The Mediating Role of Parenting Stress in the Relations Between Parental Emotion Regulation and Parenting Behaviors in Chinese Families of Children with Autism Spectrum Disorders: A Dyadic Analysis

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

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.

Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BACKGROUND

Serious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.

METHODS

This cross-sectional descriptive-correlational study was carried out in May-November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients' demographic and clinical characteristics questionnaire, an FCs' demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).

RESULTS

CB had significant inverse relationship with secure AS (r = - 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).

CONCLUSION

This study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.

Parent Facilitation of Child Emotion Regulation in ASD: An Ecological Momentary Assessment Study

Parents play a substantial role in their children's emotion regulation (ER) abilities. Children with autism spectrum disorder (ASD) often have difficulties regulating their emotions, which can manifest as externalizing behavioral issues. Parents of children with ASD facilitate their children's ER development in response to unique challenges and stressors, often developing resiliency but other times contributing to their children's dysregulation and behavioral challenges. It is unclear how much momentary stress attenuates parents' emotional facilitation of child ER and its effect on child behavioral functioning. Using an ecological momentary assessment approach, the current study explores this process by considering how parents of children with ASD facilitate child ER through (1) parent ER ability, (2) emotion socialization style, and (3) expressed emotion. Multilevel models explored the relative influences of parent ER facilitation on the association between momentary parent stress and behavioral intensity. Results suggest that parent ER abilities and specific emotion socialization styles interact with momentary parent stress and child behavior, whereas emotional climate of the home impacts child behavior more directly. The role of parent ER facilitation in the context of parent stress and children with ASD and behavioral problems is complex and multifaceted. Implications for further supporting children's emotional development via parent involvement are discussed.

Effectiveness of a positive psychology and mindfulness-based app on mental health for parents of children with a neurodevelopmental disorder: study protocol of a pragmatic international randomized controlled trial

INTRODUCTION

Parents of children with a neurodevelopmental disorder (NDD) experience more stress than parents of typically developing children. In a cocreation process with experts and parents, a low-threshold application that uses exercises based on the principles of positive psychology and mindfulness was developed. This application, called "Adappt," aims at enhancing the ability to adapt of the parents and caregivers of children with NDDs and at supporting their mental health. This protocol describes the evaluation study of the effectiveness of Adappt, its core working mechanisms and user experiences.

METHOD

A pragmatic international multicenter randomized controlled trial will compare the effectiveness of Adappt with a (delayed) waitlist control condition. At least 212 parents or primary caregivers of children younger than 18 years diagnosed with or suspected of a NDD will be randomly assigned to the intervention or waitlist control condition. Participants are excluded if they have severe anxiety or depression levels or are in treatment for mental health issues. Measures will be collected online at baseline, post-intervention (1 month after baseline), and 4 and 7 months after baseline. The primary outcome is the improvement in generic sense of ability to adapt as measured with the Generic Sense of Ability to Adapt Scale (GSAAS; (Front Psychol 14:985408, 2023)) at 4-month follow-up. Secondary outcomes are mental well-being, (parental) distress, and client satisfaction with "Adappt."

DISCUSSION

Results of this study will contribute to knowledge on the effectiveness of a low-threshold application for parents of children with a NDD in multiple countries. If the application is found to be effective in improving mental health, recommendations will be made for implementation in health care.

TRIAL REGISTRATION

This study is registered on clinicaltrials.gov (NCT06248762) on February 8, 2024, and the Open Science Framework ( https://osf.io/5znqv ).

The mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants: Cross-sectional study

PURPOSE

This study aimed to examine the relationship of stress, mental resilience, and coping style, and the mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants.

DESIGN AND METHODS

A cross-sectional design was used. A total of 231 parents of children with cochlear implants were recruited from May 1, 2022, to February 28, 2023 at a comprehensive tertiary hospital and a cochlear implant rehabilitation center in China. Parenting Stress Index-Short Form (PSI-SF), the Connor-Davidson Resilience Scale (CD-RISC) and the Simplified Coping Style Questionnaire(SCSQ) were used to measure stress, mental resilience, and coping style respectively.

RESULTS

The mean score observed for PSI-SF, CD-RISC, active coping, and passive coping was 87.85 ± 24.59, 55.63 ± 16.11, 21.36 ± 6.73, and 9.05 ± 4.52, respectively. Mental resilience was a significant mediator explaining the effect of stress on active coping (β = -0.294; 95% bias-corrected bootstrap CI: -0.358 to -0.164).

CONCLUSIONS

Attention should be paid to the status of stress, mental resilience and coping style in parents of children with cochlear implants. Mental resilience mediated stress and coping style.

PRACTICE IMPLICATIONS

This study provides a theoretical basis for establishing an active coping care program for parents of children with cochlear implants. There is a need to identify strategies that can help increase the level of mental resilience of parents of children with cochlear implants and more subjective and objective social support should be provided to reduce their stress and to encourage active coping style.

Emotion regulation strategies on psychological distress and psychological well-being of caregivers of mentally challenged children: moderating role of social support

This study investigates the moderating role of social support in the relationship between emotion regulation, psychological distress, and psychological well-being of caregivers of mentally challenged children. A total of 315 caregivers aged 18-62 (Mage = 36.99, SD = 9.90; 38.7% male, 61.3% female) completed the Emotion Regulation Questionnaire, Multidimensional Scale of Perceived Social Support, Depression Anxiety Stress Scale, and Psychological Well-being Scale. The results indicated that social support significantly moderated the relationship between cognitive reappraisal, expressive suppression, and psychological well-being. However, the moderating effect of social support in the relationship between cognitive reappraisal, expressive suppression, and psychological distress was insignificant. The findings suggest that caregivers of mentally challenged children with high social support will report higher psychological well-being when they adopt cognitive reappraisal and expressive suppression strategies.

Improving early detection, diagnosis and intervention for children with autism spectrum disorder: A cross-sectional survey in China

BACKGROUND

Detection and diagnosis of autism spectrum disorder (ASD) are prerequisites for early interventions. However, few studies focused on this topic.

AIM

This study aims to characterize the timing from symptom detection to intervention in children with ASD and identify predictors of age at ASD diagnosis, presence of intervention, and the time lag between detection and diagnosis.

METHODS AND PROCEDURES

A cross-sectional survey was conducted with 303 parents (111 fathers and 192 mothers, 21-54 years) of children with ASD in Guangzhou, China.

OUTCOMES AND RESULTS

The median time from symptom observation to the first doctor visit was 3 months, while the time to ASD diagnosis averaged 6 months. Most children (76.24 %) were diagnosed within one year after detection, and 25.58 % had no intervention after diagnosis. Predictors of earlier ASD diagnosis included ASD-related symptoms identified at an older age, less serious symptoms, and initial symptoms with atypical motor development and sensory anomalies. ASD-related symptoms observed at an older age, initial symptoms with social deficits, sensory anomalies, and without language impairment, primary caregivers other than parents, families with lower income, and less social support utilization increased the odds of a time lag between detection and diagnosis. Children with fathers having lower education were less likely to receive interventions.

CONCLUSIONS AND IMPLICATIONS

Earlier ASD identification and intervention might be facilitated by health education on typical symptoms of ASD for parents with young children and incorporating ASD screening during routine health examinations for children. For children whose primary caregivers are not their parents and from lower-income families, additional support may be required for timely diagnosis after reporting ASD-related symptoms. Moreover, more intervention supports are expected for children whose fathers have lower education levels. Helping families take full advantage of support is also important for early diagnosis and intervention.

What happened to parents' views of school success for autistic children during the COVID-19 pandemic?

Background

The educational views of parents with autistic children directly impacts their children's academic success. However, little research has been done on how the COVID-19 pandemic impacted parents' academic and social views.

Aim

This study analyzes parents' views of school success for their autistic children in the context of the COVID-19 pandemic and examines the relationships among pandemic stress, parental involvement, and parents' views of school success for autistic children in mainland China.

Methods

In this study, 713 parents of autistic children completed measures assessing their pandemic stress, parental involvement, and views of school success; linear regression and structural equation modeling were used to analyze the data.

Results

Parents' views of school success were influenced by factors such as parents' level of education, household income, parents' gender, and children's age. The effects of pandemic stress on views of school success for parents of autistic children are complex: physical and mental reaction has a negative direct effect on views of school success, a positive indirect effect mediated by parental involvement, and a net positive effect; risk perception and concern has a negative indirect effect; and both the direct and indirect effects of pragmatic hopefulness are positive. Education policymakers and practitioners need to seriously and carefully assess these results' implications for modern, inclusive education.

Emotion regulation, parental stress and family functioning: Families of children with disabilities vs normative families

Childhood disability is a major challenge for families. The aim of the present study was to explore differences between families of children with disabilities and normative families, analyzing the association of emotion dysregulation with relationship satisfaction, through parental stress and interparental conflict, using supportive dyadic coping by oneself (SDCO) as a moderator. For a sample of 445 Romanian parents, results showed higher levels of parental stress and interparental conflict and lower relationship satisfaction in families of children with disabilities compared to normative families, as well as a direct relationship between parental stress and relationship satisfaction and a stronger direct effect for SDCO with relationship satisfaction. For normative families, SDCO moderated the relationship between emotion dysregulation and parental stress, and for families of children with disabilities SDCO interacted on the link between emotion dysregulation and relationship satisfaction. Only families of children with disabilities presented indirect effects between emotion dysregulation and relationship satisfaction through parental stress, moderated by SDCO. These effects increased in impact as the use of SDCO was higher. Conditional indirect effects by SDCO were also found for the link between emotion dysregulation and relationship satisfaction through interparental conflict for both families, with this effect being higher in families of children with disabilities. These findings highlight the need to implement specific programs that can adjust to the needs of these families, strengthening parents' emotional competencies, as well as stress and conflict management abilities.

Factors related to parenting styles of Chinese mothers of children with and without intellectual disability

BACKGROUND

Parenting styles play a crucial role in children's development. However, approaches to parenting children with intellectual disability (ID) beyond Western cultures have been underexamined. This study compared the self-reported parenting styles of Chinese mothers of children with and without ID and examined some factors that might be related.

METHODS

Chinese mothers of children with ID (n = 173) and mothers of typically developing children (n = 119) completed measures of their parenting style, parenting stress, parenting sense of competence and family support.

RESULTS

Both groups endorsed similar levels of authoritative parenting, but mothers of children with ID were more likely to report adopting strategies aligned with authoritarian parenting. For mothers in the ID group, family support moderated the effects of parenting stress and parenting sense of competence on authoritative parenting. Parenting stress and parenting sense of competence, respectively, predicted authoritarian parenting for mothers of children with and without ID.

CONCLUSIONS

This study highlights the importance of reducing parenting stress, strengthening parenting sense of competence and providing family support in order to promote optimal parenting styles for Chinese mothers of children with ID.

Examining indicators of psychosocial risk and resilience in parents of autistic children

Background

Parents of autistic children experience increased levels of caregiver strain and adverse mental health outcomes, even in comparison to parents of children with other neurodevelopmental disabilities. Previous studies have largely attributed these increased levels of mental health concerns to their child behavioral concerns and autism symptomatology, but less attention has been given to other potential child factors, such as child adaptive functioning. Additionally, little is known about potential protective factors, such as parents' emotion regulation (ER) abilities, that may ameliorate the experience of caregiver strain, anxiety, and depression.

Objective

The current study examined the impact of child characteristics (restricted and repetitive behaviors, adaptive functioning and behavioral concerns) on parent mental health outcomes (caregiver strain, anxiety, depression and wellbeing). Additionally, we explore parents' ER abilities as a moderator of the impact of child characteristic on parents' mental health outcomes.

Results

Results of linear mixed effect models indicated a significant relationship between parents' ER abilities and all four parent outcomes. Additionally, children's adaptive functioning abilities and repetitive behaviors (RRBs) were significant predictors of caregiving strain. Parents' ER abilities were a significant moderator of the effect of children's repetitive behaviors and adaptive functioning challenges on caregiver strain, such that better ER abilities mitigated the impact of child clinical factors on caregiver strain. Finally, a significant difference was detected for mothers' and fathers' mental health, with mothers reporting higher caregiver strain, and more symptoms of anxiety and depression than did fathers.

Conclusion

This study leveraged a large sample of autistic children and their biological parents to examine the relationship between children's clinical characteristics and parents' psychological wellbeing. Results indicate that, although parents of autistic children do experience high rates of internalizing mental health concerns that relate to child adaptive functioning and RRBs, parent ER abilities act as a protective factor against parents' adverse mental health outcomes. Further, mothers in our sample reported significantly higher rates of depression, anxiety, and caregiver strain, as compared with fathers.

Examining the Mediating Role of Mindful Parenting: A Study on the Relationship Between Parental Emotion Regulation Difficulties and Problem Behaviors of Children with ASD

Parental emotion regulation plays a vital role in the parent-child relationship. This study examines the mediating role of mindful parenting in the relationship between parental emotion regulation difficulties and problem behaviors of children with autism spectrum disorder (ASD). The study was conducted with 273 parents of children with ASD in Istanbul. The study findings revealed a significant yet negative correlation between mindful parenting and emotion regulation difficulty and problem behaviors. The study model highlighted that emotion regulation difficulties significantly predicted mindful parenting and the child's problem behavior, whereas mindful parenting significantly predicted the child's problem behavior. Additionally, the study findings indicated that mindful parenting was a partial mediator.

Father trait anger: Associations with father–infant bonding and subsequent parenting stress

Introduction

Parent anger presents a risk to family safety and child development. Father trait anger may also compromise the early relational context of fathers and offspring, yet evidence is lacking. The aim of this study is to examine effects of father trait anger on parenting stress in the toddler years, and the mediational role of father–infant bonding.

Method

Data were from 177 Australian fathers of 205 children. Trait anger (total, angry temperament, and angry reaction), father–infant bonding subscales (patience and tolerance, affection and pride, and pleasure in interaction), and subsequent parenting stress (parental distress, difficult child, and parent–child dysfunctional interaction) were assessed. At each of the subscale levels, mediational path models examined whether father–infant bonding explained the relationship between trait anger and parenting stress. Models were presented where there was at least a small association between the mediator and both the predictor and outcome.

Results

Patience and tolerance was the only domain of father–infant bonding correlated with both trait anger and all parenting stress outcomes. Patience and tolerance partially mediated the effect of total trait anger on parental distress and fully mediated effects on difficult child and parent–child dysfunctional interaction. Patience and tolerance fully mediated relationships between angry temperament and all domains of parenting stress. Angry reactions only had a direct effect on parental distress.

Discussion

Father trait anger both directly and indirectly (through patience and tolerance in the father–infant bond) impacts their experiences of parenting stress in the toddler years. Early interventions to manage father trait anger and improve father–infant bonding may benefit fathers and children.

Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions

Behavior disorders (BDs) are common and costly, making prevention and early-intervention a clinical and public health imperative. Behavioral Parent Training (BPT) is the standard of care for early-onset (3-8 years old) BDs, yet effect sizes vary and wane with time suggesting the role of underlying factors accounting for variability in outcomes. The literature on emotion regulation (ER), which has been proposed as one such underlying factor, is reviewed here, including a brief overview of ER, theory and research linking ER, externalizing symptoms, and/or BDs, and still largely preliminary work exploring the role of parent and child ER in BPT outcomes. Research to date provides clues regarding the interrelationship of ER, BDs, and BPT; yet, determining whether adaptations to BPT targeting ER are necessary or useful, for whom such adaptations would be most important, and how those adaptations would be implemented requires addressing mixed findings and methodological limitations. To guide such work, we propose a conceptual model elucidating how standard BPT may impact ER and processes linked to ER, which we believe will be useful in organizing and advancing both basic and applied research in future work.

Parenting Stress and Parenting Efficacy of Parents Having Children with Disabilities in China: The Role of Social Support

Raising children with disabilities is challenging for parents, who experience high parenting stress. The study aimed to understand the status quo of parenting efficacy of parents having children with disabilities and to analyze the association between parent efficacy, parenting stress, and social support in China. We surveyed 373 parents having children with disabilities enrolled in special education schools or rehabilitation institutions from 14 provinces in China. The online questionnaire including Parental Stress Index-Short Form, the Child Adjustment and Parent Efficacy Scale-Developmental Disability (CAPES-DD), and Social Support Scale was applied in the study. The results suggested that parenting efficacy of parents having children with disabilities in China was at the medium level. Parenting stress, social support, and parenting efficacy were significantly related with each other, and social support played a mediating role between parenting stress and parenting efficacy. The findings indicated that reducing parenting stress and improving social support might improve parenting efficacy. We also discussed the implications of providing intervention strategies or social support to improve parenting efficacy for parents with disabled children in China.

Parents' pandemic stress, parental involvement, and family quality of life for children with autism

Background

Research has shown that parents of children with autism spectrum disorder (ASD) suffered high levels of stress during the COVID-19 pandemic and faced poor family quality of life (FQOL). However, little is known about the inherent dynamic interaction between pandemic stress and FQOL, especially in the Chinese cultural context.

Aims

This study provides preliminary evidence by examining the relationships among pandemic stress, parental involvement, and FQOL for children with autism in mainland China.

Method

A total of 709 parents of children with autism completed measures of FQOL, parental involvement, and pandemic stress. Structural equation modeling was employed to examine the interrelations among these variables.

Results

Pandemic stress has direct effect and indirect effect mediated by parental involvement on FQOL. Two dimensions of pandemic stress had a direct effect on FQOL (β1 = 0.11; β2 = -0.55) and three dimensions had an indirect effect on FQOL through parental involvement (β1 = -0.097; β2 = 0.257; β3 = 0.114).

Conclusion

Stress related to the COVID-19 pandemic affects family quality of life for children with autism in complex ways. Policies may be developed to enhance parental pragmatic hopefulness in the anti-epidemic victory and alleviate negative physical and mental reactions caused by the pandemic.

Posttraumatic growth and rumination among parents of children with autism spectrum disorder: The mediating role of social support

Although rumination and social support are regarded as essential predictors of posttraumatic growth (PTG), few studies have explored the associations among PTG, rumination, and social support in parents of children with autism spectrum disorder (ASD). This study examined whether social support mediates the relationship between rumination and PTG. Cross-sectional questionnaire data were collected from 385 parents of children with ASD from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Event Related Rumination Inventory, and Social Support Rating Scale. Path analyses showed that subjective support partially mediates the relationship between deliberate rumination and PTG (β = 0.073, P &lt; 0.001), and indirect effects account for 15.30% of the total effects. In addition, a negative direct path was found between intrusive and PTG because of the suppression effect of subjective support (β = -0.110, P &lt; 0.01), and indirect effects accounted for 80% of the direct effects. For future studies, it underscores the essential role of subjective support and rumination in promoting PTG in parents of children with ASD.

Longitudinal impact of self-stigma content and process on parental warmth and hostility among parents of children with autism spectrum disorder

This study examined whether self-stigma content and process would prospectively influence parental warmth and hostility through increasing parenting stress among parents of children with autism spectrum disorder (ASD). On three occasions across two years, 441 Hong Kong parents of children with ASD provided questionnaire data. Path analyses showed that self-stigma content and process were associated with greater parenting stress, which was, in turn, associated with reduced parental warmth and increased parental hostility. Our findings reveal the longitudinal influences of self-stigma on parenting practices and demonstrate how these influences can be explained by parenting stress. Our findings also suggest the importance of supporting parents of children with ASD to mitigate self-stigma and associated parenting stress in improving their parenting practices.

The Effect of Personality, Disability, and Family Functioning on Burnout among Mothers of Children with Autism: A Path Analysis

This path analysis of mothers of children with autism aimed to investigate the relationship between maternal burnout and the mother’s subjective reporting of difficulty in childcare, family function, and personality traits. A total of 410 mothers of children with autism (mean age 39.03, SD 7.42) completed four questionnaires: Parental Burnout Measure (PBM-12), International Personality Item Pool—Big Five Markers (IPIP-BFM-20), Flexibility and Cohesion Evaluation Scales (FACES-IV), and a survey on childcare difficulties. Path analysis using two predetermined models was used to examine the interrelations. Both models fit the empirical data equally with a Root Mean Square Error of Approximation (RMSEA) index of 0.000 and a 90% confidence interval (model 1: 0.000–0.052; model 2: 0.000–0.059). Path analysis revealed similar fit indexes for both models: (a) burnout is a mediator between exogenous variables and family functioning, and (b) family functioning is an indirect mediator between exogenous variables and burnout. These findings suggest that increased maternal emotional instability (neuroticism) and conscientiousness can lead to increased family communication problems, which may further lead to a breakdown of the equilibrium in the family system, resulting in the mother’s dissatisfaction with family life and a consequent increased risk of maternal burnout.

Effect of the Early Start Denver Model on Children With Autism Spectrum Disorder Syndrome of Different Traditional Chinese Medicine Types in Northeast China

BACKGROUND

The clinical presentation of children with autism spectrum disorder (ASD) is heterogeneous, and there are little data available on the treatment of children with different types of ASD. We sought to explore which traditional Chinese medicine (TCM) syndrome type was more effective for children with ASD after 3 months of Early Denver Model intervention and to analyze the reasons for its efficacy from the perspective of TCM.

METHODS

This was a retrospective study. The subjects were children with ASD who were first diagnosed at the Developmental Behavioral Pediatrics, the First Hospital of Jilin University, between December 2018 and September 2019. Eighty-nine children were divided into a kidney jing deficiency group, a liver qi stagnation group, and a group with deficiency of both the heart and spleen.

RESULTS

After treatment, the total Autism Behavior Checklist (ABC), Autism Treatment Evaluation Checklist, and Childhood Autism Rating Scale scores were significantly reduced in the three groups (p < 0.05) compared to before treatment. Significant improvements were seen in all five domains of the Griffiths Development Scales-Chinese version in the LQ group (p < 0.05). After intervention, the LQ group showed greater improvements compared to the other two groups in the language, eye-hand coordination, body and object use, social and self-help, and total ABC scores.

CONCLUSION

Our study showed that Early Denver Model intervention is effective in the treatment of three syndrome types of children with ASD, with the LQ group experiencing the most significant effects.

Age of Diagnosis and Demographic Factors Associated with Autism Spectrum Disorders in Chinese Children: A Multi-Center Survey

PURPOSE

The present study investigated the age of diagnosis, treatment and demographic factors of Chinese children with autism spectrum disorders (ASD), to provide a scientific basis for the early detection, diagnosis, and intervention of ASD.

PATIENTS AND METHODS

A total of 1500 ASD children aged 2-7 years old from 13 cities in China were administered questionnaires to examine their diagnosis, treatment, and basic family information. The Childhood Autism Rating Scale (CARS) was used to measure the symptoms and severity of ASD children, and the Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016) was utilized to measure neurodevelopmental levels of ASD children.

RESULTS

We found that for children with ASD, the median (p25, p75) age for the initial detection of social behavioral developmental delay was 24 (18, 30) months, while the age for the initial diagnosis was 29 (24, 36) months and the age for the beginning of intervention was 33 (27, 42) months. Multiple linear regression (MLR) analysis suggested that in children with ASD whose parents were divorced, separated, or widowed, or whose mothers were engaged in physical work, the initial detection of social behavioral developmental delay happened later. For the children with ASD who lived in urban areas, had higher levels of ASD symptom severity or whose parents were not divorced or separated, the age for the initial diagnosis was earlier. For the children with ASD who lived in urban areas or whose mothers had received higher level of education, the earlier age for the beginning of intervention was observed, while for those with ASD whose mothers were engaged in physical work, the age for the beginning of training was later.

CONCLUSION

It is recommended to actively carry out health education of ASD and strengthen the support for ASD families to enhance their rehabilitation level.

Parenting Stress and Social Style in Mothers and Fathers of Children with Autism Spectrum Disorder: A Cross-Cultural Investigation in Italy and Japan

Parents of children with autism spectrum disorder (ASD) face unique challenges, which may affect parenting functioning. However, little is known about gender and cultural variations in parenting stress and styles in these families. The aims of this study were to investigate: (1a) the differences in parenting stress and (1b) social style between Italian and Japanese mothers and fathers of children with ASD; (2) the predictive role of culture, sociodemographic, and child's characteristics on parenting stress; (3) the predictors of the social parenting style, including parenting stress dimensions. The study involved 92 Italians and 89 Japanese parents of school-age children (5-12 years) with ASD who completed the Parenting Stress Index and the Parenting Style Questionnaire. Results revealed that Japanese parents showed higher parenting stress and less engagement in social style than Italians. Across cultures, mothers used more social style than fathers. Being Japanese and having a child with greater ASD severity predicted higher levels of parenting stress. We also found that country, parent's gender, and stress related to the dysfunctional interaction were significant predictors of parenting social style. Our findings highlight the importance of a cross-cultural approach to better understand the experiences and needs of mothers and fathers of children with ASD.

The Route of Stress in Parents of Young Children with and without Autism: A Path-Analysis Study

We provide a conceptual model on the complex interaction between stress, psychological predisposition, and personality traits, accounting for gender, in parents of children with and without autism. We performed a path analysis using a structural equation modeling approach in a sample of parents including 60 ASD and 53 TD couples. In parents of typically developing children (TD), depression level and age are the main direct predictors of stress through the mediating effect of anxiety. Otherwise, in the ASD parent group, the personality trait ‘openness’ directly predicts the defensive response and stress levels without the mediating effect of anxiety. Our data suggest a route of action in promoting new behavioral strategies to prevent parenting stress, making families run smoothly.

Emotion Understanding Correlates With Parental Emotional Expressivity in Chinese Youths With Hearing Loss and Typical Hearing

This study aimed at examining the differences between Chinese youths with hearing loss (HL) and with typical hearing (TH) in emotion understanding (EU), parental emotional expressivity, and the associations between EU and parental emotional expressivity. The participants were 282 youths with HL (14.58 ± 3.42 years old) and 350 youths with TH (11.69 ± 2.49 years old). EU was measured by four visual-mode tasks, of which two involve language comprehension while the others do not. Parents reported positive and negative emotional expressivity on the Self-Expressiveness in the Family Questionnaire. Covariates were controlled for including socioeconomic status, parent gender, youth gender, age, intelligence, and teacher-reported comprehension difficulties. Results showed that the four EU tasks were more challenging for the youths with HL than for the youths with TH. The interaction effect of the two groups × 4 tasks was not significant, suggesting that the differences between the two groups of youths in EU were generally similar across the four tasks. The parents of the youths with HL did not differ from the parents of the youths with TH in how often they displayed positive and negative emotional expressivity. Multigroup regression analyses revealed that negative emotional expressivity was negatively related to EU in the youths with HL but not in the youths with TH. However, these two regression coefficients were not significantly different. Positive emotional expressivity was not related to EU in either group. In conclusion, this study extends the knowledge about the EU of Chinese youths with HL and emotion-related socialization of the parents of these youths.

Symptom Severity, Internalized and Externalized Behavioral and Emotional Problems: Links with Parenting Stress in Mothers of Children Recently Diagnosed with Autism

The present study examined which aspects of the child's behavior and clinical profile accounted for three dimensions of parenting stress: related to parenting roles, to interactions with the child, and to the child. Measures of adaptive behavior, intellectual functioning, autism symptom severity, and challenging behavior and emotional difficulties were examined as predictors of parenting stress in 157 mothers of children recently diagnosed with autism. Children's emotional problems and aggressive behavior were most predictive of parenting distress, whereas autism symptoms along with emotional problems and aggressive behavior, respectively, were linked to stress pertaining to interactions and to the child. These findings underscore the need for comprehensive and complementary interventions that focus on children's behavior and symptoms but also on parent adjustment.

Mindfulness and Stress Among Parents of Children with Autism Spectrum Disorder in China

Parenting a child with autism spectrum disorder (ASD) can be tremendously challenging. It is important to identify factors associated with parenting stress. This study examined the indirect effect of parental dispositional mindfulness on their anxiety and depressive symptoms and family quality of life (FQOL) through mindful parenting and then parenting stress. Seventy-nine Chinese parents (24.1% fathers) of children with ASD aged 3-13 years completed self-report questionnaires. Results indicated that higher dispositional mindfulness was associated with higher mindful parenting, which was related to lower parenting stress, and further related to lower anxiety and depressive symptoms and higher FQOL. The findings provide valuable insight into the potential pathways through which general mindfulness and mindful parenting may positively impact parental outcomes.

Comparison of mental health, well-being and parenting sense of competency among Australian and South-East Asian parents of autistic children accessing early intervention in Australia

LAY ABSTRACT

We know that parents of autistic children experience poorer mental health and lower well-being than parents of non-autistic children. We also know that poorer mental health among parents of autistic children has been observed across different cultures. Most research focuses on Western cultures, so we know little about parental mental health and well-being of parents from different cultural backgrounds; yet, it is likely that cultural background contributes to how parents view their child's condition and respond to the diagnosis. Here, we compared mental health, quality of life and well-being between families raising an autistic child from Australian backgrounds to families from South-East Asian backgrounds. All children in the current study were receiving the same community-based early intervention. When compared to the general population, parents had poorer mental health overall, but there were no differences between the two groups of parents. However, parents from South-East Asian backgrounds reported higher well-being and fewer difficulties associated with their child's autism. These findings suggest that cultural background likely influences not only parent's view of, and response to, their child's autism, but also their own sense of well-being. As researchers and clinicians working with families of autistic children, we should more explicitly consider family's cultural background within our work.

Evolution of the Autism Literature and the Influence of Parents: A Scientific Mapping in Web of Science

Parents interventions are relevant to address autism spectrum disorder (ASD). The objective of this study is to analyze the importance and evolution of ASD and its relationship with the parents (ASD-PAR) in the publications indexed in Web of Science. For this, a bibliometric methodology has been used, based on a scientific mapping of the reported documents. We have worked with an analysis unit of 1381 documents. The results show that the beginnings of scientific production date back to 1971. There are two clearly differentiated moments in scientific production. A first moment (1971-2004), where the production volume is low. A second moment (2005-2019), where the volume of production increases considerably. Therefore, it can be said that the subject began to be relevant for the scientific community from 2005 to the present. The keyword match rate between set periods marks a high level of match between periods. It is concluded that the main focus of the research on ASD-PAR is on the stress that is generated in families with children with ASD, in addition to the family problems that the fact that these children also have behavior problems can cause.

The Mediating Role of Social Support in the Relationship Between Parenting Stress and Resilience Among Chinese Parents of Children with Disability

Few studies have examined the relationships among parents' resilience, parenting stress, and social support. This study surveyed 486 parents of children with disability in China to understand the role of social support between parenting stress and parents' resilience. The results indicated that the resilience of Chinese parents of children with disabilities was at a high level. Additionally, parenting stress, social support and resilience were significantly associated, and the mediating effect of social support between parenting stress and parents' resilience were proved by mediation analyses. The findings suggested that reducing parental stress and improving social support may predict (or be associated with) improved parent resilience. The authors discussed the implications for the improvement the resilience of Chinese parents of children with disabilities.

Parental stress, involvement, and family quality of life in mothers and fathers of children with autism spectrum disorder in mainland China: A dyadic analysis

BACKGROUND

Research shows that parents of children with autism spectrum disorder (ASD) are burdened with childcare responsibilities and at increased risk for elevated stress and poor family quality of life (FQOL). Little is known, however, about the dynamic interactions between mothers' and fathers' perceived parenting stress in relating to parental involvement and FQOL, especially in the Chinese cultural context.

AIMS

This study examined the intrapersonal and interpersonal effects of parenting stress on parental involvement and FQOL for families of children with ASD in mainland China.

METHOD

A total of 210 Chinese couples (total N = 420) completed measures of caregiving involvement, perceived parenting stress, and FQOL. The Actor-Partner Interdependence Mediation Model (APIMeM) was employed to examine the dyadic relationships among the variables.

RESULTS

Both parents' parenting stress was negatively associated with their own involvement and FQOL. Moreover, fathers' parenting stress was indirectly related to mothers' perceptions of FQOL through their involvement in the care of their child with ASD.

CONCLUSIONS

The findings highlight the important roles of fathers' parenting stress and involvement in affecting their own and their partners' satisfaction with FQOL within Chinese families raising a child with ASD.

Parenting Stress and Depressive Symptoms Among Chinese Parents of Children With and Without Oppositional Defiant Disorder: A Three-Wave Longitudinal Study

Parents of children with oppositional defiant disorder (ODD) experience greater stress in parenting and more parental depressive symptoms. The study examined the longitudinal and bidirectional associations between three dimensions of parenting stress (i.e., parental distress, parent-child dysfunctional interaction, and difficult child) and parental depressive symptoms from a sample of Chinese parents of children with or without ODD. The sample included 256 parents of children with ODD and 265 parents of children without ODD, along with children's teachers. Using a three wave, cross-lagged design, results showed that parents of children with ODD suffered higher levels of parenting stress across three dimensions. For both groups, the links between parental depressive symptoms and subsequent parental distress and difficult child were unidirectional, whereas the relation between parental depressive symptoms and parent-child dysfunctional interaction was bidirectional. Multi-group analysis found that there was no significant difference in the relations between parenting stress and depressive symptoms between the ODD and non-ODD groups. The findings indicated that children with ODD require comprehensive services to address the stress of their parents. The study also provided support for the dynamic and longitudinal relations between specific dimensions of parenting stress and depressive symptoms among parents of children with or without ODD.

[Effect of parental training based on Early Start Denver Model combined with intensive training on children with autism spectrum disorder and its impact on parenting stress]

OBJECTIVE

To explore the effect of parental training based on the Early Start Denver Model (ESDM) combined with intensive training on the treatment outcome of children with autism spectrum disorder (ASD) and its impact on parenting stress.

METHODS

Seventy children aged 2-5 years who were diagnosed with ASD were enrolled in the study. They were divided into an ESDM group and a parental training group by the random number table method (n=35 each). The ESDM group received intensive training based on ESDM. In addition to intensive ESDM-based training, parents of the children in the parental training group received ESDM skills training. Both groups were assessed by Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC) and Parenting Stress Index-Short Form (PSI-SF) before and after the intervention of 3 months.

RESULTS

After 3 months of intervention, the total scores of ABC, CARS and ATEC were both significantly decreased in the two groups (P<0.05). There was no significant difference in the total scores of ABC, CARS and ATEC between the two groups before and after intervention (P>0.05). The change between ABC, CARS and ATEC total scores in the two groups had no significant difference (P>0.05). After 3 months of intervention, the total scores of PSI-SF were both significantly decreased in the two groups (P<0.05). The difficult child sub-scale scores in PSI-SF were significantly decreased in the ESDM group (P<0.05). While three sub-scale scores of parent distress, parent-child dysfunctional interaction and difficult child in PSI-SF were significantly decreased in the parental training group (P<0.05). Before and after intervention of 3 months, no significant difference was found in PSI-SF total scores between the two groups. Compared with the ESDM group, the change between PSI-SF total scores and two sub-scales of PSI-SF (parent distress and difficult child) were significantly bigger in the parental training group (P<0.05).

CONCLUSIONS

Both the combination of intensive training and parent training based on ESDM and ESDM intensive training alone can improve the core symptoms of children with ASD aged 2-5 years and relieve the parenting stress, however, the former is more effective in relieving parenting stress.