Parenting Children with ASD and Children with Anxiety Disorders: The Relationship Between Parental Stress, Anxiety, and Parenting Style and Child Symptom Presentation

Background: Extant literature illustrates higher stress in parents of children with autism spectrum disorder (ASD) than those with other developmental disabilities and those with typically developing (TD) children.  Child symptom severity, externalizing symptoms, parent-child relationships, and parent support have been shown to contribute to this increased stress, although results vary.   

Objectives: We examined differences in parental stress and symptoms of psychopathology between three groups: parents of TD children, parents of children with anxiety disorders, and parents of children with ASD.  This is the first study to examine differences between parents with children with ASD and parents of children with anxiety disorders and how child variables may differentially influence parenting stress and psychological functioning.  

Methods:  Participants included mothers or fathers of 47 children with ASD, 23 parents of TD children, and mothers of 101 children with anxiety disorders (e.g. generalized anxiety disorder, specific phobia, and selective mutism). Children were between 4 and 16 years of age. Parenting stress was assessed was using the Parental Stress Index-4^th Edition (PSI-4), and symptoms of anxiety and depression were examined using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory- Second Edition (BDI-II) respectively.  To address parenting behaviors, parents completed the Parent’s Report of Parental Behavior Inventory (PRPBI).  Childhood anxiety and autism symptom severity were evaluated with the SCARED, CASI, and SRS, respectively. 

Results:  Parents of typically developing children and parents of children with ASD and anxiety disorders reported similar levels of anxiety and depressive symptoms, as assessed using the BAI and BDI-III. However, parents of children with ASD reported significantly higher levels of parenting stress than parents of typically developing children (p < 0.05). In both clinical groups, child anxiety symptom severity correlated significantly with parent anxiety symptom severity (r=0.460, p < 0.01 for ASD group; r=0.219, p< 0.03 for anxiety group).

In terms of parenting behaviors, as assessed using the PRPBI, parents of children with anxiety disorders reported higher levels of acceptance and firm control (the degree to which parents use strict discipline to control their child’s behavior), as compared to parents of TD children or children with ASD (p < 0.01). In the children with anxiety disorders, child anxiety symptoms were positively correlated with parent acceptance, firm control, and psychological control (e.g. guilt or intrusiveness). In the children with ASD, social communication symptom severity, as assessed by the SRS, was negatively correlated with parent acceptance and psychological control.

Conclusions:  Parents of children with ASD experience a high level of parenting stress; however symptoms of anxiety and depression are comparable to parents of TD children and parents of children with anxiety disorders. Child symptom presentation, though, is correlated with parent anxiety symptoms as well as parenting behaviors in both clinical groups.

The challenge of parenting a child with a developmental disability or psychiatric disorder cannot be understated, and it may lead to distinct parenting styles, views, and approaches. Continued work will further elucidate this relationship with the overall goal of developing more effective strategies for parents of children with disabilities, particularly ASD.