Stress in Parents of Preschoolers Diagnosed with Autism Spectrum Disorder

Background: Parents of children diagnosed with autism spectrum disorders (ASD) experience levels of stress significantly higher than parents of children without disabilities. Several factors such as the gender and age of parents, the social support and the parent’s perceived self-efficacy, locus of control and coping style, seem to increase the risk for higher level of stress in parents of children diagnosed with ASD. However, apart from the autism severity and the behavior of the child, which child’s characteristics contribute to the increase of stress is poorly understood. Recently, it has been suggested that an increase in the degree of the autonomy of the child diagnosed with ASD could act potentially as a protective factor for the family’s quality of life and functioning. Moreover, in a pilot study with 35 preschoolers diagnosed with ASD, a significant correlation between the degree of autonomy of children and parental stress was found.        

Objectives: To explore which child’s characteristics are significant contributors to parental stress in a larger group of families with a preschooler newly diagnosed with ASD.

Methods: A cross sectional design has been used to reach the objective. Data collection was achieved with 61 children aged 3 to 4 years old and newly diagnosed with ASD using the ADI-R and ADOS-G. Other tests administered were the Merrill-Palmer-Revised (MP-R) for the cognition, the Preschool Language Scale 4^th edition (PLS-4) for the language, the Peabody Developmental Motor Scale-II (PDMS-2) for the motor component, the Sensory Profile-Short form (SSP) for the sensory information processing, the Child Behavior Checklist (CBCL) for the behavior, the Social Responsiveness Scale (SRS) for the severity of autism, the Repetitive Behavior Scale (RBS) for the stereotyped and repetitive behaviors, the Vineland Adaptive Behavior Scale-II-Daily living scale (VABS-II-DLS) for the autonomy and the Parent Stress Index-short form for the parental stress. With the exception of the VABS-II-DLS, only the total score of each scale was considered in the analysis in order to simplify the presentation of the results.

Results: Pairwise correlations revealed significant association between the high level of total parental stress and the following child’s characteristics: difficulties in sensory information processing (r=-0.4671; p=0.0002), behavioral problems (r=0.6571; p<0.0001), higher severity of autism (r=0.5145; p=0.0002), high level of repetitive and stereotyped behaviors (r=0.3935; p=0.0062) and poor daily living skills (r=-0.3451; p=0.0074). After conducting step-wise regression analysis with those variables as predictors of the total parental stress, the best model includes the SSP, the VABS-II-DLS and the CBCL and explains 49% of the variance.    

Conclusions: With a prevalence of ASD approaching 1%, there are important costs to society associated with their difficulties which are estimated in terms of billions of dollars. Sensory processing problems, behavioral difficulties and autonomy in daily living skills are domains for which interventions should be elaborated. By improving the child’s functioning, this should contribute to help parents cope with their stress following the diagnosis. This would not only impact on the parental stress and the family life, but also it should help lower the costs to society.