Comparison of Parenting Stress, Efficacy, and the Home Environment Among Families of Youth with ASD, ADHD, and ASD with ADHD Features

Background: Given the persistent and pervasive nature of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), difficulties often extend beyond the child resulting in challenges regarding parental and family functioning. Parents of youth with ASD or ADHD commonly report heightened parenting stress, decreased parental efficacy, and disruption in the home environment (e.g., Hayes & Watson, 2013; Theule, Wiener, Tannock, & Jenkins, 2013).

Objectives: While many studies have compared experiences of parents of youth with ASD or ADHD to parents of typically developing children, a paucity of research has explored differences in parenting and household experiences between families of youth with ASD, ADHD, and those presenting with symptoms of both disorders. Therefore, the present study aimed to begin to address this gap in the literature.

Methods: 124 youth were included in the current analyses; subgroups reflect ASD alone (ASD- n= 76), ADHD alone (ADHD- n= 29) and ASD with clinical levels of ADHD via the Child Behavior Checklist (ASD+ n= 19). Adolescents presented for participation in the PEERS^® intervention; data collected prior to the intervention is used here. Presence of ASD was confirmed with the ADOS-G (Lord et al., 2000), and a composite IQ greater than or equal to 70 was required for the ASD participants (KBIT-2; Kaufman & Kaufman, 2004). Youth presenting for ADHD provided documentation of an established diagnosis and demonstrated clinically-significant ADHD symptoms on the Disruptive Behavior Disorder scale (DBD; Pelham, Gnagy, Greenslade, & Millich, 1992). Parental and family functioning was assessed using the Stress Index for Parents of Adolescents (Sheras, Abidin, & Konold, 1998), Parent Sense of Competency Scale, Efficacy Subscale (Johnston & Mash, 1989), and the Confusion Hubbub and Order Scale (Matheny, Wachs, Ludwig, & Phillips, 1995).

Results: Results of ANOVA and MANOVA analyses indicated that total parenting stress and subscales of parent-domain stress (restrictions on life and social alienation) were significantly greater in the ASD+ group compared to the ASD- and ADHD- groups (Table 1). Subscales of the adolescent-domain parenting stress (adolescent moodiness, delinquency, and failure to achieve), as well as overall home disruption were significantly greater in the ADHD and ASD+ groups compared to the ASD- group (Table 1). Parental efficacy was marginally greater in the ASD- group compared to the ADHD group (Table 1).

Conclusions: Findings from the present study revealed significant differences in parenting stress and home disruption, but less robust differences in parental efficacy among parents of youth with ASD, ADHD, and ASD with ADHD features. The pattern of differences appears to be driven by either a compounding effect of ADHD and ASD or the presence of ADHD symptoms. The results highlight the importance of screening for comorbidity among these populations as varying neurodevelopmental presentations appear to be associated unique parental and family functioning and, in turn, likely impact treatment recommendations. While a strength of this study is the comparison between multiple clinical groups, lack of a typically developing control sample, small sample sizes, and reliance on parent-report limit the interpretation and generalizability of these findings.