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Pathways between Children’s Behavior problems and Parental Stress and Parenting among Parents of Children with Autism Spectrum Disorders

Final Report Summary - PARENTING STRESS (Pathways between Children’s Behavior problems and Parental Stress and Parenting among Parents of Children with Autism Spectrum Disorders)

Children with Autism Spectrum Disorders (ASD) experience a complex range of social, emotional, and behavioural difficulties that present significant, ongoing concerns for parents. A well-accepted sequel of children's ASD is increased parenting stress. The present study examined
parenting stress using both general and context-specific measures of parenting stress among families of young children with autism spectrum disorders (ASD). Assessment of context specific stressors are important because they reflect on the on-going challenges of families of young children more than general measures of parenting stress (Quittner, Glueckauf, &
Jackson, 1990). Similar to previous studies, mothers of children with ASD reported higher levels of both general and context-specific stress than mothers of children with typical development. Comparing the types of stressors experienced by the two groups revealed that the highest ranked stressors for parents of children with ASD were as follows: (1) child future, (2) child's relationships with other children, (3) child's safety, (4) communicating with child, and (5) decision making regarding the child. In contrast, highest ranked stressors for the comparison group were as follows: (1) child's safety, (2) having free time, (3) finances, (4) parental work, and (5) child's discipline. These results indicated that parents of children with ASD rated stressors specific to their child (e.g. social relationships, communication, and educational placement) whereas parents of children with typical development were stressors specific to parents contextual factors (e.g. work, free time, finance). The context-specific reflected the unique challenges faced by parents of children with ASD. Regarding children's behaviour problems, as hypothesized, based on both teachers and parents report, children with ASD experienced more externalizing and internalizing behaviour problems than typically developing children. Given that parenting stress has consistently been linked to children’s behaviour problems identification of context-specific stressors could help clinicians working with families of children with ASD.

Consistent evidence demonstrating significant ongoing associations between behavioural difficulties among children with ASD and parenting stress. Yet, few studies have examined potential underlying processes that link parenting a child with ASD, children’s behaviour problems, and parenting stress. Parental cognitions are increasingly recognised as key determinants of parenting and as a fruitful focus of parent intervention programs (Maloney & Altmaier, 2007). In the current study the role of parent cognitions and cognitive control capacities were examined in determining parenting level of stress and parenting behaviours. Parental cognitive factors have received very little empirical attention despite Mash and Johnston’s (1990) model suggesting that maternal cognitions play a substantial role in parent-child interactive stress. Metaparenting construct refers to the deliberate thoughts or effortful cognitions that parents hold regarding parenting itself (Hawk & Holden, 2006; Holden & Hawk, 2003). Metaparenting represents a profile of cognitive aspects including anticipating, assessing, problem solving, and reflecting. This construct is theorised to promote effective parenting and to drive parental transformations (Holden & Hawk, 2003). Findings form the current study demonstrated that Mothers of children with ASD reported higher levels of total metaparenting compare to mothers of children with typical development. Inspection of the specific subscales revealed that mothers of children with ASD had higher scores on all subscales (i.e. assessing, anticipating, reflecting and ruminating) besides the problem-solving subscale. In addition, mothers with higher levels of metaparenting reported higher levels of parenting stress. Accordingly, it seems that metaparenting is more likely to occur when child-rearing challenges are encountered (Holden & Hawk 2003). Furthermore, maternal metaparenting moderated the associations between child behaviour problems and parenting stress. Specifically, only among mothers who experiences average and higher levels of metaparenting, children's behavior problems were positively associated with increased context specific parenting stress. This in turn might reflect that mothers parenting cognition are associated with their sense of competence in dealing with their children behaviour problems.

The current study also examined the role played by maternal executive function (i.e. regulation of attention, inhibitory control, working memory, and executive function abilities in daily contexts) in relation to mothers' parenting stress and parenting. Executive function can be broadly defined as a central component related to individuals’ capacity to adaptively regulate their thoughts, emotions, instincts, and actions (Posner & Rothbart, 2009). Recent studies proposed that executive function is critical in allowing parents to exert cognitive control or self-regulation of emotion, and in promoting optimal responses to challenging child behaviours (Deater-Deckard, Sewell, Petrill, & Thompson, 2010; Deater-Deckard, Wang, Chen, & Bell, 2012). Parents facing difficult child behaviours must evaluate situations and potential responses in order to regulate their thoughts and emotions in an effort to respond effectively and reduce the child’s problematic behaviour (Lorber, O’Leary, & Kendziora, 2003). Indeed, findings indicated that mothers with poor working memory were more reactive to child misbehaviour than mothers without such working memory deficits (Deater-Deckard et al., 2010), and that maternal executive function appears to be a key component in the self-regulation of negative emotions arising from parenting in the face of challenging child behaviour (Deater-Deckard et al., 2012). Accordingly, executive function could be a critical aspect of emotional and behavioural regulation for parents, within the context of child behaviour that is oppositional and emotionally aversive to the parent and that influences parents' feeling of stress. Current findings demonstrated that maternal executive function and sustain attention are important coping resource for mothers of children with and without ASD.

Several theoretical models of parenting suggested that parenting stress is also known to impact subsequent parenting behaviours (e.g. Deater-Deckard, 1998), which have been applied in the context of developmental disabilities (Hastings, 2002). However, over and above the caregiving demands placed on parents of children with ASD, little is known about parenting behaviours of parents of children with ASD, let alone whether they are impacted by parenting stress or other cognitive control capacities. Preliminary findings indicated that higher levels of mothers’ executive functions were characterized with higher levels of dyadic flexibility (i.e. affective structure) and greater mutual dyadic positive affect (i.e. affective content).

Overall, the current study contributed to the provision of family support in a highly significant manner and to enhance knowledge that is directly applicable to clinical practice. It enhanced knowledge relevant for the implementation of effective early intervention programs for children with ASD and their families. Acknowledging the importance of parents’ well-being as an important ingredient of its success. The current study also coincides with family-centred service – considered the gold standard approach to services for families of children with chronic conditions (Rosenbaum, 2011) and with the call for increased family-based interventions in paediatric psychology (Fiese, 2005). Study findings urge professional to support family strengths and needs to enhance the child's outcome within the family context. Furthermore, this study corresponds with current popular initiatives of innovative stress-reduction intervention approaches such as mindfulness training for parents focusing on developing caregivers' executive function capacities such as focused attention, cognitive flexibility, and emotional regulation. (Benn, Akiva, Arel, & Roeser, 2012). In addition, information collected on context specific stressors and challenges across various child and family domains is expected to provide strong practical information that can enhance effective service delivery services and it can inform the development of a specific psychosocial assessment screener for families of children with ASD.