Cited by 865Family and Disability Support ResearchAutism Spectrum Disorder ResearchChild Nutrition and Feeding Issues

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Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay

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Estes, Annette, Munson, Jeffrey, Dawson, Geraldine, Koehler, Elizabeth, Zhou, Xiao-Hua, Abbott, Robert·2009·Autism

DOI 10.1177/1362361309105658PMC PMC2965631

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Abstract

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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“(A. Estes et al., 2009; Mugno et al., 2007) However, the specific impact of parental and family factors as well as the impact of child’s autism specific factors were not considered in previous studies.”
Influential
Daily experiences and well-being of Chinese parents of children with autism
Wang, H., Liu, S., Xu, J., Hu, X., & Han, Z. R. (2023) · Autism · doi:10.1177/13623613221144191 · Cited by 17
“Evidence shows that global levels of ASD symptoms and behavioral problems are positively associated with global parenting stress and negatively associated with parental subjective wellbeing (Estes et al., 2009; McStay et al., 2014).”
Background
Parenting stress in autism: do children’s characteristics still count more than stressors related to the COVID-19 pandemic?
Lievore, R., Lanfranchi, S., & Mammarella, I. C. (2023) · Current Psychology · doi:10.1007/s12144-023-04441-3 · Cited by 23
“…as a negative feeling prompted by the demands of parenting when they exceed levels have been reported in mothers of children with ASD than in those whose children had other conditions, such as undifferentiated developmental delays or genetic syndromes (Eisenhower et al., 2005; Estes et al., 2009).”
The NeuroDevNet Autism Spectrum Disorders Demonstration Project
Zwaigenbaum, L., Scherer, S. W., Szatmári, P., Fombonne, E. J., Bryson, S. E., Hyde, K. L., Anognostou, E., Brian, J. A., Evans, A. C., Hall, G. B. C., et al. (2011) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2011.02.003 · Cited by 18
A Practice-based Evaluation of Barnardo's Forward Steps Early Intervention Programme for Children Diagnosed with Autism
Braiden, H. J., McDaniel, B., McCrudden, E., Janes, M., & Crozier, B. (2012) · Child Care in Practice · doi:10.1080/13575279.2012.683773 · Cited by 17
“Parenting stress is a multi-faceted concept including: family cohesion, parent child interaction, parenting competence, marital satisfaction, self-blame, quality of life, disruption of finances and activities (Estes et al., 2009).”
BackgroundMethodInfluential
Exploring Partner Intimacy Among Couples Raising Children on the Autism Spectrum: A Grounded Theory Investigation
Johnson, J., & Piercy, F. P. (2017) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12247 · Cited by 16
Longitudinal Correlates of Maternal Depression Among Mothers of Children With or Without Intellectual Disability
Zeedyk, S. M., & Blacher, J. (2017) · American Journal on Intellectual and Developmental Disabilities · doi:10.1352/1944-7558-122.5.374 · Cited by 19
“There is a strong literature base for significant associations between child behavior problems and parental psychological well-being among parents of children with developmental disabilities (DDs; Abbeduto et al., 2004; Eisenhower et al., 2005; Estes et al., 2009).”
BackgroundResult
Multisystemic Therapy for Disruptive Behavior Problems in Youths with Autism Spectrum Disorder: Results from a Small Randomized Clinical Trial
Wagner, D. V., Borduin, C. M., Mazurek, M. O., Kanne, S. M., & Dopp, A. R. (2019) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2018.1560237 · Cited by 16
“For families of youths with ASD, these aggressive behaviors can result in financial strain, social isolation, and high caregiver stress (Estes et al., 2009; Hodgetts, Nicholas, & Zwaigenbaum, 2013).”
Background
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Nematollahi, M., Mehdipour‐Rabori, R., & Bagherian, B. (2019) · Journal of Religion and Health · doi:10.1007/s10943-019-00903-w · Cited by 16
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Differential Effects of Child Difficulties on Family Burdens across Diagnostic Groups
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“In fact, parents’ behaviour can be significantly modified by the child’s condition: difficulties in communication makes the parents anxious and worried (Marcus, Kunce, & Schopler, 2005) and unusual language and communication pose difficulties for parents when they spend time with their children (Estes et al., 2009), r…”
Background
Brief report: Service implementation and maternal distress surrounding evaluation recommendations for young children diagnosed with autism
Warren, Z. E., Vehorn, A. C., Dohrmann, E. H., Newsom, C. R., & Taylor, J. L. (2012) · Autism · doi:10.1177/1362361312453881 · Cited by 16
“Caregivers of children with ASD often report elevated levels of depression and distress compared to caregivers of individuals with other developmental and behavioral disorders (Dumas et al., 1991; Estes et al., 2009; Gallagher and Bristol, 1989; Montes and Halterman, 2007).”
Fostering Resilience among Couples Coparenting a Young Child with Autism: An Evaluation of Together We Are Stronger
Mendez, L. M. R., Berkman, K. A., Lam, G. Y. H., & Dawkins, C. (2019) · American Journal of Family Therapy · doi:10.1080/01926187.2019.1624225 · Cited by 15
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Uddin, M. J., & Ashrafun, L. (2023) · International Journal of Anthropology and Ethnology · doi:10.1186/s41257-023-00089-w · Cited by 21
“Research further suggests that mothers of children with autism experience double the stress compared to those of children with developmental challenges (Estes et al. 2009; Silva and Schalock 2012), with stress levels in some samples reaching as high as the 90th percentile (Mori et al.”
Background
Efficacy and Implementation of Stress-Reduction Interventions for Underserved Families of Autistic Preschoolers Across In-Person and Virtual Modalities
Fenning, R. M., Neece, C. L., Sanner, C. M., & Morrell, H. E. R. (2023) · Mindfulness · doi:10.1007/s12671-023-02250-0 · Cited by 15
“…greater parenting stress than do parents of children with neurotypical development and parents of children with other intellectual and developmental disabilities (IDD) and chronic conditions (e.g., Barroso et al., 2018; Estes et al., 2009; Dabrowska & Pisula, 2010; see also Hayes & Watson, 2013).”
Role of Pediatricians in Fostering Resilience in Parents of Children with Autism Spectrum Disorders
Zand, D. H., Braddock, B. A., Baig, W., Deasy, J., & Maxim, R. A. (2013) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2013.06.074 · Cited by 15
Dukungan Sosial Orang Tua dan Self-Esteem (Penelitian Terhadap Tim Kabupaten Sumedang di Ajang O2SN Jawa Barat)
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Relationship between caregiver burden and basic and instrumental activities of daily living among compound and noncompound caregivers
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“Both compound and noncompound caregivers often experience stress, which can result in adverse physical and psychological ramifications (Estes et al., 2009).”
Background
Modelling triadic relationships in families of children with intellectual disability
Williams, C. A., Bailey, T., & Hastings, R. P. (2022) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12988 · Cited by 15
“…disabilities (Braconnier et al., 2018; Dyke et al., 2009; Estes et al., 2013 whether the child with intellectual and developmental disabilities also has autism or Down syndrome (Estes et al., 2009; Hodapp et al., 2001), and whether the family live in poverty (Emerson, 2003; Totsika et al., 2020).”
Parent Support of Preschool Peer Relationships in Younger Siblings of Children with Autism Spectrum Disorder
the IBIS network, Estes, A. M., MUNSON, J. A., John, T. S., Dager, S. R., Rodda, A., Botteron, K. N., Hazlett, H. C., Schultz, R. T., Zwaigenbaum, L., et al. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3202-5 · Cited by 19
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“…higher levels of stress compared to parents of children with a typical development (Duarte et al. 2005; Montes and Halterman 2007), those with a child with Down syndrome (Dąbrowska and Pisula 2010; Estes et al. 2009), or other developmental disorders (Griffith et al. 2010; Schieve et al. 2007).”
Background
Mental Retardation and Parenting Stress
Siamaga, E., Lianou, A., Priftis, D., Lianou, E., Avgerinou, C., & Karasavvidis, S. (2011) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 15
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Cherewick, M., Daniel, C., Shrestha, C. C., Giri, P., Dukpa, C., Cruz, C. M., Rai, R. P., & Matergia, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1181976 · Cited by 16
“Reduction in parenting stress is an important outcome because parents and caregivers of autistic children experience higher rates of mental health disorders than parents of neurotypical children (Bitsika and Sharpley, 2004; Davis and Carter, 2008; Estes et al., 2009; Phetrasuwan and Shandor Miles, 2009).”
Background
Occupational Experiences and Subjective Well‐being of Mothers of Children with ASD in Taiwan
Hsieh, Y., & Lo, J. (2012) · Occupational Therapy International · doi:10.1002/oti.1339 · Cited by 14
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“Stress experienced by parents of individuals with ASD was shown to be greater than that experienced by parents of typically developing children (Estes et al., 2009; Hutchison et al., 2016).”
Background
Encuesta para Cuidadores de Personas del Espectro Autista en Chile. Acceso a Servicios de Salud y Educación, Satisfacción, Calidad de Vida y Estigma
García, R., Irarrázaval, M., López, I., Riesle, S., Cabezas, M., Moyano, A., Garrido, G., Valdez, D., Paula, C. S., Rosoli, A., et al. (2022) · Andes pediatrica · doi:10.32641/andespediatr.v93i3.3994 · Cited by 14
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Improving mental health in families with autistic children: benefits of using video feedback in parent counselling sessions offered alongside music therapy
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“They also experience markedly higher levels of stress and aggravation than parents of children with other developmental disabilities (Dabrowska & Pisula, 2010; Estes et al., 2009; Schieve, Blumberg, Rice, Visser, & Boyle, 2007).”
Background
An In-Depth Analysis of the Life Experiences of Parents with Children with Autism Spectrum Disorder
Yassıbaş, U., & Çolak, A. (2019) · TED EĞİTİM VE BİLİM · doi:10.15390/eb.2019.7366 · Cited by 14
“…other than ASD (Akkök, Aşkar, & Karancı, 1992; Baker-Ericzen, Brookman-Frazee, & Stahmer, 2005; Boyd, 2002; Cavkaytar, 2013; Esenler, 2001; Estes et al., 2009; Hastings & Johnson, 2001; Kaya, 2015; Krausz & Meszaros, 2005; Küçüker, 2001; Lee, Herinton, Louie, & Newsshaffer, 2008; Sunay,…”
Polymorbidity of developmental disabilities: Additive effects on child psychosocial functioning and parental distress
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Clinical and individual features associated with maternal stress in young adolescents with autism spectrum disorder
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Parental Distress and Parenting Behavior in Families of Preschool Children with and Without ASD: Spillover and Buffering
Baker, J. K., Fenning, R. M., Preston, A. E., Chan, N., McGregor, H. A., & Neece, C. L. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06163-8 · Cited by 16
“…with neurotypical development and parents of children with other intellectual and developmental disabilities (Baker-Ericzen et al., 2005; Barroso et al., 2018; Bispo-Torres et al., 2023; Dabrowska & Pisula, 2010; Estes et al., 2009 see also Hayes & Watson, 2013 and Karst & Van Hecke, 2012).”
Preliminary Results of Sensorimotor Room Training for the Improvement of Sensory and Motor Skills in Children with Autism Spectrum Disorders
Savarese, G., Mandia, R., Diavoletto, A., Piscitelli, M., Impemba, F., Siervi, A. D., Carpinelli, L., Bottiglieri, F., Sessa, M., & Corrivetti, G. (2025) · Pediatric Reports · doi:10.3390/pediatric17010004 · Cited by 19
“This can create a vicious cycle of stress that exacerbates the mental health issues of both the child and the caregivers [55].”
Strain in Caring for Youths Meeting Diagnosis for Disruptive Behavior Disorders
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“This study similarly suggests that disruptive behaviors may serve as an important predictor of caregiver strain (Chun et al., 2007; Estes et al., 2009; Floyd & Gallagher, 1997).”
Background
The Relationship Between Social Affect and Restricted and Repetitive Behaviors Measured on the ADOS-2 and Maternal Stress
Schutte, C., Richardson, W., Devlin, M., Hill, J., Ghossainy, M. E., & Hewitson, L. C. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3453-1 · Cited by 17
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Alquraini, T., Al‐Odaib, A., Aldhalaan, H., Merza, H., & Mahoney, G. J. (2018) · International Journal of Disability Development and Education · doi:10.1080/1034912x.2018.1487042 · Cited by 15
“In addition, parents of children with ASD not only experience higher levels of stress than parents of children with other disabilities (e.g. Estes et al., 2009), but their level of stress is often in the clinical range (Dale, Johoda, & Knott, 2006).”
Background
Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder
Romero, M., Marín, E., Parra, J. G., Navas, P., Aguilar, J. M., Lara, J. P., & Barbancho, M. Á. (2021) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2020.03.014 · Cited by 13
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Child, Maternal and Demographic Factors Influencing Caregiver-Reported Autistic Trait Symptomatology in Toddlers
Goh, D. A., Gan, D. Z. Q., Kung, J., Baron‐Cohen, S., Allison, C. L., Chen, H., Saw, S., Chong, Y. S., Rajadurai, V. S., Tan, K. H., et al. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3471-7 · Cited by 13
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Qu, Y., Yang, B., & Telzer, E. H. (2020) · Journal of Youth and Adolescence · doi:10.1007/s10964-020-01255-5 · Cited by 13
“…and longitudinal data show that youth’s difficulties (e.g., developmental delays and frequent behavioral problems) are associated with parents’ worse emotional well-being (e.g., lower parental self-efficacy and higher levels of stress, depression, and anxiety; Estes et al. 2009; Neece et al. 2012).”
Background
Existential Well-Being, Drug Abuse, and Parenting Stress in African American Women
Lamis, D. A., West, L. M., Mehta, N., Lisco, C. G., Tarantino, N., Wilson, C. K., & Kaslow, N. J. (2014) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-014-9503-4 · Cited by 13
“…: C. Lisco :N. Tarantino Department of Psychology, Georgia State University, Atlanta, GA, USA C. Wilson Atlanta VA Medical Center, Decatur, GA, USA parenting stress, mothers who endorse high levels of parenting stress have more psychological distress and less life satisfaction (Estes et al. 2009).”
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
ORCID: Estes, Annette
Munson, Jeffrey
Zhou, Xiao-Hua
Venue: Autism
Publisher: SAGE Publications
Published: 2009-06-17
Volume: 13
Issue: 4
Pages: 375-387
ISSN: 1362-3613 (ISSN-L)
1461-7005
DOI: 10.1177/1362361309105658
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
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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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Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay

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