Severity of Child Autistic and Comorbid Symptoms, Parent Mental Health and Parenting Behaviors

Background: Families with children with developmental disorders face unique challenges. Several studies have reported an association between the severity of autistic symptoms and mental health problems among parents (Kasari & Sigman, 1997; Hastings & Johnson, 2001). Some authors have argued that externalized problems are the most important predictors of parental stress in the context of children with disabilities, including ASD (Baker et al., 2002; Lecavalier, Leone, & Wiltz, 2006). To date, the majority of previous studies on parental stress have been conducted in Western countries. Almost no studies examining the mental health of parents with children who have ASD have been conducted in Asian countries. Furthermore, previous studies have not addressed parental stress as a potential mediator in the relationship between severity of symptoms and parenting behavior.

Objectives:  The present study examined the effects of children’s autistic (social communication and restricted interests) and comorbid symptoms (inattention/hyperactivity, sensory symptoms, anxiety/depression, and conduct problems) on parent mental health in Japan. In addition, we tested whether or not parental stress mediates the relationship between severity of child symptoms and parenting behavior (positive and negative parenting).

Methods:  The participants were the parents of 778 children and adolescents with ASD (572 boys; M age = 10.6, SD = 3.5, range 3-18). The following questionnaire scales were used: the Autism Spectrum Screening Questionnaire (ASSQ; Ehlers, Gillberg, & Wing, 1999) for ASD symptoms, the ADHD Rating Scale-IV (ADHD-RS-IV; Du Paul et al., 1998) for inattention/hyperactivity, the Sensory Profile (SP; Dunn, 1999) for sensory symptoms, the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) for anxiety/depression and conduct problems, the General Health Questionnaire (GHQ; Goldberg & Williams, 1970) for parent mental health, and the Positive and Negative Parenting Scale (PNPS; Ito, 2014) for parenting behaviors.

Results:  Path analysis revealed that parent mental health was significantly predicted by child autistic symptoms, sensory symptoms, and anxiety/depression. Parent mental health, in turn, showed a negative relationship with positive parenting and a positive relationship with negative parenting. Thus, there is evidence that parent mental health serves as a mediating factor between child symptoms and parenting behaviors. In addition, some child symptoms had a direct effect on parenting behavior.

Conclusions:  

First, the results suggest that parent mental health is more greatly affected by relatively passive symptoms, such as autistic symptoms, sensory symptoms, and anxiety/depression, in comparison to active symptoms, such as inattention/hyperactivity and conduct problems. This finding is not consistent with those of previous studies in Western countries that found externalized behaviors to be the central factor in the prediction of parental stress. This incongruence may be explained by cultural or ethnic differences. Second, the results provide evidence that parent mental health partially mediates the relationship between child symptoms and parenting behaviors. This may partly explain how negative spirals are created in families with children with ASD.