Parenting Stress and Aberrant Behavior in Children with Autism Participating in a Multi-Disciplinary Program Providing Medical Care, Dietetic Support, Educational Assessment and Family Resources

Background: Parents of children with autism frequently report significant stress related to their child’s behaviors (Hasting et al., 2005). Families with access to a variety of intervention and support services and/or resources typically report experiencing lower stress (Gutierrez et al., 2008; 2009; Levine et al., 2009).

Objectives: To examine the relationship between parental stress and aberrant behavior in children with autism enrolled in a program providing medical care, dietetic support, educational assessment and family resources.

Methods: Twenty children with autism (15 males, 5 females) with a mean age of 7.1 (SD: 2.4 years; range 3.6–11.6 years) met the inclusion criteria for this study. An autism diagnosis was confirmed by a licensed psychologist using both the Autism Diagnostic Observation Scale (ADOS) and Autism Diagnostic Interview-Revised (ADI-R). The Bright Eyes (BE) program provides children and their families with support and financial assistance to initiate appropriate diagnostics, medical care, dietetic support and educational assessment, with follow up appointments for one year. A family-care coordinator provided additional resources on recommended therapies to each family. Maternal stress was measured with the Parenting Stress Index-Long Form (PSI-LF) and problem child behaviors were assessed with the Pervasive Developmental Disorder Behavior Inventory (PDDBI). Measures were collected at two time points: at intake (T1) and 3-4 months post enrollment in the BE program (T2). Bivariate correlations were conducted between parenting stress and autism severity measures. Significant findings are reported when p<0.05.

Results: At intake, 75% (15/20) of mothers had clinically relevant PSI–LF scores compared with 60% (12/20) at T2. Maternal stress related to the child domain significantly decreased over time (T1:150.6 vs. T2:139.7, p=0.02). Specifically, stress associated the child’s demandingness (DE) and lack of adaptability (AD) as well as the mother’s acceptability of their child’s diagnosis (AC), was significantly reduced (DE, T1:29.7 vs. T2:26.85, p=0.039; AD, T1:36.65 vs. T2:33.9, p=0.023; and AC, T1:22.0 vs. T2:20.3, p=0.031). 

PDDBI scores indicated a significant reduction in SENSORY (sensory seeking-type behaviors; T1:27.4 vs. T2:23.05, p=0.031) and AROUSE (hyperactivity/hypoactivity; T1:25.5 vs. T2:21.5, p=0.045) domains over time. 

Significant correlations between AUTISM Composite (a measure of autism severity) and maternal stress were identified at both time points (T1:r=0.79, p=0.001 and T2:r=0.64, p=0.046). Specifically, maternal parenting stress was correlated with the following PDDBI domains: SENSORY (T1:r=0.61, p=0.005 and T2:r=0.6, p=0.007); SOCPP (social pragmatic problems, T1:r=0.68, p=0.001 and T2:r=0.57, p=0.011); AGG (problems with aggressive behavior towards self and/or others, T1:r=0.88, p=0.0 and T2:r=0.8, p<0.001), AROUSE (T1:r=0.8, p<0.001 and T2:r=0.68, p=0.046), REPRIT Composite (a measure of classic autism traits, T1:r=0.75, p=0.003 and T2:r=0.66, p=0.002); FEARS (fears and anxieties, T1:r=0.55, p=0.018 and T2:r=0.5, p=0.033); and AWP Composite (approach/withdrawal problems, T1:r=0.83, p=0.002 and T2:r=0.72, p=0.013).

Conclusions: These results suggest a positive relationship between maternal parenting stress and autism severity in children at initial enrollment in the BE program. However, by implementing a comprehensive treatment program and by providing considerable family support, a significant reduction in children’s aberrant behaviors, such as sensory seeking behaviors and hyperactivity/hypoactivity, and a reduction in maternal parenting stress associated with the child domain, were reported.