A stress model for couples parenting children with autism spectrum disorders and the introduction of a mindfulness intervention
Open accessAbstract
Parents of children with autism spectrum disorders (ASD) are at an increased risk for acute and chronic stress compared to parents of children with other developmental disabilities and parents of children without disabilities. It is plausible that the stressors of having a child with ASD affect the couple relationship; however, few researchers have focused on this dynamic within these families. In this article, we seek to develop a model for how stress operates in families with children with ASD. In developing this new stress model, we describe the characteristics of ASD, discuss stressors that are pronounced in families of children with ASD as supported by the literature, and highlight the limitations of Perry's (2004) model in application to this population. Our expanded stress model includes the addition of parenting couple resources and parenting couple outcomes. Finally, we demonstrate how to apply the model using a mindfulness intervention to promote positive outcomes and strengthen the couple relationship.
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Many parents report a high level of stress related to their child's disorder and intervention.
“However, many parents report a high level of stress related to their child's disorder and intervention (Bluth et al., 2013).”
From Mindfulness Parenting and Childish Play: A Clinical Trial With Parents of Children With Autism Spectrum Disorders (2023) · cites this paper as Bluth et al., 2013
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“Our rational reason for including only mothers was trifold: (1) mothers more frequently have the primary role of caregiver for children; (2) mothers experience higher level of stress; and (3) mothers have not only higher levels of unmet needs but types of needs which differ between mothers and fathers [2, 3, 15, 19, 2…”
BackgroundHwang, Y.-S., Kearney, P., Klieve, H., Lang, W., & Roberts, J. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0114-x
“Qualitative approaches to researching the effects of mindfulness training promise a way forward (Bluth et al. 2013).”
BackgroundMethodInfluentialPsychological distress and perceived burden in caregivers of persons with autism spectrum disorder
Alnazly, E. K., & Abojedi, A. (2019) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12356 · Cited by 80 · see citing works
Chamberlain, A., Cordier, R., Vaz, S. M. A., & Falkmer, T. (2016) · Research in Autism · doi:10.1016/j.rasd.2016.07.004 · Cited by 74 · see citing works
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Factors associated with stress in families of children with autism spectrum disorder
Chamberlain, A., Vaz, S. M. A., Cordier, R., Joosten, A. V., Parsons, D. N., Smith, C., & Falkmer, T. (2017) · Developmental Neurorehabilitation · doi:10.1080/17518423.2017.1326185 · Cited by 70 · see citing works
Tomeny, T. S. (2016) · Autism · doi:10.1177/1362361316655322 · Cited by 69 · see citing works
“Chronic stress is thought to be particularly predictive of long-term negative outcomes (Bluth et al., 2013), and the daily responsibilities of parenting children with ASD have been associated with increased mental health problems among parents (Sawyer et al., 2010).”
BackgroundAdair, K. C., Boulton, A. J., & Algoe, S. B. (2017) · Mindfulness · doi:10.1007/s12671-017-0801-3 · Cited by 69 · see citing works
Schiller, V. F., Dorstyn, D. S., & Taylor, A. M. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04601-5 · Cited by 66 · see citing works
Khateeb, J. M. A., Kaczmarek, L. A., & Alhadidi, M. S. (2019) · Autism · doi:10.1177/1362361319833929 · Cited by 62 · see citing works
Parental maltreatment of children with autism spectrum disorder: A developmental-ecological analysis
Chan, K. K. S., & Lam, C. B. (2016) · Research in Autism · doi:10.1016/j.rasd.2016.09.006 · Cited by 52 · see citing works
Wayment, H. A., Al‐Kire, R. L., & Brookshire, K. (2018) · Autism · doi:10.1177/1362361318763971 · Cited by 52 · see citing works
Parental care-seeking pathway and challenges for autistic spectrum disorders children
Mahapatra, P., Pati, S., Sinha, R., Chauhan, A. S., Nanda, R. R., & Nallala, S. (2019) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_257_18 · Cited by 48 · see citing works
“Raising a child with ASD is also reported to put tremendous social, financial, and emotional strain on families.[16,19,20] It is, therefore, critical that important and unmet support needs of parents are understood to enable better acceptance of the child, better parent psychology, and family outcomes.”
Relationship Satisfaction and Dyadic Coping in Couples with a Child with Autism Spectrum Disorder
Chamberlain, A., Cordier, R., Vaz, S. M. A., Parsons, R. W., & Falkmer, T. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3275-1 · Cited by 48 · see citing works
“For example, there is need to consider additional life stressors unrelated to parenting (Bluth et al. 2013; Falk et al. 2014), genetic factors (Hodge et al.”
BackgroundMegreya, A. M., Al-Attiyah, A. A., Moustafa, A. A., & Hassanein, E. E. A. (2020) · Research in Autism · doi:10.1016/j.rasd.2020.101600 · Cited by 47 · see citing works
Pandya, S. P. (2016) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2016.1222722 · Cited by 42 · see citing works
Mothers Who Take Care of Children with Disabilities in Rural Areas of a Spanish Region
Garlito, P. A. C., Miralles, P. M., & Martos, J. A. F. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082920 · Cited by 39 · see citing works
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Meleady, J., Nearchou, F., Bramham, J., & Carr, A. (2020) · Research in Autism · doi:10.1016/j.rasd.2020.101637 · Cited by 34 · see citing works
Parenting Stress of Children with Autistic Disorder
Al-Oran, H. M., & AL‐Sagarat, A. Y. (2016) · OALib · doi:10.4236/oalib.1102791 · Cited by 32 · see citing works
“Commonly, studies have compared an overall measure of stress between parents of children with autistic disorder to those of parents of children with typical development [31]-[34] or those diagnosed with Down Syndrome, intellectual disability, and Fragile X syndrome [15] [16] [19] [35]-[38].”
BackgroundAnderson, S. B., & Guthery, A. (2015) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12103 · Cited by 31 · see citing works
Definitions, theories, and measurement of stress in children
Lynch, T., Davis, S., Johnson, A. H., Gray, L., Coleman, E., Phillips, S. R., Soistmann, H. C., & Rice, M. H. (2022) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2022.07.008 · Cited by 35 · see citing works
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Parenting stress within mother-father dyads raising a young child with autism spectrum disorder
Patel, S., Rivard, M., Mello, C., & Morin, D. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.102051 · Cited by 27 · see citing works
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“In particular, these programs offer benefits for stress and anxiety coping abilities in parents of children with ASD [28,36,37,48].”
BackgroundVaz, S. M. A., Thomson, A., Cuomo, B., Falkmer, T., Chamberlain, A., & Black, M. H. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101765 · Cited by 25 · see citing works
Family functioning and disability: a study on Italian parents with disabled children
Iacolinoa, C., Pellerone, M., Pacea, U., Ramacia, T., & Castorina, V. (2016) · The European Proceedings of Social & Behavioural Sciences · doi:10.15405/epsbs.2016.05.5 · Cited by 25 · see citing works
Using the Double ABCX Model to Integrate Services for Families of Children with ASD
Pickard, K. E., & Ingersoll, B. R. (2016) · Journal of Child and Family Studies · doi:10.1007/s10826-016-0605-4 · Cited by 24 · see citing works
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“Perry’s theoretical model clearly illuminates the mechanisms underlying the experiences of parents who face stressors related to their autistic children and other life events and building upon empirical tests for parents of autistic children (Bluth et al., 2013; Zody, 2017).”
Guan, J., Blanchard, A. M., DiGuiseppi, C. G., Chihuri, S. T., & Li, G. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05065-x · Cited by 16 · see citing works
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“For example, several individual resources, including personality qualities and cognitive–emotional regulation (ER) techniques, are shown to modulate the influence of caring for children with ASD on parental psychological distress, according to a previously published stress model among parents of children with ASD [46].”
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“The expression of these characteristics occurs on a spectrum, meaning there is a wide degree of variation in how it affects individuals as well as the severity of symptoms (Bluth et al., 2013).”
BackgroundInfluentialCurley, K., & Kotera, Y. (2023) · Healthcare · doi:10.3390/healthcare11081199 · Cited by 15 · see citing works
“[46], which outlined how empathic and caring communication skills practised between parents of children with ASD can lead to reduced levels of stress and conflict and promote satisfying and supportive relationships.”
BackgroundLa determinacion social del autismo en poblacion infantil ecuatoriana
Chávez, C. L., Castelo, M. D. L. L., Breilh, J., & Muñoz, Y. T. (2020) · Revista Ciencias de la Salud · doi:10.12804/revistas.urosario.edu.co/revsalud/a.8993 · Cited by 14 · see citing works
“En este sentido existen estudios sobre que la probabilidad de que un progenitor deje de trabajar para cuidar de su hijo autista es siete veces más alta en relación con otras problemáticas (76), y esto aumenta cuando existen comorbilidades (77), así como también hay un incremento de la carga de estrés (78).”
BackgroundMendez, M. A., Oakley, B., Canitano, R., Cáceres, A. S. J., Tinelli, M., Knapp, M., Cusack, J., Parellada, M., Violland, P., Plas, J. R. D., et al. (2023) · European psychiatry · doi:10.1192/j.eurpsy.2023.2435 · Cited by 17 · see citing works
“Unfortunately, families with young autistic children describe this process as complex, long, and stressful [24 – 26].”
BackgroundEvaluating different stressors among parents with hospitalized children
Çanga, M., Malagnino, I., Malagnino, G., & Malagnino, V. A. (2020) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_529_19 · Cited by 13 · see citing works
“Other studies have had similar findings which showed that high parental stress levels could negatively influence children’s medical treatment as well as their behaviors.[42,43]”
ResultPERAN ORANG TUA ANAK BERKEBUTUHAN KHUSUS (AUTIS) SEKOLAH DASAR SELAMA MASA COVID-19
Primasari, I. F. N. D., & Supena, A. (2020) · JS (JURNAL SEKOLAH) · doi:10.24114/js.v5i1.23309 · Cited by 9 · see citing works
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Caregivers’ voices: From the world of autism spectrum disorder
Dira, P. M. M., Machailo, R. M., & Scholtz, S. (2024) · Curationis · doi:10.4102/curationis.v47i1.2519 · Cited by 8 · see citing works
“According to Bluth et al. (2013:199), researchers presumed that the presence of a child with ASD in the family was associated with elevated parental stress.”
BackgroundInfluentialParental Perspectives on Stress and Challenges in Raising Autistic Children: A Meta-Synthesis
Dharanidharan, D., & Kuruveettissery, S. (2024) · Journal of Psychosocial Rehabilitation and Mental Health · doi:10.1007/s40737-024-00420-4 · Cited by 8 · see citing works
“As Bluth et al. (2013) outlined, parental stress encompasses positive aspects like personal growth.”
InfluentialApanasionok, M. M., Paris, A., Griffin, J., Hastings, R. P., Finch, E., Austin, D., & Flynn, S. (2025) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.70081 · Cited by 8 · see citing works
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“In particular, parents raising children with ASD are more likely to experience substantial psychological, financial, and physical burdens, given the severity of their children’s disabilities [27].”
BackgroundOpoku, M. P., Moustafa, A., Anwahi, N., Shah, H., Aldhaheri, S., Almeqbaali, A., Alkateri, T., & Belbase, S. (2023) · The Linacre Quarterly · doi:10.1177/00243639231156701 · Cited by 7 · see citing works
“Consequently, such challenges affect the mental and psychological well-being of the parents (Bluth et al. 2013; Brobst, Clopton, and SS 2009; Fido and Saad 2013; Hoffman et al. 2009; Ilias et al. 2018; Phetrasuwan and Shandor Miles 2009; Weitlauf et al. 2014).”
BackgroundVirtual Mindfulness Workshops for Parents of Children on the Autism Spectrum
Curl, E. L., & Hampton, L. H. (2023) · Journal of Early Intervention · doi:10.1177/10538151231169950 · Cited by 7 · see citing works
Experience of Parents with Children with Autism in Mandaue City, Philippines
Chepngetich, V., Ng’eno, L. C., & Sanga, P. K. (2022) · Journal of Medicine Nursing & Public Health · doi:10.53819/81018102t6012 · Cited by 6 · see citing works
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Ghoreishi, M. K., Asadzadeh, H., & alhosseini, K. A. (2019) · Journal of Modern Rehabilitation · doi:10.32598/jmr.v12.n3.201 · Cited by 5 · see citing works
“According to family stress theory, existing resources play important roles in helping parents to cope with high stress conditions [1].”
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Şimşek, Ç., Mengi, A., & Yalçınkaya, E. (2021) · The Arts in Psychotherapy · doi:10.1016/j.aip.2020.101726 · Cited by 5 · see citing works
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RESILIENCE AND POST-TRAUMATIC GROWTH IN PARENTS OF CHILDREN WITH SPECIAL NEEDS
Sidener, E. A. (2018) · CSUSB ScholarWorks (California State University, San Bernardino) · Cited by 5 · see citing works
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Boettcher, J., Hohmann, S., Daubmann, A., Denecke, J., Muntau, A. C., Wiegand‐Grefe, S., & Zapf, H. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1713613 · Cited by 3 · see citing works
“While the Family Stress Model has been utilized in different contexts and populations (5–7), a relevant gap remains in large-scale research focused on families with children who have rare diseases.”
Zafar, S., & Khalid, S. (2023) · Journal of Professional & Applied Psychology · doi:10.52053/jpap.v4i2.172 · Cited by 3 · see citing works
“ASD has an effect upon the mental health of entire family of the child (Bluth et al., 2013; Yilmaz et al., 2021).”
BackgroundThe effect of hospital preparatory education on parents: A randomised controlled trial
ÜSTÜNDAĞ, A., Göktaş, A., & Ünay, B. (2025) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2025.03.005 · Cited by 3 · see citing works
The Experiences of Parents for Emotional Interaction with Children with Autism: A Systemic Approach
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Influences on Parent Perceptions of Autism Severity
Dovgan, K. N., Nowell, K. P., & Aguilar, J. (2018) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/1088357618815884 · Cited by 3 · see citing works
El trastorno del espectro autista en la Unión Europea (ASDEU)
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Narratives of Indian Parents of Children Diagnosed with Autism Spectrum DisorderPreprint
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Al‐Dwaikat, T. N., Ta’an, W., Bataineh, E. N., Aldalaykeh, M., & ALBashtawy, M. (2025) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/10883576251349210 · Cited by 2 · see citing works
“In addition, failure to build social networks with other families is consistently reported in the literature (Bluth et al., 2013), which leads to decreased social support and feelings of aggravation and frustration (Turnage & Conner, 2022).”
Chen, J., & Wu, C. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-01014-z · Cited by 2 · see citing works
“Such caregiving demands might substantially amplify economic burdens by reducing household income, increasing medical expenses, and diminishing parental employment opportunities [14–16].”
Representations of the Family and Marriage in the Subjective Picture of the Life Way of Youth
Samosadova, E. V., & Федоровна, С. Н. (2017) · Penza Psychological Newsletter · doi:10.17689/psy-2017.2.7 · Cited by 2 · see citing works
Towards Better Outcomes for Families with Transition-Age Youth or Young Adults with ASD
Wong, W. H. (2018) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2018.058 · Cited by 2 · see citing works
Klarin, M., Čirjak, V., & Šašić, S. Š. (2020) · Hrvatska revija za rehabilitacijska istraživanja · doi:10.31299/hrri.56.2.2 · Cited by 2 · see citing works
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Hocker, L., Uzer, Ç. T., Gandhi, Y., Isolani, S., Chiarolanza, C., & Randall, A. K. (2022) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2022.2058141 · Cited by 2 · see citing works
“While there is ample support for Randall and Bodenmann’s (2009) conceptualization of stress (e.g., Bluth et al., 2013; Falconier et al., 2015; Neff & Broady, 2011; Paley et al., 2013; Traa et al., 2015), limitations exist regarding a validated, self-report measure, designed to determine types…”
BackgroundParents of children with autism spectrum disorders: interventions with and for them
Rojas-Torres, L. P., Alonso-Esteban, Y., & Marín, F. A. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-824421-0.00012-6 · Cited by 4 · see citing works
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“[58] The past evidence found that parents of children with ASD and other neurodevelopmental disorder experienced higher stress levels while adjusting with behavioural problems and cognitive abilities.[59-62] There are many potential deficits and comorbid diagnoses associated with an ASD diagnosis, meaning that there a…”
BackgroundParental Stress in Families of Children with Autism
Yakniunas, E., & Gusak, N. (2020) · Psychology and Psychosocial Interventions · doi:10.18523/2617-2348.2019.2.67-74 · Cited by 2 · see citing works
“Дослідники [1; 2; 5] дійшли висновку, що одним із основних чинників, що сприяють батьківському стресу, залишається затяжне очікування діагнозу й період від його остаточного встановлення до початку інтервенцій.”
Evaluation of Mothers' Knowledge about Autism: Saudi Arabia
Mousa, O., Khars, F. A., Alkishi, A., Al-Nazzal, M., & Alkhars, A. (2020) · Scientific Journal of King Faisal University Basic and Applied Sciences · doi:10.37575/b/med/2267 · Cited by 2 · see citing works
Dimenzije i aspekti roditeljskog ponašanja u obiteljima djece s poremećajem iz spektra autizma
Kardum, A., Šegota, N. L., & Lozančić, A. J. (2022) · Metodički ogledi · doi:10.21464/mo.29.1.9 · Cited by 2 · see citing works
PARENTING STRESS IN CAREGIVERS OF CHILDREN WITHAUTISM SPECTRUM DISORDER (ASD)
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Macierzyństwo w kontekście autyzmu. O stresogennych czynnikach na drodze życia matek dzieci z ASD
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Giolo, S. R., Fernandes, Y. R., & dos Anjos, A. (2023) · OALib · doi:10.4236/oalib.1110314 · Cited by 1 · see citing works
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“By fostering emotional regulation, mindfulness has the potential to reduce stress and improve the psychological well-being of caregivers [11].”
الیقظة العقلیة وعلاقتها بالضغوط المهنیة لدى أعضاء هیئة التدریس الجامعی
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Parent resilience, couple burnout, and misogyny in fathers with disabled children
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- Authors
- Bluth, K., Roberson, P. N. E., Billen, R. M., & Sams, J. M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Tennessee at Knoxville (US)
- Corresponding author
- Bluth, Karen
- Venue
- Journal of Family Theory & Review
- Publisher
- Wiley
- Published
- 2013-08-24
- Volume
- 5
- Issue
- 3
- Pages
- 194-213
- ISSN
- 1756-2570 (ISSN-L)
- 1756-2589
- PMC
- PMC4006932
- OpenAlex
- W1903243881
- Cited by
- 111
- References
- 105
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 5 · 2023: 17 · 2022: 11 · 2021: 7 · 2020: 16 · 2019: 10 · 2018: 8 · 2017: 10 · 2016: 12 · 2015: 5 · 2014: 1
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Family Theory & Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (T32AT003378)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- autism spectrum disorder, parental stress, couples, couple relationships, stress models, mindfulness-based interventions, family stressors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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