Clinical Correlates of Parenting Stress in Children with Autism Spectrum Disorder and Serious Behavioral Problems

Abstract

We examined associations between parent-reported stress on the Parenting Stress Index (PSI) and clinical characteristics in children with autism spectrum disorder (ASD) and serious behavioral problems. The 298 children (259 males, 39 females; mean age 5.8 ± 2.2 years) were participants in one of two multisite randomized trials. The pre-treatment evaluation included standardized assessments of cognitive and adaptive functioning (Vineland Adaptive Behavior Scales) and parent ratings such as the Aberrant Behavior Checklist (ABC). Parents of children above the median on disruptive behavior (ABC Irritability) and social disability (ABC Social Withdrawal) reported higher levels on PSI Parent–Child Interaction than children below the median (Irritability 33.0 ± 7.7 vs 28.4 ± 7.3; Social Withdrawal 33.4 ± 7.5 vs 27.9 ± 7.2, p < .05). Similar findings were observed for the PSI Difficult Child subscale. Bivariate logistic regression identified that these measures as well as greater adaptive functioning deficits (≤median on Vineland Daily Living) predicted parental membership in the upper quartile on the PSI. Stepwise logistic regression models showed that greater severity on ABC Social Withdrawal and greater deficits on Vineland Daily Living uniquely predicted parental membership in the highest quartile on the Parent–Child Interaction PSI subscale (ABC Social Withdrawal odds ratio = 3.4 (95% CI 1.82–6.32); p < .001; Vineland Daily Living odds ratio = 2.6 (95% CI = 1.34–4.87; p < .001). In addition to disruptive behavior, higher levels of social disability and lower levels of adaptive functioning are associated with parental stress on the PSI.