The Relationship Between Pain and Problem Behavior in Predicting Parent Stress in Families of Children with Autism

Background: Studies have shown that children with ASD have increased severity and incidence of pain symptoms compared to typically developing children and children with other disorders (Herbert, 2005). Pain has also been shown to act as a setting event for problem behavior in children with autism spectrum disorder (ASD) and is one of the strongest predictors of parent stress. Parents of children with ASD who also experience physical illness tend to be more intensely involved in their caregiver role and are also more likely to experience stress (Krulik et al., 1999). Further, children with ASD may have difficulty communicating pain symptoms and are more likely to exhibit challenging behavior when sick (Carr & Blakeley-Smith, 2006). Currently, the relationship between child pain symptoms, problem behavior, and parent stress is unknown in parents of children with ASD; however, it is important to better understand this relationship in order to further address these issues in treatments for challenging behavior. Objectives: (1) To examine the relationship between pain symptoms, parent stress, and problem behavior; and (2) To determine the role of parenting style in the relationship between pain symptoms, problem behavior, and parent stress. Methods: Participants included 148 parents of children with ASD who were recruited from a Northeast local chapter of the Autism Society of America. Parents completed standardized self-report measures of pain symptoms, problem behavior, parent stress, and parent coping style They were compensated with a $20 Amazon.com gift card. Results: Multiple regression analyses indicated that child pain was significantly positively related to parent stress for those children with high problem behavior, r(99) = .403, p < .001, whereas it was not significantly related to parent stress for children with low problem behavior, r(33) = .04, p = .53. There was a significant interaction between pain symptoms and parent protectiveness to predict parent stress, t(128) = 2.62, p = .01 (β = .23). There was a significant, negative correlation between parent protectiveness and parent stress when child pain was low, r(99) = -.25, p = .05, and a significant, positive correlation when child pain was high, r(33) = .29, p = .02. Conclusions: Results showed that problem behavior was a moderating factor between pain and parent stress and there was a significant interaction between pain and problem behavior predicting stress. Pain could be functioning as a setting event such that when pain is present it might increase the likelihood that problem behavior will occur. An overprotective parenting style also moderated the relationship between pain and parent stress. This suggests that parents who respond to their child’s pain by reducing demands or by increasing attention to the child’s pain might be exacerbating the behavior problems and thus increasing parent stress. From a systems perspective it is important to acknowledge various factors that maintain a child’s behavior and also produce parent stress. The novel model presented here indicates the importance of providing interventions that involve families with a main goal of increasing quality of life for the family.