Mental health, broad autism phenotype and psychological inflexibility in mothers of young children with autism spectrum disorder in Australia: A cross-sectional survey
Abstract
Lay abstract Mothers of children with autism tend to have poorer mental health outcomes compared to most mothers. Lack of social support, parenting challenges and relationship difficulties are more common for mothers of children with autism and can all affect maternal mental health. Mothers of children with autism are also more likely to have some autistic features, called the broad autism phenotype, that can contribute to poorer mental health; however, how these factors relate to one another are unclear. This study found that mothers who were less flexible in their thinking and behaviour and had more difficult parenting experiences tended to have poorer mental health. Mothers with more autistic features were less flexible in their thinking and behaviour, which, in turn, was linked to greater symptoms of depression, anxiety and stress. Mothers with greater autistic features also reported more difficult parenting experiences, which was in turn linked with greater symptoms of anxiety and depression. This study suggests that supporting mothers of young children with autism to manage parenting challenges and become more flexible with their thinking and behaviour could help to improve their mental health.
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A crucial gap exists in understanding the dynamics among mindfulness, psychological inflexibility, and psychological distress in parents of school-aged children.
“However, the scientific literature has begun to focus on parents [22, 32], and a crucial gap exists in understanding the dynamics among mindfulness, psychological inflexibility, and psychological distress (anxiety and depression) in parents of school-aged children.”
From Psychological inflexibility mediates the relationship between mindfulness and psychological distress in Peruvian parents with school age children. (2026) · cites this paper as [22]
Cites
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Methodology series module 3: Cross-sectional studies
Setia, M. (2016) · Indian Journal of Dermatology · doi:10.4103/0019-5154.182410 · Cited by 1,393 · cited 1× · see citing works
“Finally, the cross-sectional design of this study precludes the inference of causal relationships as a longitudinal design is required to ascertain directionality and causation (Setia, 2016).”
BackgroundUsing acceptance and commitment training in the support of parents of children diagnosed with autism
Blackledge, J. T., & Hayes, S. C. (2006) · Child & Family Behavior Therapy · doi:10.1300/j019v28n01_01 · Cited by 383 · see citing works
The factors predicting stress, anxiety and depression in the parents of children with autism
Falk, N. H., Norris, K., & Quinn, M. G. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2189-4 · Cited by 369 · see citing works
Reducing distress in mothers of children with autism and other disabilities: a randomized trial
Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014) · Pediatrics · doi:10.1542/peds.2013-3164 · Cited by 355 · see citing works
Maternal depression and child development
Bernard-Bonnin, A.-C., Canadian Paediatric Society, & Mental Health and Developmental Disabilities Committee (2004) · Paediatrics & Child Health · doi:10.1093/pch/9.8.575 · Cited by 312 · see citing works
Rezendes, D. L., & Scarpa, A. (2011) · Autism Research and Treatment · doi:10.1155/2011/395190 · Cited by 212 · cited 1× · see citing works
“Although one study found that older mothers may experience more difficulties responding to the challenges of raising a child with ASD (Rezendes & Scarpa, 2011), another found younger parental age to be linked with poorer mental health (Falk et al., 2014).”
BackgroundBitsika, V., Sharpley, C. F., & Bell, R. (2013) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-013-9333-5 · Cited by 202 · see citing works
Executive function in parents of children with autism.
HUGHES, C., LEBOYER, M., & BOUVARD, M. (1997) · Psychological Medicine · doi:10.1017/s0033291796004308 · Cited by 181 · see citing works
Ferraioli, S. J., & Harris, S. L. (2013) · Mindfulness · doi:10.1007/s12671-012-0099-0 · Cited by 145 · cited 1× · see citing works
“…flexibility includes mindfulness, these results also point towards the potential usefulness of mindfulnessbased interventions, which have previously been shown to improve the mental health of mothers of children with ASD (Dykens et al., 2014; Ferraioli & Harris, 2013; Hastings & Manikam, 2013).”
ResultWhittingham, K., Wee, D., Sanders, M. R., & Boyd, R. (2013) · Child Care Health and Development · doi:10.1111/j.1365-2214.2012.01396.x · Cited by 105 · see citing works
Self-citationBrown, F. L., Whittingham, K., Boyd, R. N., McKinlay, L., & Sofronoff, K. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.07.001 · Cited by 101 · see citing works
Self-citationWhat helps the mother of a preterm infant become securely attached, responsive and well-adjusted?
Evans, T., Whittingham, K., & Boyd, R. (2012) · Infant Behavior and Development · doi:10.1016/j.infbeh.2011.10.002 · Cited by 91 · 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
Ingersoll, B., Meyer, K., & Becker, M. W. (2011) · Autism Research · doi:10.1002/aur.170 · Cited by 88 · see citing works
Psychological inflexibility explains distress in parents whose children have chronic conditions
Sairanen, E., Lappalainen, P., & Hiltunen, A. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201155 · Cited by 60 · cited 4× · see citing works
“…predicts symptoms of depression, anxiety and stress in mothers of children with chronic health and developmental diagnoses including autism (Sairanen et al., 2018), mothers of children with cerebral palsy (Whittingham et al., 2013) and parents of children undergoing cancer treatment…”
BackgroundResultInfluentialParents are people too: The importance of parental psychological flexibility
Leeming, E., & Hayes, S. C. (2016) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12147 · Cited by 31 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Psychological flexibility of parents of children with disabilities: A systematic literature review
Gur, A., & Reich, A. (2023) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2023.104490 · Cited by 44 · see citing works
The Route of Stress in Parents of Young Children with and without Autism: A Path-Analysis Study
Leonardi, E., Cerasa, A., Servidio, R. C., Costabile, A., Famà, F. I., Carrozza, C., Spadaro, L., Scifo, R., Baieli, S., Aiello, S., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010887 · Cited by 22 · see citing works
“The BAP has been associated with personality characteristics [39] such as rigidity, detachment, and hypersensitivity to criticism [36,40,41] as well as interpersonal difficulties [36].”
BackgroundXu, C., Tong, J., Zhang, W., Wang, X., Ma, S., Shi, D., Yan, D., & Liu, Y. (2024) · BMC Public Health · doi:10.1186/s12889-024-17731-7 · Cited by 17 · see citing works
“This may not only improve the mental health of parents of children with ASD and family well-being but may also have flow-through effects that ultimately improve children’s developmental outcomes [22].”
BackgroundResultCourtesy stigma among primary caregivers of children with autism spectrum disorder in eastern China
Chen, X., Tong, J., Jiang, B., Ma, S., Wang, X., Sun, X., Liu, Y., Yan, D.-M., & Wang, L.-L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1236025 · Cited by 11 · see citing works
Kulasinghe, K., Whittingham, K., & Mitchell, A. E. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104365 · Cited by 10 · see citing works
Self-citationEl‐Bouhali‐Abdellaoui, F., Voltas, N., Morales‐Hidalgo, P., & Canals, J. (2024) · Autism Research · doi:10.1002/aur.3295 · Cited by 12 · see citing works
Qi, X., & To, C. K. S. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102512 · Cited by 6 · see citing works
Li, S. N., Chien, W. T., Lam, S. K. K., Chong, Y. Y., & Gloster, A. T. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06610-0 · Cited by 5 · see citing works
“Previous studies indicated a significantly negative association between psychological inflexibility and mental health, indicating that psychological inflexibility could predict anxiety, depression, and stress symptomatology in mothers of children with ASD (Kulasinghe et al., 2021).”
Reich, A., Lifshitz, H., Shnitzer‐Meirovich, S., & Gur, A. (2025) · Research and Practice for Persons with Severe Disabilities · doi:10.1177/15407969251316501 · Cited by 5 · see citing works
“Among parents of children with ASD, low psychological flexibility of mothers is correlated with anxiety, depression, and stress (Kulasinghe et al., 2021).”
Cha, W.-J., & Kim, K. (2023) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2023.100399 · Cited by 5 · see citing works
“These individuals experience significantly higher levels of depression and anxiety compared to the general population and these symptoms could have been caused by their reduced social interaction and social skills (Kulasinghe et al., 2021).”
BackgroundJiao, X., Yang, L., & Li, S. (2025) · Nursing Open · doi:10.1002/nop2.70180 · Cited by 5 · see citing works
“Despite the emphasis in previous research on the mediating role of psychological flexibility in the relationship between mental health outcomes and various parental factors, few studies have specifically investigated its impact on parental self-efficacy (Kulasinghe et al. 2021).”
Zhang, Y., Liu, J., Jiang, M., Jia, F., Fang, M., & Liu, D. (2025) · Clinical Psychologist · doi:10.1080/13284207.2024.2447439 · Cited by 2 · see citing works
Wang, F., Du, W., & Iao, L. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1433823 · Cited by 2 · see citing works
The Effects of Telemedicine Parent Training on Children and Adolescents With Autism: A Meta‐Analysis
Li, Q., Wang, X., Zhang, G., Li, Y., Wang, X., Peng, N., Sun, J., Ren, J., Yao, X., & Song, F. (2026) · Child Care Health and Development · doi:10.1111/cch.70353 · Cited by 1 · see citing works
Han, T., Zhang, C. M., Liu, X. L., Jin, Y., Song, C., & Wang, Z. P. (2026) · BMC Public Health · doi:10.1186/s12889-025-26140-3
“…resilience (internal factors) and ASD symptom typicality (external factors), while controlling for seven demographic variables (child age [6, 27], parent gender [27–28], maternal and paternal educational background [27, 29], family income [27, 30–31], marital status [27, 29], diagnosed time [1]).”
Seclén Uchuya, M. L., Angulo Salas, R. J., Serpa-Barrientos, A., & Saintila, J. (2026) · Discover Public Health · doi:10.1186/s12982-026-01595-w · Cited by 1 · see citing works
“However, the scientific literature has begun to focus on parents [22, 32], and a crucial gap exists in understanding the dynamics among mindfulness, psychological inflexibil-ity, and psychological distress (anxiety and depression) in parents of school-aged children.”
Barroso-Díaz, S., Nieto-Casado, F. J., & Suárez, L. A. (2026) · Current Psychology · doi:10.1007/s12144-026-09948-z
“This notion is supported by studies linking financial strain to lower parental well-being (Kulasinghe et al., 2021; Nomaguchi & Milkie, 2020 ; Qi & To, 2025), as well as by evidence associating caregivers’ occupational status with their levels of experiential avoidance (Fonseca et al., 2018).”
Shnitzer‐Meirovich, S., Aviad, S., & Gur, A. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-026-07407-z
Qiao, F., Zhou, X. Y., & Zhang, H. D. (2026) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-026-10078-4
Forby, L., Leung, E., & Kingstone, A. (2026) · Research in Autism · doi:10.1016/j.reia.2026.202914
O’Connor, E. E., Treyvaud, K., Green, C. C., Barbaro, J., Maybery, M. T., Varcin, K. J., Wan, M. W., Whitehouse, A., & Hudry, K. (2026) · Research in Autism · doi:10.1016/j.reia.2026.202870
Forby, L., Pazhoohi, F., & Kingstone, A. (2026) · Psychological Reports · doi:10.1177/00332941261436725
“Individuals with BAP traits also experience higher rates of depression and anxiety relative to NTs (Kulasinghe et al., 2021; Kurtz et al., 2023).”
InfluentialKoç, R., & Akbulut, Ö. F. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-026-07223-5
Ο ευρύτερος φαινότυπος του αυτισμού στους γονείς παιδιών με αυτισμό
Καζαντζίδου, Π., Κωσταρέλλη, Β., Παπανικολάου, Γ., & Αντωνοπούλου, Α. (2025) · Psychology · doi:10.12681/psy_hps.40443
Richard, A. E., Scheffer, I., & Wilson, S. J. (2025) · Annals of the Child Neurology Society · doi:10.1002/cns3.20104
“The large Australian sample of mothers of children with ASD from Kulasinghe et al. [31] was not selected as a comparison sample because of their substantially higher rate of the BAP compared with previous estimates [36].”
AAPdN Virtual Conference – Accepted Abstracts
Aylward, S. A. (2022) · Journal of Pediatric Neuropsychology · doi:10.1007/s40817-022-00122-4
Carneiro, R., Boschemeier, A. G. E., & Cejas, M. (2021) · Macedonian Journal of Medical Sciences · doi:10.21057/10.21057/repamv15n1.2021.40443
“Μητέρες παιδιών με ΔΑΦ έχουν βρεθεί να είναι λιγότερο ευέλικτες στη σκέψη και τη συμπεριφορά, με αυξημένα ποσοστά κατάθλιψης και γονικού άγχους (Kulasinghe et al., 2021).”
- Authors
- Kulasinghe, K., Whittingham, K., & Mitchell, A. E.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Kulasinghe, Kavindri
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2021-01-28
- Volume
- 25
- Issue
- 5
- Pages
- 1187-1202
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- OpenAlex
- W3122969313
- Cited by
- 28
- References
- 0
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 2
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- University of Queensland Graduate School Scholarship
- Children’s Hospital Foundation Early Career Fellowship (50223)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- autism spectrum disorder, broader autism phenotype, maternal mental health, psychological inflexibility, mothers of autistic children, parental stress, depressive symptoms, anxiety symptoms, adult attachment styles, social support, mediation, parental experiences
- MeSH terms
- Autism Spectrum Disorder, Autistic Disorder, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Mental Health, Mothers, Phenotype, Stress, Psychological, Parenting
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