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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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“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]
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“Different studies indicated the negative effect of disabled children on the other family members, especially regarding psychological adjustment, and showed that mothers of children with disabilities experience higher degrees of anxiety, depression, and other mental complications that probably result from the fact that…”
BackgroundUljarević, M. (2013) · ORCA Online Research @Cardiff (Cardiff University) · Cited by 6
The Early Start Denver Model: Outcomes and Moderators of an Intervention for Toddlers with Autism
Sullivan, K. A. (2013) · ResearchWorks at the University of Washington (University of Washington) · Cited by 6
Rimlinger, N. A. (2016) · ANU Open Research (Australian National University) · doi:10.25911/5d7637355aa43 · Cited by 8
Grief among parents of children with autism spectrum disorders: a systematic review
Bhaskaran, D., Scaria, L., & George, B. (2024) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2024.2387401 · Cited by 6
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“Also, it is reported that a child’s behavior is the most important predictor of parental stress [7].”
InfluentialChung, S. T., Lok, E. Y. C., Chan, Q. K. N., Cheng, K., Lam, S.-M., & Lui, S. S. Y. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06028-0 · Cited by 6
“developmental delay (Estes, et al., 2009; Hamlyn-Wright, et al., 2007; Quintero & McIntyre, 2010).”
Cappe, É., Despax, J., Pedoux, A., Zylberberg, P., Chaste, P., de Gaulmyn, A., Doyen, C., & Pommepuy, N. (2024) · L Encéphale · doi:10.1016/j.encep.2024.01.002 · Cited by 5
da Silva, R. V., Carvalhal, M. M. D. L., & Gomes, D. L. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21050545 · Cited by 5
“According to existing research, being the main caregiver of a child with ASD, especially when there is low family and social support, can contribute a significant emotional impact when compared to caregivers of children with typical development [5,6].”
BackgroundRaising a Child with Autism Spectrum Disorder: Examining Parental Factors
Barklı, A., & Doğan, A. (2024) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1455122 · Cited by 4
“This cause to parents reporting higher levels of stress (Estes et al. 2009).”
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Mazurek, M. O. (2015) · Autism and child psychopathology series · doi:10.1007/978-3-319-19183-6_1 · Cited by 5
Stressful life events during pregnancy as risk factors for developing autistic disorder in children
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Zhao, M., Li, C., Fu, W., Ma, X., & Chen, X. (2021) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2021.1895696 · Cited by 5
“By further applying an a posteriori comparison using Scheffe’s method (Wu 2009), we found that the TQ score, the ERQ score, and the total PISQ score of the parents of children with autism spectrum disorder (ASD) were significantly lower than those of the parents of children with attention deficit hyperactivity disorde…”
ResultYamane, T. (2021) · Autism · doi:10.1177/13623613211009349 · Cited by 6
“Several studies have reported that parents of children with developmental disabilities experience higher levels of stress than parents of children without such disabilities (Baker et al., 2005; Emerson, 2003; Estes et al., 2009; Weiss, 2002).”
BackgroundA Telecommunication Model to Teach Facilitators to Deliver Acceptance and Commitment Training
Magnacca, C., Thomson, K. M., Marcinkiewicz, A., Davis, S., Steel, L., Lunsky, Y., Fung, K. P.-L., Vause, T. C., & Redquest, B. K. (2021) · Behavior Analysis in Practice · doi:10.1007/s40617-021-00628-x · Cited by 6
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“For parents, child engagement in CB has demonstrated higher rates of stress, anxiety, and depression (Estes et al., 2009; Lai, Goh, Oei, & Sung, 2015; Postorino et al., 2017).”
BackgroundBarriers to Accessing Effective Treatments for Destructive Behavior
Greer, B. D. (2023) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322221144653 · Cited by 5
“Parental and caregiver stress reliably results from destructive behavior in dependents (e.g., Brobst et al., 2009; Estes et al., 2009, 2013; Hastings et al., 2005), and it lowers martial satisfaction (e.g., Brobst et al., 2009; Hartley et al., 2012).”
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Lee, A. R., Hong, S. W., & Ju, S. J. (2012) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.2012.42.6.861 · Cited by 5
“가 점차적으로 무력감과 암담함을 느끼고 지치게 되어 모든 것을 포기하고 싶은 상태를 경험하지만(Dale, Jahoda, & Knott, 2006; Estes et al., 2009), 오히려 장애가 있는 아이를 통해 삶에 대한 태도가 긍정 적으로 변화될 수 있는 가능성이 제시되기도 하였다(Green, 2007; Hines, Balandin, & Togher, 2012). 이러한 맥락에서 Nelson (2002)은 12개의 질적 연구 논문을 메타”
Maternal Depression and Child Behavior Problems
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InfluentialBalser, S., DiPierro, G., Chaikin, C. D., Obeid, R., Berg, K. A., & Ishler, K. J. (2023) · Research in Autism · doi:10.1016/j.rasd.2023.102283 · Cited by 4
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Neijs, L. D.-D., Swaab, H., van Berckelaer‐Onnes, I. A., & Ester, W. A. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-025-06773-4 · Cited by 8
“…stress and that they present significant levels of stress-related mental and/or physical problems with elevated mortality hazard ratios compared to mothers of typically developing children (Dijkstra-de Neijs et al., 2020; Estes et al., 2009; Rezendes & Scarpa, 2011; Riahi & Izadi-Mazidi, 2012).”
A Time-use Study of Immigrant Mothers’ Positive Emotions Raising a Child with ASD
Cohen, S. R., Lee, H., Kim, S., & Guerra, A. W. (2020) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01732-2 · Cited by 4
Sense of coherence and WHOQoL among parents of children with ASD in Malaysia
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“In fact, their experience of these negative impacts is even stronger than that of parents of children with other developmental disabilities, such as Down syndrome, fragile X syndrome, mental retardation, and developmental delay [20].”
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Zampini, L., Zanchi, P., Riva, P., & Tobia, V. (2022) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2022.2062841 · Cited by 5
“For instance, the parents of children with autism spectrum disorder usually exhibit higher levels of stress than those of TD children or children with other neurodevelopmental disorders (Davis and Carter 2008, Estes et al .”
BackgroundÇocukların Problem Davranışlarında Annelerin ve Büyükannelerin Tepkilerinin İncelenmesi
Alabay, E., & ERSAL, H. (2022) · Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.21020/husbfd.940973 · Cited by 4
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Dukmak, S. J., Mousa, A., & Gharaibeh, M. (2022) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2022.2098434 · Cited by 4
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“There is a well-established literature base demonstrating that, even during typical times, many parents of individuals with ASD report increased stress levels relative to parents of typically-developing (TD) children and parents of children with other developmental disabilities (e.g., Davis & Carter, 2008; Estes et al…”
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“The generalizability of the findings regarding cost and other barriers to appointment adherence may be strengthened through additional research in children’s outpatient behavioral clinics that include children with a variety of developmental trajectories and needs (Estes et al., 2009).”
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Motivational and Personality Sphere in Mothers of Autist Children: North America and Western Europe
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Maladjustment in Families with Disabled Children
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Arslan, K., & Tuncay, T. (2023) · Uluslararası İnsan Çalışmaları Dergisi · doi:10.35235/uicd.1318620 · Cited by 4
Parental Stress and Coping Mechanisms in Families with Children on The Autism Spectrum
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Autism Spectrum and Social Pragmatic Language Disorders
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Effet différencié du chien d’assistance selon la sévérité de l’autisme chez l’enfant
Bélanger, C. M., Normand, C. L., Fecteau, S.-M., Trudel, M., & Champagne, N. (2022) · Revue de psychoéducation · doi:10.7202/1088636ar · Cited by 3
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“Persistent challenging behavior at a young age causes a negative impact on the family system and quality of life (Estes et al., 2009; Mugno et al., 2007) and can have deleterious effects on children’s development, interfere with learning, lead them to harm themselves and others, and increase risk…”
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“This statement was supported by many past studies such as Estes et al (2009) whereby they mentioned that mothers tend to experience greater parenting stress as compared to fathers.”
ResultSneed, L., Pfingston, B., Cook, I. C., Taylor, R., Samelson, D., & Fitchett, B. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06700-z · Cited by 3
“This is particularly true of families that have a child with an intellectual or developmental disability (I/DD), with parenting stress particularly elevated in families with one or more autistic child (Dumas et al., 1991; Estes et al., 2009; Hayes & Watson, 2013).”
Rattaz, C., Pickles, A. R., Vernhet, C., Michelon, C., Picot, M., & Baghdadli, A. (2025) · JCPP Advances · doi:10.1002/jcv2.12303 · Cited by 3
“We focused on oppositional defiant behaviors, which are a crucial issue for parents and were shown to be associated with parental QoL (Adams et al., 2018; Allik et al., 2006; Estes et al., 2009; Lanyi et al., 2022; McStay et al., 2014; Vernhet et al., 2022).”
Porter, N., Loveland, K. A., Saroukhani, S., Posey, Y. S., & Rahbar, M. H. (2025) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-025-00444-2 · Cited by 3
“The inconsistency in findings may be related to child behavioral and emotional problems, which is often recognized as a primary source of parenting stress (Estes et al., 2009).”
InfluentialParent Mental Models of Transition Related to Their Child’s Developmental Diagnosis
Broski, J., & Dunn, W. (2020) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01735-z · Cited by 4
Storms, N. M. (2012) · OpenSIUC (Southern Illinois University Carbondale) · Cited by 3
Parents in relationships with their children with autism: a qualitative study
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Dewinta Larasati, P., Asih, S. R., & Saraswati, I. (2019) · International Conference on Intervention and Applied Psychology (ICIAP) · doi:10.2991/iciap-18.2019.20 · Cited by 3
Martin, A. M., McIntyre, L. L., & Neece, C. L. (2023) · The Family Journal · doi:10.1177/10664807231163261 · Cited by 3
“It is well documented in the literature that parenting stress is higher on average in caregivers of children with DD (Baker et al., 2002; Estes et al., 2009) and caregivers with higher levels of parenting stress pre-pandemic were more likely to report an increase in anxiety during the pandemic…”
BackgroundLevel of Stress and Caregiver Burden among Caregivers of Cerebral Palsy Children in Lahore City
(2016) · International Journal of Science and Research (IJSR) · doi:10.21275/v5i4.nov163068 · Cited by 3
Predictors of Stress among Parents of Preschool Aged Children with Autism Spectrum Disorders
Shamash, E. R. (2011) · ProQuest Demo Repository · Cited by 3
Haisley, L. D. (2014) · OpenCommons - UConn (University of Connecticut) · Cited by 3
Liden, T. A., & Rosales‐Ruiz, J. (2024) · Behavior Analysis in Practice · doi:10.1007/s40617-024-00944-y · Cited by 2
“These stressors significantly affect both mothers and fathers of children with autism (Allen et al., 2013; Davis & Carter, 2008; Estes et al., 2009).”
Buchanan, T., Phung, N., Hammoud, M., Kjartanson, K., & Friesen, A. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02887-y · Cited by 2
“Previous research has indicated how parental stress has psychological impacts on the parents themselves, such as contributing to a lower quality of life and creating psychological distress manifesting as depression and anxiety (Estes et al., 2009).”
Investigation of parental stress in parents of children with high intellectual potential
Duplenne, L., & Bourdin, B. (2025) · Gifted Education International · doi:10.1177/02614294251335557 · Cited by 2
“For instance, parents of children with Autism Spectrum Disorder (ASD) report signi fi cant stress due to their child ’ s behavioral challenges and long-term concerns about their child ’ s future (Estes et al., 2009; Hayes & Watson, 2013).”
Zhang, C., Xu, C., Zhang, B., & Zhou, T. (2025) · Development and Psychopathology · doi:10.1017/s0954579425100436 · Cited by 2
Relationships between physical activity and quality of life in parent–child dyads with ASD
Song, Y., Shen, B., Pang, Y., & Dong, L. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1669728 · Cited by 2
Lahav, Y., & Shalev, A. (2025) · Stress and Health · doi:10.1002/smi.70118 · Cited by 2
“These include work and finances (Mandic et al. 2017), family life (e.g., Craig et al. 2016; Estes et al. 2009), physical health (e.g., Lovell et al. 2021),andmentalhealth(e.g.,Lachetal.2009;Picardietal.2018).”
Brunt, S., Menezes, M., Pappagianopoulos, J. E., Smith, J., Howard, M., Sadikova, E., Witte, L., & Mazurek, M. O. (2025) · Research in Autism · doi:10.1016/j.reia.2025.202752 · Cited by 6
Ganetsos, A., Farrelly, E. R., Magoulas, P. L., & Stevenson, D. A. (2020) · Journal of Pediatric Genetics · doi:10.1055/s-0040-1712178 · Cited by 2
Scott, S., Nealey-Moore, J. B., & Zylstra, S. E. (2020) · American Journal of Occupational Therapy · doi:10.5014/ajot.2021.041483 · Cited by 2
“Parents of children with attention de fi cit hyperactivity disorder (ADHD) and intellectual disabilities have also reported high parenting stress (Anastopoulos et al., 1992; Estes et al., 2009; Eisenhower et al., 2005).”
Brehm, B., Schill, J. E., Rauh, R., Fleischhaker, C., & Biscaldi, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.604851 · Cited by 4
Çayak, S., & Tekin, Ö. E. (2023) · International Journal of Research in Education and Science · doi:10.46328/ijres.3227 · Cited by 2
Toilet training in children with certain developmental disorders
Đurić-Zdravković, A., & Rapaić, D. (2023) · Specijalna edukacija i rehabilitacija · doi:10.5937/specedreh22-42869 · Cited by 2
Bringing up a child with autism. Parental stress and burnout syndrome in a time perspective context
Kossewska, J. (2020) · Family Upbringing · doi:10.61905/wwr/170451 · Cited by 3
Intervention for Aggressive-Destructive Behavior
Norris, H. M., Greer, B. D., Angley, S. M., Helvey, C. I., & French, J. L. (2024) · Evidence-based practices in behavioral health · doi:10.1007/978-3-031-54923-6_5 · Cited by 2
Lan, K., Jia, X., Gao, S., Feng, Z., Jia, M., Yue, W., Wei, Y. B., & Liu, J. J. (2024) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.70008 · Cited by 2
Haque, M., Bhagat, V., Simbak, N., & Jaalam, K. (2017) · Advances in Human Biology · doi:10.4103/aihb.aihb_17_17 · Cited by 2
Sladeczek, I. E., Fontil, L., Miodrag, N., Karagiannakis, A., Amar, D., & Amos, J. (2017) · Exceptionality Education International · doi:10.5206/eei.v27i1.7745 · Cited by 2
“Maladaptive behaviour in children with developmental delays has been reported as the single greatest determinant of parental stress (Baker et al., 2002; Estes et al., 2009; Hodapp, 2002; Johnston et al., 2003; McCarthy et al., 2006; Plant & Sanders, 2007; Raina et al., 2004; Raina et al., 2005).”
BackgroundBhagat, V., Simbak, N., & Haque, M. (2015) · Journal of Young Pharmacists · doi:10.5530/jyp.2015.4s.1 · Cited by 3
Sinzig, J., Vinzelberg, I., Bell, H., & Quirmbach, L. M. (2013) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000127 · Cited by 2
Metadata
- 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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