The Relationship between Parenting Stress and Behavior Problems of Children with Autistic Spectrum Disorders
Osborne, Lisa A., Reed, Phil, Exceptional Children
The amount of recognition of the role of parenting stress and its relationship to child behavior problems in children with autistic spectrum disorders (ASDs) has recently increased (Blacher & McIntyre, 2006; Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Eisenhower, Baker, & Blacher, 2005; Osborne, McHugh, Saunders, & Reed, 2008). This report focuses on two aspects that have been the subject of some debate: first, whether parenting stress associates strongly with child behavior problems over and above the severity of ASD symptoms; and second, the temporal directionality of this relationship, that is, whether child behavior problems precede parenting stress, or vice versa.
Many researchers found more highly pronounced levels of parenting stress in parents of children with ASD than in parents of children with almost any other type of disability or health problem (e.g., Blacher & McIntyre, 2006; Bouma & Schweitzer, 1990; Dunn et al., 2001; Eisenhower et al., 2005; Koegel, Schreibman, Loos, Dirlich-Wilhelm, & Dunlap, 1992; Perry, Sarlo-McGarvey, & Factor, 1992; Weiss, 2002; Wolf, Noh, Fisman, & Speechley, 1989; see Pisula, 2003, for a review). The current literature is somewhat unclear about whether parenting stress relates more strongly to the severity and symptoms of the child's ASD or to the behavior problems that commonly accompany ASD (e.g., externalizing, disruptive, and aggressive behaviors). Hastings and Johnson (2001; see also Tobing & Glenwick, 2002) reported that higher levels of symptomatology and severity of impairment involved with ASD were associated with higher levels of reported parenting stress. Similarly, Duarte, Bordin, Yazigi, and Mooney (2005) found that the strongest association was between stress in mothers and having a child with ASD and that maternal stress increased when the symptoms, poor expression of feeling and emotion, and little social interest were more severe (see also Baker-Ericzen, Brookman-Frazee, & Stahmer, 2005; Kasari & Sigman, 1997, regarding the effects of child levels of social skills being a good predictor of maternal stress).
In addition to the severity of the symptoms of ASD, a number of reports have noted a relationship between parenting stress and child behavior problems that do not directly relate to ASD symptoms (e.g., Baxter, Cummins, & Yiolitis, 2000; Hodapp, Fidler, & Smith, 1998; Stores, Stores, Fellows, & Buckley, 1998). Lecavalier, Leone, and Wiltz (2006) found a strong association between child behavior problems--especially a specific group of externalized behaviors, such as conduct problems--and caregiver stress.
In fact, some data are consistent with the view that an association exists between child behavior problems and parenting stress, over and above such other factors as type of disability, severity of ASD, and child adaptive behaviors (e.g., Blacher & McIntyre, 2006; Donenberg & Baker, 1993; Dumas, Wolf, Fisman, & Culligan, 1991; Floyd & Gallagher, 1997; Lecavalier et al., 2006). Donenberg and Baker (see also Dumas et al.) compared levels of parenting stress in parents of children with ASD; parents of children with externalizing behaviors (e.g., hyperactivity and aggression); and typically developing children with no significant problem behaviors. They found similar high child-related stress in the parents of the externalizing children and in the parents of children with ASD, compared with the parents of the typically developing children. Blacher and McIntyre (see also Hastings et al., 2005) found that neither maternal stress nor depression related to the type of disability (intellectual disability, cerebral palsy, Down syndrome, and ASD) once researchers had controlled for differences in child behavior problems.
However, researchers have not found this pattern of results in every study. For example, Eisenhower et al. (2005) noted that the type of disability (especially ASD) accounted for maternal stress, even after controlling for levels of behavior problems. …