The Effects of Problem Behavior on Parenting Stress In Young Children with ASD Over a 2-Year Period

Background: Parents of children with autism spectrum disorder (ASD) experience higher levels of stress than parents of children who are either typically developing (Rao & Beidel, 2009) or have other disabilities (Baker-Ericzen, Brookman-Frazee, & Stahmer, 2005). Links between parenting stress and child behavior problems have been well established (Hastings et al., 2005). However, most of the research to date has involved participants with ASD who are school-aged or older and has utilized data collected at one time point to examine this relationship. This limits our ability to understand the parenting stress-child behavior problem relationship over time in very young children with ASD.

Objectives: The purpose of this study was to examine the effect of child internalizing and externalizing behavior problems on parenting stress over a 2-year period in a large inception cohort of young children with ASD. 

Methods: Data were drawn from the Canadian Pathways in ASD study and included 178 children with ASD. At the time of the initial data collection, which occurred within 4 months of diagnosis, the children’s mean age was 36.7 months. The children’s parents completed the Child Behavior Checklist 1.5-5 (CBCL; Achenbach & Rescorla, 2000), which measures both internalizing and externalizing behavior problems, at baseline and at 6 and 12 months post-diagnosis. Their parents also completed the Parenting Stress Index-Short Form (PSI-SF; Abidin, 1995) at baseline and 24 months post-diagnosis. The PSI-SF factor structure reported by Zaidman-Zait et al. (2010) was used for the analysis. Structural equation modeling was employed to conduct a path analysis using LISREL 8.80 (Joreskog & Sorbom, 2006).

Results: At baseline, all of the PSI-SF subscales and both types of child behavior problems were significantly correlated. Externalizing behavior at 12 months post-diagnosis was a significant predictor of both parenting distress and general distress at 24 months post-diagnosis (ß=0.18-0.20, t=2.01-3.03, p<.05). However, internalizing behavior was not predictive of either type of parental distress at 24 months (ß=0.06-0.15, t=.67-1.7, p>.05). Finally, both externalizing and internalizing behavior at 12 months were predictive of parents’ perceptions of child demandingness and of the extent to which the child was difficult to manage at 24 months (externalizing ß=0.32-0.36, t=3.15-3.99, p<.05; internalizing ß=0.25-0.31, t=2.05-3.73, p<.05).

Conclusions: Even in very young children with ASD, child behavior problems have a significant impact on parenting stress over time. In particular, over a 24-month period, parents whose child had high scores for externalizing behavior problems experienced significant general distress as well as distress related to their role as parents. Even parents of young children with internalizing behaviors believed that their children were unusually demanding and difficult to manage. The results emphasize the importance of early intervention that are designed to ameliorate child behavior problems as well as to teach parents the skills that are required to cope with and resolve behavior problems in effective ways.