by Lai-Sang Iao
Autism Spectrum Conditions (ASC) are characterized by impaired social communication/interaction and repetitive interests or stereotyped behaviors (American Psychiatric Association, 2013). Traditionally it was believed that these autistic symptoms and behavioural problems contributed to heightened stress in parents of children with ASC (e.g., Hou, Stewart, Iao, & Wu, 2018). However, this suggestion was based on findings from cross-sectional studies, which could not conclude the direction of the relations between parenting stress and child behavioural problems in ASC. Understanding whether behavioural problems in ASC predict parenting stress or vice versa is essential to prioritise strategies to prevent negative outcomes such as poor parental mental health (e.g., Benson & Kersh, 2011; Yorke et al., 2018).
A mixed pattern of relationships was in fact suggested by longitudinal research. Peters-Scheffer, Didden, and Korzilius (2012) found that behaviour problems in children with ASC (aged 2–9 years) did not exacerbate maternal stress a year later, nor did maternal stress exacerbate child behaviour problems over two years. However, Totsika et al. (2013) indicated that parenting stress in mothers of children with ASC when their children were 3 years old exacerbated child behaviour problems two years later while child behaviour problems did not predict parenting stress. More recent studies found that behavioural problems in children with ASC (aged 5-12 years in Rodriguez, Hartley & Bolt, 2019; aged 24-47 months in Zaidman-Zait et al., 2014) predicted parenting stress and vice versa.
Two of these studies tested a wide age range of participants which may have masked different relationship patterns between parenting stress and behavioural problems in ASC at different developmental stages (Totsika et al., 2013). More importantly, none of these studies has focused on examining the relations between parenting stress and behavioural problems in young children with ASC under 3 years old despite their importance for effective early intervention and family services. Lin, Iao, Lee and Wu (2020) thus aimed to investigate how parenting stress and child behaviour problems influenced each other in ASC across two time points: One was when children with ASC were 18 months to 3 years old and the other was 1.5 years later. In order to provide implications for effective early intervention and family services, we examined different domains of parenting stress (i.e., child-related domain and parent-related domain) and their independent relationships with child’s internalising and externalising behavioural problems. Child-related parenting stress arises from parents’ report of child characteristics (e.g., adaptability, demandingness) while parent-related parenting stress arises from parent characteristics (e.g., competence, health). Child’s internalising behavioural problems include emotional reactivity, anxious/depressed, somatic complaints, and withdrawal. Externalising behavioural problems include hyperactivity, impulsivity, and aggressive behaviour.
In our study, seventy-five young children with ASC in Taiwan were individually assessed using the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 1999) when they were 18 months to 3 years old and received their diagnoses within 1.5 years. Their parents were asked to answer questionnaires for parenting stress and child behavior problems at both timepoints. Consistent with Totsika et al. (2013), our findings indicated that parenting stress predicted externalising behavioural problems in young children with ASC over 1.5 years, but not vice versa. However, a reason for no effect of child behaviour problems on parenting stress could be due to the possibility that our parents in Taiwan may have accepted their child’s diagnosis and their role as a parent of a child with ASC and developed stress coping strategies by the second timepoint (Chao, Chang, Chin, Li, & Chen, 2018). Our findings also did not exclude the possibility that behaviour problems in ASC may predict parenting stress at later developmental stages. Given that we focused on young children with ASC, we were not able to find the late effect of child behaviour problems on parenting stress in children with ASC aged nearly 6 years old and beyond in both Zaidman-Zait et al. (2014) and Rodriguez et al. (2019).
The effect of early parenting stress on later child’s externalizing behavioral problems was found in young children with ASC in the current study as well as older children with ASC in previous studies (Rodriguez et al., 2019; Totsika et al., 2013; Zaidman-Zait et al., 2014). Our findings further indicated that it was child-related rather than parent-related parenting stress that predicted child externalising behavioural problems 1.5 years later. That is, the more negative perception a parent had regarding his/her child characteristics, the more child externalising behavioural problems were reported later. Although further research is needed to verify this finding, it provides crucial implications to early diagnosis, assessment and intervention for young children with ASC and their families. First, consistent with previous Western studies (e.g., Mansell & Morris, 2004), Chao et al. (2018) suggested that parents in Taiwan understand their child’s problems more and experience less anxiety and uncertainty about their difficulties after a diagnosis of ASC was confirmed for their child. Therefore, early diagnosis is essential in helping parents understand their child’s characteristics and decrease their anxiety and child-related stress which may in turn reduce their child’s externalising behavioural problems. Second, high ratings on the items of the parenting stress questionnaire such as “Child cries or fusses more often than other children” may not only indicate high child-related parenting stress but also reflect parents did not have the skills to manage their child’s behaviours, leading to more child externalising behavioural problems. Parent training programs that teach parents to identify the antecedents and consequences of their child’s behaviours, to prevent child disruptive behaviours and to promote child compliance may reduce child disruptive and noncompliant behaviours (Bearss et al., 2015). Third, child-related parenting stress should be assessed at an early stage so as to provide bespoke intervention and support to parents, e.g., teaching them adaptive strategies to cope with their child-related parenting stress as a priority. Previous research also showed that parent-focused interventions could effectively decrease parenting stress in parents of young children who were newly diagnosed with ASC (e.g., Zaidman-Zait et al., 2017).
To conclude, parenting stress that was related to parent’s perceptions on child characteristics predicts externalising behavioural problems in young children with ASC over 1.5 years. Hence, adjusting parental perceptions of child characteristics by promoting a better understanding and skills in reforming children’s behaviours would prevent later externalising behavioural problems during early childhood. Parenting stress should also be assessed early and included in early intervention.
About Lai-Sang Iao:
Dr Lai-Sang Iao is a Senior Lecturer in Psychology and the Course Leader for MSc Applied Child Psychology at Nottingham Trent University. Her research interests include social and cognitive development in typically developing individuals and individuals with ASC. She uses a variety of research methods to understand the mechanism of different social and cognitive aspects in both typical and atypical development so as to provide theoretical and practical implications for creating positive changes and better outcomes for both individuals with and without ASC. She also does research on the clinical aspects of ASC, including early screening and parental mental health.
The full paper is here: Lin, Y.-N., Iao, L.-S., Lee, Y.-H., & Wu, C.-C. (2020). Parenting stress and child behavior problems in young children with Autism Spectrum Disorder: Transactional relations across time. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-020-04720-z
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Psychology at Nottingham Trent University 