Parents of children with autism spectrum disorders (ASD) reported higher stress than those of typically developing children. The role of child problem behaviors in the relationship between autism spectrum symptoms and parenting stress is little known. A total of 731 parents of 177 children with ASD and 554 typically developing children in primary schools (6–11 years old) completed an ASD screening survey containing measures of parenting stress and child problem behaviors. While autism spectrum symptoms were positively associated with parenting stress, the relationship was mediated by child problem behaviors. Results suggest neither the severity of autism spectrum symptoms nor knowledge of ASD diagnosis was a primary source of parenting stress. A hypothesized path model was tested using structural equation modeling.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Abidin, R. R. (1995). Parenting stress index, third edition: Professional manual. Odessa: Psychological Assessment Resources.
Achenbach, T. M. (1978). The child behavior profile: I. Boys aged 6–11. Journal of Consulting and Clinical Psychology, 46(3), 478–488.
American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: American Psychiatric Association.
Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice—a review and recommended 2-step approach. Psychological Bulletin, 103(3), 411–423.
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(2), 133–154.
Baron-Cohen, S., Scott, F. J., Allison, C., Williams, J., Bolton, P., Matthews, F. E., & Brayne, C. (2009). Prevalence of autism-spectrum conditions: UK school-based population study. British Journal of Psychiatry, 194(6), 500–509.
Bebko, J. M., Konstantareas, M. M., & Springer, J. (1987). Parent and professional evaluations of family stress associated with characteristics of autism. Journal of Autism and Developmental Disorders, 17(4), 565–576.
Bishop, S. L., Richler, J., Cain, A. C., Lord, C., & Floyd, F. (2007). Predictors of perceived negative impact in mothers of children with autism spectrum disorder. American Journal on Mental Retardation, 112(6), 450–461.
Boyd, B. A. (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on Autism and Other Developmental Disabilities, 17(4), 208–215.
Bromley, J., Hare, D. J., Davison, K., & Emerson, E. (2004). Mothers supporting children with autistic spectrum disorders: Social support, mental health status and satisfaction with services. Autism, 8(4), 409–423.
Casey, L. B., Zanksas, S., Meindl, J. N., Parra, G. R., Cogdal, P., & Powell, K. (2012). Parental symptoms of posttraumatic stress following a child’s diagnosis of autism spectrum disorder: A pilot study. Research in Autism Spectrum Disorders, 6(3), 1186–1193.
Chandler, S., Howlin, P., Simonoff, E., O'sullivan, T., Tseng, E., Kennedy, J., … Baird, G. (2016). Emotional and behavioural problems in young children with autism spectrum disorder. Developmental Medicine & Child Neurology, 58(2), 202–208.
Cridland, E. K., Jones, S. C., Magee, C. A., & Caputi, P. (2014). Family-focused autism spectrum disorder research: A review of the utility of family systems approaches. Autism, 18(3), 213–222.
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(7), 1278–1291.
de Alba, M. J. G., & Bodfish, J. W. (2011). Addressing parental concerns at the initial diagnosis of an autism spectrum disorder. Research in Autism Spectrum Disorders, 5(1), 633–639.
Deater-Deckard, K. (1998). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5(3), 314–332.
Denham, S. A., & Almeida, M. C. (1987). Children’s social problem-solving skills, behavioral adjustment, and interventions: A meta-analysis evaluating theory and practice. Journal of Applied Developmental Psychology, 8(4), 391–409.
Donenberg, G., & Baker, B. L. (1993). The impact of young children with externalizing behaviors on their families. Journal of Abnormal Child Psychology, 21(2), 179–198.
Duarte, C. S., Bordin, I. A., Yazigi, L., & Mooney, J. (2005). Factors associated with stress in mothers of children with autism. Autism, 9(4), 416–427.
Dumas, J. E., Wolf, L. C., Fisman, S. N., & Culligan, A. (1991). Parenting stress, child behavior problems, and dysphoria in parents of children with autism, down syndrome, behavior disorders, and normal development. Exceptionality, 2(2), 97–110.
Durand, V. M., Hieneman, M., Clarke, S., Wang, M., & Rinaldi, M. (2013). Positive Family Intervention for challenging behavior: A multisite randomized clinical trial. Journal of Positive Behavior Interventions, 15, 133–143.
Eisenberg, N., Cumberland, A., Spinrad, T. L., Fabes, R. A., Shepard, S. A., Reiser, M., et al. (2001). The relations of regulation and emotionality to children’s externalizing and internalizing problem behavior. Child Development, 72(4), 1112–1134.
Eisenberg, N., Guthrie, I. K., Fabes, R. A., Shepard, S., Losoya, S., Murphy, B., … Reiser, M. (2000). Prediction of elementary school children’s externalizing problem behaviors from attentional and behavioral regulation and negative emotionality. Child Development, 71(5), 1367–1382.
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, 13(4), 375–387.
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(2), 133–138.
Fox, L., Vaughn, B. J., Wyatte, M. L., & Dunlap, G. (2002). We can’t expect other people to understand”: Family perspectives on problem behavior. Exceptional Children, 68(4), 437–450.
Goodman, A., Lamping, D. L., & Ploubidis, G. B. (2010). When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): Data from British parents, teachers and children. Journal of Abnormal Child Psychology, 38(8), 1179–1191.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345.
Guajardo, N. R., Snyder, G., & Petersen, R. (2009). Relationships among parenting practices, parental stress, child behaviour, and children’s social-cognitive development. Infant and Child Development, 18(1), 37–60.
Hall, H. R., & Graff, J. C. (2012). Maladaptive behaviors of children with autism: Parent support, stress, and coping. Issues in Comprehensive Pediatric Nursing, 35(3–4), 194–214.
Harper, A., Taylor Dyches, T., Harper, J., Olsen Roper, S., & South, M. (2013). Respite care, marital quality, and stress in parents of children with autism spectrum disorders. J Autism Dev Disord, 43(11), 2604–2616.
Hastings, R. P. (2003). Child behaviour problems and partner mental health as correlates of stress in mothers and fathers of children with autism. Journal of Intellectual Disability Research, 47(4-5), 231–237.
Hastings, R. P., & Johnson, E. (2001). Stress in UK families conducting intensive home-based behavioral intervention for their young child with autism. Journal of Autism and Developmental Disorders, 31(3), 327–336.
Hastings, R. P., Kovshoff, H., Brown, T., Ward, N. J., Espinosa, F. D., & Remington, B. (2005a). Coping strategies in mothers and fathers of preschool and school-age children with autism. Autism, 9(4), 377–391.
Hastings, R. P., Kovshoff, H., Ward, N. J., Degli Espinosa, F., Brown, T. & Remington, B. (2005b). Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism. Journal of Autism and Developmental Disorders, 35(5), 635–644.
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(3), 629–642.
Herring, S., Gray, K., Taffe, J., Tonge, B., Sweeney, D., & Einfeld, S. (2006). Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: Associations with parental mental health and family functioning. Journal of Intellectual Disability Research, 50(Pt 12), 874–882.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.
Ingersoll, B., & Hambrick, D. Z. (2011). The relationship between the broader autism phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 337–344.
Johnson, N., Frenn, M., Feetham, S., & Simpson, P. (2011). Autism spectrum disorder: Parenting stress, family functioning and health-related quality of life. Families, Systems and Health, 29(3), 232–252.
Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277.
Konstantareas, M. M., & Papageorgiou, V. (2006). Effects of temperament, symptom severity and level of functioning on maternal stress in Greek children and youth with ASD. Autism, 10(6), 593–607.
Lai, K. Y., Luk, E. S., Leung, P. W., Wong, A. S., Law, L., & Ho, K. (2010). Validation of the Chinese version of the strengths and difficulties questionnaire in Hong Kong. Social Psychiatry and Psychiatric Epidemiology, 45(12), 1179–1186.
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(3), 172–183.
Lyons, A. M., Leon, S. C., Phelps, C. E. R., & Dunleavy, A. M. (2010). The impact of child symptom severity on stress among parents of children with ASD: The moderating role of coping styles. Journal of Child and Family Studies, 19(4), 516–524.
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(5), 502–510.
Milshtein, S., Yirmiya, N., Oppenheim, D., Koren-Karie, N., & Levi, S. (2010). Resolution of the diagnosis among parents of children with autism spectrum disorder: Associations with child and parent characteristics. Journal of Autism and Developmental Disorders, 40(1), 89–99.
Moh, T. A., & Magiati, I. (2012). Factors associated with parental stress and satisfaction during the process of diagnosis of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(1), 293–303.
Montes, G., & Halterman, J. S. (2007). Psychological functioning and coping among mothers of children with autism: A population-based study. Pediatrics, 119(5), e1040–e1046.
Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). Parenting stress reduces the effectiveness of early teaching interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1092–1103.
Osborne, L. A., & Reed, P. (2009). The relationship between parenting stress and behavior problems of children with autistic spectrum disorders. Exceptional Children, 76(1), 54–73.
Pedhazur, E. J. (1997). Multiple regression in behavioral research (3rd ed.). Orlando: Harcourt Brace.
Russell, D. W., Kahn, J. H., Spoth, R., & Altmaier, E. M. (1998). Analyzing data from experimental studies: A latent variable structural equation modeling approach. Journal of Counseling Psychology, 45(1), 18–29.
Schieve, L. A., Blumberg, S. J., Rice, C., Visser, S. N., & Boyle, C. (2007). The relationship between autism and parenting stress. Pediatrics, 119(Supplement 1), S114–S121.
Scott, F. J., Baron-Cohen, S., Bolton, P., & Brayne, C. (2002). The CAST (Childhood Asperger Syndrome Test): Preliminary development of a UK screen for mainstream primary-school-age children. Autism, 6(1), 9–31.
Shure, M. B., & Spivack, G. (1980). Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children. Journal of Applied Developmental Psychology, 1(1), 29–44.
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(1), 39–60.
Solem, M. B., Christophersen, K. A., & Martinussen, M. (2011). Predicting parenting stress: Children’s behavioural problems and parents’ coping. Infant and Child Development, 20(2), 162–180.
Stone, L. L., Mares, S. H., Otten, R., Engels, R. C., & Janssens, J. M. (2016). The co-development of parenting stress and childhood internalizing and externalizing problems. Journal of Psychopathology and Behavioral Assessment, 38(1), 76–86.
Sun, X., Allison, C., Matthews, F. E., Zhang, Z., Auyeung, B., Baron-Cohen, S., & Brayne, C. (2015). Exploring the underdiagnosis and prevalence of autism spectrum conditions in Beijing. Autism Research, 8(3), 250–260.
Totsika, V., Hastings, R. P., Emerson, E., Lancaster, G. A., & Berridge, D. M. (2011). A population-based investigation of behavioural and emotional problems and maternal mental health: Associations with autism spectrum disorder and intellectual disability. Journal of Child Psychology and Psychiatry, 52(1), 91–99.
Williams, J., Scott, F., Stott, C., Allison, C., Bolton, P., Baron-Cohen, S., & Brayne, C. (2005). The CAST (Childhood Asperger Syndrome Test): Test accuracy. Autism, 9(1), 45–68.
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(2), 251–263.
Yeh, C. H., Chen, M. L., Li, W., & Chuang, H. L. (2001). The Chinese version of the Parenting Stress Index: A psychometric study. Acta Paediatrica, 90(12), 1470–1477.
Yi, H., Siu, Q. K. Y., Chan, D. F. Y., Greenberg, J. H., & Griffiths, S. (2017). Parents’ experiences and views of screening and diagnostic assessment for autism spectrum disorder (ASD) in Hong Kong: A mixed-methods study. Poster session presented at the 2017 International Meeting for Autism Research, San Francisco, CA.
Zaidman-Zait, A., Mirenda, P., Duku, E., Szatmari, P., Georgiades, S., Volden, J., … Smith, I. (2014). Examination of bidirectional relationships between parent stress and two types of problem behavior in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(8), 1908–1917.
Zaidman-Zait, A., Mirenda, P., Duku, E., Vaillancourt, T., Smith, I. M., Szatmari, P., … Thompson, A. (2017). Impact of personal and social resources on parenting stress in mothers of children with autism spectrum disorder. Autism, 21(2), 155–166.
Zaidman-Zait, A., Mirenda, P., Zumbo, B. D., Georgiades, S., Szatmari, P., Bryson, S., … Pathways in ASD Study Team. (2011). Factor analysis of the parenting stress index-short form with parents of young children with autism spectrum disorders. Autism Research, 4(5), 336–346.
The authors thank the study participants and teachers who helped us to conduct the survey. We also like to thank other co-investigators of the study who provided valuable comments on study design and data analysis. This research was supported by the Health and Medical Research Fund, Food and Health Bureau, Hong Kong SAR.
Conflict of interest
Authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Siu, Q.K.Y., Yi, H., Chan, R.C.H. et al. The Role of Child Problem Behaviors in Autism Spectrum Symptoms and Parenting Stress: A Primary School-Based Study. J Autism Dev Disord 49, 857–870 (2019). https://doi.org/10.1007/s10803-018-3791-7
- Autism spectrum symptoms
- Child problem behaviors
- Parenting stress
- Mediation analysis
- Hong Kong