Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder
Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a lifelong impact on multiple domains of functioning, characterized from a profound impairment in social communication and social interaction and restricted and repetitive behavior, interest and activities (APA, 2013). The everyday management of children with ASD is a big challenge for parents, especially during early childhood. A considerable number of studies reported higher levels of stress in parents of young children with ASD as compared to typically developing peers or to children suffering from other pathologies, including down syndrome, cerebral palsy, intellectual disability (ID), developmental delay and cystic fibrosis (Baker-Ericzen et al., 2005, Blacher and McIntyre, 2006, Bouma and Schweitzer, 1990, Dabrowska and Pisula, 2010, Eisenhower et al., 2005, Estes et al., 2009, Estes et al., 2013, Hayes and Watson, 2013, Mugno et al., 2007, Sanders and Morgan, 1997, Wolf et al., 1989, Zablotsky et al., 2013). Furthermore, stress experienced by parents of children with ASD seems to be greater during the early childhood and the preschool age as compared to older ages (Schieve, Blumberg, Rice, Visser, & Boyle, 2007). Higher parental stress levels were also shown to reduce the effectiveness of early teaching intervention programs, thereby impairing the clinical improvement in intellectual and educational skills, adaptive behavior and social functioning (Osborne, McHugh, Saunders, & Reed, 2008). Several studies investigated the predictors of stress in parents of school-aged children and adolescents with autism, identifying crucial factors, including diagnosis of autism, behavioral problems, social interaction impairment, coping strategies of parents and family-related variables (Duarte et al., 2005, Falk et al., 2014, Firth and Dryer, 2013, Hastings et al., 2005, Huang et al., 2013, Johnson et al., 2011, Lecavalier et al., 2006, McStay et al., 2014). However, so far, only few studies have investigated the predictors of parental stress in children with ASD during the very early childhood (Davis and Carter, 2008, Estes et al., 2009, Estes et al., 2013, Hastings and Johnson, 2001, Hill-Chapman et al., 2013, Rivard et al., 2014). In one of these studies, evaluating parental stress in a sample of 141 parents of young children with autism conducting home-based behavioral interventions, Hastings and Johnson (2001) reported a significant positive correlation between severity of autistic symptoms severity and parental stress, suggesting that the severity of autistic traits could also be related to parental stress (Baker-Ericzen et al., 2005, Hastings and Johnson, 2001, Hastings et al., 2005, Hill-Chapman et al., 2013, Osborne and Reed, 2009). On the other hand, other researches highlighted the everyday management of behavioral problems and the child's characteristics (i.e. adaptive behavior, intelligence, gender, age, etc.) as a relevant source of parental stress (Dabrowska and Pisula, 2010, Davis and Carter, 2008, Estes et al., 2009, Estes et al., 2013, Hastings et al., 2005, Rivard et al., 2014). Indeed, Rivard and colleagues (2014) reported that levels of parental stress were significantly correlated with the child's age, intellectual abilities, and adaptive behaviors as well as with the severity of autistic symptoms. Another study addressing the relationships between child, partner, and parent variables in 48 parents of preschool children with autism showed that stress was strongly predicted by the child's behavioral problems, but not by the autistic symptoms or adaptive behavior (Hastings et al., 2005). Taken together, all of these studies indicate that the available data on predictors of parental stress in preschool aged children with ASD are very inconsistent and that the role played by autistic symptoms, intelligence quotient, adaptive skills, and behavioral problems on parental stress onset has not been clarified yet.
Furthermore, behavioral problems in young children with ASD include several maladaptive behaviors, such as sleep problems, attention problems, hyperactivity, self-injuries and aggressiveness. However, it remains unclear how each of them exactly should impact on parental stress. Indeed, many studies have investigated the interaction between behavioral problems and parental stress in families with children with ASD simply evaluating the total score of a questionnaire, without dissecting which factors are typically implicated (Eisenhower et al., 2005, Estes et al., 2009, Estes et al., 2013). An extensively used measure for the assessment of a wide range of emotional and behavioral disorders is the Child Behavior Checklist (Achenbach & Rescorla, 2000), which has been used in several research studies in order to investigate behavioral and emotional problems on school aged children and adolescents (Bolte et al., 1999, Duarte et al., 2005, Mazefsky et al., 2011, Ooi et al., 2011). Nonetheless, only few studies have applied the CBCL for ages 1½–5 (CBCL/1½–5) to explore behavioral and emotional problems in preschool aged children with ASD, describing a behavioral and emotional profile characterized from high scores on the CBCL subscales related to withdrawal problems, attention problems and emotionally reactive problems as compared to typically developing children (Georgiades et al., 2011, Hartley et al., 2008, Muratori et al., 2011, Myers et al., 2013, Pandolfi et al., 2009, Rescorla et al., 2014, Sikora et al., 2008). Moreover, Muratori and colleagues reported that the same CBCL subscale scores were also significantly different between children with ASD and peers suffering from other psychiatric disorders (Muratori et al., 2011). However, none of these studies has evaluated the influence that these behavioral and emotional problems may have on parental stress.
The aim of the present study was to investigate the prevalence of maladaptive behaviors and parental stress in a sample of preschool aged children with ASD with respect to a group of healthy controls. Moreover, we wanted to investigate the impact of behavioral and emotional problems, autistic symptoms, intellectual abilities and adaptive behaviors on parental stress in both ASD and TD sample in order to identify potential predictors.
Section snippets
Sample characteristics and procedure
The present study involved 130 preschool children suffering from ASD (111 boys and 19 girls, respectively 85.4% and 14.6%, mean age ± SD: 42.9 ± 9.2 months) and 84 typically developing peers (TD) (63 boys and 21 girls, respectively 75% and 25%, mean age ± SD: 42.4 ± 14.6 months) and their parents. All the ASD children were recruited at the Child and Adolescent Neuropsychiatry Unit of the Children Hospital Bambino Gesù of Rome (Italy). The demographic characteristics (i.e. age, level of education and
Data analysis
Data analyses were performed using the Statistical Package for Social Sciences (SPSS 20.0 for Windows). Descriptive statistics were used to compute parents’ information i.e., age, educational and occupational level. Prevalence rates of children's behavioral and emotional problems and parental stress were calculated on the total number of participants and on ASD and TD groups separately. Differences between ASD and TD samples were analyzed by Chi-square for dichotomous variables and one-way
Prevalence rates of behavioral and emotional problems and parental stress in ASD and TD children
The analysis of the prevalence rates of behavioral and emotional problems in the current sample revealed that 34.6% of children with ASD had a CBCL total problems score within the clinical range, with internalizing problems and externalizing problems documented in 30% and 12.3% of cases, respectively (Table 2). Within the CBCL syndrome scales, the highest percentages of clinically significant scores in the ASD group were found in the withdrawal (53.8%) and attention problems (18.5%) subscales,
Discussion
Behavioral problems have been documented from several studies since early childhood in children with ASD (Georgiades et al., 2011, Hartley et al., 2008, Muratori et al., 2011, Myers et al., 2013, Pandolfi et al., 2009, Sikora et al., 2008). These dysfunctional behaviors negatively impact family's well-being, as they are frequently related to parental stress more than to the core symptoms of autism. In the present research, we wanted to study the impact of various characteristics of young
Conclusion
Results of this research are consistent with previous studies demonstrating that parents of preschool children with ASD experienced higher stress levels than parents of typically developing children. Findings also indicate that preschool children with ASD show more behavioral and emotional problems than their typically developing peers. In the present study, we found that parental stress is strongly predicted by behavioral and emotional problems, over and above severity of autistic symptoms,
Acknowledgement
None.
References (63)
- et al.
Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders
Brain and Development
(2013) - et al.
Aligning over the child: Parenting alliance mediates the association of autism spectrum disorder atypicality with parenting stress
Research in Developmental Disabilities
(2013) The parenting stress index-short form. Test manual
(1990)Parenting stress index: Professional manual
(1995)- et al.
Manual for the child behavior checklist
(1983) - et al.
Manual for the ASEBA preschool forms and profiles
(2000) - et al.
Manual for the ASEBA school-age forms and profiles
(2001) Diagnostic and statistical manual of mental disorders
(1994)Diagnostic and statistical manual of mental disorders-5
(2013)- et al.
Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders
Research and Practice for Persons with Severe Disabilities
(2005)
Vineland adaptive behavior scales. Intervista – Forma completa
Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress
Journal of Child Psychology and Psychiatry
Syndrome specificity and behavioral disorders in young adults with intellectual disability: Cultural differences in family impact
Journal of Intellectual and Developmental Disability
Patterns of parent-reported problems indicative in autism
Psychopathology
The impact of chronic childhood illness on family stress: A comparison between autism and cystic fibrosis
Journal of Clinical Psychology
Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome
Journal of Intellectual Disability Research
Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics
Journal of Autism and Developmental Disorders
Standardized ADOS scores: Measuring severity of autism spectrum disorders in a Dutch sample
Journal of Autism and Developmental Disorders
Factors associated with stress in mothers of children with autism
Autism
Preschool children with intellectual disability: Syndrome specificity, behaviour problems, and maternal well-being
Journal of Intellectual Disability Research
Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay
Autism
The factors predicting stress, anxiety and depression in the parents of children with autism
Journal of Autism and Developmental Disorders
The predictors of distress in parents of children with autism spectrum disorder
Journal of Intellectual and Developmental Disability
Gilliam autism rating scale, Austin, TX
Phenotypic overlap between core diagnostic features and emotional/behavioral problems in preschool children with autism spectrum disorder
Journal of Autism and Developmental Disorders
Standardizing ADOS scores for a measure of severity in autism spectrum disorders
Journal of Autism and Developmental Disorders
The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity
Journal of Autism and Developmental Disorders
Griffiths mental development scales extended revised manual
Parenting stress index – Forma breve
Maladaptive behaviors of children with autism: parent support, stress and coping
Issues in Comprehensive Pediatric Nursing
Prevalence and risk factors of maladaptive behaviour in young children with Autistic Disorder
Journal of Intellectual Disability Research
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