The Relationship Between Child-Related Stress of Parent Participants and Child Gains in a Behavioral Intervention Program for Children with Autism Spectrum Disorders (ASD)

Background:
Parents of children with ASD have been shown to have higher stress levels than parents of children without disabilities (Baker-Ericzen et al., 2005).  Studies also show that child-related stress may be mediated by parent education (e.g., Koegel, Bimbela, & Schreibman, 1996).
Objectives:
To examine the effect of a behavioral intervention parent education program on various areas of parent stress as measured by the Parenting Stress Index (PSI; Abidin, 1995).
Methods:
Parents of children (aged 2-4 years) with ASD were trained in one of two naturalistic teaching strategies, Pivotal Response Training (PRT, N=20) or the Picture Exchange Communication System (PECS, N = 19). Parents completed the Parenting Stress Index (PSI) before and after intervention. The PSI is a questionnaire that evaluates stress in the parent-child relationship along two scales, one scale focuses on parent-related stress (stress due to issues unrelated to the child, such as financial stress or divorce) and the other scale focuses on child-related stress (stress due to the child, such as a disability).  Child participants received a comprehensive battery of cognitive, language and adaptive behavior assessments before and after intervention.  Changes in child-related stress on the PSI were analyzed using analyses of variance by intervention group. After the analyses, for each statistically significant subscale parents were grouped based on whether their stress decreased or did not decrease over the course of intervention. Children were then compared by group (parental decreasing stress or no decreasing stress) using ANOVA to determine whether there were any differences across groups in outcome.
Results:                                
No differences in stress level or changes in stress were found between the intervention groups (PECS;PRT), therefore data were collapsed across groups for subsequent analyses. No parent-related stress scales changed substantially over time. On the child-related stress scales, the Child Reinforces Parent subscale of the PSI showed a statistically significant decrease overall from pre- to post- intervention. In this analysis, two groups of parents emerged: Group 1 demonstrated decreasing stress over time and Group 2 demonstrated no decreasing stress over time. Changes in child-related parent stress on this subscale were related to child gains in adaptive social behaviors in our sample, in that child participants in Group 1 showed greater improvements after intervention than child participants in Group 2.
Conclusions:
Although some aspects of child-related stress are positively affected by parent education, parents may need additional support to mediate parent-related stress and a majority of types of child-related stress. Despite the complexity of addressing social deficits in children with ASD, gains in child adaptive social behaviors may be most important in mediating child-related stress in parents of children with ASD. Autism service providers should consider these findings when developing intervention programs for young children with ASD.