PARENTING STRESS AND SOCIAL BEHAVIOURAL

CHANGES AMONG PARENTS OF PRESCHOOL AUTISTIC

CHILDREN

SEHER SOHAIL

DEPARTMENT OF PHYSICAL THERAPY

ABSTRACT

Background: Those who suffer from autism have a problem with how their brains

grow and develop. Parental stress may be elevated while dealing with a child who falls

anywhere on the autistic spectrum, according to the available literature. The focus of this study

was on the mental anguish endured by guardians of autistic children. Objective: The study

aims to identify parenting stress and social behavioral changes among parents of autistic

children. Methodology: A survey was conducted among parents in different autism centers in

Lahore. Total 72 responses were collected throughout a span of 6 months. . The survey was

conducted by using questionnaire. Data was analyzed by using the SPSS statistics version 22.

Results: In this study depending on their responses, it was determined whether or not parents

are happy with their parental responsibilities. In a sample of 72 people, 15 (20%) strongly

disagreed, 23 (31.9%) disagreed, 10 (13.8%) said they couldn't decide, 9 (12.5%) said they

agreed, and 15 (20%) strongly agreed. The responses from the parents revealed whether or not

the parents' major cause of stress was their child. Out of 72 respondents, 7 (9.5%) agreed, 53

(73.6%) strongly agreed, 4 (5.5%) disagreed, and 5 (6.4%) couldn't determine. Conclusion:

This systematic review provides a comprehensive overview of factors contributing to parenting

stress, including parental depression and social support. It highlights the potential for medical

intervention to mitigate certain stressors. However, further research, particularly longitudinal

studies involving diverse samples, is necessary to inform the development of effective

preventive and intervention strategies targeting parent, child, and environmental stressors. Key

words: Parenting stress, Autism spectrum disorder (ASD), Parents of preschool autistic

children, Parental stress scale, social behavioral changes.

INTRODUCTION:

Early-onset (before the age of two) severe impairment in social interaction and

communication as well as atypical, stereotyped behaviours are hallmarks of the neuro

developmental condition autism. Children with autism spectrum disorders struggle with their

behaviour, are unable to participate in conversations, have trouble communicating nonverbally

through gestures and facial expressions, find it difficult to interact with others, and engage in

repetitive body movements or patterns of behavior like hand flapping, spinning, and head

banging(1). Although autism awareness has grown significantly over the past 20 years, there

is little information available on the comorbid illnesses that affect individuals with autism(2).

Children and teenagers with autism may also have other comorbid conditions. While some

health conditions, including epilepsy, intellectual disabilities, and digestive problems seem to

be more prevalent, there is generally a lack of research on other chronic conditions, like hearing

and vision impairments, physical disabilities, and intellectual disabilities(3). In the first few

years of school, social isolation becomes more prevalent as kids with ASD find it difficult to

interact with their peers or pick up developmentally adequate social skills through casual

contacts. Children with ASD frequently display problematic behaviours, repeated language or

motor patterns, and specialised, fixated interests that further obstruct peer interactions. These

behaviours occur in addition to trouble with social communication. One of the top sources of

worry for many parents throughout their kid's formative years is the deficiencies in social

communication that their youngster exhibits(4). Parenting stress was measured with the

Parenting Stress Scale(5) and Social behavoiur change measured with Social behavior scale.
Its pathophysiology's mechanism is yet unknown. Our earlier research revealed that the values

of cortical thickness in ASD participants declined with age. Cortical layering appeared to be

substantially undamaged in histological sections, with layer I and the subplate exhibiting cell

clustering and supernumerary cells. Specifically, those with ASD had higher spine densities in

layer II of all cortical regions and layer V of the temporal lobe. Those with ASD who had

higher spine densities also had worse levels of cognitive functioning(6). Parents of children

with autism spectrum disorder (ASD) report greater levels of emotional suffering than parents

of typically developing children. Psychological distress may manifest as a wide range of

feelings, including perplexity, helplessness, frustration, sadness, anger, and fear(7). Higher

rates of psychological distress, such as depression, anxiety, and stress components like

decreased family cohesion, increased somatic complaints, and burnout, were reported by

parents of children with autism and ASDs compared to parents of typically developing children

(ages 1-4) and non-autistic children with mental retardation or other developmental disabilities

(8). 10 From young children and teenagers through adults and the elderly, social impairment is

a consistent major symptom. Those with social impairments often have issues with things like

mutually beneficial engagement and understanding facial emotions (9). Parenting a child with

autism may provide unique difficulties and concerns. Parents of children with ASD worry most

about three things: the long-term effects of their child's disorder, the social stigma that comes

with their child's behaviors, and the inaccessibility of help for their family (10). As compared

to the general adult population, parents of children with ASD had significantly higher levels of

anxiety and depression. They are more likely to experience social isolation and marital

problems if parents of children with ASD do not have social support or if they use escape-

avoidance coping mechanisms such as withdrawing from others, clinging to the hope that

things will improve on their own, or playing down the gravity of the situation (11). Parent-

implemented treatment seems to be effective for young children with ASD, and research shows
that toddlers with ASD need distinct early intervention programs from those of older children

with ASD (12). A study by the Centers for Disease Control and Prevention (CDC) found that

the prevalence of autism spectrum disorder (ASD) among children in the United States

increased from 1 in 68 in 2007 to 1 in 59 in 2014. (CDC). Although there has been an uptick

in the number of articles detailing ASD prevalence, the incidence of ASD, another indicator of

ASD frequency, has received comparatively less attention. Difficulties in estimating incidence

rates are likely to blame for a dearth of studies on the phenomenon (13). Parents of children

with ASD who had several events themselves exhibited more emotional distancing, social

isolation, communication difficulties, sensitivity to criticism, and anxiety than those whose

children experienced just one or no ASD occurrences. Nevertheless, there was no difference in

symptom severity between children with one or two affected parents(14). Children with one

affected parent displayed more severe ASD symptoms than those without an affected parent.

Self-report assessments of parental mental difficulties revealed a much higher frequency of

psychological issue in parents of children with ASD than standardized diagnostic interviews

did (15). At present, very few studies are available to provide research findings on the

association of parenting stress and social behavioral changes among parents of pre school

autistic children. Hence this present study aims to further investigate the association between

parenting stress and social behavior problems among parents of autistic children.

OBJECTIVE:

The aim of this study is to assess and identify the stress and social behavior in parents

of autistic children.

METHODOLOGY:
 This study is a cross sectional study design with a sample size of n=72. The data was

collected from Global health care center and SLI institute. Total 72 responses were collected

throughout a span of 6 months. A pre tested structured valid and reliable questionnaire was

used for the assessment of Parental stress and social behavior change among parents of

preschool autistic children. The questionnaire used in this study are Parental stress scale (PSS)

and social behavioural scale (SBC). The questionnaire contained questions about how they

maintain their stress and social response managed and what effects they faced. All the

participants were included in this study; mother and father who are effected to ASD. Data was

analyzed by using the SPSS statistics version 22.

DATA ANALYSIS AND RESULTS:

The data analysis and results of the study on parental stress and social behavioral

changes among parents of preschool autistic children involved collecting data from 72

participants. The study utilized a cross-sectional design and a non-probabilistic purposive

sampling technique. The analysis included demographic variables, such as age, gender

distribution, and parental stress levels. The descriptive statistics revealed that the mean age of

the participants was 3.97 years, with a minimum age of 3 years and a maximum of 5 years. In

terms of gender distribution, 54.2% were females, and 45.8% were males. The study assessed

various aspects related to parenting stress and social behavior changes among parents of

preschool autistic children. The results indicated that a significant proportion of parents

experienced stress related to caregiving duties, found it challenging to balance caring for

themselves and their children with ASD, and faced financial burdens. Additionally, the study

highlighted the correlation between social behavior and parental stress, showing a significant

relationship between the two factors at a p<0.01 level of significance.

 Figure 1.1: Descriptive statistics of parents spending time with their children.

The bar chart above shows the responses of the parents either they enjoy spending time

with their child or not. Out of 72 population, 4 (5.5%) strongly disagreed, 18(25%) disagreed,

17(23.6%) couldn’t decide, 16(9.7%) agreed and 17(22.2%) strongly agreed.

Figure 1.2: Descriptive statistics of major source of stress in parents life.

 The bar chart above shows the responses of the parents either the major source of stress

in their life were their child or not. Out of 72 population, 5 (6.9%) strongly disagreed, 4(5.5%)

disagreed, 3(4.16%) couldn’t decide, 7(9.7%) agreed and 53(73.6%) strongly agreed.

Figure 1.3: Descriptive statistics of impact of children behaviour on parents

 The bar chart above shows the responses of the parents either the behavior of their

children was often embarrassing or stressful to them or not. Out of 72 population, 2 (2.7%)

strongly disagreed, 10(13.8%) disagreed, 1(1.38%) couldn’t decide, 31(43%) agreed and

28(38.8%) strongly agreed.

Table 1.1: Correlations between social behavior and parental stress:

Social Parental
Behavior Stress
Social Pearson Correlation
1 .017
Behavior
Sig. (2-tailed) .005
N 72 72
Parental Stress Pearson Correlation .017 1
Sig. (2-tailed) .005
N 72 72
The above table shows the correlation between social behavior and parental stress. This

shows that there is a significant relation between social behavior and parental stress considering

p<0.01 level of significance.

DISCUSSION:

This study is the first to access the parental stress and social behavioural changes among

parents of preschool autistic children. Most of the participants were females (n= 39) and the

males were (n=33).A survey was conducted to determine parental stress and social behavioural

changes among parents of preschool autistic children. The parents of children age 3-5 years

with ASD. Measures Demographic variables. Parents were polled on a variety of

socioeconomic factors, including marriage rate, number of children, age range, level of

education, and work position. The child's gender, intelligence, age upon diagnosis, and place

in the family's birth order were all inquired about. In order to protect the anonymity of the

participants, no personal data was recorded. According to the study's findings, mothers make

up a large portion of ASD parents. In addition, Padden and James16 discovered that moms of

children with ASD are more responsible for their upbringing than fathers. In most societies,

males are more involved in providing for the family financially while women typically assume

more household tasks. Although the majority of the parents in the current study had more than

five years of experience caring for their autistic children, they were all college graduates and

had no prior training in caring for children with ASD. According to our findings, parents were

significantly burdened as a result of the time spent on caregiving duties, the complexity of the

duties, and adverse life changes. Parents found it challenging to balance caring for themselves

and their ASD-affected children. Parenting's psychosocial burdens have been evaluated in

earlier studies. Our study differs from earlier research in that it looks at how stressed parents

feel about the amount of time they spend providing care and the level of difficulty of those

jobs. The opinions of the parents, including whether or not they experienced financial stress

after having children. Out of 72 population, 2 (2.7%) strongly disagreed, 19(26.3%) disagreed,

19(26.3%) couldn’t decide, 17(23.6%) agreed and 15(20.8%) strongly agreed. Findings from

the present study's participants' reports of high levels of stress and behavioural concerns are
consistent with those from previous research on parents of children with ASD. Yet the findings

of Lerthattasilp et al., who found a low frequency of depression among parents of children with

ASD, go counter to these findings. Caregivers may feel overwhelmed by their own life events

and adjustments despite the fact that they are continually expending extra resources to meet the

needs of children with ASD. Such feelings may lead to a great deal of anxiety and depression.

The correlation between social behavior and parental stress. This reveals a high correlation

between social behaviour and parental stress at the p0.01 level of significance.

CONCLUSION:

Parenting stress is caused by a variety of intricate and complicated variables. This

systematic review offers a thorough summary of research on the parental, child, and

environmental stressors. The findings indicate that some factors may be controllable with the

assistance of medical professionals, including parental depression and the amount of social

support. Further research is needed, especially longitudinal studies with representative samples

of men and women, to guide the development of preventative and intervention strategies. The

factors of parent, child, and environment that contribute to stressful parenting should all be

investigated.

REFERENCES:

1. Ede MO, Anyanwu JI, Onuigbo LN, Ifelunni CO, Alabi-Oparaocha FC, Okenyi EC, et al. Rational
emotive family health therapy for reducing parenting stress in families of children with autism
spectrum disorders: a group randomized control study. Journal of Rational Emotive & Cognitive-
Behavior Therapy. 2020;38(2):243-71.
2. Rydzewska E, Hughes-McCormack LA, Gillberg C, Henderson A, MacIntyre C, Rintoul J, et al.
Prevalence of long-term health conditions in adults with autism: observational study of a whole
country population. BMJ open. 2018;8(8):e023945.
3. Rydzewska E, Hughes-McCormack LA, Gillberg C, Henderson A, MacIntyre C, Rintoul J, et al.
Prevalence of sensory impairments, physical and intellectual disabilities, and mental health in children
and young people with self/proxy-reported autism: Observational study of a whole country
population. Autism. 2019;23(5):1201-9.
4. Tripathi I, Estabillo JA, Moody CT, Laugeson EA. Long-term treatment outcomes of PEERS® for
preschoolers: A parent-mediated social skills training program for children with autism spectrum
disorder. Journal of Autism and Developmental Disorders. 2022;52(6):2610- 26.
5. Johnson N, Frenn M, Feetham S, Simpson P. Autism spectrum disorder: parenting stress, family
functioning and health-related quality of life. Families, systems, & health. 2011;29(3):232.
6. Huang X-q, Zhang H, Chen S. Neuropsychiatric symptoms, parenting stress and social support in
Chinese mothers of children with autism spectrum disorder. Current medical science. 2019;39(2):291-
7.
7. Al-Oran HM, AL-Sagarat AY. Parenting stress of children with autistic disorder. Open Access Library
Journal. 2016;3(7):1-10.
8. Schieve LA, Blumberg SJ, Rice C, Visser SN, Boyle C. The relationship between autism and parenting
stress. Pediatrics. 2007;119(Supplement_1):S114-S21.
9. Barendse EM, Hendriks MP, Thoonen G, Aldenkamp AP, Kessels RP. Social behaviour and social
cognition in high-functioning adolescents with autism spectrum disorder (ASD): two sides of the same
coin? Cognitive processing. 2018;19(4):545-55.
10. Clauser P, Ding Y, Chen EC, Cho S-J, Wang C, Hwang J. Parenting styles, parenting stress, and
behavioral outcomes in children with autism. School Psychology International. 2021;42(1):33-56.
11. Trentacosta CJ, Irwin JL, Crespo LM, Beeghly M. Financial hardship and parenting stress in families
with young children with autism: Opportunities for preventive intervention. Handbook of parent-
implemented interventions for very young children with autism: Springer; 2018. p. 79-91.
12. Dababnah S, Olson EM, Nichols HM. Feasibility of the incredible years parent program for
preschool children on the autism spectrum in two US sites. Research in Autism Spectrum Disorders.
2019;57:120-31.
13. Saito M, Hirota T, Sakamoto Y, Adachi M, Takahashi M, Osato-Kaneda A, et al. Prevalence and
cumulative incidence of autism spectrum disorders and the patterns of co occurring
neurodevelopmental disorders in a total population sample of 5-year-old children. Molecular autism.
2020;11(1):1-9.
14. Crowell JA, Keluskar J, Gorecki A. Parenting behavior and the development of children with autism
spectrum disorder. Comprehensive psychiatry. 2019;90:21-9. 43
15. Schnabel A, Youssef GJ, Hallford DJ, Hartley EJ, McGillivray JA, Stewart M, et al. Psychopathology
in parents of children with autism spectrum disorder: A systematic review and meta-analysis of
prevalence. Autism. 2020;24(1):26-40.
16. Fang Y, Luo J, Boele M, Windhorst D, van Grieken A, Raat H. Parent, child, and situational factors
associated with parenting stress: a systematic review. European Child & Adolescent Psychiatry.
2022:1-19.
17. Lee V, Albaum C, Tablon Modica P, Ahmad F, Gorter JW, Khanlou N, et al. The impact of COVID‐
19 on the mental health and wellbeing of caregivers of autistic children and youth: A scoping review.
Autism Research. 2021;14(12):2477-94.
18. Lim N, O’Reilly M, Sigafoos J, Lancioni GE, Sanchez NJ. A review of barriers experienced by
immigrant parents of children with autism when accessing services. Review Journal of Autism and
Developmental Disorders. 2021;8(3):366-72.
19. Alnazly EK, Abojedi A. Psychological distress and perceived burden in caregivers of persons with
autism spectrum disorder. Perspectives in psychiatric care. 2019;55(3):501-8.
20. Ilias K, Cornish K, Kummar AS, Park MS-A, Golden KJ. Parenting stress and resilience in parents of
children with autism spectrum disorder (ASD) in Southeast Asia: A systematic review. Frontiers in
psychology. 2018;9:280.
21. Williams ZJ, He JL, Cascio CJ, Woynaroski TG. A review of decreased sound tolerance in autism:
Definitions, phenomenology, and potential mechanisms. Neuroscience & Biobehavioral Reviews.
2021;121:1-17.
22. McStay RL, Dissanayake C, Scheeren A, Koot HM, Begeer S. Parenting stress and autism: The role
of age, autism severity, quality of life and problem behaviour of children and adolescents with autism.
Autism. 2014;18(5):502-10.
23. Klin A, Jones W, Schultz R, Volkmar F, Cohen D. Defining and quantifying the social phenotype in
autism. American Journal of Psychiatry. 2002;159(6):895-908.