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Relationship between Child Dysregulation and Parenting Stress Scores in Toddlers with ASD
Parents of children with ASD are known to experience levels of stress significantly higher than those experienced by parents of children with other disabilities (Osborne, McHugh, Saunders, & Reed, 2008). Child challenging behaviors are also shown to be correlated with these parent stress levels, wherein more challenging behaviors are associated with greater parent stress (Lecavalier, Leone, & Wiltz, 2005). However, it is unclear what specific aspects of child behavior are most predictive of parent stress among a sample of parents who have a toddler at risk for ASD or recently-diagnosed with ASD.
Objectives:
The present study aimed to: (1) establish whether there is an association between parent perceptions of discrete child behaviors (as measured by the Infant-Toddler Social and Emotional Assessment (ITSEA)) and parenting stress (as measured by the Parenting Stress Index (PSI)) (2) to determine the relationship between significant ITSEA subdomain scores and PSI subdomain scores controlling for demographic characteristics.
Methods:
This study is a secondary analysis of an RCT of toddlers at-risk for ASD (N=86 parent-child dyads; Kasari, et al., 2015). Parents completed the ITSEA and the PSI prior to beginning a caregiver mediated intervention study. This study reports on baseline associations only. The ITSEA has four subdomains including: Externalizing problems, Internalizing problems, Dysregulation and Competence. The PSI assesses stress in the parent-child system based on three categories: child-related, parent-related, and total stress. Analyses first included, bivariate correlations to determine the associations between ITSEA and PSI subdomain raw scores at baseline. Significant correlations between subdomain scores informed the subsequent predictors within the multiple regression models. Next, three regression analyses determined which ITSEA subdomains significantly predicted each PSI subdomain. This analysis controlled for autism severity (as measured by ADOS Clinical Severity Scores), IQ (Mullen developmental quotient), treatment assignment, age, and gender. Insignificant predictors were excluded from presented analyses.
Results:
All four ITSEA subscale scores externalizing, internalizing, dysregulation, and competence significantly correlated with the PSI child subdomain scores as well as the PSI total stress subdomain scores. The ITSEA dysregulation and externalizing subscale scores significantly correlated with the PSI parent subdomain scores (see table 1 for full matrix). In pursuit of the second objective, PSI total stress and parent domain scores were each uniquely predicted by ITSEA dysregulation scores (β=0.44, p=.002; β=0.39, p=.001). Additionally, PSI child domain was significantly predicted by both ITSEA dysregulation (β=0.33, p=.01) and competence (β=-0.32, p=.006) subscale scores.
Conclusions:
Child dysregulation is a behavior that strongly predicts parents’ stress across all domains of the PSI, highlighting the need to address these behaviors in behavioral intervention studies. Consistent with previous findings (see Davis & Carter, 2008), impairments in child social relatedness (as measured by competence domain of ITSEA) also produced high-levels of parent stress in this sample. These findings suggest that intervention studies may find it useful to explicitly target parent stress and integrate tools to help manage child dysregulation.