Journal of Abnormal Child Psychology

, Volume 46, Issue 3, pp 449–461 | Cite as

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

  • Nicole E. Barroso
  • Lucybel Mendez
  • Paulo A. Graziano
  • Daniel M. Bagner


Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.


Parenting stress Behavior problems Autism Developmental delay Chronic illness 


Compliance with Ethical Standards

Conflict of Interest

The authors report no conflict of interest related to this work.

Supplementary material

10802_2017_313_MOESM1_ESM.pdf (151 kb)
ESM 1 (PDF 150 kb)


  1. Abidin, R. R. (2012). Parenting stress index. Odessa: Psychological Assessment Resources.Google Scholar
  2. Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles: an integrated system of multi-informant assessment. Burlington: University of Vermont Department of Psychiatry.Google Scholar
  3. Anderson, L. S. (2008). Predictors of parenting stress in a diverse sample of parents of early adolescents in high-risk communities. Nursing Research, 57, 340–350. doi: 10.1097/01.NNR.0000313502.92227.87.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Anthony, L. G., Anthony, B. J., Glanville, D. N., Naiman, D. Q., Waanders, C., & Shaffer, S. (2005). The relationships between parenting stress, parenting behaviour and preschoolers’ social competence and behaviour problems in the classroom. Infant and Child Development, 14, 133–154. doi: 10.1002/icd.385.
  5. Baker, B. L., Blacher, J., Crnic, K. A., & Edelbrock, C. (2002). Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. American Journal of Mental Retardation, 107, 433–444. doi: 10.1352/0895-8017(2002)107<0433:BPAPSI>2.0.CO;2.CrossRefPubMedGoogle Scholar
  6. Baker, B. L., McIntyre, L. L., Blacher, J., Crnic, K. A., Edelbrock, C., & Low, C. (2003). Pre-school children with and without developmental delay: behaviour problems and parenting stress over time. Journal of Intellectual Disability Research, 47, 217–230. doi: 10.1046/j.1365-2788.2003.00484.x.CrossRefPubMedGoogle Scholar
  7. Barry, T. D., Dunlap, S. T., Cotten, S. J., Lochman, J. E., & Wells, K. C. (2005). The influence of maternal stress and distress on disruptive behavior problems in boys. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 265–273. doi: 10.1097/00004583-200503000-00011.CrossRefPubMedGoogle Scholar
  8. Beernink, A.-C. E., Swinkels, S. H. N., Van der Gaag, R. J., & Buitelaar, J. K. (2012). Effects of attentional/hyperactive and oppositional/aggressive problem behaviour at 14 months and 21 months on parenting stress. Child and Adolescent Mental Health, 17, 113–120. doi: 10.1111/j.1475-3588.2011.00616.x.CrossRefGoogle Scholar
  9. Begg, C. B., & Mazumdar, M. M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088. doi: 10.2307/2533446.
  10. Benzies, K. M., Harrison, M. J., & Magill-Evans, J. (2004). Parenting stress, marital quality, and child behavior problems at age 7 years. Public Health Nursing, 21, 111–121. doi: 10.1111/j.0737-1209.2004.021204.x.CrossRefPubMedGoogle Scholar
  11. Berry, J. O., & Jones, W. H. (1995). The parental stress scale: initial psychometric evidence. Journal of Social and Personal Relationships, 12, 463–472. doi: 10.1177/0265407595123009.CrossRefGoogle Scholar
  12. Biederman, J., Mick, E., Faraone, S. V., Braaten, E., Doyle, A., Spencer, T., et al. (2002). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. The American Journal of Psychiatry, 159, 36–42. doi: 10.1176/appi.ajp.159.1.36.CrossRefPubMedGoogle Scholar
  13. Bornstein, M. H. (2002). In M. H. Bornstein (Ed.), Bornstein, M. H. (Ed.). (2013). Handbook of parenting: volume 5 practical issues in parenting (Vol. 5, 2nd ed.). Mahwah: Lawrence Erlbaum Associates.Google Scholar
  14. Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire: measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5, 212–222. doi: 10.1177/106342669700500404.CrossRefGoogle Scholar
  15. Chung, K. M., Ebesutani, C., Bang, H. M., Kim, J., Chorpita, B. F., Weisz, J. R., et al. (2013). Parenting stress and child behavior problems among clinic-referred youth: cross-cultural differences across the US and Korea. Child Psychiatry and Human Development, 44, 460–468. doi: 10.1007/s10578-012-0340-z.CrossRefPubMedGoogle Scholar
  16. Cochran, W. G. (1954). Some methods for strengthening the common χ2 tests. Biometrics, 10, 417–451. doi: 10.2307/3001616.CrossRefGoogle Scholar
  17. Cousino, M. K., & Hazen, R. A. (2013). Parenting stress among caregivers of children with chronic illness: a systematic review. Journal of Pediatric Psychology, 38, 809–828.CrossRefPubMedGoogle Scholar
  18. Crnic, K. A., Gaze, C., & Hoffman, C. (2005). Cumulative parenting stress across the preschool period: relations to maternal parenting and child behaviour at age 5. Infant and Child Development, 14, 117–132. doi: 10.1002/icd.384.CrossRefGoogle Scholar
  19. Crnic, K. A., & Greenberg, M. T. (1990). Minor parenting stresses with young children. Child Development, 61(5), 1628–1637. doi: 10.1111/j.1467-8624.1990.tb02889.x.CrossRefPubMedGoogle Scholar
  20. Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics. Journal of Autism and Developmental Disorders, 38, 1278–1291. doi: 10.1007/s10803-007-0512-z.CrossRefPubMedGoogle Scholar
  21. Deater-Deckard, K. (1998). Parenting stress and child adjustment: some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5, 314–332. doi: 10.1111/j.1468-2850.1998.tb00152.x.Google Scholar
  22. Donenberg, G., & Baker, B. L. (1993). The impact of young children with externalizing behaviors on their families. Journal of Abnormal Child Psychology, 21, 179–198. doi: 10.1007/BF00911315.CrossRefPubMedGoogle Scholar
  23. Dubois-Comtois, K., Moss, E., Cyr, C., & Pascuzzo, K. (2013). Behavior problems in middle childhood: the predictive role of maternal distress, child attachment, and mother-child interactions. Journal of Abnormal Child Psychology, 41, 1311–1324. doi: 10.1007/s10802-013-9764-6.CrossRefPubMedGoogle Scholar
  24. Duval, S., & Tweedie, R. (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. doi: 10.1111/j.0006-341X.2000.00455.x.
  25. Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autism: The International Journal of Research and Practice, 13, 375–387. doi: 10.1177/1362361309105658.CrossRefGoogle Scholar
  26. Estes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G., & Munson, J. (2013). Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders. Brain and Development, 35, 133–138. doi: 10.1016/j.braindev.2012.10.004.CrossRefPubMedGoogle Scholar
  27. Evans, S. W., Sibley, M., & Serpell, Z. N. (2009). Changes in caregiver strain over time in young adolescents with ADHD: the role of oppositional and delinquent behavior. Journal of Attention Disorders, 12, 516–524. doi: 10.1177/1087054708322987.CrossRefPubMedGoogle Scholar
  28. Eyberg, S. M., Boggs, S. R., & Rodriguez, C. M. (1993). Relationships between maternal parenting stress and child disruptive behavior. Child & Family Behavior Therapy, 14, 1–9. doi: 10.1300/J019v14n04_01.CrossRefGoogle Scholar
  29. Farmer, J. E., Deidrick, K. M., Gitten, J. C., Fennell, E. B., & Maria, B. L. (2006). Parenting stress and its relationship to the behavior of children with Joubert syndrome. Journal of Child Neurology, 21, 163–167. doi: 10.1177/08830738060210020401.CrossRefPubMedGoogle Scholar
  30. Farrace, D., Tommasi, M., Casadio, C., & Verrotti, A. (2013). Parenting stress evaluation and behavioral syndromes in a group of pediatric patients with epilepsy. Epilepsy and Behavior, 29, 222–227. doi: 10.1016/j.yebeh.2013.07.020.CrossRefPubMedGoogle Scholar
  31. Fischer, M. (1990). Parenting stress and the child with attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 19, 337–346. doi: 10.1207/s15374424jccp1904_5.CrossRefGoogle Scholar
  32. Franco, L. M., Pottick, K., & Huang, C.-C. (2010). Early parenthood in a community context: neighborhood conditions, race-ethnicity, and parenting stress. Journal of Community Psychology, 38, 574–590. doi: 10.1002/jcop.20382.CrossRefGoogle Scholar
  33. Gallo, L. C., Penedo, F. J., Espinosa de los Monteros, K., & Arguelles, W. (2009). Resiliency in the face of disadvantage: do hispanic cultural characteristics protect health outcomes? Journal of Personality, 77(6), 1707–1746. doi: 10.1111/j.1467-6494.2009.00598.x.CrossRefPubMedGoogle Scholar
  34. Golfenshtein, N., Srulovici, E., & Medoff-Cooper, B. (2015). Issues in comprehensive pediatric nursing investigating parenting stress across pediatric health conditions: a systematic review. Issues in Comprehensive Pediatric Nursing, 1, 1–49. doi: 10.3109/01460862.2015.1078423.CrossRefGoogle Scholar
  35. Hastings, R. P., Daley, D., Burns, C., & Beck, A. (2006). Maternal distress and expressed emotion: cross-sectional and longitudinal relationships with behavior problems of children with intellectual disabilities. American Journal of Mental Retardation, 111, 48–61. doi: 10.1352/0895-8017(2006)111[48:MDAEEC]2.0.CO;2.CrossRefPubMedGoogle Scholar
  36. Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43, 629–642. doi: 10.1007/s10803-012-1604-y.CrossRefPubMedGoogle Scholar
  37. Hedges, L. V. (1994). Fixed effects models. The handbook of research synthesis (Vol. 285).Google Scholar
  38. Hedges, L. V., & Vevea, J. L. (1998). Fixed- and random-effects models in meta-analysis. Psychological Methods, 3, 486–504. doi: 10.1037/1082-989X.3.4.486.CrossRefGoogle Scholar
  39. Higgins, J. P. T., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558. doi: 10.1002/sim.1186.CrossRefPubMedGoogle Scholar
  40. Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ: British Medical Journal, 327, 557–560. doi: 10.1136/bmj.327.7414.557.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Hilliard, M. E., Monaghan, M., Cogen, F. R., & Streisand, R. (2011). Parent stress and child behaviour among young children with type 1 diabetes. Child: Care, Health and Development, 37, 224–232. doi: 10.1111/j.1365-2214.2010.01162.x.Google Scholar
  42. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183. doi: 10.1111/j.1365-2788.2005.00732.x.CrossRefPubMedGoogle Scholar
  43. Levy, S. E., Giarelli, E., Lee, L.-C., Schieve, L. A., Kirby, R. S., Cunniff, C., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics, 31, 267–275. doi: 10.1097/DBP.0b013e3181d5d03b.CrossRefPubMedGoogle Scholar
  44. Lilienfeld, S. O. (2003). Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions. Journal of Abnormal Child Psychology, 31, 285–291. doi: 10.1023/A:1023229529866.CrossRefPubMedGoogle Scholar
  45. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks: Sage Publications, Inc.Google Scholar
  46. McStay, R. L., Dissanayake, C., Scheeren, A., Koot, H. M., & Begeer, S. (2014). Parenting stress and autism: the role of age, autism severity, quality of life and problem behaviour of children and adolescents with autism. Autism, 18, 502–510. doi: 10.1177/1362361313485163.CrossRefPubMedGoogle Scholar
  47. Mesman, J., & Koot, H. M. (2000). Common and specific correlates of preadolescent internalizing and externalizing psychopathology. Journal of Abnormal Psychology, 109, 428–437. doi: 10.1037/0021-843X.109.3.428.CrossRefPubMedGoogle Scholar
  48. Neece, C. L., Green, S. A., & Baker, B. L. (2012). Parenting stress and child behavior problems: a transactional relationship across time. American Journal on Intellectual and Developmental Disabilities, 117, 48–66. doi: 10.1352/1944-7558-117.1.48.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Nereo, N. E., Fee, R. J., & Hinton, V. J. (2003). Parental stress in mothers of boys with Duchenne muscular dystrophy. Journal of Pediatric Psychology, 28, 473–484. doi: 10.1093/jpepsy/jsg038.CrossRefPubMedPubMedCentralGoogle Scholar
  50. O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women. JAMA, 315, 388–406. doi: 10.1001/jama.2015.18948.CrossRefPubMedGoogle Scholar
  51. Östberg, M., & Hagekull, B. (2013). Parenting stress and external stressors as predictors of maternal ratings of child adjustment. Scandinavian Journal of Psychology, 54, 213–221. doi: 10.1111/sjop.12045.CrossRefPubMedGoogle Scholar
  52. Ray, D. C. (2008). Impact of play therapy on parent–child relationship stress at a mental health training setting. British Journal of Guidance & Counselling, 36, 165–187. doi: 10.1080/03069880801926434.CrossRefGoogle Scholar
  53. Roddenberry, A., & Renk, K. (2008). Quality of life in pediatric cancer patients: the relationships among parents’ characteristics, children’s characteristics, and informant concordance. Journal of Child and Family Studies, 17, 402–426. doi: 10.1007/s10826-007-9155-0.CrossRefGoogle Scholar
  54. Rodriguez, C. M. (2011). Association between independent reports of maternal parenting stress and children’s internalizing symptomatology. Journal of Child and Family Studies, 20, 631–639. doi: 10.1007/s10826-010-9438-8.CrossRefGoogle Scholar
  55. Rosenberg, M. S., & Goodnight, C. (2005). The filew-drawer problem revistied: a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution, 59, 464–468. doi: 10.1554/04-602.CrossRefPubMedGoogle Scholar
  56. Ross, C. N., Blanc, H. M., McNeil, C. B., Eyberg, S. M., & Hembree-Kiging, T. L. (1998). Parenting stress in mothers of young children with oppositional defiant disorder and other severe behavior problems. Child Study Journal, 28, 93–110.Google Scholar
  57. Rutter, M., Kim-Cohen, J., & Maughan, B. (2006). Continuities and discontinuities in psychopathology between childhood and adult life. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 276–295. doi: 10.1111/j.1469-7610.2006.01614.x.CrossRefGoogle Scholar
  58. Silver, R. B., Measelle, J. R., Armstrong, J. M., & Essex, M. J. (2005). Trajectories of classroom externalizing behavior: Contributions of child characteristics, family characteristics, and the teacher–child relationship during the school transition. Journal of School Psychology, 43, 39–60. doi: 10.1016/j.jsp.2004.11.003.
  59. Slack, K. S., & Yoo, J. (2005). Food hardship and child behavior problems among low-income children. Social Service Review, 79(3), 511–536. doi: 10.1086/430894.CrossRefGoogle Scholar
  60. Smith, R. L., Rose, A. J., & Schwartz-Mette, R. A. (2010). Relational and overt aggression in childhood and adolescence: clarifying mean-level gender differences and associations with peer acceptance. Social Development, 19, 243–269. doi: 10.1111/j.1467-9507.2009.00541.x.CrossRefGoogle Scholar
  61. Spratt, E. G., Saylor, C. F., & Macias, M. M. (2007). Assessing parenting stress in multiple samples of children with special needs (CSN). Families, Systems, & Health, 25, 435–449. doi: 10.1037/1091-7527.25.4.435.CrossRefGoogle Scholar
  62. Tharner, A., Luijk, M. P. C. M., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Jaddoe, V. W. V., Hofman, A., et al. (2012). Infant attachment, parenting stress, and child emotional and behavioral problems at age 3 years. Parenting, 12, 261–281. doi: 10.1080/15295192.2012.709150.CrossRefGoogle Scholar
  63. Theule, J., Wiener, J., Tannock, R., & Jenkins, J. M. (2013). Parenting stress in families of children with ADHD: a meta-analysis. Journal of Emotional and Behavioral Disorders, 21, 3–17. doi: 10.1177/1063426610387433.CrossRefGoogle Scholar
  64. Valentine, J. (2009). Judging the quality of primary research. In H. Cooper, L. V. Hedges, & J. C. Valentine (Eds.), The handbook of research synthesis and meta-analysis (pp. 129–148). New York: Russel Sage Foundation.Google Scholar
  65. Vierhaus, M., Lohaus, A., Schmitz, A.-K., & Schoppmeier, M. (2013). Relationships between maternal parenting stress and reports on children’s internalizing and externalizing problems: a cross-lagged structural equation model. Journal of Educational and Developmental Psychology, 3, 39–50. doi: 10.5539/jedp.v3n1p39.CrossRefGoogle Scholar
  66. Villatoro, A. P., Morales, E. S., & Mays, V. M. (2014). Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: the NLAAS. American Journal of Orthopsychiatry, 84, 353–363. doi: 10.1037/h0099844.CrossRefPubMedPubMedCentralGoogle Scholar
  67. Wiener, J., Biondic, D., Grimbos, T., & Herbert, M. (2016). Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 44, 561–574. doi: 10.1007/s10802-015-0050-7.CrossRefPubMedGoogle Scholar
  68. Williford, A. P., Calkins, S. D., & Keane, S. P. (2007). Predicting change in parenting stress across early childhood: child and maternal factors. Journal of Abnormal Child Psychology, 35, 251–263. doi: 10.1007/s10802-006-9082-3.CrossRefPubMedGoogle Scholar
  69. Wolfe-Christensen, C., Mullins, L. L., Fedele, D. a., Rambo, P. L., Eddington, A., & Carpentier, M. Y. (2010). The relation of caregiver demand to adjustment outcomes in children with cancer: the moderating role of parenting stress. Children’s Health Care, 39, 108–124. doi: 10.1080/02739611003679881.CrossRefGoogle Scholar
  70. Woodman, A. C., Mawdsley, H. P., & Hauser-Cram, P. (2015). Parenting stress and child behavior problems within families of children with developmental disabilities: transactional relations across 15 years. Research in Developmental Disabilities, 36, 264–276. doi: 10.1016/j.ridd.2014.10.011.CrossRefGoogle Scholar
  71. Wren, F. J., Bridge, J. A., & Birmaher, B. (2004). Screening for childhood anxiety symptoms in primary care: integrating child and parent reports. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1364–1371. doi: 10.1097/01.chi.0000138350.60487.d3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Nicole E. Barroso
    • 1
  • Lucybel Mendez
    • 2
  • Paulo A. Graziano
    • 1
  • Daniel M. Bagner
    • 1
  1. 1.Florida International UniversityMiamiUSA
  2. 2.University of UtahSalt Lake CityUSA

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