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The Association between Parenting Stress and Parenting Behaviors in Chinese Parents of Children with Autism Spectrum Disorders: The Mediating Role of Parental Anxiety and Depression

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Title: The Association between Parenting Stress and Parenting Behaviors in Chinese Parents of Children with Autism Spectrum Disorders: The Mediating Role of Parental Anxiety and Depression
Language: English
Authors: Chang Zhang, Fu Lin, Yanlin Chen, Rui Wang, Ting Zhou, Chunli Yi
Source: Journal of Mental Health Research in Intellectual Disabilities. 2024 17(4):275-296.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 22
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Child Rearing, Stress Variables, Parent Child Relationship, Children, Autism Spectrum Disorders, Depression (Psychology), Parent Attitudes, Symptoms (Individual Disorders), Negative Attitudes, Foreign Countries
Geographic Terms: China
DOI: 10.1080/19315864.2024.2401833
ISSN: 1931-5864
1931-5872
Abstract: Background: Parents of children with autism spectrum disorders (ASD) experience heightened levels of parenting stress and more affective symptoms. Although the relationship between parenting stress and mental health has been extensively studied, limited understanding exists regarding parenting behaviors and related factors. This study aimed to explore the role of parents' affective symptoms in the relationship between parenting stress and parenting behaviors among Chinese parents of children with ASD. Methods: A total of 185 parents participated in one online survey, reporting parenting behaviors, parenting stress, depression and anxiety symptoms. Results: (1) A higher level of parenting stress was associated with reduced positive parenting behaviors and increased negative parenting behaviors. (2) Parents' anxiety and depression symptoms mediated the relationship between parenting stress and positive parenting behaviors. Conclusion: Parenting stress has potential detrimental effects on parenting behaviors in Chinese parents of children with ASD through the mediation of parental depression and anxiety.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1449652
Database: ERIC
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  Value: <anid>AN0180919752;[5ew6]01oct.24;2024Nov19.01:51;v2.2.500</anid> <title id="AN0180919752-1">The Association Between Parenting Stress and Parenting Behaviors in Chinese Parents of Children with Autism Spectrum Disorders: The Mediating Role of Parental Anxiety and Depression </title> <p>Background: Parents of children with autism spectrum disorders (ASD) experience heightened levels of parenting stress and more affective symptoms. Although the relationship between parenting stress and mental health has been extensively studied, limited understanding exists regarding parenting behaviors and related factors. This study aimed to explore the role of parents' affective symptoms in the relationship between parenting stress and parenting behaviors among Chinese parents of children with ASD. Methods: A total of 185 parents participated in one online survey, reporting parenting behaviors, parenting stress, depression and anxiety symptoms. Results: (<reflink idref="bib1" id="ref1">1</reflink>) A higher level of parenting stress was associated with reduced positive parenting behaviors and increased negative parenting behaviors. (<reflink idref="bib2" id="ref2">2</reflink>). Parents' anxiety and depression symptoms mediated the relationship between parenting stress and positive parenting behaviors. Conclusion: Parenting stress has potential detrimental effects on parenting behaviors in Chinese parents of children with ASD through the mediation of parental depression and anxiety.</p> <p>Keywords: Autism spectrum disorders; parenting stress; parenting behaviors; parents' anxiety; parents' depression</p> <hd id="AN0180919752-2">INTRODUCTION</hd> <p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties with social communication and the presence of rigid and repetitive behaviors, interests or activities (American Psychiatric Association, [<reflink idref="bib1" id="ref3">1</reflink>]). The estimated prevalence of ASD in China is increasing to over 1% of the total population (Clark et al., [<reflink idref="bib16" id="ref4">16</reflink>]).</p> <p>There has been increasing evidence that parenting behaviors play a crucial role in the development and social adaptation of children with ASD (Boonen et al., [<reflink idref="bib9" id="ref5">9</reflink>]). Insightful, sensitive and responsive parenting behaviors contribute to multiple domains of child development, including secure attachment (Koren-Karie et al., [<reflink idref="bib36" id="ref6">36</reflink>]; Meins et al., [<reflink idref="bib52" id="ref7">52</reflink>]; Oppenheim et al., [<reflink idref="bib56" id="ref8">56</reflink>]), language development (Bornstein & Tamis-Lemonda, [<reflink idref="bib10" id="ref9">10</reflink>]; Meins & Fernyhough, [<reflink idref="bib51" id="ref10">51</reflink>]; Paavola et al., [<reflink idref="bib58" id="ref11">58</reflink>]), psychosocial adjustment (Healey et al., [<reflink idref="bib32" id="ref12">32</reflink>]; Maljaars et al., [<reflink idref="bib44" id="ref13">44</reflink>]) and educational placement (Dolev et al., [<reflink idref="bib22" id="ref14">22</reflink>]; Shahar-Maharik et al., [<reflink idref="bib64" id="ref15">64</reflink>]). Conversely, negative parenting behaviors have been associated with increased behavioral problems in children with ASD (Cruz et al., [<reflink idref="bib19" id="ref16">19</reflink>]; O'Nions et al., [<reflink idref="bib55" id="ref17">55</reflink>]; Siller et al., [<reflink idref="bib68" id="ref18">68</reflink>]). For example, Gau et al. ([<reflink idref="bib26" id="ref19">26</reflink>]) found an association between suboptimal parenting and heightened levels of depression, anxiety, social problems, inattentiveness, hyperactivity, disruptiveness, and maladaptive behavior in their children with ASD (Gau et al., [<reflink idref="bib26" id="ref20">26</reflink>]). In addition to the general parenting behaviors mentioned above, Lambrechts et al ([<reflink idref="bib38" id="ref21">38</reflink>]) pointed out that children with ASD require two specific types of parenting behaviors: stimulating development and adapting to the environment. Stimulating development refers to parents' efforts to promote cognitive and social functioning improvement, while adapting the environment refers to managing the environment to meet the special needs of children with ASD. ASD-specific parenting is considered crucial for the behavioral rehabilitation and social adjustment of children with ASD (Boonen et al., [<reflink idref="bib9" id="ref22">9</reflink>]). Interventions targeting parenting behaviors have emerged as a key approach to improve children's social functioning (Lord et al., [<reflink idref="bib40" id="ref23">40</reflink>]). Given the pivotal role of parenting behaviors of children with ASD and its differences from that of typically developing (TD) children, further research is warranted to explore the factors influencing parenting behaviors of children with ASD, thereby providing empirical evidence for improving parenting practices. We focused on the effects of parenting stress and parental affective symptoms (anxiety and depression were the main concern) in the present study.</p> <p>Parents of children with ASD encounter various stressors, including challenges in understanding and accepting their child's symptoms and limitations, effectively communicating with their child, managing their child's behaviors, locating appropriate medical resources and interventions, and coping with the financial burdens associated with rehabilitation (Glidden et al., [<reflink idref="bib27" id="ref24">27</reflink>]; McCabe, [<reflink idref="bib46" id="ref25">46</reflink>]; Sharpe & Baker, [<reflink idref="bib65" id="ref26">65</reflink>]; Zhou et al., [<reflink idref="bib88" id="ref27">88</reflink>]). Another significant stressor for families of children with ASD is the social stigma attached to the behaviors accompanying ASD (Chan et al., [<reflink idref="bib14" id="ref28">14</reflink>]; Sharpley et al., [<reflink idref="bib66" id="ref29">66</reflink>]; Yip & Chan, [<reflink idref="bib84" id="ref30">84</reflink>]). Related to the limited awareness of autism in Chinese society and the traditional public stigma of mental health problems, parents experience affiliate stigma because of their children's diagnosis of ASD and affiliated stigma is a salient stressor for Chinese parents (Tait et al., [<reflink idref="bib71" id="ref31">71</reflink>]; Zhou et al., [<reflink idref="bib88" id="ref32">88</reflink>]).</p> <p>Based on Pearlin's ([<reflink idref="bib59" id="ref33">59</reflink>]) stress process model, individuals' coping abilities vary depending on the level of stress they experience. Research on parents of typically developing (TD) children has indicated that parental stress significantly influences parenting behaviors. Higher levels of reported stress are associated with an increase in parenting behaviors that are less conducive to a child's positive development (Baker et al., [<reflink idref="bib2" id="ref34">2</reflink>]; Clauser et al., [<reflink idref="bib17" id="ref35">17</reflink>]; Healey et al., [<reflink idref="bib32" id="ref36">32</reflink>]; McPherson et al., [<reflink idref="bib48" id="ref37">48</reflink>]). Stressed parents may exhibit selective attention toward negative aspects of their children's behaviors and generate negative attributions, thereby reducing their tolerance for misbehavior and endorsing suboptimal parenting (McPherson et al., [<reflink idref="bib48" id="ref38">48</reflink>]).</p> <p>Several studies have examined the association between parenting stress and parenting behaviors in parents of children with ASD, revealing similar findings (Meadan et al., [<reflink idref="bib50" id="ref39">50</reflink>]). These studies indicate that heightened parenting stress was related to a higher level of authoritarian and permissive parenting styles, reduced flexibility and sensitivity and increasing controlling and overprotective parenting behaviors in parents of children with ASD (DesChamps et al., [<reflink idref="bib21" id="ref40">21</reflink>]; Enea & Rusu, [<reflink idref="bib23" id="ref41">23</reflink>]; Olson et al., [<reflink idref="bib54" id="ref42">54</reflink>], Ueda et al., [<reflink idref="bib75" id="ref43">75</reflink>]; Vahedparast et al., [<reflink idref="bib76" id="ref44">76</reflink>]). A recent longitudinal study also demonstrated that heightened parental stress was related to reduced warmth and increased hostility toward their children two years later (Chan et al., [<reflink idref="bib14" id="ref45">14</reflink>]). However, the literature has primarily focused on general parenting behaviors applicable to both TD children and those with ASD. Limited studies have examined the relationship between parenting stress and ASD-specific parenting behaviors within Chinese families (van Esch et al., [<reflink idref="bib77" id="ref46">77</reflink>]). Therefore, further research is warranted to investigate how parenting stress is related to different types of parenting behaviors, particularly those specific to ASD within Chinese families.</p> <p>Based on the available literature evidence, it is possible that parental affective symptoms play a mediating role in the relationship between parental stress and parenting behaviors among parents of children with ASD. Studies have indicated that between one-fourth and two-thirds of parents of children with ASD exhibit symptoms of depression, and a third to nearly half display symptoms of anxiety (Bitsika et al., [<reflink idref="bib7" id="ref47">7</reflink>]; Machado et al., [<reflink idref="bib43" id="ref48">43</reflink>]). A considerable portion of parents had reached a clinical level of mental distress, particularly anxiety (Shepherd et al., [<reflink idref="bib67" id="ref49">67</reflink>]). In the context of Chinese collectivist culture, affiliate stigma in parents of children with autism was prevalent and severe; which was associated with higher levels of parental depression (Zhou et al., [<reflink idref="bib88" id="ref50">88</reflink>]). Parents of children with ASD are at higher risk of developing emotional symptoms, such as anxiety and depression, than parents of TD children or children with other neurodevelopmental disorders (Blacher & Baker, [<reflink idref="bib8" id="ref51">8</reflink>]; Dale et al., [<reflink idref="bib20" id="ref52">20</reflink>]; Gunes & Ekinci, [<reflink idref="bib30" id="ref53">30</reflink>]; Kütük et al., [<reflink idref="bib37" id="ref54">37</reflink>]; Lee et al., [<reflink idref="bib39" id="ref55">39</reflink>]; Olson et al., [<reflink idref="bib54" id="ref56">54</reflink>]; Sawyer et al., [<reflink idref="bib62" id="ref57">62</reflink>]; Teague et al., [<reflink idref="bib72" id="ref58">72</reflink>]; Vahedparast et al., [<reflink idref="bib76" id="ref59">76</reflink>]; Yirmiya & Shaked, [<reflink idref="bib85" id="ref60">85</reflink>]).</p> <p>There has been consistent evidence that parental stress has a negative effect on parents' affective symptoms; that is, a higher level of parental stress is related to more anxiety and depression symptoms and higher risks of mood disorders (Cohrs & Leslie, [<reflink idref="bib18" id="ref61">18</reflink>]; Gong et al., [<reflink idref="bib29" id="ref62">29</reflink>]; McCloskey & Pei, [<reflink idref="bib47" id="ref63">47</reflink>]; Schiltz et al., [<reflink idref="bib63" id="ref64">63</reflink>]).</p> <p>Although the association between parenting stress and parental depression/anxiety has been extensively studied, there remains a gap in understanding how affective symptoms experienced by parents of children with ASD are linked to their parenting behaviors (Ventola et al., [<reflink idref="bib78" id="ref65">78</reflink>]). Research focusing on parents of TD children suggests that mothers suffering from depression or anxiety tend to show more signs of withdrawal and intrusiveness and less sensitivity during mother-child interactions, experience challenges and have difficulty in emotional exchange and regulation with their infants, and have difficulty in managing their own emotions (Beebe et al., [<reflink idref="bib6" id="ref66">6</reflink>], [<reflink idref="bib5" id="ref67">5</reflink>]; Carreras et al., [<reflink idref="bib12" id="ref68">12</reflink>]; Feldman et al., [<reflink idref="bib24" id="ref69">24</reflink>]; Field, [<reflink idref="bib25" id="ref70">25</reflink>]; Kaitz et al., [<reflink idref="bib35" id="ref71">35</reflink>]; Pratt et al., [<reflink idref="bib61" id="ref72">61</reflink>]; Tronick & Reck, [<reflink idref="bib73" id="ref73">73</reflink>]; S. L. Warren et al., [<reflink idref="bib82" id="ref74">82</reflink>]). Parents with anxiety symptoms tend to be more critical and less likely to encourage autonomy (Hirshfeld et al., [<reflink idref="bib33" id="ref75">33</reflink>]; Turner et al., [<reflink idref="bib74" id="ref76">74</reflink>]; Whaley et al., [<reflink idref="bib83" id="ref77">83</reflink>]), while depressed parents are more indifferent and lack attention toward their children (Schiltz et al., [<reflink idref="bib63" id="ref78">63</reflink>]). Moreover, postpartum depression has been associated with feelings of desperation and sadness and obsessive thoughts, which are liable to generate ideas of suicide and violent behavior toward the infant (O'Hara & McCabe, [<reflink idref="bib53" id="ref79">53</reflink>]). Inspired by research findings in TD children, we hypothesized that parental affective symptoms might mediate the association between parental stress and parenting behaviors for parents of children with ASD; however, depression and anxiety might be linked to distinct types of parenting behaviors.</p> <p>Overall, research on the effects of parenting stress and parent affective symptoms on different types of parenting behaviors among families of children with ASD was limited. Considering the importance of parenting in the development of children with ASD, it is reasonable to investigate the relationship between parenting stress, affective symptoms, and parenting behaviors specifically among families of children with ASD, as this can provide valuable insights for interventions and support strategies.</p> <hd id="AN0180919752-3">Current Study</hd> <p>The aim of the current study was to examine the links between parental stress and parenting behaviors, encompassing both general parenting behaviors and those specific to children with ASD, and to examine the mediating effect of parent affective symptoms (i.e., anxiety and depression) in the association. This study extended previous research by (<reflink idref="bib1" id="ref80">1</reflink>) utilizing instruments that assess ASD-specific parenting in addition to general parenting behaviors, thereby investigating the effects of parenting stress and affective symptoms on different types of parenting behaviors, and (<reflink idref="bib2" id="ref81">2</reflink>) separately examining the mediating role of parental anxiety and depression to delineate different mediating pathways.</p> <p>Based on the previous literature, we hypothesized that (<reflink idref="bib1" id="ref82">1</reflink>) higher levels of parental stress would be predictive of greater symptoms of anxiety and depression and (<reflink idref="bib2" id="ref83">2</reflink>) parental stress would indirectly influence parenting behaviors through the mediation of parental anxiety or depression symptoms. Specifically, higher levels of parental anxiety might be more related to greater negative control behaviors, while elevated parental depression might be more related to reduced adaptive parenting behaviors and ASD-specific behaviors. The hypothesized mediation model is shown in Figure 1.</p> <p>Graph: Figure 1. The framework of the present study.</p> <hd id="AN0180919752-4">METHOD</hd> <p></p> <hd id="AN0180919752-5">Participants</hd> <p>A total of 185 parents of children with ASD participated in this cross-sectional survey. Among them, 145 (78.4%) were mothers, and 40 (21.6%) were fathers. The average age of the parents was 35.34 years old (SD = 4.97; range: 24–58). For their children, 149 (80.5%) were boys, and 36 (19.5%) were girls. The age of the children ranged from 2 to 14 years old, and the average age was 4.79 years old (SD = 2.15). The average age of children at diagnosis was 2.95 years old (SD = 1.18). In addition, 136 (73.5%) children were receiving various interventions, including sensory integration training, play therapy, speech-therapy, physiotherapy, pharmacological treatment and traditional Chinese medicine treatment. Parents' marital status, education attainment and subjective socioeconomic status are displayed in Table 1.</p> <p>Table 1. Descriptive characteristics of participants(<emph>n</emph> = 185).</p> <p> <ephtml> <table><thead><tr><td>Variable</td><td><italic>M/n</italic></td><td><italic>SD/%</italic></td></tr></thead><tbody><tr><td><bold>child</bold></td><td><bold>gender</bold></td><td /></tr><tr><td /><td>male</td><td>149</td><td>80.5%</td></tr><tr><td>female</td><td>36</td><td>19.5%</td></tr><tr><td><bold>age</bold></td><td>4.79</td><td>2.15</td></tr><tr><td /><td><bold>age at diagnosis</bold></td><td>2.95</td><td>1.18</td></tr><tr><td /><td><bold>whether received intervention</bold></td><td /><td /></tr><tr><td /><td>yes</td><td>136</td><td>73.5%</td></tr><tr><td /><td>no</td><td>49</td><td>26.5%</td></tr><tr><td><bold>parents</bold></td><td><bold>gender</bold></td><td /><td /></tr><tr><td>male</td><td>40</td><td>21.6%</td></tr><tr><td>female</td><td>145</td><td>78.4%</td></tr><tr><td><bold>age</bold></td><td>35.34</td><td>4.97</td></tr><tr><td><bold>whether having more than one child</bold></td><td /><td /></tr><tr><td>yes</td><td>85</td><td>45.9%</td></tr><tr><td>no</td><td>100</td><td>54.1%</td></tr><tr><td><bold>education attainment</bold></td><td /></tr><tr><td>junior high school and below</td><td>14</td><td>7.6%</td></tr><tr><td>senior high school</td><td>21</td><td>11.4%</td></tr><tr><td>junior college</td><td>36</td><td>19.5%</td></tr><tr><td>bachelor degree</td><td>85</td><td>45.9%</td></tr><tr><td>master's degree and above</td><td>29</td><td>15.7%</td></tr><tr><td><bold>marital status</bold></td><td /></tr><tr><td>married</td><td>181</td><td>97.8%</td></tr><tr><td>divorced</td><td>4</td><td>2.2%</td></tr><tr><td><bold>subjective socioeconomic status</bold></td><td /><td /></tr><tr><td>Above average</td><td>19</td><td>10.3%</td></tr><tr><td>On average</td><td>108</td><td>58.4%</td></tr><tr><td>below average</td><td>58</td><td>31.4%</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. Demographic information was incomplete in one parent and seven children (1 missing data in parents' age, 7 missing data in child's age at diagnosis).</p> <hd id="AN0180919752-6">Measures</hd> <p></p> <hd id="AN0180919752-7">Demographic Questionnaire</hd> <p>Parents completed a questionnaire that included basic demographic information, such as the gender and age of both the parent and child, the age of the child at diagnosis, intervention experience, parental marital status, education level, number of children and subjective socioeconomic status (SES). Parents rated their family's local socioeconomic status on a 5-point scale ranging from 1 (lowest) to 5 (highest). Participants who rated their SES as 1 or 2 were categorized as below average, while those who rated it as 4 or 5 were categorized as above average because very few parents rated the SES at the two extreme points in this survey.</p> <hd id="AN0180919752-8">Autism Parenting Stress Inventory (APSI)</hd> <p>The Autism Parenting Stress Inventory (APSI) was utilized to assess parenting stress related to ASD. This inventory comprised 13 items rated on a 5-point rating (not stressful = 1, so stressful sometimes we feel we can't cope = 5), aiming to measure the specific parenting stress in relation to core and comorbid symptoms of autism (Silva & Schalock, [<reflink idref="bib69" id="ref84">69</reflink>]). The APSI encompasses three dimensions: core deficits, comorbid behavioral symptoms, and comorbid physical symptoms. A total score was computed, with higher scores indicating greater severity of ASD-related parenting stress. The Chinese version of the APSI demonstrated good reliability (Cheung & Yeung, [<reflink idref="bib15" id="ref85">15</reflink>]), with a Cronbach's α of.84 in the present sample.</p> <hd id="AN0180919752-9">The Chinese Version of the Parental Behavior Scale for Autism Spectrum (C-PBS-A)</hd> <p>The Chinese version of the Parental Behavior Scale for Autism Spectrum (C-PBS-A) is a 41-item questionnaire used to measure parenting behaviors in the ASD population (Zhang et al., [<reflink idref="bib87" id="ref86">87</reflink>]). It assesses seven specific behaviors, including positive parenting, rules, material rewarding, punishment and discipline, promoting planning and cognitive flexibility, promoting social emotional cognition and visual aids. The frequencies of these behaviors are rated on a 5-point Likert scale ((almost) never = 1, (almost) always = 5). The seven behaviors can be aggregated into three composite scores: support (positive parenting, rules and material rewarding), negative control (punishment and discipline) and ASD-specific parenting (promoting planning and cognitive flexibility, promoting social emotional cognition and visual aids). The Cronbach's αs of the seven behaviors in the present sample ranged from.65 to.88, and the Cronbach's αs of the three composite subscales were.88 (support).84 (negative control), and.88 (ASD-specific parenting).</p> <hd id="AN0180919752-10">The Depression Anxiety and Stress Scale-21</hd> <p>The Depression Anxiety and Stress Scale-21 (DASS-21) is a 21-item self-report questionnaire used to measure the levels of depression, anxiety, and stress. The DASS-21 consists of three subscales: the depression subscale (DASS21-D), anxiety scale (DASS21-A) and stress scale (DASS21-S). Each subscale has 7 items, and it is possible to use a separate subscale (Bottesi et al., [<reflink idref="bib11" id="ref87">11</reflink>]). Participants were asked to rate each item from 1 (did not apply to me at all) to 4 (applied to me most of the time). The Chinese version of the DASS-21 showed good reliability and validity in Chinese mainland adult samples (Lu et al., [<reflink idref="bib42" id="ref88">42</reflink>]; Gonget al., [<reflink idref="bib28" id="ref89">28</reflink>]). The present study used the depression and anxiety subscales, and Cronbach's αs in the present sample were.89 (anxiety) and 0.94 (depression).</p> <hd id="AN0180919752-11">Procedure</hd> <p>The present study was approved by the University of Peking University Health Science Center Institutional Review Board. Convenience sampling was employed in the present study. Parents of children with ASD were recruited through posters displayed in an integrated education kindergarten and a rehabilitation hospital in Beijing as well as an internet forum for ASD. The inclusion criteria were as follows: (<reflink idref="bib1" id="ref90">1</reflink>) the child had been diagnosed with ASD from either a psychiatrist or pediatrician; (<reflink idref="bib2" id="ref91">2</reflink>) the child's age ranged from 2–18 years old; and (<reflink idref="bib3" id="ref92">3</reflink>) parents were primary caregivers of the child with ASD. The exclusion criteria consisted of (<reflink idref="bib1" id="ref93">1</reflink>) comorbid psychiatric diagnoses or significant physical illnesses in the child and (<reflink idref="bib2" id="ref94">2</reflink>) severe physical or mental illness in the parent.</p> <p>A total of 185 participants completed the online questionnaires. Prior to the survey, informed consent was obtained from each participant. To mitigate social desirability bias, participants were told that there were no correct or wrong answers and emphasized providing honest responses in the instructions of the online questionnaires. All questionnaires were submitted anonymously, and each participant received financial compensation upon completion.</p> <hd id="AN0180919752-12">Statistical Analyses</hd> <p>The data were analyzed using SPSS 23 and the process macro. Independent samples t tests were conducted to examine differences in parental stress, affective symptoms and parenting behaviors on the gender of both the child and parent. One-way ANOVAs were conducted to examine the effects of parental education level and subjective socioeconomic status on parental stress, affective symptoms and parenting behaviors. Pearson correlations were calculated to examine correlations among the main variables (children's age, parenting stress, depression, anxiety, and parenting behaviors). Multiple regressions and bootstrap analyses were conducted to examine the hypothesized model and the mediating effects of affective symptoms (anxiety/depression) among parents between parental stress and parenting behaviors.</p> <hd id="AN0180919752-13">RESULTS</hd> <p></p> <hd id="AN0180919752-14">Demographic Differences in Parenting Stress, Affective Symptoms and Parenting Behaviors</hd> <p>The results of independent samples t tests showed that the scores of parental stress, affective symptoms and parenting behaviors did not differ between parents of boys and parents of girls (all <emph>p</emph> >.05). Moreover, there were no significant differences in parenting stress, affective symptoms or parenting behaviors between fathers and mothers (all <emph>p</emph> >.05).</p> <p>The results of ANOVAs revealed significant effects of parental education level on parental anxiety (F (<reflink idref="bib4" id="ref95">4</reflink>, 180) = 3.42, <emph>p</emph> <.05), depression (F (<reflink idref="bib4" id="ref96">4</reflink>, 180) = 4.27, <emph>p</emph> <.01), parental support (F (<reflink idref="bib4" id="ref97">4</reflink>, 180) = 8.81, <emph>p</emph> <.01) and ASD-specific parenting behaviors (F (<reflink idref="bib4" id="ref98">4</reflink>, 180) = 3.45, <emph>p</emph> <.01). Post hoc analyses indicated that parents with a master's degree or higher reported lower levels of anxiety than parents with junior high school and below or a bachelor's degree (<emph>p</emph> <.05). Similarly, parents with a master's degree and above reported lower levels of depression than parents with bachelor's degrees and below, except for those who had completed senior high school education (<emph>p</emph> <.05). Regarding parenting behaviors, parents with a master's degree and above reported higher scores in terms of parental support than other parents with a bachelor's degree and below; meanwhile, parents with junior high school education and below reported the lowest scores of support in comparison with other parents. In addition, parents with a master's degree and above reported higher scores in ASD-specific parenting than those with a bachelor's degree and below, except for those who had completed junior college education attainment (<emph>p</emph> <.05).</p> <p>Parents reporting various SES significantly differed in terms of parental stress (F (<reflink idref="bib2" id="ref99">2</reflink>, 182) = 4.34, <emph>p</emph> <.05), anxiety (F (<reflink idref="bib2" id="ref100">2</reflink>, 182) = 6.73, <emph>p</emph> <.01), depression (F (<reflink idref="bib2" id="ref101">2</reflink>, 182) = 6.68, <emph>p</emph> <.01) and the support dimension of parenting behaviors (F (<reflink idref="bib2" id="ref102">2</reflink>, 182) = 3.81, <emph>p</emph> <.05). Post hoc analyses indicated that parents with above-average SES reported lower levels of anxiety and depression and exhibited more supportive parenting behaviors compared to parents with on or below average SES levels (<emph>p</emph> <.05). Parents with average SES reported lower levels of parental stress than those with below-average SES levels (<emph>p</emph> <.05).</p> <hd id="AN0180919752-15">Correlation Analysis Between Child Age, Parent Age, Parenting Stress, Affective Symptoms and...</hd> <p>As shown in Table 2, parenting stress exhibited moderate positive correlations with parental anxiety (<emph>r</emph> =.39, <emph>p</emph> <.01) and depression (<emph>r</emph> =.39, <emph>p</emph> <.01). It demonstrated significant correlations with three types of parenting behaviors in the C-PBS-A. Specifically, it displayed a moderate negative correlation with Support (<emph>r</emph> = −.30, <emph>p</emph> <.01), a low positive correlation with Negative Control (<emph>r</emph> =.25, <emph>p</emph> <.01), and a low negative correlation with ASD-specific Parenting (<emph>r</emph> = −.26, <emph>p</emph> <.01). Furthermore, parental anxiety and depression had low positive correlations with Negative Control (r<subs>anxiety</subs> =.20, <emph>p</emph> <.01, r<subs>depression</subs> =.17, <emph>p</emph> <.05) and low to moderate negative correlations with Support and ASD-specific Parenting, with r ranging from −.29 to −.35, <emph>p</emph> <.01.</p> <p>Table 2. Correlations among APSI, DASS and C-PBS-A.</p> <p> <ephtml> <table><thead><tr><td /><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>Score Range</italic></td><td>1</td><td>2</td><td>3</td><td>4</td><td>5</td><td>6</td><td>7</td></tr></thead><tbody><tr><td>1 child age</td><td>4.79</td><td>2.15</td><td>2-14</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>2 parents age</td><td>35.34</td><td>4.97</td><td>24-58</td><td>.44**</td><td /><td /><td /><td /><td /><td /></tr><tr><td>3 Parental Stress</td><td>34.12</td><td>9.49</td><td>14-63</td><td>.12</td><td>.09</td><td /><td /><td /><td /><td /></tr><tr><td>4 Anxiety</td><td>11.48</td><td>4.55</td><td>7-28</td><td>.14</td><td>−.05</td><td>.39**</td><td /><td /><td /><td /></tr><tr><td>5 Depression</td><td>12.51</td><td>5.38</td><td>7-28</td><td>.13</td><td>.00</td><td>.39**</td><td>.87**</td><td /><td /><td /></tr><tr><td>6 Support</td><td>73.04</td><td>9.92</td><td>24-93</td><td>.01</td><td>.09</td><td>−.30**</td><td>−.33**</td><td>−.35**</td><td /><td /></tr><tr><td>7 Negative Control</td><td>21.22</td><td>5.88</td><td>10-35</td><td>.20**</td><td>.06</td><td>.25**</td><td>.20**</td><td>.17*</td><td>−.19*</td><td /></tr><tr><td>8 ASD-specific Parenting</td><td>37.77</td><td>8.36</td><td>13-56</td><td>.04</td><td>.14</td><td>−.26**</td><td>−.29**</td><td>−.33**</td><td>.64**</td><td>−0.10</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. * Statistically significant with two-tailed p-value <.05, ** Statistically significant with two-tailed p-value <.01.</p> <hd id="AN0180919752-16">Model Testing</hd> <p>For the purpose of examining the hypothesized mediation model, Model 4 of the process macro ((Hayes & Scharkow, [<reflink idref="bib31" id="ref103">31</reflink>]) was used. Parental stress was used as the predictor, anxiety/depression as the mediator, and parenting behaviors (support/negative control/ASD-specific parenting) as the criterion. SES, parents' age, gender and education attainment, and children's age and gender were included as covariates. Six models were tested separately. A nonparametric bootstrapping method (<emph>n</emph> = 5,000) was used, with a 95% confidence interval calculated using the bias-corrected bootstrapping method.</p> <p>All the models significantly predicted parenting behaviors. The R<sups>2</sups> of the total effect model ranges between.13 and.21. The standardized path coefficients of the mediation models are shown in Figure 2. A higher level of parental stress was significantly associated with elevated parental anxiety/depression and was also significantly associated with heightened parental negative control behaviors, reduced parental supportive behaviors and reduced ASD-specific parenting behaviors. Parental anxiety/depression was negatively related to parental support and ASD-specific parenting behaviors; however, their associations with parental negative control were not significant.</p> <p>Graph: Figure 2. Mediation model.</p> <p>The results of the mediating analyses are shown in Table 3. The mediating effect of parental affective symptoms was significant in the following four mediation models: the stress-anxiety-support model (Model 1), stress-depression-support model (Model 2), stress-anxiety-ASD-specific parenting model (Model 5) and stress-depression-ASD-specific parenting model (Model 6). The direct effect and indirect effect were all significant in the four models. That is, parental stress was negatively related to supportive parenting behaviors and ASD-specific parenting behaviors through the mediation of parental anxiety and depression.</p> <p>Table 3. Direct and indirect effects in the mediation models.</p> <p> <ephtml> <table><thead><tr><td>Model</td><td>Type</td><td /><td>Path</td><td>Effect</td><td>SE</td><td>95%CI</td></tr><tr><td>LL</td><td>UL</td></tr></thead><tbody><tr><td>1 Stress-Anxiety −Support</td><td>Partial mediation</td><td>Direct effect</td><td>Stress-Support</td><td>−.21</td><td>.08</td><td>−.364</td><td>−.062</td></tr><tr><td>Indirect effect</td><td>Stress-Anxiety-Support</td><td>−.07</td><td>.03</td><td>−.139</td><td>−.013</td></tr><tr><td>Total effect</td><td /><td>−.28</td><td>.07</td><td>−.425</td><td>−.139</td></tr><tr><td>2 Stress-Depression −Support</td><td>Partial mediation</td><td>Direct effect</td><td>Stress-Support</td><td>−.21</td><td>.08</td><td>−.363</td><td>−.062</td></tr><tr><td>Indirect effect</td><td>Stress-Depression-Support</td><td>−.07</td><td>.03</td><td>−.146</td><td>−.012</td></tr><tr><td>Total effect</td><td /><td>−.28</td><td>.07</td><td>−.425</td><td>−.139</td></tr><tr><td>3 Stress-Anxiety −Negative Control</td><td>Absent</td><td>Direct effect</td><td>Stress-Negative Control</td><td>.19</td><td>.08</td><td>.031</td><td>.342</td></tr><tr><td>Indirect effect</td><td>Stress-Anxiety-Negative Control</td><td>.03</td><td>.04</td><td>−.031</td><td>.111</td></tr><tr><td>Total effect</td><td /><td>.21</td><td>.07</td><td>.068</td><td>.358</td></tr><tr><td>4 Stress-Depression −Negative Control</td><td>Absent</td><td>Direct effect</td><td>Stress-Negative Control</td><td>.20</td><td>.08</td><td>.045</td><td>.356</td></tr><tr><td>Indirect effect</td><td>Stress-Depression-Negative Control</td><td>.01</td><td>.04</td><td>−.052</td><td>.096</td></tr><tr><td>Total effect</td><td /><td>.21</td><td>.07</td><td>.068</td><td>.358</td></tr><tr><td>5 Stress-Anxiety -ASD-specific Parenting</td><td>Partial mediation</td><td>Direct effect</td><td>Stress-ASD-specific Parenting</td><td>−.17</td><td>.08</td><td>−.329</td><td>−.014</td></tr><tr><td>Indirect effect</td><td>Stress-Anxiety-ASD-specific Parenting</td><td>−.06</td><td>.03</td><td>−.132</td><td>−.007</td></tr><tr><td>Total effect</td><td /><td>−.23</td><td>.08</td><td>−.383</td><td>−.086</td></tr><tr><td>6 Stress-Depression -ASD-specific parenting</td><td>Partial mediation</td><td>Direct effect</td><td>Stress-ASD-specific Parenting</td><td>−.16</td><td>.08</td><td>−.311</td><td>.000</td></tr><tr><td>Indirect effect</td><td>Stress-Depression-ASD-specific Parenting</td><td>−.08</td><td>.03</td><td>−.154</td><td>−.020</td></tr><tr><td>Total effect</td><td /><td>−.23</td><td>.08</td><td>−.383</td><td>−.086</td></tr></tbody></table> </ephtml> </p> <p>As displayed in Table 3, the indirect effects of parental anxiety and depression on the relationship between parental stress and negative control behaviors were not significant (see Model 3 and Model 4). However, the direct effect of parental stress was significant in both models.</p> <hd id="AN0180919752-17">DISCUSSION</hd> <p>The present study investigated the relationship between ASD-related parental stress, parents' affective symptoms (anxiety and depression), and parenting behaviors in the population of Chinese parents of children with ASD.</p> <p>Consistent with prior research, this study found that parents with higher education levels and subjective economic status experienced lower levels of stress, anxiety and depression problems and displayed more supportive parenting behaviors (Dolev et al., [<reflink idref="bib22" id="ref104">22</reflink>]; S. F. Warren & Brady, [<reflink idref="bib81" id="ref105">81</reflink>]; Zaidman-Zait et al., [<reflink idref="bib86" id="ref106">86</reflink>]). These findings corroborate previous evidence suggesting that higher educational level and socioeconomic status serve as protective factors for parenting. Although this phenomenon is also observed in families of TD children, its significance might be amplified for families raising children with ASD. This is because of the additional challenges faced by these parents, such as acquiring knowledge about ASD etiology, symptoms and intervention. It is worth noting that Chinese families of children with ASD currently experience limited and unequal access to medical and rehabilitation services. Consequently, they heavily rely on their own abilities to seek medical resources for their children (McCabe, [<reflink idref="bib45" id="ref107">45</reflink>]). These results also highlight the importance of enhancing educational programs targeting parents with lower education levels and socioeconomic statuses within autism rehabilitation services. These parents are likely to experience heightened stress levels while facing greater threats to their mental well-being. Improving their knowledge and abilities to cope with autism conditions could effectively reduce parental stress levels, alleviate psychological symptoms, and enhance overall parenting quality.</p> <p>In the present study, no significant relationship was found between child age and parenting stress. This result was inconsistent with some research suggesting higher levels of parenting stress in parents of younger children with ASD (Barker et al., [<reflink idref="bib3" id="ref108">3</reflink>]; Lounds et al., [<reflink idref="bib41" id="ref109">41</reflink>]; Smith et al., [<reflink idref="bib70" id="ref110">70</reflink>]). However, previous studies examining the relationship between child age and parenting stress have yielded inconsistent results. For example, Orr et al. ([<reflink idref="bib57" id="ref111">57</reflink>]) found that mothers of middle childhood children (aged 6–12 years) reporting significantly higher levels of stress than mothers of preschool children (aged 2–5 years) and adolescents (aged 13–18 years) in mothers of children with developmental delays. There are also studies that did not find a significant correlation between child age and parenting stress (McStay et al., [<reflink idref="bib49" id="ref112">49</reflink>]; Peters-Scheffer et al., [<reflink idref="bib60" id="ref113">60</reflink>]). McStay et al. ([<reflink idref="bib49" id="ref114">49</reflink>]) argues that the absent association between child age and parenting stress suggests that a child's stage of development does not influence parental perceptions on their parenting skills. Another possible explanation for the nonsignificant correlation is that the narrow age range of children in this study (96.2% 10 years and below, 84.9% 6 years and below) may be insufficient to capture the full spectrum of the relationship between child age and parenting stress.</p> <p>Our results showed that parents' anxiety and depression symptoms increased when their stress increased; therefore, the first hypothesis was supported. This aligns with previous research indicating that heightened parental stress has a negative effect on their psychological wellbeing (Chan & Leung, [<reflink idref="bib13" id="ref115">13</reflink>]; Johnson et al., [<reflink idref="bib34" id="ref116">34</reflink>]; Wang et al., [<reflink idref="bib80" id="ref117">80</reflink>]). As indicated in Pearlin's ([<reflink idref="bib59" id="ref118">59</reflink>]) stress model, high parental pressure over a long period of time has the potential to impair parental coping mechanisms to increase the risk of developing mental problems (Gong et al., [<reflink idref="bib29" id="ref119">29</reflink>]; Meadan et al., [<reflink idref="bib50" id="ref120">50</reflink>]; Pearlin, [<reflink idref="bib59" id="ref121">59</reflink>]). This study extends upon previous research by specifically examining ASD-related parenting stress and its impact on parents' affective symptoms among families of children with ASD. These findings underscore the significance of self-care for parents of children with ASD, emphasizing the need for effective stress management and emotion regulation to protect their mental health.</p> <p>Partly supporting Hypothesis 2, we found significant mediating effects of parents' affective symptoms (anxiety and depression) in four models, that is, the stress-anxiety-support model, stress-depression-support model, stress-anxiety-ASD-specific parenting model and stress-depression-ASD-specific parenting model. These results suggest that heightened ASD-related parental stress was associated with reduced supportive and ASD-specific parenting behaviors through the mediation of parental anxiety and depression. According to the extant literature, when parents have relatively high affective problems, parenting is more likely to be low in warmth and sensitivity because anxiety and depression involve preoccupation with negative events, negative affectivity, stress intolerance, and/or low energy. These parents may be overinvolved and protective because they worry about negative events. If distressed parents lack energy or patience, they are less likely to use inductive reasoning (Bayer et al., [<reflink idref="bib4" id="ref122">4</reflink>]). The negative association between parental affective symptoms and positive parenting behaviors among parents of children with ASD was also reported in some other studies. For example, Schiltz et al. ([<reflink idref="bib63" id="ref123">63</reflink>]) found that higher levels of parental depressive symptoms were related to decreased parental involvement, and Wang et al. ([<reflink idref="bib79" id="ref124">79</reflink>]) found that higher levels of anxiety and depressive symptoms were associated with less mindful parenting behaviors ([<reflink idref="bib63" id="ref125">63</reflink>]). The present findings added to the literature that ASD-specific parenting behaviors were negatively impacted by ASD-related parenting stress via the mediation of parental anxiety and depression symptoms. When parents were preoccupied by depressive and anxious emotions, they could hardly take the perspective of the child and provide appropriate support to adjust to the environment or stimulate development.</p> <p>Inconsistent with Hypothesis 2, indirect effects were not significant in the stress-anxiety/depression-negative control models. It might be that the mean score of negative control was relatively low and the range of the score was narrow because of selection bias (parents who volunteered to participate in a parenting study might have a more positive parenting attitude) or reporting bias (parents might avoid reporting negative parenting behaviors), which may lead to the floor effect. Nevertheless, the direct effect of parenting stress on negative control behaviors was significant. Parental stress might induce negative emotions such as frustration and anger, which have a negative impact on mentalizing functioning at the moment and in turn lead to excessively strict parenting behaviors. Thus, the effect of parenting stress on negative control does not require the path of parental affective symptoms.</p> <p>In contrast to Hypothesis 2, the results did not reveal a distinction between depression and anxiety in predicting the three types of parenting behaviors. This lack of distinction may be attributed to the high collinearity between depression and anxiety symptoms in this population, as both symptoms often coexist and are closely related.</p> <hd id="AN0180919752-18">Strengths and Limitations</hd> <p>The findings of this study contribute new evidence elucidating the mechanisms underlying the influence of parenting stress on parenting behaviors among Chinese parents of children with ASD. Moreover, these results have important practical implications for comprehensive service to families of children with ASD. Given the important role of parenting in the socioemotional development of children with ASD and the detrimental effects of parenting stress and affective symptoms on parenting, it becomes imperative to assist parents in coping with stress properly and reducing anxiety and depression symptoms.</p> <p>This study had several limitations. First, the majority of the sample was composed of mothers, and the subjective socioeconomic status and education level of the respondents were relatively high. This may limit the generalizability of the findings to mothers with moderate to high subjective socioeconomic status and education levels. Second, the cross-sectional nature of the study limited our results to proving the causal relations between variables. Future studies should adopt a longitudinal research design to examine the in-depth relationship between variables. Third, although diagnosis of ASD was an inclusion criterion of participants, the diagnosis was not confirmed by the research team. Additionally, due to the lack of information on the severity of ASD symptoms, level of language abilities and nonverbal intelligence (IQ), the effects of these child factors on the parent-related variables could not be examined. It would be valuable to address these limitations and incorporate comprehensive assessments of ASD symptoms and associated child factors in future research.</p> <hd id="AN0180919752-19">CONCLUSION</hd> <p>Higher levels of ASD-related parental stress were significantly associated with lower levels of general supportive parenting behaviors and ASD-specific parenting behaviors and higher levels of negative control behaviors in Chinese parents of children with ASD. Parental stress directly predicted negative control parenting behaviors but was indirectly associated with supportive parenting behaviors and ASD-specific parenting behaviors through the mediation of parental depression and anxiety.</p> <hd id="AN0180919752-20">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0180919752-21">Ethics approval and consent to participate</hd> <p>All included patients gave their oral and written informed consent. The study was approved by the University of Peking University Health Science Center Institutional Review Board. All methods were performed in accordance with the relevant guidelines and regulations.</p> <hd id="AN0180919752-22">Availability of data and materials</hd> <p>The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.</p> <ref id="AN0180919752-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.).</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Baker, B. L., McIntyre, L. L., Blacher, J., Crnic, K., Edelbrock, C., & Low, C. (2003). Pre-school children with and without developmental delay: Behaviour problems and parenting stress over time. 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Header DbId: eric
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Association between Parenting Stress and Parenting Behaviors in Chinese Parents of Children with Autism Spectrum Disorders: The Mediating Role of Parental Anxiety and Depression
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Chang+Zhang%22">Chang Zhang</searchLink><br /><searchLink fieldCode="AR" term="%22Fu+Lin%22">Fu Lin</searchLink><br /><searchLink fieldCode="AR" term="%22Yanlin+Chen%22">Yanlin Chen</searchLink><br /><searchLink fieldCode="AR" term="%22Rui+Wang%22">Rui Wang</searchLink><br /><searchLink fieldCode="AR" term="%22Ting+Zhou%22">Ting Zhou</searchLink><br /><searchLink fieldCode="AR" term="%22Chunli+Yi%22">Chunli Yi</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Mental+Health+Research+in+Intellectual+Disabilities%22"><i>Journal of Mental Health Research in Intellectual Disabilities</i></searchLink>. 2024 17(4):275-296.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 22
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Child+Rearing%22">Child Rearing</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Attitudes%22">Parent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22China%22">China</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/19315864.2024.2401833
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1931-5864<br />1931-5872
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Parents of children with autism spectrum disorders (ASD) experience heightened levels of parenting stress and more affective symptoms. Although the relationship between parenting stress and mental health has been extensively studied, limited understanding exists regarding parenting behaviors and related factors. This study aimed to explore the role of parents' affective symptoms in the relationship between parenting stress and parenting behaviors among Chinese parents of children with ASD. Methods: A total of 185 parents participated in one online survey, reporting parenting behaviors, parenting stress, depression and anxiety symptoms. Results: (1) A higher level of parenting stress was associated with reduced positive parenting behaviors and increased negative parenting behaviors. (2) Parents' anxiety and depression symptoms mediated the relationship between parenting stress and positive parenting behaviors. Conclusion: Parenting stress has potential detrimental effects on parenting behaviors in Chinese parents of children with ASD through the mediation of parental depression and anxiety.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1449652
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1449652
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/19315864.2024.2401833
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 22
        StartPage: 275
    Subjects:
      – SubjectFull: Child Rearing
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Parent Attitudes
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Negative Attitudes
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: China
        Type: general
    Titles:
      – TitleFull: The Association between Parenting Stress and Parenting Behaviors in Chinese Parents of Children with Autism Spectrum Disorders: The Mediating Role of Parental Anxiety and Depression
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Chang Zhang
      – PersonEntity:
          Name:
            NameFull: Fu Lin
      – PersonEntity:
          Name:
            NameFull: Yanlin Chen
      – PersonEntity:
          Name:
            NameFull: Rui Wang
      – PersonEntity:
          Name:
            NameFull: Ting Zhou
      – PersonEntity:
          Name:
            NameFull: Chunli Yi
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 1931-5864
            – Type: issn-electronic
              Value: 1931-5872
          Numbering:
            – Type: volume
              Value: 17
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of Mental Health Research in Intellectual Disabilities
              Type: main
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