51(3), 364–370. doi:10.1111/j.1442-200X.2008.02728.x.

    Article  PubMed  Google Scholar 

  • Mullen, E. M. (1997). Mullen scales of early learning. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Neece, C., & Baker, B. (2008). Predicting maternal parenting stress in middle childhood: the roles of child intellectual status, behaviour problems and social skills. Journal of Intellectual Disability Research, 52(12), 1114–1128. doi:10.1111/j.1365-2788.2008.01071.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1092–1103.

    Article  PubMed  Google Scholar 

  • Podolski, C., & Nigg, J. (2001). Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems. Journal of Child Clinical Psychology, 30(4), 503–513. doi:10.1207/S15374424JCCP3004_07. http://dx.doi.org.ezproxy.lib.uwm.edu/.

    Article  Google Scholar 

  • Pottie, C., Cohen, J., & Ingram, K. (2009). Parenting a child with autism: contextual factors associated with enhanced parental mood. Journal of Pediatric Psychology, 34(4), 419–429. doi:10.1093/jpepsy/jsn094. http://dx.doi.org.ezproxy.lib.uwm.edu/.

    Article  PubMed  Google Scholar 

  • Rodrigue, J. R., Morgan, S. B., & Geffken, G. (1990). Families of autistic children: psychological functioning of mothers. Journal of Clinical Child Psychology, 19(4), 371.

    Article  Google Scholar 

  • Rutter, M., LeCouteur, A., & Lord, C. (2003). Autism diagnostic interview revised (WPS Edition Manual ed.). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Schieve, L. A., Blumberg, S. J., Rice, C., Visser, S. N., & Boyle, C. (2007). The relationship between autism and parenting stress. Pediatrics, 119, S114–S121. doi:10.1542/peds.2006-2089Q.

    Article  PubMed  Google Scholar 

  • Sexton, D., Burrell, B., Thompson, B., & Sharpton, W. (1992). Measuring stress in families of children with disabilities. Early Education and Development, 3(1), 60.

    Article  Google Scholar 

  • Sikora, D. M., Hall, T., Hartley, S., Gerrard-Morris, A., & Cagle, S. (2008). Does parent report of behavior differ across ADOS-G classifications: analysis of scores form the CBCL and GARS. Journal of Autism and Developmental Disorders, 38, 440–448.

    Article  PubMed  Google Scholar 

  • Silva, L. M. T., & Schalock, M. (2012). Autism parenting stress index: initial psychometric evidence. Journal of Autism and Developmental Disorders, 42(4), 566–574. doi:10.1007/s10803-011-1274-1.

    Article  PubMed  Google Scholar 

  • Singer, G. H. S. (2006). Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. American Journal of Mental Retardation, 111(3), 155–169.

    Article  PubMed  Google Scholar 

  • Singer, G. H. S., Ethridge, B. L., & Aldana, S. L. (2007). Primary and secondary effects of parenting stress and stress management interventions for parents of children with developmental disabilities: a meta-analysis. Mental Retardation and Developmental Disabilities Research Review, 13, 357–369.

    Article  Google Scholar 

  • Sparrow, S., Balla, D., & Cicchetti, D. (1984). Vineland adaptive behavior scales (Interviewth ed.). Circle Pines: American Guidance Service.

    Google Scholar 

  • Stevens, J. (1984). Outliers and influential data points in regression analysis. Psychological Bulletin, 95(2), 334–344.

  • Tabachnick, B. G., & Fidell, L. S. (2007). Cleaning up your act: Screening data prior to analysis. Using multivariate statistics (Fifth Edition ed., 72–88). Boston: Pearson/Allyn and Bacon.

  • Taylor, J. L., & Warren, Z. E. (2012). Maternal depressive symptoms following autism spectrum diagnosis. Journal of Autism and Developmental Disorders, 42(7), 1411–1418.

    Article  PubMed  Google Scholar 

  • Tervo, R. C. (2010). Attention problems and parent-rated behavior and stress in young children at risk for developmental delay. Journal of Child Neurology, 25(11), 1325–1330. doi:10.1177/0883073810362760.

    Article  PubMed  Google Scholar 

  • Tervo, R. C. (2012). Developmental and behavior problems predict parenting stress in young children with global delay. Journal of Child Neurology, 27(3), 291–296. doi:10.1177/0883073811418230.

    Article  PubMed  Google Scholar 

  • Weiss, J. A., Sullivan, A., & Diamond, T. (2003). Parent stress and adaptive functioning of individuals with developmental disabilities. Journal on Developmental Disabilities, 10(1), 129–135.

    Google Scholar 

  • Weiss, J. A., Cappadocia, M. C., MacMullin, J. A., Viecili, M., & Lunsky, Y. (2012). The impact of child problem behaviors of children with ASD on parent mental health: the mediating role of acceptance and empowerment. Autism: The International Journal of Research & Practice, 16(3), 261–274. doi:10.1177/1362361311422708.

    Article  Google Scholar 

  • Zaidman-Zait, A., Mirenda, P., Zumbo, B., Wellington, S., Dua, V., & Kalynchuk, K., (2010). An item response theory analysis of the parenting stress index-short form with parents of children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51(11), 1269–1277.

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Acknowledgments

This research was supported by funds from Sigma Xi and a University of Wisconsin-Milwaukee Graduate School Research Committee Award. The authors would like to thank the participants and their families for their valuable contribution to the research. The authors would also like to thank all research personnel at the Child Neurodevelopment Research Lab at the University of Wisconsin-Milwaukee for their help with data collection, especially Michael Gaffrey, Ph.D.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Brei, N.G., Schwarz, G.N. & Klein-Tasman, B.P. Predictors of Parenting Stress in Children Referred for an Autism Spectrum Disorder Diagnostic Evaluation. J Dev Phys Disabil 27, 617–635 (2015). https://doi.org/10.1007/s10882-015-9439-z

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