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Parental Distress and Parenting Behavior in Families of Preschool Children with and without ASD: Spillover and Buffering

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Title: Parental Distress and Parenting Behavior in Families of Preschool Children with and without ASD: Spillover and Buffering
Language: English
Authors: Jason K. Baker (ORCID 0000-0001-5172-1420), Rachel M. Fenning, Amanda E. Preston, Neilson Chan, Hadley A. McGregor, Cameron L. Neece
Source: Journal of Autism and Developmental Disorders. 2024 54(12):4661-4673.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 13
Publication Date: 2024
Sponsoring Agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
Contract Number: R15HD09172601A1
Document Type: Journal Articles
Reports - Research
Descriptors: Parent Child Relationship, Stress Variables, Behavior, Preschool Children, Autism Spectrum Disorders, Well Being, Depression (Psychology), Emotional Response, Individual Differences, Parenting Styles
DOI: 10.1007/s10803-023-06163-8
ISSN: 0162-3257
1573-3432
Abstract: Parents of children with autism spectrum disorder (ASD) report increased distress relative to parents of children with neurotypical development. Parent well-being is generally considered a key determinant of parenting behavior, thus increased distress may spill over into less optimal parenting in families of children with ASD. However, evidence is mixed regarding the degree to which parenting is actually compromised in this population, suggesting the possibility of buffering, wherein the parenting of children with ASD may be robust against spillover from increased parental distress. The current study tested competing "spillover" and "buffering" models with regard to relations among child ASD status, parental distress, and parenting behavior. Parents of preschoolers with (n = 73) and without (n = 55) ASD completed self-report measures of parenting stress, depressive symptoms, and emotion dysregulation, as well as of positive and negative parenting behaviors. Families of preschoolers with ASD reported higher distress and negative parenting, and lower positive parenting than did their counterparts. Findings supported the spillover model for negative parenting such that increased parental distress accounted for status-group differences in negative parenting. In contrast, potential buffering was observed for positive parenting in that an inverse association between distress and parenting was observed for parents of children with neurotypical development only. Findings highlight the potential benefit of intervention to reduce parental distress in families of children with ASD, but also suggest some existing ability of these families to buffer certain parenting behaviors from deleterious effects of parent distress.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1447823
Database: ERIC
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  Value: <anid>AN0180804674;aut01dec.24;2024Nov13.05:17;v2.2.500</anid> <title id="AN0180804674-1">Parental Distress and Parenting Behavior in Families of Preschool Children with and Without ASD: Spillover and Buffering </title> <p>Parents of children with autism spectrum disorder (ASD) report increased distress relative to parents of children with neurotypical development. Parent well-being is generally considered a key determinant of parenting behavior, thus increased distress may spill over into less optimal parenting in families of children with ASD. However, evidence is mixed regarding the degree to which parenting is actually compromised in this population, suggesting the possibility of buffering, wherein the parenting of children with ASD may be robust against spillover from increased parental distress. The current study tested competing spillover and buffering models with regard to relations among child ASD status, parental distress, and parenting behavior. Parents of preschoolers with (n = 73) and without (n = 55) ASD completed self-report measures of parenting stress, depressive symptoms, and emotion dysregulation, as well as of positive and negative parenting behaviors. Families of preschoolers with ASD reported higher distress and negative parenting, and lower positive parenting than did their counterparts. Findings supported the spillover model for negative parenting such that increased parental distress accounted for status-group differences in negative parenting. In contrast, potential buffering was observed for positive parenting in that an inverse association between distress and parenting was observed for parents of children with neurotypical development only. Findings highlight the potential benefit of intervention to reduce parental distress in families of children with ASD, but also suggest some existing ability of these families to buffer certain parenting behaviors from deleterious effects of parent distress.</p> <p>Keywords: Autism spectrum disorder; Parenting; Parental distress; Stress; Depression</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Although determinants of parenting are complex and multifaceted, theoretical conceptualizations commonly feature parent psychological characteristics as a central influence on parenting behavior (Abidin, [<reflink idref="bib1" id="ref1">1</reflink>]; Belsky, [<reflink idref="bib15" id="ref2">15</reflink>]; Crnic & Low, [<reflink idref="bib22" id="ref3">22</reflink>]). Efforts to understand the role of parent characteristics in families of children with autism spectrum disorder (ASD) have often focused on parent psychological <emph>distress</emph>, given evidence of markedly elevated parenting stress and mental health difficulties in these parents relative to parents of children with neurotypical development and parents of children with other intellectual and developmental disabilities (Baker-Ericzen et al., [<reflink idref="bib11" id="ref4">11</reflink>]; Barroso et al., [<reflink idref="bib12" id="ref5">12</reflink>]; Bispo-Torres et al., [<reflink idref="bib16" id="ref6">16</reflink>]; Dabrowska & Pisula, [<reflink idref="bib24" id="ref7">24</reflink>]; Estes et al., [<reflink idref="bib30" id="ref8">30</reflink>] see also Hayes & Watson, [<reflink idref="bib41" id="ref9">41</reflink>] and Karst & Van Hecke, [<reflink idref="bib45" id="ref10">45</reflink>]).</p> <p>Decades of research robustly link core features of parental distress, including parenting stress, depressive symptoms, and emotion dysregulation, with less optimal parenting behavior in families of children with neurotypical development (e.g., Anthony et al., [<reflink idref="bib6" id="ref11">6</reflink>]; Crnic et al., [<reflink idref="bib23" id="ref12">23</reflink>]; Goodman et al., [<reflink idref="bib35" id="ref13">35</reflink>]; Lovejoy et al., [<reflink idref="bib53" id="ref14">53</reflink>]; Zimmer-Gembeck et al., [<reflink idref="bib76" id="ref15">76</reflink>]). Emerging evidence suggests the potential for parental distress to adversely affect parenting in families of children with ASD as well (De Clercq et al., [<reflink idref="bib26" id="ref16">26</reflink>]; Shawler & Sullivan, [<reflink idref="bib66" id="ref17">66</reflink>]). However, evidence is mixed regarding the extent to which parenting may be compromised by high levels of parental distress in these families. For example, a recent meta-analysis found that parents of children with ASD exhibited comparatively higher levels of observed negative parenting behavior (e.g., hostility, aversion), but no significant differences in observed positive parenting (e.g., support, warmth) as compared to families of children without ASD (Ku et al., [<reflink idref="bib46" id="ref18">46</reflink>]). Such findings raise the compelling possibility of both status-group effects on parenting (perhaps as mediated through increased distress) and <emph>buffering</emph>, wherein certain aspects of parenting behavior, such as positive parenting behaviors, may be protected against elevated parental distress in families of children with ASD. The current study tested contrasting <emph>spillover</emph> and <emph>buffering</emph> models to enhance understanding of the relationships among ASD status, parental distress (stress, depression symptoms, dysregulation), and positive and negative parenting behavior in families of children with ASD and families of children with neurotypical development.</p> <p>Parenting stress has long been conceptualized as a core determinant of parenting behavior (Abidin, [<reflink idref="bib1" id="ref19">1</reflink>]; Belsky, [<reflink idref="bib15" id="ref20">15</reflink>]). Studies of families of children with neurotypical development have linked greater parenting stress with less observed positive affect during parent-child interaction (Crnic et al., [<reflink idref="bib23" id="ref21">23</reflink>]), stricter and harsher reported discipline strategies (e.g., Anthony et al., [<reflink idref="bib6" id="ref22">6</reflink>]; Jackson & Choi, [<reflink idref="bib43" id="ref23">43</reflink>]), a more critical family emotional climate (De Clercq et al., [<reflink idref="bib26" id="ref24">26</reflink>]), and more negative and controlling parenting behavior (see Crnic & Low, [<reflink idref="bib22" id="ref25">22</reflink>] and Deater-Deckard, [<reflink idref="bib27" id="ref26">27</reflink>] for reviews). Less research has focused on associations between parenting stress and parenting behavior in families of children with ASD. Nonetheless, existing findings suggest that higher levels of parenting stress in families of children with ASD may be similarly associated with a more critical emotional climate (De Clercq et al., [<reflink idref="bib26" id="ref27">26</reflink>]), harsher reported discipline strategies (Shawler & Sullivan, [<reflink idref="bib66" id="ref28">66</reflink>]), and lower levels of reported mindful parenting (i.e., more reactivity, less present-moment focus; Beer et al., [<reflink idref="bib14" id="ref29">14</reflink>]; Raulston et al., [<reflink idref="bib60" id="ref30">60</reflink>]; Wang et al., [<reflink idref="bib72" id="ref31">72</reflink>]).</p> <p>Parenting stress is robustly tied to other facets of parent psychological wellbeing, including parental depression, in both neurotypical development (Fang et al., [<reflink idref="bib31" id="ref32">31</reflink>]) and ASD (Davis & Carter, [<reflink idref="bib25" id="ref33">25</reflink>]; Enea & Rusu, [<reflink idref="bib29" id="ref34">29</reflink>]; Weitlauf et al., [<reflink idref="bib73" id="ref35">73</reflink>]). In turn, parental depression increases risk for disrupted parenting behavior (e.g., Goodman et al., [<reflink idref="bib35" id="ref36">35</reflink>]; Lovejoy et al., [<reflink idref="bib53" id="ref37">53</reflink>]). A recent meta-analysis involving longitudinal studies of families of children with neurotypical development demonstrated significant predictive associations between parental depression and subsequent positive and negative parenting behavior (Goodman et al., [<reflink idref="bib35" id="ref38">35</reflink>]). Similarly, an earlier meta-analysis focused on observed parenting in families of children with neurotypical development found links between parental depression and both positive and negative parenting, with the largest associations with the latter (Lovejoy et al., [<reflink idref="bib53" id="ref39">53</reflink>]). Despite evidence of the heightened incidence of depression symptoms in parents of children with ASD (e.g., Bispo-Torres et al., [<reflink idref="bib16" id="ref40">16</reflink>]), the association between depression and parenting behavior in this population has received surprisingly limited attention. A 14-day diary study revealed an association between mothers' daily endorsements of depressive symptoms and their reports of frustrating parent-child interactions (Pruitt et al., [<reflink idref="bib58" id="ref41">58</reflink>]). Additionally, a recent investigation reported an inverse correlation between parental depression and reported mindful parenting in ASD (Raulston et al., [<reflink idref="bib60" id="ref42">60</reflink>]). Further investigation in this area is clearly needed.</p> <p>Emotion dysregulation, or difficulties modulating internal states in the service of goal-directed activity (Gross, [<reflink idref="bib37" id="ref43">37</reflink>]; Thompson, [<reflink idref="bib69" id="ref44">69</reflink>]), is thought to underlie psychological distress and increase risk for psychopathology, including depression (Aldao et al., [<reflink idref="bib3" id="ref45">3</reflink>]; Joormann & Stanton, [<reflink idref="bib44" id="ref46">44</reflink>]). In parents of children with neurotypical development, parent emotion dysregulation is linked with greater parenting stress (Cao et al., [<reflink idref="bib18" id="ref47">18</reflink>]) and with multiple aspects of parenting behavior (for reviews see Leerkes & Augustine, [<reflink idref="bib49" id="ref48">49</reflink>] and Zimmer-Gembeck et al., [<reflink idref="bib76" id="ref49">76</reflink>]). Specifically, a recent meta-analysis revealed greater parent emotion dysregulation to be significantly associated with reduced positive parenting and increased negative parenting behavior (Zimmer-Gembeck et al., [<reflink idref="bib76" id="ref50">76</reflink>]). Effects were strongest for prediction of negative parenting (Zimmer-Gembeck et al., [<reflink idref="bib76" id="ref51">76</reflink>]) and for investigations utilizing the Difficulties with Emotion Regulation Scale (DERS), the parent self-report measure used in the current study. Within families of children with ASD, preliminary evidence suggests associations between reported parent emotion dysregulation and both reported positive parenting and what the authors considered to be reported negative overprotection (Hu et al., [<reflink idref="bib42" id="ref52">42</reflink>]). Inverse associations between dysregulation and reported mindful parenting have also been documented (Aydin, [<reflink idref="bib8" id="ref53">8</reflink>]). The relative dearth of research in this area highlights the importance of advancing understanding of these processes in families of children with ASD.</p> <hd id="AN0180804674-2">Current Study</hd> <p>Challenges related to symptoms of ASD and associated behavioral difficulties are associated with increased parenting stress and distress (Ekas & Whitman, [<reflink idref="bib28" id="ref54">28</reflink>]; Lecavalier et al., [<reflink idref="bib47" id="ref55">47</reflink>]; Shawler & Sullivan, [<reflink idref="bib66" id="ref56">66</reflink>]). Further, parental distress can feedback upon the child through <emph>spillover</emph> from parental stress into the parenting behavior the child receives, as outlined previously. Conversely, it is possible that this chain of influence may not occur. Indeed, the parenting of children with ASD is often not compromised despite established elevations in parental distress (e.g., Ku et al., [<reflink idref="bib46" id="ref57">46</reflink>]). This apparent contradiction suggests that parents may also <emph>buffer</emph> their parenting behavior against the distress commonly associated with certain child challenges related to ASD (Alostaz et al., [<reflink idref="bib4" id="ref58">4</reflink>]).</p> <p>Building upon the existing evidence base, the current study tested two competing models of associations among ASD status, parent distress (parenting stress, depression symptoms, and emotion dysregulation), and parenting behavior. The <emph>spillover</emph> hypothesis predicted that higher levels of distress in parents of children with ASD relative to parents of children with neurotypical development would account for any differences in parenting behavior related to child ASD status. The <emph>buffering</emph> hypothesis predicted that the association between parent distress and parenting behavior would be moderated by child ASD status such that less spillover from distress to parenting occurred for families of children with ASD.</p> <hd id="AN0180804674-3">Methods</hd> <p></p> <hd id="AN0180804674-4">Participants</hd> <p>Participants included 128 families of children ages 3 to 5 years, including 73 families of preschool-aged children with ASD and 55 age-matched children with neurotypical development (NTD). Data for families of children with ASD involved baseline measures drawn from the first two in-person cohorts of a larger randomized controlled trial examining the efficacy of stress-reduction interventions for families of young children with ASD (Neece et al., [<reflink idref="bib55" id="ref59">55</reflink>]). Recruitment for these cohorts occurred from September 2018 to September 2019. Of the 81 families who participated in an initial visit as part of this randomized trial, 8 families did not return relevant questionnaire data and were not included in the current study. Two of these families did not return any demographic data; the remaining 6 families did not differ significantly from included participants on examined demographics. Community ASD diagnosis was confirmed by study administration of the Autism Diagnostic Observation Schedule-2 (ADOS-2; Lord et al., [<reflink idref="bib52" id="ref60">52</reflink>]) by research-reliable assessors. One child who did not meet the ADOS-2 criterion for an ASD classification was retained in the sample following completion of an in-depth, multimethod clinical best estimate by a licensed clinical psychologist with research reliability in the ADOS-2 and significant expertise in ASD assessment. Exclusionary criteria for the larger trial included (<reflink idref="bib1" id="ref61">1</reflink>) primary caregiver positive screen for suicidality, substance use, or active psychosis on the Structured Clinical Interview for DSM Disorders, Research Version Non-Patient Edition (First et al., [<reflink idref="bib34" id="ref62">34</reflink>]); (<reflink idref="bib2" id="ref63">2</reflink>) parent participation in auxiliary mental health treatment or support groups at time of randomization; and (<reflink idref="bib3" id="ref64">3</reflink>) child sensory or motor impairments that would prevent participation in the parent-child interaction tasks that were part of the larger assessment protocol (e.g., blindness or deafness, difficulty sitting independently). Parents participated in study procedures in English. Of the participating primary caregivers of children with ASD, 18 (25%) reported a history of mental health problems, including depression (<emph>n</emph> = 17), anxiety (<emph>n</emph> = 12), bipolar disorder (<emph>n</emph> = 4), and post-traumatic stress disorder (<emph>n</emph> = 2). A majority of the children with ASD (65%) met DSM-5 (American Psychiatric Association, [<reflink idref="bib5" id="ref65">5</reflink>]) criteria for intellectual disability based upon standardized scores below 76 on the Stanford-Binet-5 Abbreviated Battery IQ (SB-5 ABIQ; Roid, [<reflink idref="bib61" id="ref66">61</reflink>]) and the Vineland Adaptive Behaviors Scales-3 Adaptive Behavior Composite (Sparrow et al., [<reflink idref="bib67" id="ref67">67</reflink>]). ASD symptom severity fell in the <emph>moderate</emph> to <emph>high</emph> range (ADOS-2 Comparison Score <emph>M</emph> = 7.33, <emph>SD</emph> = 1.68).</p> <p>Families of children with neurotypical development were recruited from the community through local organizations, service providers, and social media postings. These families were recruited from January 2019 to December 2019. Exclusionary criteria for families of children with NTD included (<reflink idref="bib1" id="ref68">1</reflink>) child community diagnosis of ASD or other developmental delay, (<reflink idref="bib2" id="ref69">2</reflink>) a sibling with ASD or other developmental delay; (<reflink idref="bib3" id="ref70">3</reflink>) a total score of 12 or higher on the Social Communication Questionnaire (SCQ; Rutter et al., [<reflink idref="bib64" id="ref71">64</reflink>]), which is the recommended adjusted cutoff for ASD in young children (Corsello et al., [<reflink idref="bib20" id="ref72">20</reflink>]); and (<reflink idref="bib4" id="ref73">4</reflink>) Stanford-Binet-5 Abbreviated Battery IQ score (SB-5 ABIQ; Roid, [<reflink idref="bib61" id="ref74">61</reflink>]) score below 85. Among primary caregivers of children with neurotypical development, 9 (16%) reported a history of mental health problems, including depression (<emph>n</emph> = 6), anxiety (<emph>n</emph> = 4), bipolar disorder (<emph>n</emph> = 1), post-traumatic stress disorder (<emph>n</emph> = 1), and obsessive compulsive disorder (<emph>n</emph> = 1).</p> <p>Table 1 presents participant demographics by diagnostic group. Groups differed significantly in race/ethnicity, with a greater proportion of caregivers of children with ASD identifying as Hispanic/Latino relative to caregivers of children with NTD, χ 2 = 6.99, p <.001. Additionally, caregivers of children with NTD reported having achieved a higher educational level than caregivers of children with ASD, t = 3.15, p <.01. Regarding child characteristics, children with NTD had significantly higher measured intellectual functioning than children with ASD, t = 15.08, p <.001. Groups also differed in child gender, with the majority of children with ASD identified as male compared to just under half of the children with NTD, χ 2 = 14.50, p <.001. Each of these variables was controlled in all status-group analyses in which the variable was also related to the outcome variable of interest.</p> <p>The average age in years of children with ASD (<emph>M</emph> = 3.96, <emph>SD</emph> = 0.90) did not differ from children with NTD (<emph>M</emph> = 3.96, <emph>SD</emph> = 0.72). Half of the families of children with ASD reported receiving a primary ASD diagnosis for their child during the second year of life (50%), and 34% reported receiving this diagnosis in the third year. 61% of families of children with ASD reported having received some behavioral intervention services for their child within the previous six months.</p> <hd id="AN0180804674-5">Procedures</hd> <p>Procedures were approved by an Institutional Review Board and were overseen by the participating universities. Following an initial phone screening, eligible families were scheduled for a baseline laboratory assessment and caregivers provided informed consent. For all children, the laboratory visit included direct testing of child intellectual functioning and participation in interactive laboratory tasks. Parents also completed questionnaires. Children with ASD participated in additional direct assessment, including the ADOS-2, and their parents reported on adaptive behavior.</p> <hd id="AN0180804674-6">Measures</hd> <p></p> <hd id="AN0180804674-7">Parent Distress</hd> <p></p> <hd id="AN0180804674-8">Parenting Stress</hd> <p>Parenting stress was measured with the Parent Distress scale of the <emph>Parenting Stress Index – Short Form</emph> (PSI-SF; Abidin, [<reflink idref="bib2" id="ref75">2</reflink>]). Items are rated on a 5-point Likert scale ranging from 1 (<emph>strongly disagree</emph>) to 5 (<emph>strongly agree</emph>). Parent Distress subscale scores range from 12 to 60, with higher scores indicating more stress. The PSI-SF has been used widely in families of children with NTD (Abidin, [<reflink idref="bib2" id="ref76">2</reflink>]; Haskett et al., [<reflink idref="bib39" id="ref77">39</reflink>]; Lee et al., [<reflink idref="bib48" id="ref78">48</reflink>]) and children with ASD (for reviews see Barroso et al., [<reflink idref="bib12" id="ref79">12</reflink>] and Hayes & Watson, [<reflink idref="bib41" id="ref80">41</reflink>]). However, some authors have questioned the coherence of the overall Parent Distress factor for families of children with ASD, recommending further delineation of this scale to separate "general" from "parenting" distress (Zaidman-Zait et al., [<reflink idref="bib75" id="ref81">75</reflink>]). Given planned status-group comparisons, and evidence of acceptable and similar internal consistency across our subsamples (Table 2), we retained primary focus on the original Parenting Distress subscale. However, due to the valid points and evidence presented by Zaidman-Zait et al. ([<reflink idref="bib75" id="ref82">75</reflink>]), the relevant factor-derived composites for General and Parenting Distress were also examined, and considerations for the use of these subscales appear in the bivariate analyses section.</p> <p>Table 1 Participant demographics</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Demographic</p></th><th align="left"><p>ASD (<italic>n</italic> = 73)</p></th><th align="left"><p>NTD (<italic>n</italic> = 55)</p></th></tr><tr><th align="left" colspan="2"><p>Parent Demographics</p></th></tr></thead><tbody><tr><td align="left"><p>Age in Years <italic>M</italic> (<italic>SD</italic>)</p></td><td align="left"><p>34.51 (6.97)</p></td><td align="left"><p>33.29 (5.39)</p></td></tr><tr><td align="left"><p>Gender</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Female</p></td><td align="left"><p>87%</p></td><td align="left"><p>89%</p></td></tr><tr><td align="left"><p> zMale</p></td><td align="left"><p>13%</p></td><td align="left"><p>11%</p></td></tr><tr><td align="left"><p>Race/Ethnicity<sup>a</sup></p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Hispanic/Latino</p></td><td align="left"><p>63%</p></td><td align="left"><p>40%</p></td></tr><tr><td align="left"><p> White, non-Hispanic</p></td><td align="left"><p>32%</p></td><td align="left"><p>56%</p></td></tr><tr><td align="left"><p> Multiracial</p></td><td align="left"><p>14%</p></td><td align="left"><p>11%</p></td></tr><tr><td align="left"><p> Asian</p></td><td align="left"><p>9%</p></td><td align="left"><p>6%</p></td></tr><tr><td align="left"><p> Black</p></td><td align="left"><p>7%</p></td><td align="left"><p>7%</p></td></tr><tr><td align="left"><p> Pacific Islander</p></td><td align="left"><p>1%</p></td><td align="left"><p>0</p></td></tr><tr><td align="left"><p> Native American</p></td><td align="left"><p>1%</p></td><td align="left"><p>2%</p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>0</p></td><td align="left"><p>2%</p></td></tr><tr><td align="left"><p>Marital Status</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Married</p></td><td align="left"><p>62%</p></td><td align="left"><p>80%</p></td></tr><tr><td align="left"><p> Living Together</p></td><td align="left"><p>20%</p></td><td align="left"><p>4%</p></td></tr><tr><td align="left"><p> Separated</p></td><td align="left"><p>6%</p></td><td align="left"><p>4%</p></td></tr><tr><td align="left"><p> Divorced</p></td><td align="left"><p>0</p></td><td align="left"><p>6%</p></td></tr><tr><td align="left"><p> Widowed</p></td><td align="left"><p>1%</p></td><td align="left"><p>0</p></td></tr><tr><td align="left"><p> Single</p></td><td align="left"><p>11%</p></td><td align="left"><p>7%</p></td></tr><tr><td align="left"><p>Annual Income</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> <$30k</p></td><td align="left"><p>29%</p></td><td align="left"><p>28%</p></td></tr><tr><td align="left"><p> $30k to <$50k</p></td><td align="left"><p>16%</p></td><td align="left"><p>13%</p></td></tr><tr><td align="left"><p> $50k to <$70k</p></td><td align="left"><p>23%</p></td><td align="left"><p>26%</p></td></tr><tr><td align="left"><p> $70k to <$90k</p></td><td align="left"><p>10%</p></td><td align="left"><p>11%</p></td></tr><tr><td align="left"><p> >$90k</p></td><td align="left"><p>23%</p></td><td align="left"><p>22%</p></td></tr><tr><td align="left"><p>Education Level</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> High school or less</p></td><td align="left"><p>22%</p></td><td align="left"><p>16%</p></td></tr><tr><td align="left"><p> Some college</p></td><td align="left"><p>21%</p></td><td align="left"><p>9%</p></td></tr><tr><td align="left"><p> Technical Degree/AA</p></td><td align="left"><p>35%</p></td><td align="left"><p>15%</p></td></tr><tr><td align="left"><p> Bachelor's Degree</p></td><td align="left"><p>10%</p></td><td align="left"><p>40%</p></td></tr><tr><td align="left"><p> Graduate Degree</p></td><td align="left"><p>13%</p></td><td align="left"><p>20%</p></td></tr></tbody></table> </ephtml> </p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Child Demographics</p></th></tr></thead><tbody><tr><td align="left"><p>Age in Years <italic>M</italic> (<italic>SD</italic>)</p></td><td align="left"><p>3.96 (0.90)</p></td><td align="left"><p>3.96 (0.72)</p></td></tr><tr><td align="left"><p>Gender</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Male</p></td><td align="left"><p>78%</p></td><td align="left"><p>46%</p></td></tr><tr><td align="left"><p> Female</p></td><td align="left"><p>23%</p></td><td align="left"><p>55%</p></td></tr><tr><td align="left"><p>Estimated IQ <italic>M</italic> (<italic>SD</italic>)</p></td><td align="left"><p>65.79 (17.17)</p></td><td align="left"><p>103.76 (11.91)</p></td></tr><tr><td align="left"><p>Race/Ethnicity<sup>a</sup></p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Hispanic/Latino</p></td><td align="left"><p>62%</p></td><td align="left"><p>51%</p></td></tr><tr><td align="left"><p> White</p></td><td align="left"><p>44%</p></td><td align="left"><p>73%</p></td></tr><tr><td align="left"><p> Multiracial</p></td><td align="left"><p>24%</p></td><td align="left"><p>40%</p></td></tr><tr><td align="left"><p> Asian</p></td><td align="left"><p>7%</p></td><td align="left"><p>9%</p></td></tr><tr><td align="left"><p> Black</p></td><td align="left"><p>10%</p></td><td align="left"><p>16%</p></td></tr><tr><td align="left"><p> Pacific Islander</p></td><td align="left"><p>3%</p></td><td align="left"><p>0</p></td></tr><tr><td align="left"><p> Native American</p></td><td align="left"><p>3%</p></td><td align="left"><p>0</p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>1%</p></td><td align="left"><p>0</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>NTD</emph> Neurotypical development <emph>ASD</emph> Autism spectrum disorder <sups>a</sups>Cumulative percentages for race/ethnicity exceed 100% given that each identification was treated independently (i.e., those identifed as "multi-racial" were also included for any racial/ethnicity category variable for which they identified)</p> <p>Table 2 Descriptive statistics for predictor variables, group differences in these variables, and interrelations among these composited variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Stress</p><p>(PSI-PD)</p></th><th align="left"><p>Depression (CES-D)</p></th><th align="left"><p>Dysregulation (DERS)</p></th><th align="left"><p>Mean (<italic>SD)</italic></p><p>NTD/ASD</p></th><th align="left"><p>Group Difference</p></th><th align="left"><p>Internal Consistency (<italic>a</italic>)</p><p>NTD/ASD/Full</p></th></tr></thead><tbody><tr><td align="left"><p>Stress (PSI-PD)</p></td><td align="left" /><td align="left"><p>0.32**</p></td><td align="left"><p>0.19</p></td><td char="." align="char"><p>24.28 (6.79) / 38.95 (8.50)</p></td><td align="left"><p><italic>F</italic>(1,124) = 57.10***</p></td><td align="left"><p>0.88 /0.82 /0.91</p></td></tr><tr><td align="left"><p>Depression (CES-D)</p></td><td align="left"><p>0.48***</p></td><td align="left" /><td align="left"><p>0.60***</p></td><td char="." align="char"><p>7.18 (7.10) / 20.37 (11.75)</p></td><td align="left"><p><italic>F</italic>(1,117) = 23.11***</p></td><td align="left"><p>0.86 /0.91 /0.91</p></td></tr><tr><td align="left"><p>Dysregulation (DERS)</p></td><td align="left"><p>0.56***</p></td><td align="left"><p>0.64***</p></td><td align="left" /><td char="." align="char"><p>62.11 (16.00) / 82.01(22.10)</p></td><td align="left"><p><italic>F</italic>(1,120) = 24.34***</p></td><td align="left"><p>0.93 /0.95 /0.95</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>NTD</emph> Neurotypical development <emph>ASD</emph> Autism spectrum disorder Correlations in the lower left represent those for NTD; correlations in the upper right are those for ASD. <emph>F</emph>-tests include for control of child estimated IQ ***<emph>p</emph> <.001; **<emph>p</emph> <.01</p> <hd id="AN0180804674-9">Parent Depression Symptoms</hd> <p>Parent depression symptoms were measured with the widely-used <emph>Center for Epidemiological Studies – Depression Scale</emph> (CES-D; Radloff, [<reflink idref="bib59" id="ref83">59</reflink>]), which has demonstrated reliability and evidence of validity in parents of children with NTD (e.g., Beck, [<reflink idref="bib13" id="ref84">13</reflink>]; Loechner et al., [<reflink idref="bib50" id="ref85">50</reflink>]) and parents of children with ASD (e.g., Bispo-Torres et al., [<reflink idref="bib16" id="ref86">16</reflink>]). The scale consists of 20 items that are used to assess various depressive symptoms over the previous week, such as depressed affect, difficulties with interpersonal functioning, low positive affect, and somatic complaints. Each item is rated on a 4-point Likert scale ranging from 0 (<emph>rarely or none of the time)</emph> to 3 <emph>(most or all of the time).</emph> Total scores range from 0 to 60; a score of 16 or higher indicates clinically-significant levels of depressive symptoms. Internal consistency of the CES-D was high for the full sample and within each status group (Table 2).</p> <hd id="AN0180804674-10">Parent Dysregulation</hd> <p>Parent dysregulation was indexed with the <emph>Difficulties with Emotion Regulation Scale</emph> (DERS; Gratz & Roemer, [<reflink idref="bib36" id="ref87">36</reflink>]). The DERS is a 36-item self-report measure of emotion regulation difficulties. Items are rated on a 5-point Likert scale ranging from 1 (<emph>almost never</emph>) to 5 (<emph>almost always</emph>). Higher scores on the DERS indicate more difficulty regulating emotions. The measure asks parents about levels of non-acceptance, goals, impulsivity, awareness, emotion regulation strategies, and clarity. The DERS has been used widely in studies of emotion dysregulation (Zimmer-Gembeck et al., [<reflink idref="bib76" id="ref88">76</reflink>]), including in parents of children with ASD (Costa et al., [<reflink idref="bib21" id="ref89">21</reflink>]; Hu et al., [<reflink idref="bib42" id="ref90">42</reflink>]). Although some concerns regarding factor structure have been identified (e.g., Hallion et al., [<reflink idref="bib38" id="ref91">38</reflink>]), we utilized the total score given our theoretical rationale and evidence of excellent internal consistency for the full sample as well as each subsample (Table 2).</p> <hd id="AN0180804674-11">Parenting Behavior</hd> <p></p> <hd id="AN0180804674-12">Negative Parenting</hd> <p>Negative parenting was assessed via parent report on the <emph>O'Leary Parenting Scale</emph> (OPS; Arnold et al., [<reflink idref="bib7" id="ref92">7</reflink>]), a 30-item self-report measure of problematic parenting in discipline situations. The total scale includes subscales related to laxness (e.g., <emph>"If my child gets upset, I back down and give in")</emph>, overreactivity (e.g., <emph>"I raise my voice or yell")</emph>, and verbosity (<emph>"If saying no doesn't work right away, I keep talking and try to get through to my child")</emph>, and higher ratings reflect less optimal parenting. The scale has exhibited adequate reliability and validity evidence through associations with child misbehavior and observed problematic discipline in families of children with NTD (Arnold et al., [<reflink idref="bib7" id="ref93">7</reflink>]; Lorber et al., [<reflink idref="bib51" id="ref94">51</reflink>]), and in families of children with ASD (Tellegen & Sanders, [<reflink idref="bib68" id="ref95">68</reflink>]). Internal consistency for the full sample and within each status group were acceptable (full α = 0.76, NTD = 0.78, ASD = 0.72).</p> <hd id="AN0180804674-13">Positive Parenting</hd> <p>To measure positive parenting, which is not indexed by the O'Leary Parenting Scale, we utilized the Positive Parenting scale of the <emph>Alabama Parenting Questionnaire – Preschool Revision</emph> (AP-PR; Clerkin et al., [<reflink idref="bib19" id="ref96">19</reflink>]). The APQ-PR Positive Parenting scale consists of six items rated on a 5-point Likert scale ranging from 1 (<emph>never</emph>) to 5 (<emph>always</emph>). The scale largely considers behaviors related to rewarding the child with positive physical, verbal, and/or tangible stimuli for compliance or performance (e.g., <emph>"You reward or give something extra to your child for obeying you or behaving well</emph>," <emph>"You hug or kiss your child when he/she has done something well</emph>."). The APQ-PR has appropriate reliability and validity evidence from studies of parenting behavior in families of children with NTD (Blower et al., [<reflink idref="bib17" id="ref97">17</reflink>]; Clerkin et al., [<reflink idref="bib19" id="ref98">19</reflink>]) and children with ASD (Baker et al., [<reflink idref="bib10" id="ref99">10</reflink>]; McRae et al., [<reflink idref="bib54" id="ref100">54</reflink>]). Internal consistency for the APQ-PR Positive Parenting subscale was acceptable (full α = 0.84, NTD = 0.83, ASD = 0.82).</p> <hd id="AN0180804674-14">Data Analysis Plan</hd> <p>Following consideration of missing data, interrelations among the composited distress variables and the internal consistencies of the distress composites by group and for the full sample were considered. Bivariate correlations between the distress predictors and parenting behaviors were examined by group, and linear regressions were performed with the PROCESS macro for SPSS (Hayes, [<reflink idref="bib40" id="ref101">40</reflink>]) to test hypotheses related to mediation (<emph>spillover model</emph>) and moderation (<emph>buffering model</emph>). Regressions were performed for each parenting outcome (negative and positive) through PROCESS Model 4 with 5000 bootstrap samples. For each of these regressions, diagnostic status group (ASD/NTD) was entered as the predictor, any potential confounding variables were entered as covariates, and the parent distress composite was entered as a mediator. The option to test for interactions between the predictor and the mediator was enabled to test the moderation/buffering hypothesis. Finally, any variable that covaried with status group was examined as a possible alternate moderator in order to ensure that any significant moderation was not due to confounding factors.</p> <hd id="AN0180804674-15">Results</hd> <p></p> <hd id="AN0180804674-16">Missing Data</hd> <p>A small proportion of data was missing for predictor variables comprising the parental distress composite: PSI (<emph>n</emph> = 1; 0.7%), DERS (<emph>n</emph> = 5; 4%), CES-D (<emph>n</emph> = 8; 6%). All participants returned at least 2 of the 3 distress measures. Missing parental distress data were not significantly related to any child (age, gender, race/ethnicity, IQ, ASD symptoms), parent (age, race/ethnicity, education), or family (annual income) factor examined. Regarding the parenting behavior outcome measures, all families returned the APQ-PR, and the OPS was missing for 5 families (4%). Families missing the OPS reported a significantly lower level of parent education than families with complete OPS data, <emph>t</emph> = − 2.64, <emph>p</emph> =.005.</p> <hd id="AN0180804674-17">Group Differences</hd> <p>Consistent with expectations and existing literature, parents of children with ASD reported significantly greater parenting stress, depressive symptoms, and emotion dysregulation than did parents of children with NTD (Table 2). Group differences were also significant for the parenting behavior measures, with parents of children with ASD reporting lower levels of positive parenting and higher levels of negative parenting relative to parents of children with NTD (Table 3).</p> <p>Table 3 Correlations between predictor and criterion variables by status group, and status-group differences on criterion variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="4"><p>Parent Distress</p></th><th align="left" /><th align="left" /></tr><tr><th align="left"><p>Stress</p><p>(PSI-PD)</p></th><th align="left"><p>Depression</p><p>(CES-D)</p></th><th align="left"><p>Dysregulation (DERS)</p></th><th align="left"><p>Distress</p><p>Composite</p></th><th align="left"><p>Mean (<italic>SD</italic>)</p></th><th align="left"><p>Group Difference</p></th></tr></thead><tbody><tr><td align="left"><p>NTD: Negative Parenting (OPS)</p></td><td align="left"><p>0.32*</p></td><td align="left"><p>0.24<sup>+</sup></p></td><td align="left"><p>0.29*</p></td><td align="left"><p>0.34*</p></td><td align="left"><p>2.90 (0.50)</p></td><td align="left"><p><italic>F</italic>(1, 116) = 7.05**</p></td></tr><tr><td align="left"><p>Positive Parenting (APQ-PR)</p></td><td align="left"><p>− 0.34*</p></td><td align="left"><p>− 0.35*</p></td><td align="left"><p>− 0.42**</p></td><td align="left"><p>− 0.44**</p></td><td align="left"><p>4.43 (0.39)</p></td><td align="left"><p><italic>F</italic>(1, 125) = 5.70*</p></td></tr><tr><td align="left"><p>ASD: Negative Parenting (OPS)</p></td><td align="left"><p>0.08</p></td><td align="left"><p>0.32**</p></td><td align="left"><p>0.61***</p></td><td align="left"><p>0.42***</p></td><td align="left"><p>3.27 (0.55)</p></td><td align="left" /></tr><tr><td align="left"><p>Positive Parenting (APQ-PR)</p></td><td align="left"><p>0.10</p></td><td align="left"><p>0.14</p></td><td align="left"><p>− 0.07</p></td><td align="left"><p>0.09</p></td><td align="left"><p>3.99 (0.64)</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>ASD</emph> Autism spectrum disorder <emph>NTD</emph> Neurotypical development; <emph>F</emph>-test for negative parenting included control for child gender, child estimated IQ, and maternal education; <emph>F</emph>-test for positive parenting included control for child estimated IQ <sups>+</sups><emph>p</emph> =.10, <emph>*p <.</emph>05, <emph>**p</emph> <.01, ***<emph>p</emph> <.001</p> <hd id="AN0180804674-18">Distress Composite Development</hd> <p>Standardized scores for the distress variables were averaged to create a unitary composite. Associations among the three distress variables were positive and significant at moderate to high magnitude for families of children with NTD, resulting in good internal reliability for an overall composite, α = 0.80. Associations among the three distress variables were similarly positive for families of children with ASD, with significance reached for two of the three associations. Although the association between stress (PSI-PD) and dysregulation (DERS) was not significant for families of children with ASD, overall internal consistency for the composite was generally adequate (α = 0.64; full sample α = 0.82). A three-scale distress composite was therefore retained due to the need to compare across groups, the desire to minimize Type 1 error, and the theoretical rationale that these scales are measuring relatively distinct constructs that combine to index overall parent distress. Of note, the association between the PSI-PD and DERS scales remained nonsignificant for families of children with ASD even when utilizing the proposed alternate structure for the PSI Parent Distress Scale (Zaidman-Zait et al., [<reflink idref="bib75" id="ref102">75</reflink>]): general stress <emph>r</emph> =.21, parenting stress <emph>r</emph> =.19.</p> <hd id="AN0180804674-19">Bivariate Correlations</hd> <p>As presented in Table 3, relations between parent distress variables and <emph>negative</emph> parenting behaviors were generally consistent across status groups, with three of the four correlations demonstrating significant positive associations. The remaining nonsignificant association for families of children with NTD (depression and negative parenting) was similar in strength to the significant associations, but fell to a trend at <emph>p</emph> =.10. In contrast, the nonsignificant association for ASD with regard to negative parenting (stress) was quite small. Associations between parent distress and <emph>positive</emph> parenting appeared to differ substantially across status groups, with increased distress consistently and significantly related to lower positive parenting for families of children with NTD, whereas a consistent lack of significant associations with positive parenting was observed across all distress variables for families of children with ASD (Table 3).</p> <p>Interestingly, with regard to consideration of the two-component model of parental stress proposed by Zaidman-Zait et al. ([<reflink idref="bib75" id="ref103">75</reflink>]), significant relations between parental stress and each of the parenting behaviors for NTD families appeared largely driven by associations with the "general" distress subscale (negative parenting <emph>r</emph> =.43, <emph>p</emph> <.01; positive parenting <emph>r</emph> = −.37, <emph>p</emph> <.01) rather than the "parenting stress" subscale (<emph>r</emph> =.06, − 0.18, <emph>ns</emph>, respectively). All associations remained consistently nonsignificant for families of children with ASD regardless of the construction of the PSI scale.</p> <p>Of the demographic variables considered (e.g., child age, child gender, child IQ, caregiver race/ethnicity, caregiver education and income), child gender, <emph>r</emph> = −.20, <emph>p</emph> <.05, estimated IQ, <emph>r</emph> = −.24, <emph>p</emph> <.01, and caregiver education, <emph>r</emph> = −.22, <emph>p</emph> <.05, were each significantly related to negative parenting. Child IQ was also related to the distress composite, <emph>r</emph> = −.44, <emph>p</emph> <.001. Neither gender (<emph>r</emph> = −.10) nor education (<emph>r</emph> = −.16) was related to the distress composite, but both were related to status group (<emph>r</emph> = −.34 <emph>p</emph> <.001, <emph>r</emph> = −.27, <emph>p</emph> <.01, respectively), so these variables were controlled in the final regression for negative parenting. With regard to positive parenting, only child age, <emph>r</emph> =.19, <emph>p</emph> <.05, and estimated IQ, <emph>r</emph> =.32, <emph>p</emph> <.001, were related for the full sample. Age was not significantly related to any of the predictor variables, including the distress composite, <emph>r</emph> =.04, <emph>ns</emph>, or group status, <emph>r</emph> = −.02, <emph>ns</emph>, so only estimated IQ was controlled in the final regression for positive parenting.</p> <hd id="AN0180804674-20">Mediation and Moderation Analyses</hd> <p>The regression for negative parenting revealed that the association between ASD status and negative parenting behavior was no longer significant once the covariates and the interaction term were included (Table 4). Further, the test of indirect effects was significant, <emph>b</emph> = 0.45, <emph>SE</emph> = 0.19, <emph>CI</emph> = 0.10 to 0.84, suggesting that distress mediated the association between status group and negative parenting. The interaction term between distress and status was not significant (Table 4), supporting the suggestion from the bivariate analyses, that links between distress and negative parenting seemed to operate similarly for each group of families. Results suggest support for the <emph>spillover</emph> model whereby child ASD status was associated with increase parental distress which, in turn, related to more negative parenting.</p> <p>Table 4 Linearregression predicting negative parenting</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="6"><p>Negative Parenting</p></th></tr><tr><th align="left"><p><italic>b</italic></p></th><th align="left"><p><italic>SE</italic></p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p>Lower<italic> CI</italic></p></th><th align="left"><p>Upper <italic>CI</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Status (ASD or NTD)</p></td><td align="left"><p>−.02</p></td><td align="left"><p>.19</p></td><td align="left"><p>−0.12</p></td><td align="left"><p>.904</p></td><td align="left"><p>−.396</p></td><td align="left"><p>.351</p></td></tr><tr><td align="left"><p>Child gender</p></td><td align="left"><p>−.13</p></td><td align="left"><p>.10</p></td><td align="left"><p>−1.31</p></td><td align="left"><p>.193</p></td><td align="left"><p>−.324</p></td><td align="left"><p>.066</p></td></tr><tr><td align="left"><p>Caregiver education</p></td><td align="left"><p>−.06</p></td><td align="left"><p>.02</p></td><td align="left"><p>−2.38*</p></td><td align="left"><p>.019</p></td><td align="left"><p>−.104</p></td><td align="left"><p>−.010</p></td></tr><tr><td align="left"><p>Child estimated IQ</p></td><td align="left"><p>.00</p></td><td align="left"><p>.00</p></td><td align="left"><p>0.22</p></td><td align="left"><p>.827</p></td><td align="left"><p> −.006</p></td><td align="left"><p>.007</p></td></tr><tr><td align="left"><p>Parent distress</p></td><td align="left"><p>.32</p></td><td align="left"><p>.12</p></td><td align="left"><p> 2.71**</p></td><td align="left"><p>.008</p></td><td align="left"><p>.085</p></td><td align="left"><p>.551</p></td></tr><tr><td align="left"><p>Status x parent distress</p></td><td align="left"><p>−.02</p></td><td align="left"><p>.14</p></td><td align="left"><p> −0.17</p></td><td align="left"><p>.866</p></td><td align="left"><p> −.310</p></td><td align="left"><p>.261</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>ASD</emph> Autism spectrum disorder <emph>NTD</emph> Neurotypical development *p <.05, **p <.01</p> <p>In the regression predicting positive parenting behaviors, the association between ASD status and parenting was no longer significant with the inclusion of the covariates and parent distress (Table 5). However, the test for indirect effects was not significant, <emph>b</emph> = − 0.10, <emph>SE</emph> = 0.16, <emph>CI</emph> = − 0.215 to 0.430, suggesting that distress did not mediate the association between status group and positive parenting. The interaction between status group and parent distress was significant, consistent with examination of the bivariate associations (Table 5). Follow-up analyses indicated that increased parent distress was related to lower positive parenting for families of children with NTD <emph>only</emph>, <emph>b</emph> = − 0.31, <emph>t</emph> = -2.34, <emph>p</emph> =.021, <emph>CI</emph> = − 0.568 to − 0.047. Distress was unrelated to positive parenting for families of children with ASD, <emph>b</emph> = 0.07, <emph>t</emph> = 0.88, <emph>p</emph> =.433, <emph>CI</emph> = − 0.105 to 0.242, providing evidence for the <emph>buffering</emph> model for positive parenting (Fig. 1).</p> <p>Table 5 Linearregression predicting positive parenting</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="6"><p><bold>Positive Parenting</bold></p></th></tr><tr><th align="left"><p><italic>b</italic></p></th><th align="left"><p><italic>SE</italic></p></th><th align="left"><p><italic>t</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p>Lower <italic>CI</italic></p></th><th align="left"><p>Upper <italic>CI</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Status (ASD or NTD)</p></td><td align="left"><p>− 0.21</p></td><td align="left"><p>0.19</p></td><td align="left"><p>-1.10</p></td><td align="left"><p>0.273</p></td><td align="left"><p>− 0.588</p></td><td align="left"><p>0.167</p></td></tr><tr><td align="left"><p>Child Estimated IQ</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.56</p></td><td align="left"><p>0.576</p></td><td align="left"><p>− 0.005</p></td><td align="left"><p>0.008</p></td></tr><tr><td align="left"><p>Parent Distress</p></td><td align="left"><p>− 0.31</p></td><td align="left"><p>0.13</p></td><td align="left"><p>2.34*</p></td><td align="left"><p>0.021</p></td><td align="left"><p>− 0.568</p></td><td align="left"><p>− 0.047</p></td></tr><tr><td align="left"><p>Status x Parent Distress</p></td><td align="left"><p>. 38</p></td><td align="left"><p>0.16</p></td><td align="left"><p> 2.39*</p></td><td align="left"><p>0.018</p></td><td align="left"><p>0.065</p></td><td align="left"><p>0.688</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>ASD</emph> Autism spectrum disorder <emph>NTD</emph> Neurotypical development <emph>*p</emph> <.05</p> <p>Graph: Fig. 1 Parent distress predicting positive parenting for children with autism spectrum disorder (ASD) and neurotypical development (NTD)</p> <hd id="AN0180804674-21">Alternative Post-Hoc Analyses</hd> <p>Additional, post-hoc analyses were performed in order to ensure that group status did not moderate the association between distress and positive parenting as a function of a significant covariation with another variable. Child gender, child IQ, caregiver education, and caregiver race/ethnicity as White/Hispanic, all differed between status groups. Regressions were performed with each of these variables replacing status group as the moderator. None of these interactions were significant (child gender <emph>b</emph> = − 0.17, <emph>p</emph> =.17; child IQ <emph>b</emph> = − 0.06, <emph>p</emph> =.88; parent education <emph>b</emph> = − 0.43, <emph>p</emph> =.20; parent race/ethnicity <emph>b</emph> = 0.01, <emph>p</emph> =.92), increasing confidence that the relations differed primarily as a function of whether the families had a child with or without ASD.</p> <hd id="AN0180804674-22">Discussion</hd> <p>The current study tested two competing models of associations among children's ASD status, parental distress, and parenting behavior. Support for each model depended upon the type of parenting considered. Processes reflective of the <emph>spillover</emph> model were observed for negative parenting in that increased parental distress (parenting stress, depression symptoms, and dysregulation) appeared to account for the higher rates of negative parenting reported by parents of preschoolers with ASD as compared to their counterparts. In contrast, the <emph>buffering</emph> model was supported for positive parenting in that associations between higher distress and reduced positive parenting were observed for parents of children with neurotypical development, but not for parents of preschoolers with ASD.</p> <p>Evidence that parental distress mediated the association between ASD status and negative parenting underscores the importance of intervening to reduce distress in these families. It is likely that such efforts may require an explicit focus on parental distress, given that parental distress may remain otherwise unchanged in the context of interventions for families of children with ASD (e.g., Oono et al., [<reflink idref="bib56" id="ref104">56</reflink>]). Moreover, findings suggest an urgent need to intervene early, as problematic associations between parental distress and negative parenting already appear observable during the preschool years, and parental distress may further impede the uptake and effectiveness of child-focused interventions during this period (Osborne et al., [<reflink idref="bib57" id="ref105">57</reflink>]). Results from mindfulness-based interventions suggest promising distress reduction for parents of children with ASD (e.g., Ferraioli & Harris, [<reflink idref="bib33" id="ref106">33</reflink>]; Rojas-Torres et al., [<reflink idref="bib62" id="ref107">62</reflink>]; Schwartzman et al., [<reflink idref="bib65" id="ref108">65</reflink>]; Weitlauf et al., [<reflink idref="bib74" id="ref109">74</reflink>]). Indeed, our recently concluded randomized trial highlights Mindfulness-Based Stress Reduction as a promising avenue for supporting socioeconomically and racially/ethnically diverse parents of preschoolers with ASD (Fenning et al., [<reflink idref="bib32" id="ref110">32</reflink>]).</p> <p>Although spillover between parent distress and negative parenting was observed, parents of preschoolers with ASD also appeared to demonstrate <emph>buffering</emph> in that increased distress was not related to reduced positive parenting in the manner that was observed for parents of children with neurotypical development. Although intervention with parent distress remains warranted, it is important to recognize the existing strengths of these parents. Findings suggest that parents of young children with ASD may be able to "set aside" or compartmentalize their distress when engaged in parent-child interaction such that their ability to deliver praise and affection to their children is independent of their underlying distress. Having a child with a recognized disability may increase intentionality in parenting such that parents actively monitor relations between their own distress and their parenting behavior more so than do parents of children with neurotypical development. However, the identified association for negative parenting suggests that it may be easier for parents to retain certain positive behaviors despite distress than to inhibit less optimal ones. Indeed, findings from the present study are consistent with those of the previously mentioned meta-analysis suggesting that families of children with ASD tended to differ more from other families on negative as compared to positive parenting (Ku et al., [<reflink idref="bib46" id="ref111">46</reflink>]).</p> <p>Within this study, we were not able to account for the mechanism by which this buffering occurs. Alostaz et al. ([<reflink idref="bib4" id="ref112">4</reflink>]) found that parental active coping (e.g., planning, problem-solving) appeared to buffer associations between externalizing behavior problems and parental reactions to negative child emotion in families of somewhat older children with ASD. Interestingly, this buffering was only observed for supportive (positive) and not unsupportive (negative) parenting (Alostaz et al., [<reflink idref="bib4" id="ref113">4</reflink>]), dovetailing with the current findings of increased buffering for positive aspects of parenting. A more complete examination of the role of coping in these processes is necessary.</p> <p>The current study involved a relatively large sample of young children with ASD from an underserved, diverse sample of families. Further strengths include a multi-faceted examination of parental distress and consideration of both positive and negative aspects of parenting. The largest limitation involves the use of a single timepoint, which precludes interpretation of causal direction; however, it is more likely that distress would influence parenting behavior than vice-versa (e.g., Belsky, [<reflink idref="bib15" id="ref114">15</reflink>]), and neither would influence children's ASD status. Some measurement considerations also exist. The current study relied exclusively upon parent report. Self-report is likely the most accurate and feasible method for measuring distress, but investigations considering observation of parenting are needed. Indeed, a series of studies of very young children with ASD in the Netherlands found that parents <emph>reported</emph> themselves as less authoritative in their parenting style (Rutgers et al., [<reflink idref="bib63" id="ref115">63</reflink>]) but were not scored lower on relevant sensitive behaviors when <emph>observed</emph> (Ijzendoorn, Rutgers et al., [<reflink idref="bib63" id="ref116">63</reflink>]). It is also worth noting that our measures of parenting were generally oriented towards more behaviorally-based processes (e.g., praise, discipline), whereas many examinations of the parenting of children with ASD are often based upon more developmental measures such as parent sensitivity or warmth (e.g., Baker et al., [<reflink idref="bib9" id="ref117">9</reflink>]; van Ijzendoorn et al., [<reflink idref="bib70" id="ref118">70</reflink>]). Additionally, future studies would benefit from incorporating additional measures of mental health, such as anxiety, to further enhance understanding of parents' internal experiences.</p> <p>Additional considerations include some unique characteristics of the sample. The children in our sample were young, with relatively recent diagnoses. It is possible that a larger percentage of these families were still actively coping with the diagnosis of their child (Wachtel & Carter, [<reflink idref="bib71" id="ref119">71</reflink>]). It is also the case that the families of children with ASD were recruited specifically for participation in a larger randomized trial of parent stress-reduction interventions; thus, findings may be less generalizable to parents experiencing lower levels of distress or to those who are not seeking services. Similarly, the 4% of parents who did not provide negative parenting data reported significantly lower education than the remaining families, which is a further consideration for external validity.</p> <p>Findings from the current study support common models of stress and parenting but also present an intriguing challenge to the traditional assumption that parent mental health is necessarily key to understanding parenting behavior (e.g., Belsky, [<reflink idref="bib15" id="ref120">15</reflink>]). Recognizing, and perhaps building upon, existing strengths in parents of children with ASD, while providing assistance through distress-reducing support is likely a fruitful avenue for improving both quality of life and parenting in this population.</p> <hd id="AN0180804674-23">Acknowledgments</hd> <p>All authors contributed to the study conception and design. Material preparation, data collection and initial data processing were performed by CN, RF, AP, NC, and HM. Study analyses were performed by JB, RF, and AP. The first draft of the manuscript was written by JB and RF with contributions from all other authors, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.</p> <hd id="AN0180804674-24">Funding</hd> <p>This work was supported by funding to C. Neece and R. Fenning from the <emph>Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health</emph> (R15HD091726-01A1). Preparation of this manuscript was further supported through intramural funding from California State University Fullerton College of Health and Human Development to the first author.</p> <hd id="AN0180804674-25">Declarations</hd> <p></p> <hd id="AN0180804674-26">Competing Interests</hd> <p>The authors have no relevant financial or non-financial interests to disclose.</p> <hd id="AN0180804674-27">Ethical Approval</hd> <p>All procedures performed were in accordance with the 1964 Helsinki Declaration and its later amendments. Procedures were approved and overseen by an Institutional Review Board of Loma Linda University in collaboration with the additional participating universities.</p> <hd id="AN0180804674-28">Informed Consent</hd> <p>Informed consent was obtained from the primary caregivers in the study for themselves and their minor children.</p> <hd id="AN0180804674-29">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0180804674-30"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Abidin RR. The determinants of parenting behavior. Journal of Clinical Child Psychology. 1992; 21; 4: 407-412. 10.1207/s15374424jccp2104_12</bibtext> </blist> <blist> <bibl id="bib2" idref="ref63" type="bt">2</bibl> <bibtext> Abidin, R. R. (2012). Parenting stress index, Fourth Edition (PSI-4). 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  Data: Parental Distress and Parenting Behavior in Families of Preschool Children with and without ASD: Spillover and Buffering
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  Data: <searchLink fieldCode="AR" term="%22Jason+K%2E+Baker%22">Jason K. Baker</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-5172-1420">0000-0001-5172-1420</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rachel+M%2E+Fenning%22">Rachel M. Fenning</searchLink><br /><searchLink fieldCode="AR" term="%22Amanda+E%2E+Preston%22">Amanda E. Preston</searchLink><br /><searchLink fieldCode="AR" term="%22Neilson+Chan%22">Neilson Chan</searchLink><br /><searchLink fieldCode="AR" term="%22Hadley+A%2E+McGregor%22">Hadley A. McGregor</searchLink><br /><searchLink fieldCode="AR" term="%22Cameron+L%2E+Neece%22">Cameron L. Neece</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2024 54(12):4661-4673.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Data: 13
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  Label: Publication Date
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  Data: 2024
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  Data: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
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  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior%22">Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Differences%22">Individual Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Parenting+Styles%22">Parenting Styles</searchLink>
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  Data: 10.1007/s10803-023-06163-8
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  Data: 0162-3257<br />1573-3432
– Name: Abstract
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  Data: Parents of children with autism spectrum disorder (ASD) report increased distress relative to parents of children with neurotypical development. Parent well-being is generally considered a key determinant of parenting behavior, thus increased distress may spill over into less optimal parenting in families of children with ASD. However, evidence is mixed regarding the degree to which parenting is actually compromised in this population, suggesting the possibility of buffering, wherein the parenting of children with ASD may be robust against spillover from increased parental distress. The current study tested competing "spillover" and "buffering" models with regard to relations among child ASD status, parental distress, and parenting behavior. Parents of preschoolers with (n = 73) and without (n = 55) ASD completed self-report measures of parenting stress, depressive symptoms, and emotion dysregulation, as well as of positive and negative parenting behaviors. Families of preschoolers with ASD reported higher distress and negative parenting, and lower positive parenting than did their counterparts. Findings supported the spillover model for negative parenting such that increased parental distress accounted for status-group differences in negative parenting. In contrast, potential buffering was observed for positive parenting in that an inverse association between distress and parenting was observed for parents of children with neurotypical development only. Findings highlight the potential benefit of intervention to reduce parental distress in families of children with ASD, but also suggest some existing ability of these families to buffer certain parenting behaviors from deleterious effects of parent distress.
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  Data: 2024
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        PageCount: 13
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      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Stress Variables
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      – SubjectFull: Behavior
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      – SubjectFull: Parenting Styles
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      – TitleFull: Parental Distress and Parenting Behavior in Families of Preschool Children with and without ASD: Spillover and Buffering
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