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Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy


Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3–13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.

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  1. To control for these variables, exogenous variables were correlated with covariates in the model and endogenous variables were regressed onto covariates. Covariates were also allowed to correlate with each other.


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We thank Charles Albright, Jessica Scherr, Taylor Pifher, Amy Hess, and Kelly McKinnon-Bermingham for their work in the larger study project. We are grateful for the support and guidance of Karen A. Kuhlthau. We also gratefully acknowledge all the families who made this work possible.


This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement UA3 MC11054—Autism Intervention Research Network on Physical Health.

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KGS, RMF, EAM, MN, EMB, and RSE conceptualized and designed the study and provided study oversight. FL and EAM assisted in management, cleaning, and oversight of study data. KGS and EAM performed quantitative analysis. KGS drafted the initial manuscript and all authors critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Kevin G. Stephenson.

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Conflict of Interest

Dr. Macklin reported serving on advisory boards for Biogen, Cerevance, and Stoparkinson Healthcare Systems, serving on data monitoring boards for Novartis and Takeda Pharmaceutical, and receipt by his institution of research funds on his behalf from Amylyx Pharmaceuticals, Biohaven Pharmaceuticals, Clene Nanomedicine, GlaxoSmithKline, Mitsubishi Tanabe Pharma America, Prilenia Therapeutics, Ra Pharmaceuticals, and the National Institutes of Health.

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Stephenson, K.G., Fenning, R.M., Macklin, E.A. et al. Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy. J Autism Dev Disord (2022).

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  • Autism spectrum disorder
  • Parenting self-efficacy
  • Parenting stress
  • Family resources
  • Externalizing and internalizing behaviors
  • Mediation analysis