ASD Symptom Severity Moderates the Relationship Between Child Externalizing Behavior and Maternal Stress
Objectives: The present study analyzes whether ASD symptomatology moderates the relationship between child externalizing behaviors and maternal stress.
Methods: Mothers (N = 223) with exactly one child with ASD (age M = 6.74, SD= 2.99; 84% male) completed the Behavioral Assessment System for Children (BASC-2; Reynolds & Kamphaus, 2004) as a measure of externalizing behaviors and the Social Responsiveness Scale-2 (SRS-2; Constantino et al., 2012) to identify the presence and extent of autistic social impairment in the child. Mothers self-reported stress indices via the Parental Stress Index (PSI-4-SF; Abidin 2012).
Results: Total child externalizing behaviors were found to predict maternal stress, particularly in the Difficult Child Subscale of the PSI (𝞫= -.57, p<.001). Moderation analyses revealed that SRS-2 total scores moderated the relationship between child externalizing behaviors and maternal stress (B= -.01, p<.001), such that the relation was strongest when child ASD symptoms were low (B= .66, p<.001; Figure 1). Post-hoc probing indicated that the same pattern of effects was found in all subdomains of externalizing behaviors (hyperactivity, aggression, and conduct problems all B=-.01, p<.02) and with all SRS-2 subscales (all B < -.01, p< .007).
Conclusions: Externalizing behavior in ASD youth was found to predict maternal stress, with a stronger effect seen in children with lower ASD symptomatology. Essentially, the relationship between externalizing behavior and maternal stress was strongest at low levels of ASD symptomatology. It may be that mothers of children with fewer ASD symptoms may attribute parenting stress to child externalizing behaviors, whereas mothers of those with high ASD symptoms may attribute stress to ASD symptoms. Specifically, mothers’ behavioral expectations may differ when perceiving their child’s social ability as greater than other children with ASD (Mori et. al 2009). Subsequently, these expectations may affect mothers’ sense of parenting efficacy, leading to increased stress. The poignant relationship found between externalizing behavior, maternal stress and ASD symptomatology demonstrates a significant need in providing relevant and comprehensive interventions that address all three elements of this model, thereby ameliorating stress levels in mothers and improving family quality of life for families of youth with ASD.