Parent Stress, Parent-Child Interactions, and Symptom Expression in At-Risk Infants

Background: Research suggests that parents of children with autism exhibit higher levels of stress than parents of typically developing children or parents of children with other disabilities (e.g., Dumas et al., 1991). Given this existing level of stress along with concern regarding the genetic liability of ASD, parents of infant siblings of children with autism face a unique set of circumstances which warrant further understanding (McMahon et al., 2007; Ozonoff et al., 2009). High levels of stress coupled with emerging developmental challenges may be consequential for parent-child interactions, and speak to the need for early intervention programs for infants at-risk.

Objectives: To examine differences in parental concern, stress, and interactional style, as well as the relationship of these variables to diagnostic outcomes and autistic symptomatology across two groups: parents of infant siblings of children with ASD (High-Risk, HR) and parents of infants with typically developing siblings (Low-Risk, LR),

Methods: Participants included 46 parents and their 12-month infants, including 31 HR and 15 LR dyads. Parents completed a concerns questionnaire, the Parenting Stress Index (PSI) and also participated in a standardized parent-child interaction. Infants completed the Mullen Scales of Early Learning (Mullen, 1995) and the Autism Diagnostic Observation Schedule (ADOS) at 12, 18, 24, and 36 months of age.

Results: HR parents reported more generalized concern regarding their child's development at 12 months of age (p=.016) than LR parents. HR parents reported concern regardless of observed developmental challenges at 12 months, although some parental concern was related to later observed autistic symptomatology (p=.044). When asked specifically regarding parental stress on the PSI, there were no significant differences between risk groups. However, within the HR group, those parents whose children presented with more language vulnerabilities at 12 months reported higher levels of stress in multiple PSI domains. In addition, while parents did not differ in terms of overall levels of synchrony in their interactions with their children across risk groups, HR parents were more active, engaging in more teaching behaviors with their children (p=.007). Within the HR group, teaching behaviors were positively correlated with levels of parental stress across several child domains (p<.01), but did not appear to be related to concurrent or future child behavior.

Conclusions: HR parents demonstrated greater levels of concern regarding their 12-month infants, although these concerns appeared to be more generalized, and not necessarily related to child development. More specific types of parental stress appeared to stem from observable child behaviors, and parents of children who do go on to have an ASD diagnosis likely have higher levels of stress early on. In addition, HR parents as a group were more active in their interactions with their children, particularly those parents who were more stressed and whose children were exhibiting more signs of social impairment. Parents' perceptions and concerns regarding their children's vulnerabilities speak to the importance of early intervention programs, and the need for programs aimed for children at-risk as well as those with identified delays.