Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay
Open accessAbstract
Parents of children with developmental disabilities, particularly autism spectrum disorders (ASDs), are at risk for high levels of distress. The factors contributing to this are unclear. This study investigated how child characteristics influence maternal parenting stress and psychological distress. Participants consisted of mothers and developmental-age matched preschool-aged children with ASD (N = 51) and developmental delay without autism (DD) ( N = 22). Evidence for higher levels of parenting stress and psychological distress was found in mothers in the ASD group compared to the DD group. Children's problem behavior was associated with increased parenting stress and psychological distress in mothers in the ASD and DD groups. This relationship was stronger in the DD group. Daily living skills were not related to parenting stress or psychological distress. Results suggest clinical services aiming to support parents should include a focus on reducing problem behaviors in children with developmental disabilities.
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Raising a child with autism involves chronic challenges consistently associated with high levels of psychological distress.
“It has been widely demonstrated that raising a child with autism involves chronic challenges consistently associated with high levels of psychological distress [3,4,5,6].”
From The effect of acceptance and commitment therapy for improving psychological well‐being in parents of individuals with autism spectrum disorders: A randomized controlled trial (2021) · cites this paper as [4]
The Discussion reports higher mean parenting stress and psychological distress among mothers of preschool children with ASD than among mothers of children with developmental delay, and links child problem behavior with both outcomes. The study examined a cross-sectional relationship and says longitudinal research is needed, so it does not establish that these challenges or their association with distress are chronic; its findings also concern mothers rather than all caregivers. (LLM, conf=0.84)
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“These parents also report higher levels of stress and depression in comparison to parents of children with other developmental disorders (Estes et al., 2009).”
BackgroundResultProfile and predictors of service needs for families of children with autism spectrum disorders
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“This may be especially important for parents of children with disruptive behaviors (Brown et al., 2012; Douma et al., 2006; Hodgetts et al., 2013a), which was the largest reported risk for unmet needs.”
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MethodShorey, S., Ng, E. D., Haugan, G., & Law, E. C. N. (2019) · Autism · doi:10.1177/1362361319886513 · Cited by 132 · see citing works
“…parenting stress, poorer mental health, and lower quality of life compared to parents of typical children or even parents of children with other developmental disorders, intellectual difficulties, and physical disabilities (Estes et al., 2009; Hayes & Watson, 2013; Vasilopoulou & Nisbet, 2016).”
BackgroundBrief Report: Stress and Perceived Social Support in Parents of Children with ASD
Drogomyretska, K., Fox, R., & Colbert, D. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04455-x · Cited by 114 · see citing works
Cerezuela, G. P., Andrés, M. I. F., Mínguez, R. T., & Navarro-Peña, J. M. (2015) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/1088357615583471 · Cited by 131 · see citing works
“Studies of parents raising children with ASD document elevated stress levels (e.g., Estes et al., 2009; Wolf, Noh, Fisman, & Speechley, 1989).”
BackgroundMediating Effects of Social Support on Quality of Life for Parents of Adults with Autism
Marsack‐Topolewski, C. N., & Samuel, P. S. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3157-6 · Cited by 125 · see citing works
Wang, Y., Huang, Z., & Kong, F. (2017) · Journal of Health Psychology · doi:10.1177/1359105317739100 · Cited by 125 · see citing works
“, 2005), while parents of children with developmental disorders, such as cerebral palsy (CP), autism, and intellectual disabilities, tend to suffer from higher parenting stress (Baker et al., 2003; Davis and Carter, 2008; Estes et al., 2009; Glenn et al., 2009; Hassall et al., 2005).”
BackgroundEapen, V., Črnčec, R., Walter, A., & Tay, K. P. (2014) · Autism Research and Treatment · doi:10.1155/2014/160783 · Cited by 124 · see citing works
Neurobiological correlates of social functioning in autism
Neuhaus, E., Beauchaine, T. P., & Bernier, R. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.05.007 · Cited by 122 · see citing works
The effects of early autism intervention on parents and family adaptive functioning
Estes, A. M., Swain, D. M., & MacDuffie, K. E. (2019) · Pediatric Medicine · doi:10.21037/pm.2019.05.05 · Cited by 127 · see citing works
Marsack‐Topolewski, C. N., & Church, H. L. (2019) · American Journal on Intellectual and Developmental Disabilities · doi:10.1352/1944-7558-124.2.145 · Cited by 121 · see citing works
Home Sweet Home? Families’ Experiences With Aggression in Children With Autism Spectrum Disorders
Thompson‐Hodgetts, S., Nicholas, D. B., & Zwaigenbaum, L. (2013) · Focus on Autism and Other Developmental Disabilities · doi:10.1177/1088357612472932 · Cited by 120 · see citing works
“This increase in parental stress due to aggression is significant because families of children with ASD without aggression already are at increased risk for stress, depression, and marital discord, and experience decreased social support, parenting satisfaction, and confidence compared with the general population and…”
BackgroundFathers' Experience With Autism Spectrum Disorder: Nursing Implications
Frye, L. S. (2015) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2015.10.012 · Cited by 119 · see citing works
Family Quality of Life and ASD: The Role of Child Adaptive Functioning and Behavior Problems
Gardiner, E., & Iarocci, G. (2015) · Autism Research · doi:10.1002/aur.1442 · Cited by 117 · see citing works
“Adaptive function deficits are also more common across those with ASD than are behavior problems [Kanne et al., 2011; Lecavalier, 2006], and the latter are more related to parental and family outcomes in those with developmental delay [Estes et al., 2009; Pozo et al., 2014].”
BackgroundMinnes, P., Perry, A., & Weiss, J. A. (2014) · Journal of Intellectual Disability Research · doi:10.1111/jir.12160 · Cited by 114 · see citing works
Galpin, J., Barratt, P., Ashcroft, E., Greathead, S., Kenny, L., & Pellicano, E. (2017) · Autism · doi:10.1177/1362361316687989 · Cited by 113 · see citing works
Gould, E. R., Tarbox, J., & Coyne, L. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.06.003 · Cited by 110 · see citing works
“Raising a child with autism involves chronic challenges consistently associated with high levels of psychological distress in parents (Eikeseth, Klintwall, Hayward, & Gale, 2015; Estes et al., 2009; Grindle, Kovshoff, Hastings, & Remington, 2009; Hayes &Watson, 2013).”
BackgroundBluth, K., Roberson, P. N. E., Billen, R. M., & Sams, J. M. (2013) · Journal of Family Theory & Review · doi:10.1111/jftr.12015 · Cited by 111 · see citing works
Foody, C., James, J. E., & Leader, G. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2263-y · Cited by 113 · see citing works
“…that parents of children with ASD experience higher levels of stress than both the general population and parents of children with other developmental disabilities (e.g., Duarte et al. 2005; Eisenhower et al. 2005; Estes et al. 2009; Hayes and Watson 2013; Hoffman et al. 2009; Rao and Beidel 2009).”
BackgroundHuang, C.-Y., Yen, H.-C., Tseng, M.-H., Tung, L.-C., Chen, Y.-D., & Chen, K.-L. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-2000-y · Cited by 134 · see citing works
Parenting stress in Chinese mothers of children with autism spectrum disorders
Wang, J., Hu, Y., Wang, Y., Qin, X., Xia, W. T., Sun, C., Wu, L., & Wang, J. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0569-7 · Cited by 109 · see citing works
Ijalba, E. (2016) · American Journal of Speech-Language Pathology · doi:10.1044/2015_ajslp-13-0017 · Cited by 113 · see citing works
“The literature reports higher levels of stress, depression, and social stigma among parents of children with autism (Estes et al., 2009).”
BackgroundHartley, S. L., Papp, L. M., & Bolt, D. M. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1152552 · Cited by 108 · see citing works
“Having a day with fewer positive marital interactions was associated with having a more stressful parenting day for mothers of children with ASD.”
BackgroundCoping and care-related stress in parents of a child with autism spectrum disorder
Shepherd, D., Landon, J., Taylor, S., & Goedeke, S. (2018) · Anxiety Stress & Coping · doi:10.1080/10615806.2018.1442614 · Cited by 107 · see citing works
“…with an Autism Spectrum Disorder (ASD) typically experience higher levels of stress, depression, anxiety and anger than other parents (e.g., Hayes & Watson, 2013; Sawyer et al., 2010), including parents of children with other developmental disabilities (Estes et al., 2009; Schieve et al., 2011).”
BackgroundCaregiving Experiences of Latino Families With Children With Autism Spectrum Disorder
Blanche, E. I., Díaz, J., Barretto, T. A., & Cermak, S. A. (2015) · American Journal of Occupational Therapy · doi:10.5014/ajot.2015.017848 · Cited by 106 · see citing works
“In particular, parents of children with ASD report caregiving challenges and increased stress levels, depression, anxiety, and physical health challenges (Estes et al., 2009; Ingersoll & Hambrick, 2011).”
Participation Patterns in Preschool Children with an Autism Spectrum Disorder
LaVesser, P., & Berg, C. (2010) · OTJR Occupational Therapy Journal of Research · doi:10.3928/15394492-20100823-01 · Cited by 106 · see citing works
“These findings are similar to the findings reported in studies that investigate parenting stress (Davis & Carter, 2008; Estes et al., 2009; Rao & Beidel, 2009).”
BackgroundResultBernier, R., Gerdts, J. A., MUNSON, J. A., Dawson, G., & Estes, A. M. (2011) · Autism Research · doi:10.1002/aur.226 · Cited by 103 · see citing works
“For example, living with one or more children with significant disabilities, particularly ASD, is known to increase parental stress [e.g. Estes et al., 2009].”
BackgroundPeters-Scheffer, N., Didden, R., & Korzilius, H. (2012) · Research in Autism · doi:10.1016/j.rasd.2011.10.003 · Cited by 110 · see citing works
Solomon, A. H., & Chung, B. (2012) · Family Process · doi:10.1111/j.1545-5300.2012.01399.x · Cited by 103 · see citing works
“…the family therapist to support parents’ efforts to create a home environment that meets the needs of all members.8 Research has suggested that parental stress is strongly correlated, not with the child’s level of impairment, but with the child’s level of negative behavior (Estes et al., 2009).”
BackgroundStress in Parents of Children with Autism Spectrum Disorder: An Exploration of Demands and Resources
Krakovich, T. M., McGrew, J. H., Yu, Y., & Ruble, L. A. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2728-2 · Cited by 99 · see citing works
“…et al. 1994; Smith et al. 2012), older age of the child (Rivard et al. 2014), lower IQ (Baker-Ericzén et al. 2005; Ingersoll and Hambrick 2011), and restricted and repetitive behaviors, and communication impairments (Benson 2010; Estes et al. 2009; Lecavalier et al. 2006; Hayes and Watson 2013).”
BackgroundShalev, R. A., Lavine, C., & Martino, A. D. (2019) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-018-9641-x · Cited by 98 · see citing works
Parent Training Interventions for Toddlers with Autism Spectrum Disorder
Beaudoin, A. J., Sébire, G., & Couture, M. M. (2014) · Autism Research and Treatment · doi:10.1155/2014/839890 · Cited by 99 · see citing works
Derguy, C., Michel, G., M’Baïlara, K., Roux, S., & Bouvard, M. P. (2015) · Journal of Intellectual & Developmental Disability · doi:10.3109/13668250.2015.1023707 · Cited by 96 · see citing works
“Parents report significant stress levels (Eisenhower, Baker, & Blacher, 2005; Estes et al., 2009; Harper et al., 2013; Johnson et al., 2011) and are more likely to have anxiety and depressive disorders (Barker et al., 2011; Piven & Palmer, 1999).”
BackgroundLaterobasal Amygdalar Enlargement in 6- to 7-Year-Old Children With Autism Spectrum Disorder
Kim, J. E., Lyoo, I. K., Estes, A. M., Renshaw, P. F., Shaw, D., Friedman, S. D., Kim, D. J., Yoon, S. J., Hwang, J., & Dager, S. R. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.148 · Cited by 95 · see citing works
Lunsky, Y., Fung, K., Lake, J., Steel, L., & Bryce, K. (2018) · Mindfulness · doi:10.1007/s12671-017-0846-3 · Cited by 91 · see citing works
“It is well recognized that parents of children with autism spectrum disorder (ASD) experience higher levels of stress than other parents and that they are at greater risk for mental health problems (Dykens et al. 2014; Estes et al. 2009;Miodrag andHodapp 2010; Taylor and Warren 2012).”
BackgroundMaljaars, J., Boonen, H., Lambrechts, G., Leeuwen, K. G. V., & Noens, I. L. J. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1894-8 · Cited by 95 · see citing works
Salomone, E., Leadbitter, K., Aldred, C. R., Barrett, B. M., Byford, S., Charman, T., Howlin, P., Green, J., Couteur, A. S. L., McConachie, H., et al. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3392-x · Cited by 94 · see citing works
Jamison, J., Fourie, E., Siper, P. M., Trelles, M. P., George-Jones, J., Grice, A. B., Krata, J., Holl, E., Shaoul, J., Hernández, B., et al. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3045-0 · Cited by 91 · see citing works
Parenting and Future Anxiety: The Impact of Having a Child with Developmental Disabilities
Bujnowska, A. M., Rodríguez, C., García, T., Areces, D., & Marsh, N. V. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16040668 · Cited by 91 · see citing works
Karst, J. S., Hecke, A. V. V., Carson, A. M., Stevens, S., Schohl, K. A., & Dolan, B. K. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2231-6 · Cited by 91 · see citing works
“Finally, the current investigation will be presented, which sought to determine whether families and caregivers demonstrated benefit from participating in the PEERS intervention.”
Derguy, C., M’Baïlara, K., Michel, G., Roux, S., & Bouvard, M. P. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2719-3 · Cited by 91 · see citing works
“Severe autism profile is characterized by comorbidities (Mori et al. 2009), behavioral problems (Davis and Carter 2008; Estes et al. 2009; Hall and Graff 2011; Hastings 2003; Hastings et al. 2005; Herring et al. 2006; McStay et al. 2014; Peters-Scheffer et al. 2012; Samadi and McConkey 2014), few…”
BackgroundParenting stress in caregivers of young children with ASD concerns prior to a formal diagnosis
DesChamps, T. D., Ibañez, L. V., Edmunds, S. R., Dick, C. C., & Stone, W. L. (2020) · Autism Research · doi:10.1002/aur.2213 · Cited by 98 · see citing works
“For example, child behavior problems are strongly associated with parenting stress among parents of children with ASD [Blacher & McIntyre, 2006; Estes et al., 2009; Firth & Dryer, 2013; Hastings et al., 2005; Lecavalier et al., 2006; McStay et al., 2013, 2014; Peters-Scheffer et al., 2012;…”
BackgroundFarmer, J., & Reupert, A. (2013) · Australian Journal of Rural Health · doi:10.1111/ajr.12004 · Cited by 90 · see citing works
Hwang, Y.-S., Kearney, P., Klieve, H., Lang, W., & Roberts, J. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0114-x
Paynter, J. M., Riley, E., Beamish, W., Davies, M., & Milford, T. (2013) · Research in Autism · doi:10.1016/j.rasd.2013.07.006 · Cited by 89 · see citing works
“Consistent with previous research (e.g., Estes et al., 2009), greater pile-up of additional demands were associated with higher levels of individual distress in terms of depression, anxiety and stress symptoms, and lower relationship quality.”
BackgroundMethodResultInfluentialParenting dimensions in mothers and fathers of children with Autism Spectrum Disorders
Öztürk, Y., Riccadonna, S., & Venuti, P. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.07.001 · Cited by 88 · see citing works
ACT Processes in Group Intervention for Mothers of Children with Autism Spectrum Disorder
Fung, K., Lake, J., Steel, L., Bryce, K., & Lunsky, Y. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3525-x · Cited by 85 · see citing works
A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD
Gerow, S., Hagan–Burke, S., Rispoli, M. J., Gregori, E. V., Mason, R., & Ninci, J. (2017) · Behavior Modification · doi:10.1177/0145445517740872 · Cited by 87 · see citing works
“It is important to evaluate the extent to which the current body of 338 Behavior Modification 42(3) literature in parent-implemented FCT for children with ASD has demonstrated that the intervention is likely to be used in natural settings, without outside support.”
BackgroundInfluentialPre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda
Grzadzinski, R., Amso, D., Landa, R. J., Watson, L. R., Guralnick, M. J., Zwaigenbaum, L., Deák, G. O., Estes, A. M., Brian, J. A., Bath, K. G., et al. (2021) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-021-09393-y · Cited by 88 · see citing works
The relationship between chronic paediatric feeding disorders and caregiver stress
Silverman, A. H., Erato, G., & Goday, P. S. (2020) · Journal of Child Health Care · doi:10.1177/1367493520905381 · Cited by 86 · see citing works
“Parents of children with autism (Estes et al., 2009, 2013) and other developmental conditions also report higher stress levels (Miodrag and Hodapp, 2010; Moran et al., 1992; Schwarz and Children, 2003).”
BackgroundKurzrok, J., McBride, E. R., & Grossman, R. B. (2021) · Autism · doi:10.1177/1362361321990931 · Cited by 93 · see citing works
“In addition, given the very different developmental needs over the course of childhood and adolescence, more attention should be given to the examination of PSEa at different ages and at different moments in the trajectory of diagnosis and treatment (Estes et al., 2009; Sofronoff & Farbotko, 2002).”
Background
- Authors
- Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., & Abbott, R.
- Affiliations
- University of Washington (US)
- University of Washington, USA
- Corresponding author
- Estes, Annette
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2009-06-17
- Volume
- 13
- Issue
- 4
- Pages
- 375-387
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- PMC
- PMC2965631
- OpenAlex
- W2165770244
- Cited by
- 865
- References
- 28
- Citations by year
- 2026: 40 · 2025: 43 · 2024: 61 · 2023: 57 · 2022: 48 · 2021: 70 · 2020: 62 · 2019: 70 · 2018: 59 · 2017: 63 · 2016: 57 · 2015: 62 · 2014: 50 · 2013: 54 · 2012: 27
- FWCI
- 24.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50HD055782, U19HD035482, U19HD34565, U19HD035468, U19HD035465)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- parental stress, maternal distress, autism spectrum disorder, developmental delay, preschool children, child behavior problems, daily living skills, mothers of children with developmental disabilities, parenting support
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Adult, Autistic Disorder, Child Behavior Disorders, Developmental Disabilities, Child, Preschool, Female, Humans, Male, Mothers, Parent-Child Relations, Personality Inventory, Surveys and Questionnaires, Stress, Psychological, Comorbidity, Parenting
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