Five Factor Structure of Parenting Stress Index – Short Form in Evaluating Stress in Parents of Children with ASD

Background:  

Parents of children with autism spectrum disorder (ASD) experience high levels of stress compared to parents with children without ASD (Baker-Ericzn, Brookman-Frazee, & Stahmer, 2005). This has been attributed to child factors, parent factors, as well as dysfunctional parent-child interactions (Rivard, Terroux, Parent-Boursier, & Mercier, 2014). Parenting Stress Index-Short Form (PSI-SF; Abidin, 1990) is a quick screen for all 3 domains of parenting stress in a clinical setting (Parental Distress, PD,  Difficult Child, DC and Parent Child Dysfunctional Interactions, P-CDI). It has been used to provide parent focused interventions to improve child outcomes in primarily non-ASD familes, but may also be of utility in assessing parenting stress in families with ASD children (Rao & Beidel, 2009). Given the unique multidimensional parenting challenges of ASD families, it is not known if the 3 factor structure of PSI-SF is valid for them and if the individual line items congregate within the same domains in ASD families as in families with non-ASD children (Zaidman‐Zait et al., 2011).   

Objectives:  

To assess the validity of the three factor structure and individual line items of the Parenting Stress Index-Short Form (PSI-SF) in a large clinical sample of parents of children with ASD.

Methods:  

The participants included 685 parents (90.51% mothers) of children evaluated at Kennedy Krieger Institute’s Center for Autism and Related Disorders in an ongoing clinical research registry between June 2014 and June 2015. Mean child age was 6.02 years (range =1.42-11.95; 17.7% female). The parent completed PSI- SF prior to the child’s evaluation. The 685 children were then evaluated by a multidisciplinary team to determine the presence or absence of ASD diagnosis using DSM – IV criteria. Of these, 410 were also administered ADOS-2.  ASD diagnosis status was determined either from the child’s medical record or from adapted Ohio Autism Clinical Impressions Scale (OSU Research Unit on Pediatric Psychopharmacology, 2005)  filled by the evaluating clinicians. 458 children (66.86%) had a confirmed ASD diagnosis; in 177 children (25.84%) ASD was ruled out; for 50 children (7.30%), data were not available.

Results:  

Unlike the 3 factor domains previously described in PSI-SF, exploratory factor analysis revealed the presence of a 5 factor structure for parents of children with ASD. The first domain was similar to the original PD domain in the PSI-SF. Differences were noted in DC domain and the P-CDI domains from the original with some items crossing over across the domains. We identified a 4^thand a 5th domain specifically pertaining to “socio-emotional expectations” and “learning expectations” respectively. 3 items were found to be unique and did not correlate well with any of the domains. 

Conclusions:  

The three factor structure in the original PSI-F may be more valid for the normative sample of the population. For ASD families, the five factor structure identified in this sample may help identify the focus of parenting needs including parental socio-emotional and learning expectations so as to provide interventions that may positively influence child outcomes.