Externalizing Behaviors are Associated with Increased Parenting Stress in Caregivers of Young Children with Autism

Abstract

Parents of children diagnosed with autism spectrum disorder (ASD) report higher levels of stress than parents of typically developing children. Few studies have examined factors associated with parental stress in early childhood. Even fewer have investigated the simultaneous influence of sociodemographic, clinical, and developmental variables on parental stress. We examined factors associated with stress in parents of young children with ASD. Multiple regression models were used to test for associations between socioeconomic indices, developmental measures, and parental stress. Externalizing behaviors, communication, and socialization skills accounted for variance in parental stress, controlling for ASD diagnosis. Results highlight the importance of interventions aimed at reducing externalizing behaviors in young children as well as addressing stress in caregivers of children with ASD.

Keywords: ASD; Early childhood; Externalizing behaviors; Parental stress.

Fig. 1

Boxplots displaying PSI Child (a) and Parent (b) domain T scores by diagnostic group. a t = − 8.0, p < 0.001, b t = − 2.0, p < 0.02

Fig. 2

Correlation heat maps. Bivariate Pearson’s correlations between the PSI-4 Child and Parent domain scores and developmental, clinical, and demographic variables in a participants with ASD and b TDparticipants. Only significant correlations (at p < 0.05, uncorrected) are displayed in color. INR income-to-needs ratio, MEL maternal education level, CBCL Ext externalizing problems, CBCL Opp oppositional defiance, Vine Comm Vineland Communica-tion, Vine Soc Vineland Socialization, MSEL ELC Mullen Scales of Early Learning, Early Learning Composite score, MSEL Rec receptive language, MSEL Exp expressive language. Higher scores on ADOS, CBCL, and SCQ represent greater ASD symptoms and behavioral problems, while higher scores on Vineland and MSEL represent greater or more advanced developmental skills. Higher T scores on PSI-4 represent greater levels of stress

Fig. 3

a, b Scatterplots depicting significant associations between PSI-Child domain T scores and scores on a parent-rated externalizing behaviors (CBCL) and b parent-rated communication skills (Vineland). Associations were significant when controlling for one another and for the effect of diagnosis on child-relatedstress. c, d Scatterplots depicting significant associations between PSI-Parent domain T scores and c parent-rated socialization skills (Vineland) and d income-to-needs ratio by diagnosis interaction. Associations were significant when controlling for one another and for the effect of diagnosis

Fig. 4

a, b Parental stress cluster membership in a TD children and b children with ASD. c Bar plots depicting PSI Child and Parent domain T scores (y-axis) by Stress Cluster (x-axis) with standard error bars. d–i Boxplots displaying scores for each PSI child-related subscale, in each cluster. j–q Boxplots displaying scores for each PSI parent-related subscale, in each cluster. Child-related stress subscales include: child’s d distractibility/hyperactivity, e adaptability, f demandingness, g child mood, h the extent to which the parent experiences interactions with the child as reinforcing, and i the extent to which child’s characteristics meet parental expectations (acceptability). Non-child-related stress subscales include: parent’s sense of j competence, k parent’s affective status, l perceived emotional and physical support from the parenting partner, m parent’s overall health, n sense of isolation and social support, o sense of attachment to the child, p sense of role restriction and constrained personal identity, and q overall life stress. For d–q, dashed lines indicate clinically significant threshold (at 90th percentile)