Parent Reported Child Attention Problems and Depression Related to Parenting Stress in ASD

Background: It is well established that parents of children with autism spectrum disorder (ASD) report more stress than parents of typically developing (TD) children (Hayes & Watson, 2013). Common parent-reported stressors include child externalizing behaviors (Baker et al., 2003), social communication impairment, and restrictive and repetitive interests (Hastings & Johnson, 2001). A less studied factor related to parenting stress may be the presence of comorbid symptoms (Simonoff et al., 2008). Research over the past decade has confirmed comorbidities between ASD and a wide array of psychiatric disorders, of which attention difficulties (Matson & Nebel-Schwalm, 2005) and depressive symptoms (Kim et al., 2000) are commonly noted. Understanding the various mechanisms underlying parental stress is crucial as it informs future interventions to better support families.

Objectives: The objective of our study was to investigate how attention difficulties and child depression symptoms influence frequency of stress events in parents of children with ASD.

Methods: Our sample included 100 children (ages 3:0 to 6:11) and their parents. Sixty-one TD children (37.7% female) and 39 children with ASD (25.6% female) participated. Parents’ ratings from the Behavior Assessment System for Children—Second Edition (BASC-2; Reynolds & Kamphaus, 2004) were used to evaluate children’s attention problems and depression symptoms. Frequency of parenting stress was measured using the parent-reported Parenting Events Questionnaire (Crnic & Greenberg, 1990).

Results: A serial mediation model was conducted using the SPSS 24 macro PROCESS (Hayes, 2008), which provided bootstrapped estimates of the indirect effects based on 5000 resamples. The results indicated that status was positively associated with attention-related problem behaviors (B = 14.64, p < .001), child attention problems was positively associated with child depression symptoms (B = .70, p < .001), and depression symptoms were positively associated with frequency of parenting stress (B = .30, p = .003). The direct effect was significant (B = 8.21, p < .001). Results of the bootstrapping analysis supported the mediational role of child’s depression symptoms (B = .27, CI95 = .10 to.45) in the association between status and frequency of parental stress. The role of attention problems was not significantly associated with frequency of parental stress (B = .08, CI95 = -.15 to .32). The results support a serial indirect effect in the relation between status and frequency of parenting stress such that when compared to TD children, children with ASD had higher attention problems, which was associated with higher depression symptoms, which predicted greater frequency of parenting stress (B = 2.76, CI95 = .96 to 5.60). Additionally, this model accounted for 35% of the variance in predicting frequency of parenting stress in our sample.

Conclusions: Our results suggest that compared to TD children, children with ASD have higher levels of attention problems predicting more depressive symptoms which is associated with greater parental stress. These findings suggest that targeting interventions to decrease child attention difficulties and depressive symptoms may play a role in decreasing parenting stress. Future research should explore the relations between parenting stress and other common comorbid psychiatric symptoms.