The Role of Theory of Mind on the Stress Intensity of Parents of Young Children with Autism

Background: A substantial amount of research indicates that parents of children with ASD experience higher levels of stress than parents of typically developing (TD) children (Rao & Beidel, 2009). In addition, research suggests that children with ASD have deficits in theory of mind (ToM), the ability to attribute mental states to others and oneself (Baron-Cohen, Leslie, Frith, 1985; Colle, Baron-Cohen, & Hill, 2007). Limited research suggests that increased parental stress may predict lower child ToM abilities, but this association has yet to be explored in children with ASD (Guajardo, Snyder, & Petersen, 2008).

Objectives: Understanding the factors that may contribute to parental stress is crucial in both treatment outcomes and family functioning. We hypothesized that a child’s ToM ability would moderate the association between developmental status and the intensity of parental stress, such that parents of children with ASD and lower ToM skills would report the most intense stress.

Methods: Participants were 101 children (ages 3:0 to 6:11) and their parents. Sixty-one children were typically developing (38% female) and 40 children had a diagnosis of autism spectrum disorder (25% female). Children’s theory of mind was assessed using a battery of tasks comprised of a diverse beliefs task, an unexpected contents false belief task and a changed location false belief task. Intensity of parenting stress was reported by parents on the Parenting Daily Hassles Scale (Crnic & Greenberg, 1990). Children’s verbal abilities were measured using the verbal comprehension and naming vocabulary subtests of the Differential Ability Scales II (DAS-II; Elliot, 2007).

Results: A moderation analysis using the SPSS macro PROCESS (Hayes, 2013) evaluated whether the association between developmental status and intensity of parental stress is moderated by child ToM abilities. Controlled variables included children’s language abilities and age. Results indicated the main effect of status on parental stress intensity (B = -1.509, CI₉₅ [-12.386, 9.368], p = .783) and the main effect of ToM skills on parental stress intensity were not significant (B = -.956, CI₉₅ [-4.673, 2.761], p = .611). The contribution of the interaction between status and ToM was significant, ΔR2 = .04, F(1, 95) = 4.012, p = .048. Specifically, at higher levels of ToM ability in children with ASD, parental stress intensity is higher (ToM = 3: B = 16.516, CI₉₅ [5.248, 27.784], p = .005; ToM = 2: B = 10.501, CI₉₅ [3.217, 17.798], p = .005). When ASD children had low levels of ToM ability, parental stress intensity did not differ compared to parents of TD children.

Conclusions: The current study found that parents of children with ASD and higher ToM abilities experienced the highest intensity of stress, in contrast with our hypothesis and limited past research. The findings suggest that, although children with ASD and higher ToM abilities may appear more similar to their TD peers, their parents may be experiencing more intense stress than parents of TD children. More research is needed to better understand the experience of stress in parents with children with ASD.