Elsevier

Research in Autism Spectrum Disorders

Volume 5, Issue 3, July–September 2011, Pages 1143-1152
Research in Autism Spectrum Disorders

Parenting behaviour among parents of children with autism spectrum disorder

https://doi.org/10.1016/j.rasd.2010.12.011Get rights and content

Abstract

Contrary to the extensive amount of empirical findings about parental perceptions, parenting cognitions, and coping in families with a child with autism spectrum disorder (ASD), research about parenting itself is very scarce. A first goal of this study was to examine the factor structure and internal consistency of two scales to measure parenting behaviour: the Parental Behaviour Scale-short version (PBS, Van Leeuwen, 2002, Van Leeuwen and Vermulst, 2004, Van Leeuwen and Vermulst, 2010) and a new scale to measure parenting behaviours more specifically relevant to children with ASD. A second goal was to compare general and more specific parenting behaviour among parents of children with and without ASD. The participants were 305 parents of a child with ASD between 8 and 18 years old and 325 parents of a typically developing child between 8 and 18 years old. Parents completed both scales. Exploratory factor analysis of the new scale resulted in two factors: Stimulating the Development and Adapting the Environment. Multisample confirmatory factor analyses showed good fit indices for the noninvariant model of both the PBS and the new scale. Mean level analyses revealed significant main effects of group with higher mean scores for the control group in comparison with the experimental group for the subscale Harsh Punishment and the reversed effect for the subscale Stimulating the Development. We concluded that it is possible to use the parenting constructs of the PBS-short version to investigate parenting behaviour of parents with and without children with ASD. Furthermore, the new scale showed a relatively stable two factor structure for the control group as well as for the experimental group. The two factors ‘Stimulating the child's Development’ and ‘Adapting the child's Environment’ were also convincing as regards content. A first indication was found that parents of children with ASD indeed use more specifically relevant parenting behaviours. It is self-evident that more research is needed to gain further insight into the nature of these behaviours.

Research highlights

▶ The PBS-short version shows a relatively stable five factor structure. ▶ A new scale for parenting behaviour among parents of children with ASD was developed. ▶ The factor analysis yielded two main factors: Stimulating the Development and Adapting the Environment.

Introduction

Since Leo Kanner's pioneering article in 1943, many theories about the origin of autism have been proposed. From Kanner's first description of autism, two possible causes of the disorder can be derived. On the one hand, he suggested that the characteristic problems of the disorder were innate; on the other hand, he mentioned the cold and intellectual nature of parents as a possible cause (Kanner, 1943). In the following years, the latter more psychogenic explanation became the prevalent theory, influenced by the psychoanalytical views current at the time. For example, Bettelheim (1967) put forward the ‘refrigerator mother hypothesis’, referring to chilly, distant, and rejecting mothers. This view caused much distress to parents of children with ASD (Wing, 2004). Fortunately, these implausible theories have long been abandoned by the majority of the scientific community. Theories about the causes of ASD have progressed from these more psychogenic ideas to a more detailed understanding of the neurobiological basis of the disorder. There is now enough evidence that the disorder has a neurological basis in the brain and that genetic causes play a major role, even though no specific biological markers are known yet (Hill & Frith, 2003). However, along with the growing emphasis on the neurobiological basis of the disorder, parenting behaviour among parents of children with ASD remained out of the picture and has never been properly investigated.

So far, most research on parenting in families with a child diagnosed with ASD has been focusing on perceptions, cognitions, and coping of parents. A significant finding of the research on parental perceptions, is that parents of a child with ASD experience high levels of parenting stress and psychological distress (Bromley et al., 2004, Dabrowska and Pisula, 2010, Davis and Carter, 2008, Duarte et al., 2005, Estes et al., 2009, Montes and Halterman, 2007). Some studies put forward factors contributing to the increased levels of stress in parents of children with ASD, like gender of the parents (Dabrowska and Pisula, 2010, Tehee et al., 2009), child age (Tehee et al., 2009) and behavioural characteristics of the child (Davis and Carter, 2008, Estes et al., 2009). Meirsschaut, Roeyers, & Warreyn (2010) investigated mothers’ perceptions of the impact of having a child with ASD on their personal and family life. In line with other studies, mothers reported impaired family functioning in several ways, such as a lack of spontaneity or flexibility in family life, job and career adjustments in order to care for their child and little time left for personal social activities. A small part of the studies also focuses on the strengths and opportunities for parents of children with ASD (Davis and Carter, 2008, Phelps et al., 2009). Davis and Carter (2008) found that at least half of the parents in their study did not evidence clinically significant levels of parenting stress or depressive symptoms. They concluded that one should also recognize that many families bring important strengths in coping with and adjusting to the diagnosis of ASD. In a study of Phelps et al. (2009) enrichment and posttraumatic growth scores were gathered. A negative correlation was found between parental ratings of stress and enrichment for just over half of the stress/enrichment variables. A second topic of the current research concerns parenting cognitions. One dimension of these cognitions is parenting self-efficacy, which can be defined as feelings of competence in the caretaking role. Kuhn and Carter (2006) explored the association between maternal self-efficacy and other parenting cognitions, namely maternal agency (i.e. the extent to which a parent assumes an active role in the child's development), autism knowledge (i.e. factual knowledge of the core deficits in autism spectrum disorders, aetiology and effective intervention methods) and maternal guilt (i.e. guilt related to the feeling one is not doing enough to promote the child's development). They found a positive correlation between maternal agency and self-efficacy and a negative correlation between maternal guilt and self-efficacy. Maternal self-efficacy, in its turn, is negatively correlated with parenting stress and depression (Kuhn and Carter, 2006, Meirsschaut et al., 2010). In addition, mothers are able to differentiate between parenting cognitions about their child with ASD and their typically developing child. Mothers report a lower sense of self-efficacy about parenting their child with ASD, whereas they report feeling more guilty about ‘not doing enough’ for their typically developing child. Moreover, mothers’ beliefs of self-efficacy and guilt about one of their children are significantly correlated with the beliefs about their other child (Meirsschaut et al., 2010). A last topic of the current research is coping in families with a child diagnosed with ASD. A study of Hastings et al. (2005) revealed four key coping dimensions relevant to parents raising a child with ASD, namely active avoidance coping, problem-focused coping, positive coping and religious coping/denial. The emotion-focused and active avoidance coping styles are related to more stress and mental health problems in parents of children with ASD, whereas problem-focused coping and positive coping are associated with lower levels of depression (Dunn et al., 2001, Hastings et al., 2005). In addition, mothers reported more frequent use of active avoidance coping and problem-focused coping strategies than fathers (Hastings et al., 2005).

Contrary to the extensive amount of empirical findings about parental perceptions, cognitions and coping, research about parenting behaviour itself is very scarce. However, parents of children with ASD face specific challenges in parenting. They often have to fulfil multiple and demanding parental roles (National Research Council, 2001). These challenges in parenting are partly due to the specific behavioural patterns of children with ASD. Following Wing (2004), autism spectrum disorders are characterized by a triad of impairments of social interaction, communication and imagination, associated with restricted, repetitive and stereotyped patterns of behaviour, interests, and activities. The triad manifests itself in different ways, depending on age and severity of the disorder (Wing, 1996). As a consequence of these behavioural characteristics, parents of children with ASD need to implement, apart from the skills every parent has to demonstrate, more intensive and specific interventions, like the stimulation of joint attention and language, attention for social interactions with peers and structuring the environment and activities (National Research Council, 2001).

To understand why children with ASD need a specific parenting approach, it is necessary to understand why they behave differently. For this purpose, one should be able to grasp the specific cognitive difficulties children with ASD are facing. For parents, comprehending the way their child thinks is important to anticipate difficult situations and to help their child cope with these complexities. Various cognitive theories about ASD exist, which can each contribute to a better understanding of the core features of the disorder (Happé, Ronald, & Plomin, 2006). Firstly, children with ASD can fail to acquire an intuitive ‘theory of mind’ (Hill & Frith, 2003). Tager-Flusberg (2007) describes theory of mind as “the ability to evaluate the behaviour of other people on the basis of their mental states, such as their goals, emotions, and beliefs” (Tager-Flusberg, 2007, p. 311). Children with ASD have difficulties attributing mental states to themselves or to other people (Hill & Frith, 2003). Parents can support their child with ASD in social interactions by making the mental states of other children explicit, for example when a child is crying, by explaining how that child feels and why. Secondly, children with ASD are described as exhibiting ‘weak central coherence’ (Happé & Frith, 2006). Weak central coherence is considered to be the result of two separable dimensions, namely a reduced tendency to integrate pieces of information into coherent wholes and an increased tendency to local processing (Frith, 1989, Happé and Booth, 2008). For parents, it can be helpful to understand their child's specific cognitive style. For example, it may explain why their child is very stressed or withdrawn in a chaotic environment with a lot of stimuli, like the playground. Moreover, it gives parents tools to adapt and structure the environment for their child. A third cognitive explanation of the core features of ASD is a theory of executive dysfunction. ‘Executive functions’ is an umbrella term referring to a range of higher level functions such as planning, working memory, impulse control, set shifting and initiation and monitoring of action (Hill & Frith, 2003). Executive impairment is proposed to explain mainly the rigid, repetitive and restricted behaviour in individuals with ASD (Happé, 1999). Parents can take these specific deficits into account, by helping their child plan his or her activities, e.g. by giving only one task a time or by announcing changes in routines.

To our knowledge, no empirical research has yet focused on parenting behaviour among parents of children with ASD. In the treatment of children with ASD, however, parenting behaviour plays an important role. Since the 1970s, educational approaches to the treatment of children with ASD came to the fore (Howlin & Rutter, 1987). The treatment goals of Rutter (1985) can be used as a matrix to classify the variety of these educational approaches. On the one side, Rutter's goals are aimed at Adapting the Environment of the child with ASD. An example of a program that fits within this environmental axis of the matrix is the TEACCH program (Treatment and Education of Autistic and Communication related handicapped CHildren). The aim of the program is to improve both social interaction and communication by means of a specially created environment in which the child with ASD can function through an adapted teaching approach. For example, the workplace of the child is kept as distraction-free as possible and the child makes use of timetables which indicate the activities for the day and the order in which they occur (Tutt, Powell, & Thornton, 2006). On the other side, Rutter (1985) stated three goals directed to the child. The first goal involves fostering typical development. The second goal is the reduction of ASD specific maladaptive behaviours such as rigidity and stereotypy. The third goal involves the elimination of non-specific maladaptive behaviours. A great amount of educational approaches can be situated on this child-directed axis of the matrix. The strategies vary on a continuum from traditional behavioural, discrete-trial approaches to more social-pragmatic approaches. An example of a behavioural approach is the Lovaas program. The main purposes of the program are teaching specified skills (small, measurable units of behaviours) systematically and managing maladaptive behaviour (Tutt et al., 2006); complex behaviour is divided into small steps (Dempsey & Foreman, 2001). Another educational approach is Pivotal Response Training (PRT), which can be situated in the middle of the continuum. The program aims at developing communicative skills and appropriate social communicative interactions (Koegel, Koegel, Harrower, & Carter, 1999) and can be described as a more contemporary behavioural approach using naturalistic teaching methods (National Research Council, 2001). Teaching trials focusing on the child's interest are embedded in the natural environment and use natural reinforcers (National Research Council, 2001). At last, the SCERTS model is an example of the social-pragmatic approach. This comprehensive program is developed to support the development of young children with ASD and their parents and prioritizes social communication, emotional regulation and transactional support. Family involvement is emphasized. Moreover, communication and socio-emotional development are supported in everyday activities and routines (Prizant, Wetherby, Rubin, & Laurent, 2003).

Although little is known about parenting behaviour in children with ASD, many empirical findings exist about parenting behaviour in typically developing children. Several studies have investigated the role of parenting in the socialization of children, or the way in which children acquire the social, emotional and cognitive skills to function in the social community (Grusec & Davidov, 2010). In this research domain, two primary dimensions of parenting are distinguished: parental warmth (support or responsiveness) and parental control, a multidimensional construct referring to (a) behavioural control (efforts of parents to influence their child's behaviour, by setting and enforcing standards of behaviour) and (b) psychological control (control of the child's behaviour through psychological means such as love withdrawal or guilt induction) (Galambos, Barker, & Almeida, 2003). These dimensions are based on small, elementary parts, i.e. parenting behaviour. An important frame of reference to operationalize parenting behaviour, is the social interactional theory of Patterson, Reid, and Dishion (1992). The ecological model of Dishion, French, and Patterson (1995) takes contextual factors into account and emphasizes five parental skills, namely parent involvement, monitoring, discipline, positive reinforcement and problem solving.

The present paper reports on a first effort to obtain more knowledge about parenting behaviours among parents of children with ASD. First of all, a scale to measure more general parenting behaviour was presented to parents: The Parental Behaviour Scale-short version (PBS, Van Leeuwen, 2002, Van Leeuwen and Vermulst, 2004, Van Leeuwen and Vermulst, 2010). This scale is based on the five parenting skills of Dishion et al. (1995) and Patterson et al. (1992) mentioned above and involves items about Positive Parenting, Discipline, Harsh Punishment, Material Rewarding and Rules. Furthermore, a new scale was developed to measure parenting behaviours more specifically relevant to children with ASD. A first goal was to examine the factor structure and internal consistency of these two measures in a group of parents of children with ASD and in a control group. A second goal was to compare general and specific parenting behaviour among parents of children with and without ASD. We expected to find most differences on specific parenting, namely, that parents of children with ASD would use these behaviours more frequently in comparison with parents of children without ASD.

Section snippets

Participants

The experimental group consisted of parents with a child with ASD between 8 and 18 years old. The data of children with an IQ below 70, as reported by the parents, were excluded. In total, 305 parents were included in this study. Participants were 268 biological mothers, 32 biological fathers, 4 adoptive mothers, and 1 adoptive father. They filled in questionnaires about 57 daughters and 248 sons. Eighteen children were reported to have borderline intellectual functioning (70 < IQ < 85), 137

Multigroup confirmatory factor analysis (MGCFA) of the Parental Behaviour Scale-short version

Multigroup confirmatory factor analyses were conducted with LISREL 8.72 (Jöreskog & Sörbom, 2005). It was specified that: (a) each item loaded on the target factor with zero loading on the non-target factors, (b) the factors were free to correlate, and (c) the unique error-variances of the items were uncorrelated. Because of non-normality of the data, Satorra–Bentler chi-square (SBS-χ2; Satorra & Bentler, 1994) is reported. Furthermore, to evaluate model fit, the Root Mean Square Error of

Discussion

This study tried to obtain more knowledge about parenting behaviour among parents of children with ASD by asking parents to fill in two questionnaires: the PBS-short version (Van Leeuwen, 2002, Van Leeuwen and Vermulst, 2004, Van Leeuwen and Vermulst, 2010) about parenting behaviour in general and a new developed scale about parenting behaviour more specifically relevant to children with ASD.

First of all, the PBS-short version shows a relatively stable five factor structure for the control

Acknowledgements

The authors wish to thank Eva Awouters, Ilke De Vos, Anke Jochems, and Rita Wijnants for their contribution to the collection of the data. We would like to thank the Flemish Autism Association, all schools and parents whose participation made this study possible. This research was funded by the Marguerite-Marie Delacroix Support Fund and the Research Fund Katholieke Universiteit Leuven.

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