Parent-Child Interaction in Children with Autism Spectrum Disorder Who Vary in Symptom Severity and Level of Functioning

Background:  Parenting children with autism spectrum disorder (ASD) is understood to be extremely stressful and presents unique challenges. Research with typically developing (TD) children suggests that parent-child relationship difficulties and ineffectual/negative parenting practices are likely to exist in the context of high parental stress and child behavior problems. However, few studies have examined the full continuum of parenting behaviors in families of children with ASD. 

Objectives:  To examine three well-established components of parenting (emotional support, instruction/patience, and negative parenting) using a parent-child interaction task in a sample of children with ASD and a parent or caregiver.

Methods:  Thirty children with ASD were included in this study (ages 5-12; racially and ethnically diverse sample). Diagnostic symptoms were assessed using the Autism Diagnostic Interview – Revised and the Autism Diagnostic Observation Schedule, Second Edition.  The parent-child interaction was assessed using the Psychological Multifactor Care Scale – ASD Adapted Version (PMCS-ASD; Donnelly, Brassard, & Hart, 2014; Brassard, Hart, & Hardy, 1993); making this study the first time the PMCS-ASD was adapted for use in this population. Sessions were coded by independent raters for both child and parent behaviors.  Through observations, two positive parenting factors were assessed: emotional support (e.g., displaying a supportive presence, praising, encouraging, calming, and warmth) and patience (e.g., scaffolding, guidance, limit setting, and positive affect). One negative parenting factor was also assessed (e.g., negative talk, interfering with materials or learning, lack of instruction, & absence of emotional support).  Additionally, coders rated the child’s experience of the session (e.g., observed success and competence, positivity of interactions) and child negativity towards the caregiver during the parent-child interaction.  Correlational and regression analyses were conducted.  

Results:  Parents and caregivers of children with ASD demonstrated high rates of positive parenting and low rates of negative parenting. Similar to what has been reported in TD children (e.g., Brassard et al., 1993; Patterson et al., 1990; Webster-Stratton & Eyberg, 1982), children with ASD acted more negatively towards their parents when negative parenting was exhibited in the structured task (r_s=.433, p<.05).  Positive parenting was positively correlated with the degree to which children were observed to have a good experience of the session (b=.671, p<.001), and this relationship was moderated by comorbidity of other disorders (mostly ADHD) in the unstructured session (b=-.513, p<.05), such that children without comorbid disorders were observed to have better experiences in the session when their parents exhibited greater amounts of positive parenting. The presence of comorbidity was also associated with the degree to which parents exhibited patience during the structured task (b*=-.469, p<.01). Parents of children without comorbid diagnoses displayed higher levels of patience (r=-.538, p<.01) and less negative parenting (r=.471, p<.01). 

Conclusions:  Findings of high levels of positive parenting and low levels of negative parenting suggest that, despite challenging behaviors associated with ASD, parents of children with ASD generally display supportive and flexible parenting.  However, the presence of comorbid diagnoses can negatively impact the parent-child relationship.  Future directions include clarifying moderators of the parent-child relationship and developing tools to better support parents.