Predictors and Moderators of Parenting Stress in Youth with Autism Spectrum Disorder and Their Typically-Developing Siblings

Background: Mothers of children with autism spectrum disorder (ASD) experience a particularly elevated level of stress (Schieve et al., 2007) and depression than mothers of children with other developmental disabilities or typically-developing (TD) children (Abedduto et al., 2004; Davis & Carter, 2008). Increased rates of problem behaviors in children with ASD contribute to parenting stress more than ASD symptoms (Peters-Schefferet al. 2012). A less studied component of parenting stress is the clinical functioning of TD siblings in the context of ASD. Mothers may also respond differently to child characteristics, including sex-based differences (Sameroff, 2009). A better understanding of factors contributing to parenting stress, including clinical functioning in children with and without ASD and across genders, is crucial for developing interventions that enhance well-being of families affected by ASD.

Objectives: Examine whether the relationships between clinical functioning in children and parenting stress are moderated by maternal depression or child’s gender, in children with ASD and in TD siblings.

Methods: Mothers (N=256) with one child with ASD (M_age=11.82, SD_age=3.02; 84% male) and a TD child (M_age=11.24, SD_age=3.18; 47% male) completed a measure of clinical functioning in their children (BASC-2; Reynolds & Kamphaus, 2004), as well as a measure of parenting stress (PSI-4SF; Abidin, 2012) and their own depressive symptoms (BDI-II; Beck, Steer, & Brown, 1996).

Results: PSI total score positively correlated with externalizing, internalizing, behavioral symptoms (r>.30, p<.001), and negatively with adaptive skills (r=-.52, p<.001) in children with ASD. BDI moderated the relationship between the child with ASD’s internalizing behaviors and PSI (B=-.02, p=.012), such that the relation was present only when BDI was low or average (Fig 1A). The gender of children with ASD moderated the relationship between child externalizing behavior and PSI (B=-.85, p=.006), such that these relationships were only present for with boys (Fig 1B). TD children’s behavioral symptoms (r=.17, p=.016) and adaptive skills (r=-.14, p=.025) related to PSI. These relationships were not moderated by BDI, but the relationship between adaptive skills and PSI was moderated by gender (B=-0.35, p=.041), such that the relation was only in TD girls (B=-0.25, p=.015).

Conclusions: Results suggest that both children with ASD and their TD siblings’ clinical functioning contribute to parenting stress, supporting bidirectional relations along with parenting stress predicting child psychopathology (Anthony et al., 2005; Bauminger et al., 2010). Surprisingly, these relations were not seen in highly depressed mothers. Given that parenting stress predicts depressive symptoms above and beyond child characteristics (Weitlauf et al., 2014), it is possible that depressed mothers may experience elevated parenting stress regardless of child behaviors. Moderation by gender suggests that mothers’ differential expectations of behavior, such as perceiving externalizing behaviors in boys with ASD and low adaptive skills in TD girls as more stressful, may affect mothers’ sense of parenting efficacy. As parental stress has a negative impact on treatment outcome (Osborne et al., 2008), these findings highlight the importance of addressing emotional and behavioral problems in both children with ASD and TD siblings, and considering maternal (depression) and child-specific (gender) factors to reduce parental stress.