Coping and care-related stress in parents of a child with autism spectrum disorder

Background and Objectives: Parenting a child with Autism Spectrum Disorder (ASD) is challenging and can result in elevated levels of parenting stress. This study investigated the relationship between parent-ratings of their child’s ASD symptoms and two conceptually different measures of parenting stress: One specific to the ASD context and the other a general stress measure applicable to the broader caregiving context. Additionally, the influence of coping style on the relationship between child’s ASD symptoms and parenting stress was investigated.

Design and Methods: Using an internet survey, parents (N?=?178) caring for a child with ASD reported on coping strategies, completed two measures of parenting stress, and assessed their child’s ASD symptoms.

Results: Parenting stress increased with severity of the child’s ASD symptoms, but the strength of this relationship depended on whether a general or disorder-specific measure of parenting stress was used. Regression analyses indicated that some coping strategies moderated the impact of ASD symptom severity on the parent’s care-related stress, but moderation depended on how stress was conceptualized.

Conclusion: This study reinforces the importance of identifying the coping strategies of parents of children with developmental disorders, and highlights the consequences of using different conceptual approaches to measure parenting stress.     

Parenting Young Children (PARYC): Validation of a Self-Report Parenting Measure

The measurement of parenting behaviors is important to the field of psychology and the goal of remediating problematic parenting as a means of reducing child problem behaviors. The Parenting Young Children (PARYC) is a self-report measure designed to address parenting behaviors relevant for the caregivers of young children, and was assessed in sample of 579 high risk families. The measure assesses the frequency of several parenting behaviors, the perception of the parenting behaviors as problematic, and the degree to which the caregiver would like to make changes in specific parenting skills. An examination of the validity of the parenting behavior items revealed three parenting scales: (1) Supporting Positive Behavior (2) Setting Limits, and (3) Proactive Parenting. Confirmatory factor analysis results corroborate the findings of the exploratory factor analysis, supporting the measurement structure of these parenting scales. Tests of convergent validity indicate the PARYC scale is a suitable measure of parenting behaviors. In addition, the self-perception of parenting behaviors as problematic predicted concurrent levels of service utilization while controlling for simultaneous child behavior problems.     

Leveraging Healthcare to Promote Responsive Parenting: Impacts of the Video Interaction Project on Parenting Stress

We sought to determine impacts of a pediatric primary care intervention, the Video Interaction Project, on 3-year trajectories of parenting stress related to parent–child interactions in low socioeconomic status families. A randomized controlled trial was conducted, with random assignment to one of two interventions Video Interaction Project (VIP); Building Blocks or control. As part of VIP, dyads attended one-on-one sessions with an interventionist who facilitated interactions in play and shared reading through review of videotaped parent–child interactions made on primary care visit days; learning materials and parenting pamphlets were also provided to facilitate parent–child interactions at home. Parenting stress related to parent–child interactions was assessed for VIP and Control groups at 6, 14, 24, and 36 months using the Parent–Child Dysfunctional Interaction subscale of the Parenting Stress Index—Short Form, with 378 dyads (84 %) assessed at least once. Group differences emerged at 6 months with VIP associated with lower parenting stress at three of four ages considered cross-sectionally and an 17.7 % reduction in parenting stress overall during the study period based on multi-level modeling. No age by group interaction was observed, indicating persistence of early VIP impacts. Results indicated that VIP, a preventive intervention targeting parent–child interactions, is associated with decreased parenting stress. Results therefore support the expansion of pediatric interventions such as VIP as part of a broad public health strategy to address poverty-related disparities in school-readiness.     

Association Between Independent Reports of Maternal Parenting Stress and Children’s Internalizing Symptomatology

Although considerable research has investigated parenting stress and children’s externalizing behavior problems, comparatively less has considered parenting stress in relation to children’s internalizing difficulties. Even less research on parenting stress has incorporated children’s report of their internalizing symptoms or the potential mediating role of children’s attributional style. The current study hypothesized that children’s independent reports of internalizing symptoms would be associated with mothers’ reports of parenting stress through children’s attributional style. A community sample of 92 mother–child dyads participated. Results suggest maternal parenting stress from both child and parent sources were significantly associated with children’s anxious and depressive symptoms. Parenting stress was associated with children’s internalizing symptoms partially mediated by children’s maladaptive attributional style, primarily negative attributions for positive outcomes. Findings are discussed in terms of future directions to tease apart specific areas of parenting stress that may be most pertinent as well as to explore other cognitive mechanisms in children that may relate to parenting stress and children’s adjustment.     

Stress in Mothers with Intellectual Disabilities

Both low parental IQ and stress have been shown to be associated with parenting difficulties and adverse child outcomes. We examined stress in parents with low IQ as a potential contributor to their documented parenting problems. Eighty-two mothers with intellectual disabilities (IQ < 80; labelled as having mental retardation) were given the Parenting Stress Index and they were found to be enduring very high levels of overall stress (95th percentile), stress related to child characteristics (95th percentile), and stress related to other life experiences (90th percentile) as compared to the normative test group. We divided the 82 mothers with intellectual disabilities into three groups depending on the age of their children. The mothers with school-age children reported significantly higher stress than parents of infant/toddler and preschool children. A hierarchical regression analysis revealed that child age and living in a crowded environment were significant predictors of parenting stress. The results confirm that mothers with intellectual disabilities experience extreme stress that, together with other factors, may hinder adequate parenting.     

Authoritative Parenting, Parenting Stress, and Self-Care in Pre-Adolescents with Type 1 Diabetes

Parent involvement in type 1 diabetes (T1DM) care leads to improved adherence; however, the manner in which parents approach illness management interactions with children must also be considered. It was hypothesized that greater use of an authoritative parenting style and less parenting stress would be associated with greater behavioral adherence and better metabolic control. Ninety-five primary caregivers of preadolescents (ages 8-11) with T1DM completed questionnaires assessing parenting style, pediatric parenting stress, and child behavioral adherence. Caregivers primarily self-identified as using an authoritative parenting style. Greater authoritative parenting was associated with greater behavioral adherence and less difficulty with pediatric parenting stress; no differences in metabolic control were observed. Greater engagement in authoritative parenting behaviors may contribute to increased age-appropriate child behavioral adherence and less pediatric parenting stress. Interventions highlighting diabetes-specific authoritative parenting techniques may enhance health outcomes and improve overall family functioning.     

Association of social-environmental factors with cognitive function in children with sickle cell disease

The aim of this study was to examine the relationship between cognitive function in pediatric sickle cell disease (SCD) patients and mothers’ reports of social-environmental stress, depressive symptoms, and parenting. A total of 65 children with SCD completed comprehensive neuropsychological testing to assess several domains of cognitive functioning, including general intellectual ability, academic achievement, and executive function. Mothers reported on demographics, social-environmental stress, depressive symptoms, and parenting. As predicted, children with SCD significantly underperformed relative to normative data on measures of cognitive function. Associations between maternal social-environmental stress, maternal depressive symptoms, and parenting were mixed. The results show partial support for the hypothesis that greater stress and depressive symptoms and less positive parenting are associated with poorer cognitive function in children with SCD. Linear regression analyses showed that maternal financial stress was the strongest predictor across all domains of cognitive function. The findings replicate and extend past research, reaffirming that children with SCD are at risk for cognitive impairment across multiple domains. Additionally, social-environmental stress, particularly financial strain, is linked to mothers’ depressive symptoms and parenting behaviors as well as children’s cognitive function. Future studies using direct observations of parenting behaviors are needed. These findings, along with recent research on parenting interventions, may inform the development of concrete, teachable parenting and coping skills to improve cognitive functioning in children with SCD.     

Parental Problem-Solving Abilities and the Association of Sickle Cell Disease Complications with Health-Related Quality of Life for School-Age Children

Children with sickle cell disease (SCD) are at risk for poor health-related quality of life (HRQOL). The current analysis sought to explore parent problem-solving abilities/skills as a moderator between SCD complications and HRQOL to evaluate applicability to pediatric SCD. At baseline, 83 children ages 6–12 years and their primary caregiver completed measures of child HRQOL. Primary caregivers also completed a measure of social problem-solving. A SCD complications score was computed from medical record review. Parent problem-solving abilities significantly moderated the association of SCD complications with child self-report psychosocial HRQOL (p = .006). SCD complications had a direct effect on parent proxy physical and psychosocial child HRQOL. Enhancing parent problem-solving abilities may be one approach to improve HRQOL for children with high SCD complications; however, modification of parent perceptions of HRQOL may require direct intervention to improve knowledge and skills involved in disease management.     

Parenting stress and external stressors as predictors of maternal ratings of child adjustment

This study sought to disentangle the effects of different kinds of stress on maternal ratings of child externalizing and internalizing problems, social inhibition, and social competence, with a primary focus on parenting stress. The relations were explored in a sample consisting of mothers of 436 children (M_age = 7 years) in Sweden. Half the sample had had early clinical contacts during infancy due to child regulation problems, and the rest were mothers without known such early contacts. Demographic factors, family stressors, and parenting stress were examined in stress – adjustment models. Family stressors were clinical contact during infancy, current child and parent health problems, recent negative life events, and insufficient social support. Parenting stress as a mediator of the effect of other stressors on rated child adjustment was tested as was social support as a moderator of the effect of parenting stress on adjustment. The results showed that a higher parenting stress level was associated with maternal ratings of more externalizing and internalizing behaviors, more social inhibition, and lower social competence. Other family stressors and background variables were also found to be of importance, mainly for externalizing and internalizing problems and to some extent for social competence. Social inhibition had a unique relation to parenting stress only. Parenting stress mediated effects of other stressors in twelve models, whereas social support had no moderating effect on the link between parenting stress and child adjustment. Thus, parenting stress seems to be an important overarching construct. Clinical implications are proposed.     

Bidirectional Effects of Parenting Quality and Child Externalizing Behavior in Predominantly Single Parent, Under-Resourced African American Families

This study investigates the bidirectional perspective of parent–child effects by examining the extent to which parenting quality predicted child externalizing behavior and vice versa. Data was collected over four time points from primary caregivers and early school age children in low-income, primarily single parent homes (N = 249, mean age of children at Time 1 = 6.41 years). Parenting quality was operationalized as primary caregiver perceptions of positive parenting, effectiveness of parenting discipline, parenting efficacy and satisfaction. Child externalizing behavior data was captured via an assessment of the frequency of externalizing behavior as reported by caregivers. We hypothesized that parenting quality and child externalizing behavior would remain stable over time and that a bidirectional relationship would be present. Data was analyzed using structural equation modeling and results indicated that child externalizing behavior predicted subsequent parenting quality, and parenting quality predicted subsequent child externalizing. Specifically, our research team found that the influence of child externalizing behavior on parenting quality decreased with time, while the influence of parenting quality on child externalizing behavior increased with time. Overall results reveal the complex transactional influences of child externalizing behavior and parenting quality in our sample. Findings support the notion that parenting quality and child externalizing behavior are interactive processes which might best be handled by continual assessment and which may be potentially strong targets for interventions.     

Parental Locus of Control and Family Functioning in the Quality of Life of Children with Sickle Cell Disease

The objective was to examine the association of parental locus of control (PLOC) with pediatric quality of life (QOL) for children with sickle cell disease (SCD), specifically addressing the potential mediating role of family functioning. Associations with disease severity were also investigated. Thirty-one primary caregivers completed standard measures of parental locus of control, family functioning, and quality of life during their child's inpatient admission for pain or fever. Results indicated that the PLOC total score was significantly associated with QOL in terms of self-competence and showed marginal significance with QOL social competence; it was significantly negatively correlated with family functioning. The association of the PLOC with QOL subscales was maintained when controlling for family functioning. Disease severity was not associated with PLOC scores. Primary caregivers endorsed more external parental locus of control beliefs. Further investigation of the association of caregiver appraisals and family functioning is warranted with the goal of addressing the stress that disease management with sickle cell may add to parent–child relationships.     

Developmental and medical factors associated with parenting stress in mothers of toddlers born very preterm in a neonatal follow-up clinic

The purpose of this exploratory, cross-sectional study was to identify child-related factors associated with maternal parenting stress in toddlers born very preterm and followed in a neonatal follow-up (NFU) clinic. The study aimed to describe the associations of current medical complications and presence of developmental delays with total parenting stress. Participants were 53 mother–child dyads presenting in a NFU clinic. Mothers completed the Parenting Stress Index-Short Form (PSI-SF), and children were administered the Brigance Early Head Start Screen II. Medical variables were also collected from the child's medical record. Approximately 24% of mothers had at least one elevated subscale score on the PSI-SF. Regression analyses indicated that receipt of early intervention services was associated with increased parenting stress among mothers of toddlers born very preterm, though number of current medical complications was not. Parents of children born very preterm are at increased risk for parenting stress that extends beyond discharge from the neonatal intensive care unit . Clinicians working in NFU clinics are positioned to monitor for increased parenting stress, particularly among families of children with emerging signs of developmental delay.     

Dual trajectories of maternal parenting stress and marital intimacy during toddlerhood

Parenting stress disrupts both parenting and child adjustment. Marital intimacy is often conceptualized as a source of support that may reduce parenting stress. We examined the association between mothers' trajectories of parenting stress and marital intimacy when their children were 15–36 month old. We also explored whether maternal depressive symptoms at 15 months accounted for individual differences concurrently or in the trajectories of parenting stress and marital intimacy. Mothers' marital intimacy was negatively associated with their concurrent levels of parenting stress and declines in parenting stress over time. Depressive symptoms were associated with 15‐month parenting stress and marital intimacy. Overall, intimacy within the marriage appears to be a resource that reduces mothers' parenting stress during the toddler years     

Parental and Child Characteristics Predicting Asian immigrants’ Feeding Practices

To explore parenting style, child effortful control, parenting stress, and their associations with maternal use of pressure to eat among Asian U.S. immigrant families with preschoolers. One hundred and nine Asian immigrant mothers with 3-to-5-year-old children in Maryland, United States rated their authoritative and authoritarian parenting styles, frequency of pressuring their child to eat, perceived parenting stress, and child’s effortful control. Two proposed moderated mediation models were tested using conditional process modeling. Effortful control mediated the association between authoritative parenting style and pressure to eat practices, αβ?=??0.07, p?<?0.05, and the association between authoritarian style and pressure to eat, αβ?=?0.12, p?<?0.05. Moreover, parenting stress moderated the association between child effortful control and maternal pressure to eat in the authoritarian style model, but not in the authoritative style model. Specifically, higher effortful control was associated with less use of pressure to eat at low and mean levels of parenting stress. Our findings revealed potential mechanisms underlying the associations between parenting styles and controlling feeding practices. Importantly, information learned from the present study may guide transdisciplinary efforts to design and implement culturally sensitive and family-based interventions targeting Asian immigrants’ wellbeing and obesity in the United States.

     

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.     

The contribution of parenting practices in a risk and resiliency model of children's adjustment

A risk and resiliency model of children's adjustment was evaluated, with a focus on the relationship of parenting practices to risk and protective factors. Risk factors included family stress, family conflict, parent psychopathology and low socio‐economic status. Protective factors included family cohesion, family social support and family moral– religious orientation. The research hypothesis was that parenting practices would have a direct effect on child outcomes, as well as a moderating effect on the relationship between risk and protective factors and child outcomes. Three different outcomes were utilized: disruptive behaviour disorders, adaptive emotional functioning and school achievement. Participants were 80 children aged 6–12 years and their mothers. Hierarchical regression analyses suggested that the combination of family risk and protection and parenting practices was highly predictive of child functioning for both disruptive externalizing behaviours and positive emotional adaptation. It was found that negative family factors were more highly associated with negative child outcomes, whereas positive family factors were more highly associated with positive child outcomes. Family risk factors and poor parenting primarily accounted for the variance in externalizing child behaviours. Alternately, family protective factors and positive parenting primarily accounted for the variance in child adaptive behaviours. Parenting practices had a direct effect on child outcomes, but was not a strong moderator of the relationship between risk and protection factors and child outcomes.     

Parenting stress, perceived parenting behaviors, and adolescent self-concept in European American families

This study assesses whether the stresses associated with parenting a child are indirectly related to adolescent self-concept through parenting behaviors. We examined longitudinal associations among mothers' and fathers' parenting stress at age 10, children's perceptions of parenting at age 10, and adolescents' self-concept at age 14 in 120 European American families. Mothers' and fathers' parenting stress was related to children's perceptions of acceptance and psychologically controlling behavior, and psychologically controlling behavior (and lax control for fathers) was related to adolescent self-concept. We further examined which domains of parenting stress and perceived parenting behaviors were associated with adolescents' scholastic competence, social acceptance, physical appearance, and behavioral conduct. Parenting stress was related to specific parenting behaviors, which were, in turn, related to specific domains of self-concept in adolescence. Parenting stress appears to exert its effects on early adolescent self-concept indirectly through perceived parenting behavior.     

A Secondary Analysis of Integrated Pediatric Chronic Pain Services Related to Cost Savings

Youth with chronic pain have high healthcare utilization and associated costs. Research supports integrated treatment; though, it’s unclear which treatments are used and cost-effective. This study expands on work that found reduced service use and cost savings following participation in an outpatient integrated pediatric pain clinic. We explored which services were commonly used and which individual (psychotherapy, medication management, acupuncture, massage, biofeedback) and/or combinations of services were associated with service use reduction and cost savings. Medication management and psychotherapy were more common than complementary integrative medicine (CIM) services. Massage services were associated with reduced inpatient costs. There were trends of fewer emergency department visits for participants who received CIM services in addition to medication management and psychotherapy, and more visits for those with biofeedback. Findings suggest that a more detailed examination of service utilization is needed to better understand cost outcomes related to the integrated treatment of pediatric chronic pain.

     

Associations among mothers’ representations of their relationship with their toddlers,maternal parenting stress,and toddlers’ internalizing and externalizing behaviors

This study examined the array of associations among the emotional valence and the coherence of mothers’ representations of their relationship with their toddlers, mothers’ reported parenting stress, and toddlers’ internalizing and externalizing behaviors. To evaluate maternal representations, 55 mothers were interviewed using the Five Minute Speech Sample procedure (FMSS; Magaña et al., 1986), which was coded for criticism and positive comments (Magaňa-Amato, 1993), as well as coherence (Sher-Censor & Yates, 2015). Mothers also completed the Parenting Stress Index − Short Form (PSI; Abidin, 1997) to evaluate their parenting stress and the Child Behavior Checklist (CBCL/1.5–5; Achenbach & Rescorla, 2000) to assess their toddlers’ internalizing and externalizing behaviors. Results indicated that parenting stress was associated with maternal criticism and fewer positive comments in the FMSS, but not with the coherence of mothers’ FMSS. Parenting stress, criticism, and lower coherence in the FMSS were associated with maternal reports of externalizing behaviors. Only parenting stress and lower coherence in the FMSS were related to mothers’ reports of internalizing behaviors of the child. Thus, the emotional valence and the coherence of mothers’ representations of their relationship with their child and parenting stress may each constitute a distinct aspect of parenting and contribute to the understanding of individual differences in toddlers’ internalizing and externalizing behaviors. Implications for research and practice with families of toddlers are discussed.