Parenting Stress Associated with Autism Spectrum Disorders, 2007 National Survey of Children's Health

Background:   Previous studies suggest parenting a child with an autism spectrum disorder (ASD) is associated with high stress levels.  Most studies were based on small clinical samples, few included non-ASD comparison groups, and analyses of underlying predictors of stress were limited. One past population-based study suggested that the association between parenting stress and ASD varied according to the child’s special service needs, but further research is needed to fully explore this finding.

Objectives:   To examine the association between having a child with an ASD and parenting stress and aggravation and to examine associations between parenting aggravation and  family sociodemographic characteristics, health care access, and social supports among parents of children with and without ASDs.

Methods: Weighted prevalence estimates of parent-reported stress indicators, including a composite measure of aggravation in parenting, were assessed for parent respondents of 73,030 US children aged 4-17 years included in the 2007 National Survey of Children’s Health.  Parents who reported their children had ASDs currently were compared with 4 mutually-exclusive groups of parents of children without a current report of ASD.  Within each group, risk factors for high aggravation were assessed.

Results: The proportion of parents of children with current ASDs who were in the high-aggravation range (36.6%) was comparable to the proportions for parents who reported their child had a past but not current ASD (35.2%), or had another non-ASD emotional, developmental, or behavioral problem (31.2%).  Proportions of high aggravation were significantly lower for parents of children with other types of special health care needs (6.5%) and no special health care needs (5.1%).  Among parents of children with current ASDs, variations in high aggravation were observed based on whether the child received family-centered care (26.1% high aggravation versus 46.3% for those without family-center care), received care within a medical home (defined based on American Academy of Pediatrics framework)  (12.5% versus 48.4%), recently received mental health treatment (51.3% versus 23.3%), was uninsured during the past year (68.5% versus 35.0%), whether the parent had someone to turn to for emotional support  (32.8% versus 53.8%), and parent-reported ASD severity (27.3%, 41.6%, and 54.1% for mild, moderate, and severe ratings, respectively). After multivariable adjustment, independent associations were observed between high parent aggravation and child age <6 years (adjusted prevalence ratio [aPR]=1.7), child uninsured in past year (aPR=1.6), child not receiving care in a medical home (aPR=2.0), child recently received mental health treatment (aPR=1.8), parent lacks someone to turn to for emotional support (aPR=2.1), and child’s current ASD rated as moderate/severe (aPR=1.4). While some of these same factors were associated with aggravation within the non-ASD groups, the association between lack of a medical home and parental aggravation was particularly noteworthy for children with current or past only ASDs reported.

Conclusions: Having a child with an ASD is associated with high stress levels; however, there is variability within health care and social support subgroups. Strategies to strengthen family-centered care and other components of the medical home construct might positively impact parent stress levels for children with ASDs.