Parental Stress and Needs in Families of Children with Autism Spectrum Disorder

Bernadette Benson and Deborah Dewey

Abstract

The stress associated with parenting a child with autism spectrum disorder (ASD) and the resources/needs mothers and fathers deemed most important for stress reduction were examined. On the Parenting Stress Index, 60% of the parents of children with ASD experienced high stress relative to the normative sample. In terms of resources most important for stress reduction, parents of children with ASD ranked the need for financial assistance highly, as well as the needs for support of family members and for professional supports. Overall mothers' and fathers' rankings were similar, however, they did differ significantly in their ranking of the need for in-home training in managing the child, with fathers ranking this need significantly higher than mothers. Significant differences were found between high and low stress parents in the rank order of resources identified as important for reducing stress with low stress parents ranking the need for agency information higher and the need for church support lower. Parents of school age children ranked the needs for supportive relatives, other parent contact, and community acceptance/understanding neighbors significantly higher than parents of preschool children. In contrast, parents of preschool children ranked the needs for an early, consistent diagnosis and for in-home training in managing the child significantly higher than parents of school age children. Parents of children given a diagnosis within the past year reported significantly more feelings of incompetence and isolation and felt generally more restricted and unhealthy than parents of children who had been diagnosed more than a year ago.

Introduction

Autism Spectrum Disorder (ASD) is a severe pervasive developmental disorder. It is characterized by abnormalities in social interaction and communication, as well as unusual interests and behaviors (American Psychiatric Association, 1994). Children with ASD initiate few social behaviors and their social expressiveness and sensitivity to others' social cues are limited (Mash & Wolfe, 1999). Language delay and speech problems are also salient among children with ASD (De Giacomo & Fombonne, 1998). These behavioral symptoms have been associated with high levels of anxiety, depression and everyday stress in parents (DeMeyer, 1979; Harris, 1984). Parental stress has also been associated with the community's reaction to the child's diagnosis and the lack of supports available to provide relief to the caregiver (Konstantareas, Homatidis, & Plowright, 1992; Sharpley & Bitsika, 1997). Studies that have investigated the stress levels in parents of children with ASD compared to non-disabled children have found that parents of children with ASD experience higher levels of stress (Konstantareas et al., 1992; Sharpley & Bitsika, 1997). Parents of children with ASD have also been found to experience more stress than parents of children with other developmental disabilities such as Down syndrome and mental retardation (Hastings & Johnson, 2001; Konstantareas et al., 1992).

Parenting a child with ASD requires an inordinate amount of time and energy and may have detrimental effects on marital relations (Piven, Chase, Landa, & Wzorek, 1991), attention devoted to other children in the family (Holroyd, Brown, Wikler, & Simmons, 1975) and career opportunities for caregivers (Gray, 2002). Parents may find themselves withdrawing from social relationships and recreational and community events (Boyd, 2002; Sanders & Morgan, 1997), the very activities that may serve to buffer the stress associated with caring for their child.

The literature suggests that certain resources reduce the stress parents experience in caring for their child with ASD. Financial support has been reported by parents to be among the most influential resource for reducing stress (Dunlap & Fox, 1996; Freedman & Boyer, 2000). Adequate funds allow caregivers to enroll their children in interventions that most appropriately target their children's needs and enable the parents to purchase respite care as needed (DeMyer & Goldberg, 1983; Freedman & Boyer, 2000). Support of one's spouse and relatives has also been associated with lower level of parental stress (Bristol, 1984; Hastings & Johnson, 2001; Sharpley & Bitsika, 1997). In addition, parent support groups that provide opportunities for meeting other parents of children with ASD and discussing common concerns have been identified as being beneficial in reducing parental stress (Bristol, 1984; Krauss, 1993; Peck, 1998). Other factors that have been found to be important for stress reduction include early and consistent diagnosis, knowledgeable professionals who provide information about programs and resources for families of children with ASD and good day programs that run all day, year-round (Dunlap & Fox, 1996; Freedman & Boyer, 2000; Marcus, 1984; Nissenbaum, Tollefson, & Reese, 2002). Social and recreational opportunities for the family and the child with ASD have also been reported by parents to be important for stress reduction (Freedman & Boyer, 2000).

The main objectives of the present study were to replicate the findings of previous research that has examined stress levels in parents of children with ASD and that has investigated the reports of parents of children with ASD regarding the resources they deemed most important for stress reduction. It was hypothesized that parents of children with ASD would report higher levels of stress than the normative sample. It was also hypothesized that financial and social supports would be rated more highly than other needs, such as legal help and recreational opportunities. Few studies have examined whether mothers and fathers identify similar resource needs, whether high stress parents show different patterns of resource needs than low stress parents or whether the age of the child, severity of ASD and recency of diagnosis impact parental stress. These issues were explored in the present study.

Method

Participants

Fifty-five biological parents of children with ASD aged 12 and under were recruited from several agencies serving children with ASD in Calgary, Alberta, Canada. Thirty-five participants were mothers and 20 were fathers. Parents ranged in age from 26 to 43 years (M = 36.39, SD = 4.59). Fifty-two respondents had a spouse or partner, one was divorced, and two were separated. Nineteen parents participated with their partner and 17 participated alone. Socioeconomic status (SES) was determined using the Blishen Index of Canadian Occupations (Blishen, Carroll, & Moore, 1987). This index provides numerical ratings of occupations in Canada based on education requirements, generated income and prestige. The highest-level occupation in the family was used to estimate SES. These ratings were then coded into low, medium and high SES groups based on Blishen et al's (1987) criteria. Thirty-five percent (n= 19) of the families were in the high SES group, 45% (n = 25) were in the middle SES group, and 20% (n = 11) were in the low SES group. Respondents represented 36 children (31 males, 5 females) with ASD, whose mean age was 5.70 years (SD = 2.48). The mean age of diagnosis was 3.44 years (SD = .84). Of the 36 children, 24 were enrolled in full-time educational placements, 4 received in-home therapy, and one child did not participate in any formal education or therapy program. For seven children, information on participation in day programs was not provided.

Measures

Parenting Stress Index Third Edition (PSI)

The PSI (Abidin, 1995) assessed parents' levels of stress using a 5-point Likert-type scale, ranging from strongly agree to strongly disagree. Three PSI scores were used, the Total Stress score, the Child Domain score (i.e., stress attributed to child characteristics such as distractibility/hyperactivity, adaptability, acceptability, demandingness, mood, and reinforces parent) and the Parent Domain score (i.e., stress associated with aspects of functioning in the parental role such as depression, attachment, competence, isolation, role restriction, spouse, and health). Alpha reliability coefficients for the Total Stress scale, the Child Domain and the Parent Domain were found to be .90 or higher (Abidin, 1995). Test-retest reliability coefficients obtained from 4 different studies were between .55 and .82 for the Child Domain, .69 and .91 for the Parent Domain and .65 and .96 for the Total Stress scale (Abidin, 1995). These coefficients represent the stability of scores from 3-weeks to 1-year. The PSI has been employed in several studies (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Freeman, Perry, & Factor, 1991; Tobing & Glenwick, 2002) examining stress in parents of children with ASD.

Resources/Needs Inventory

This inventory was developed by the authors based on findings reported in the literature (Bristol & Schopler, 1983; Darling, 1991; DeMyer & Goldberg, 1983; Dunlap & Fox, 1996), and was used to determine the most important resources/needs (i.e., both formal and informal) of parents of children with ASD. Resources/needs were listed in random order and included the following: money/financial assistance, support of relatives, respite, support of spouse, support of church, other parent contact and/or support groups, babysitters, recreational opportunities for self, recreational opportunities for child with ASD, community acceptance/understanding neighbors, parent/sibling counseling, good residential treatment, early/consistent diagnosis, better agency information/cooperation, transportation for child, knowledgeable/concerned professionals, legal assistance, good day programs/teachers (all day, year-round), and in-home training on how to manage the child. Parents were provided with a space to list any other resources/needs that were not incorporated in the list (i.e., Item 20). Respondents were asked to rank each need from 1 (most important) to 20 (least important).

Gilliam Autism Rating Scale (GARS)

The GARS (Gilliam, 1995), a 42-item behaviour checklist, assisted in identifying individuals with ASD and also provided information on the severity of ASD symptomatology. It includes four subtests: (a) Stereotyped Behaviors, (b) Communication, (c) Social Interaction and (d) Developmental Disturbances. Items are presented in terms of characteristic behaviors usually seen in children with ASD. For three subtests (i.e., Stereotyped Behaviors, Communication, Social Interaction), items are rated on a 4-point Likert-type scale ranging from never observed to frequently observed, whereas, for the Developmental Disturbances subtest a yes/no response format is used. Raw scores on each of the subtests are converted to standard scores. The sum of these standard scores is used to generate an Autism Quotient with a mean of 100 and a standard deviation of 15. An Autism Quotient of 90 or above is considered indicative of autism and scores of 90 through 110 are within the average range of severity for individuals with autism. Alpha coefficients for the GARS have been reported as follows: Stereotyped Behaviors .90, Communication .89, Social Interaction .93, Developmental Disturbances .88, and Autism Quotient .96. Test-retest reliability after 2 weeks for each subtest ranged from .81 to .88 (Gilliam, 1995).

Procedure

This study was reviewed and approved by the appropriate institutional review board for the ethics of human research. Various agencies in Calgary serving children with ASD and their families sent letters to parents outlining the study. Parents who were interested in participating contacted the principal investigator. Those parents who agreed to participate were sent a consent form and the questionnaires. One week after the package was mailed, the principal investigator contacted the parents by telephone, and arrangements were made to meet at their convenience. During the meeting, parents were given the opportunity to clarify any concerns that arose while completing the questionnaires.

Results

Parent- and Child-Related Stress

The means and standard deviations on the subscales of the PSI for the entire sample are presented in relation to data obtained from the normative sample (Abidin, 1995) (see Table 1). On Total PSI Stress, the Child domain, the Parent Domain and most of the subscales, the parents of children with ASD reported significantly higher levels of stress relative to the normative sample.

Parents' Rankings on the Resources/Needs Inventory

Friedman tests were used to examine the hypothesis that resources/needs related to financial (i.e., money/financial assistance) and social support (i.e., support of your spouse, support of your relatives) would be ranked higher than other resources/needs such as legal help, recreation opportunities for your child and good residential treatment. Results revealed significant differences between the resources/needs in terms of how they were ranked, χ2 (18, N = 52) = 395.04, p < .01. Mean rankings for the entire sample, mothers and fathers and the high and low stress groups are presented in Table 2. Examination of the entire sample revealed that parents ranked the need for financial assistance most highly, followed by the need for support of a spouse and professional supports (i.e., day program/teachers, early diagnosis, knowledgeable professionals). Needs related to legal assistance, residential treatment, and church support were deemed to be considerably less important. The need for recreational opportunities for the child was ranked higher by the parents than the availability of such opportunities for themselves.

Mothers versus Fathers

Differences between mothers and fathers in the overall sample, as well as differences between mothers and fathers from the same family were examined. Comparison of mothers and fathers in the overall sample indicated that fathers ranked support of spouse as their greatest need (M = 3.89), whereas mothers ranked it second (M = 4.39) to their need for financial assistance (M = 4.03). A significant difference was found for mothers' and fathers' ranking of the importance of the need for in-home training in managing the child, U = 212.50, p < .05. Fathers ranked this need (8.84) significantly higher than mothers (12.52) (see Table 2). Wilcoxin Signed Ranks tests were used to compare differences between mothers and fathers from the same family. Consistent with the finding for the overall sample, mothers and fathers from the same family ranked the need for in-home support differently, z = -2.44, p < .05. Fathers ranked this need (8.95) significantly higher than mothers (12.32). In this subgroup of parents, fathers also ranked the need for recreation opportunities for the child as significantly more important compared to mothers, z = -2.20, p < .05. Fathers' mean rank was 9.26 and mothers' was 11.63.

High versus Low Stress Parents

Parents were categorized into either a high stress or low stress group based on the PSI Total Stress cutoff score proposed by Abidin (1995). Parents who obtained a PSI Total Stress score at or above 258 (85th percentile) were placed in the high stress group (n = 30) and those who obtained a score below 258 were placed in the low stress group (n = 22). Group differences in the mean rankings for parents in the high and low stress groups indicated that there were significant differences in the need for church support, U = 232.50, p < .05, and the need for agency information or cooperation, U = 225.00, p < .05. Low stress parents ranked the need for agency information higher and the need for church support lower than high stress parents (see Table 2).

Parents of School age Versus Preschool Children with ASD

Differences between parents of school age children (age 6 and over) and parents of preschool children (under age 6) in resources/needs were examined. Parents of preschool children ranked two needs significantly more highly than parents of school age children: need for early/consistent diagnosis, U = 225.00, p < .05, and need for in-home training in managing the child, U = 233.00, p < .05. In contrast, parents of school-age children ranked three needs more highly than parents of preschool children: need for support of relatives, U = 225.00, p < .05, need for other parent contact, U = 174.50, p < .01, and need for community acceptance/ understanding neighbors, U = 229.00, p < .05 (see Table 3).

Severity of ASD and Parenting Stress

The severity of the children's ASD was also examined. On the GARS, the mean Autism Quotient for this sample was 91.36 (SD = 15.16) and ranged from 57 (very low probability of autism/low severity of autism) to 123 (high probability of autism/high severity of autism). Independent samples t-tests indicated a trend toward a significant difference between high and low stress parents on the GARS, t (53) = -1.74, p = .09, suggesting that high stress parents tended to report that their children's symptoms were more severe.

Recency of Diagnosis and Parenting Stress

Parents who had received the diagnosis of ASD for their child within the past 12 months (n = 21) were compared to the remainder of the parents (n = 34). Parents with a more recent diagnosis for their child had significantly higher scores on four subscales of the PSI Parent Domain: Competence, t (53) = 2.76, p < .01; Isolation, t (53) = 2.44, p < .05; Health, t (53) = 2.18, p < .05; and Role Restriction, t (53) = 2.18, p < .05 (see Table 4).

Discussion

Stress in families of children with ASD has been well documented in the research literature (Boyd, 2002; Dunn et al., 2001; Sharpley & Bitsika, 1997). Less attention has been focused, however, on assessing the resources/needs that parents believe are most important in reducing the stress associated with caring for children with this disorder. The present study examined the levels of stress experienced by parents of children with ASD and the resources/needs they reported as being important in reducing the stress associated with parenting a child with ASD.

The stress associated with parenting a child with ASD could be due to a number of factors, including the behavioral, cognitive and social deficits characteristic of this disorder, the adverse effects of ASD on the family system, increased financial difficulties, the child's lack of independence and misconceptions regarding the nature of ASD by the general public and other family members (Sharpley & Bitsika, 1997; Trigonaki, 2002). The results of the present study confirm the fact that a substantial proportion of parents of children with ASD experience high levels of stress associated with child-related characteristics. Higher levels of stress were also associated with parents' perceptions of their own care-giving abilities.

Lack of resources has consistently been found to be related to higher levels of family stress and poorer family adjustment (Konstantareas & Homatidis, 1989; Nissenbaum et al., 2002; Sanders & Morgan, 1997). Previous research has suggested that financial assistance (Dunlap & Fox, 1996; Freedman & Boyer, 2000) and the support of one's spouse and relatives (Bristol, 1984; Hastings & Johnson, 2001; Sharpley & Bitsika, 1997) may be of prime importance in reducing stress. The results of the present study support these findings. Overall, monetary support and the support of one's spouse were rated very high in terms of their ability to ease parental burden and stress. Differences were found, however, between mothers and fathers in terms of their needs. Specifically, fathers rated support of spouse as their highest need, whereas mothers rated monetary support as their highest need. Further, fathers ranked in-home training of the child with autism as a significantly higher need than mothers. Such differences in prioritization of needs between mothers and fathers suggest that service providers charged with assessing family needs need to examine these needs from both the mothers' and fathers' perspectives.

Consistent with a number of other studies (Bristol & Schopler, 1983; Dunlap & Fox, 1996; Freedman & Boyer, 2000), parents, regardless of stress levels, ranked needs related to the professional community highly. These included the availability of good day programs for their child, knowledgeable, concerned professionals who were capable of providing an early, consistent diagnosis and professionals that provided information about the programs and resources available to families.

Previous studies suggested that access to parent support groups in which members are able to share their experiences in caring for a child with developmental disabilities, may prove highly beneficial in reducing parental stress (Bristol, 1984; Krauss, 1993; Peck, 1998). Support from the community, such as other parent contact and community acceptance, however, was not ranked as a primary need by parents in this study. It is possible that the age of the child may be an important determinant of the need for parent support groups. Indeed, the authors found the need for other parent contact to be ranked significantly higher by parents of school age children (6-12 years) compared to parents of preschool age children. Also of interest was the relatively low ranking of the need for babysitters and respite. DeMyer and Goldberg (1983) reported the need for respite to be ranked second highest in their sample of parents of children with autism. The differences between these two studies may be due to the fact that in the present study, 78% of the children were involved in full-day school or therapy programs and such programs may have provided sufficient relief for the parents. The percentage of DeMyer and Goldberg's participants enrolled in such programs was not reported; however, it is possible that many of these participants may not have been enrolled in such extensive programs.

Consistent with other studies, parents who rated their children's ASD symptoms to be more severe tended to report heightened levels of stress relative to parents of children with less severe symptoms (Freeman et al., 1991; Hastings & Johnson, 2001; Tobing & Glenwick, 2002). Time since diagnosis was also found to be a significant factor in parenting stress. Thirty-eight percent of the parents had children who were diagnosed with ASD within the past year. These parents reported higher levels of stress in a number of child-related areas compared to parents whose children had been diagnosed with ASD for more than one year. Specifically, they found their children to be more demanding of their time and attention and felt that they were more restricted by their children. They also reported feeling incompetent, isolated and generally unhealthy. These findings are consistent with previous research (Darling, 1991; Dunlap & Fox, 1996) and suggest that parents whose children have been recently diagnosed with ASD are an especially important group to target for professional support.

Although the present study yielded a number of important findings, there are some limitations that must be taken into consideration when interpreting the results. Of particular concern was the relatively small sample size. As a result, there may not have been sufficient power to detect significant differences between parents experiencing high and low levels of stress. In addition, the self-report nature of the questionnaire used to assess the presence and severity of ASD in the child may have been subject to retrospective bias, as parents may not accurately recall the skills and behaviors their children displayed from several years ago. It would be useful to have other individuals involved in the child's daily life (e.g., teachers) provide ratings of the severity of the child's ASD symptomatology to corroborate parents' reports. It is also important to note that parents from the same family are represented in many of the analyses, confounding the assumption of independence. To address this issue, Wilcoxin Signed Ranks tests were utilized in order to assess for differences between mothers and fathers from the same family. The results of these analyses were consistent with the analyses that utilized the overall sample; therefore, the inclusion of mothers and fathers from the same family did not appear to compromise the findings of this study. Finally, given that participants volunteered to take part in the study (i.e., self-selection bias), this sample may not be representative of families with a child with ASD.

The findings of this study clearly indicate that there are particular resources/needs that parents deem to be of greatest utility in reducing the stress associated with caring for their children with ASD. This study also highlighted the fact that not all parents of children with ASD experience high levels of stress in response to caring for their child. The focus of this study was on factors external (i.e., formal and informal supports) to parents that may influence the degree of parenting stress experienced. An examination of internal characteristics such as parental self-esteem and personality traits would likely prove beneficial in providing a more comprehensive understanding of the inherent variability in parents' responses to raising a child with ASD. Parent self-report questionnaires have been used in most of the research that has examined stress in parents of children with ASD. Future research using qualitative methodologies could assist in developing a better understanding of differences between mothers and fathers in terms of their needs.

The results of this study have several practical implications. Specifically, it is imperative that professionals in the field understand how both formal and informal resources can be used to alleviate the stress associated with raising a child with ASD and how resources/needs may differ for mothers and fathers, for those with younger or older children, and for those with a more recent diagnosis. This knowledge may assist professionals in developing effective interventions that target both the characteristics of ASD in the child and the needs of the parents.

References

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Table 1:
Means and Standard Deviations on the Parenting Stress Index Third Edition (PSI)

Measure and Subscales

Current Sample n = 55

Normative Sample n = 2,633

p value

M

SD

M

SD

PSI Total Stress

272.73

47.50

222.80

36.60

p < .0001

PSI Child Domain

141.29

24.77

99.70

18.80

p < .0001

Distractibility/Hyperactivity

31.16

6.63

24.70

4.80

p < .0001

Adaptability

34.73

6.24

24.90

5.70

p < .0001

Reinforces Parent

14.05

5.74

9.40

2.90

p < .0001

Demandingness

27.75

6.34

18.30

4.60

p < .0001

Mood

12.89

3.14

9.70

2.90

p < .0001

Acceptability

21.25

4.71

12.60

3.50

p < .0001

PSI Parent Domain

131.80

29.46

123.10

24.40

p < .01

Competence

30.49

7.33

29.10

6.00

p < .10

Isolation

14.42

4.67

12.60

3.70

p < .001

Attachment

12.85

3.78

12.70

3.20

p = .732

Health

14.22

4.27

11.70

3.40

p < .0001

Role Restriction

21.00

6.18

18.90

5.30

p < .01

Depression

20.09

6.09

20.30

5.50

p = .780

Spouse

18.91

5.58

16.90

5.10

p < .01


Table 2:
Resource/Needs Inventory Mean Ranks

Need

Entire Sample

n=52

Mothers

n=33

Fathers

n=19

High Stress

n=30

Low Stress

n=22

Financial Assistance

4.19

4.03

4.47

4.40

3.91

Support of Spouse

4.21

4.39

3.89

4.63

3.64

Day Program/Teachers

5.38

5.21

5.68

5.87

4.73

Early Diagnosis

6.11

5.38

7.37

5.55

6.86

Knowledgeable Professionals

6.48

6.24

6.89

6.23

6.82

Support of Relatives

7.52

7.18

8.11

7.07

8.14

Babysitters

9.32

9.11

9.68

9.08

9.64

Recreation for Child

9.87

10.45

8.84

9.60

10.23

Other Parent Contact

10.12

9.39

11.37

9.93

10.36

Agency Information

10.12

10.48

9.47

11.67*

8.00*

Respite

10.48

10.42

10.58

10.43

10.55

In-Home Training

11.17

12.52*

8.84*

11.93

10.14

Recreation for Self

11.92

11.67

12.37

11.67

12.27

Counselling

13.35

13.18

13.63

13.43

13.23

Legal Help

14.81

14.48

15.37

15.27

14.18

Residential Treatment

15.77

16.03

15.32

15.27

16.45

Support of Church

16.40

16.30

16.58

15.50*

17.64*

*p < .05

           

 

Table 3:
Resource/Needs Inventory Mean Ranks for Parent of Children Age 6 and Over and Children under Age 6

Need

Age ≥72 mos

n=21

Age < 72 mos

n=31

Financial Assistance

4.81

3.77

Support of Spouse

3.71

4.55

Day Program/Teachers

4.62

5.90

Early Diagnosis

7.88*

4.90*

Knowledgeable Professionals

7.10

6.06

Support of Relatives

6.00*

8.55*

Babysitters

9.98

8.87

Recreation for Child

9.33

10.23

Other Parent Contact

8.10**

11.48**

Agency Information

10.95

9.55

Respite

11.48

9.81

In-Home Training

13.00*

9.94*

Community Acceptance

10.14*

12.10*

Recreation for Self

11.43

12.26

Counselling

13.62

13.16

Legal Help

14.05

15.32

Residential Treatment

16.57

15.23

Support of Church

16.48

16.35

*p < .05; **p < .01

           

 

Table 4:
Means and Standard Deviations on the PSI for Parents of Children Having Received a Diagnosis of ASD within the Past 12 Months and Parents of Children Having Received a Diagnosis More Than 12 Months Ago

Measure and Subscales

Diagnosis within past 12 months

n = 21

Diagnosis more than 12 months ago

n = 34

M

SD

M

SD

PSI Child Domain

149.67**

23.43

136.12**

24.47

Distractibility/Hyperactivity

32.71

7.50

30.21

5.94

Adaptability

35.14

4.59

34.47

7.13

Reinforces Parent

15.62

5.77

13.09

5.58

Demandingness

30.90***

5.03

25.79***

6.33

Mood

13.52

3.04

12.50

3.18

Acceptability

23.19**

3.53

20.06**

4.98

PSI Parent Domain

145.14***

26.33

123.56***

28.57

Competence

33.76***

7.83

28.47***

6.31

Isolation

16.29**

3.39

13.26**

5.00

Attachment

13.67

3.35

12.35

3.98

Health

15.76*

4.63

13.26**

3.79

Role Restriction

23.24**

4.95

19.62**

6.52

Depression

21.95*

7.22

18.94*

5.04

Spouse

20.48

5.22

17.94*

5.64

PSI Total Stress

294.81***

42.82

259.09***

45.59

*p < .10. **p < .05. ***p < .01.

           

 

Abbrevations:

ASD - autism spectrum disorder
PSI - Parenting Stress Index
GARS - Gilliam Autism Rating Scales

Submitted by:

Bernadette Benson, M.Sc.
Department of Educational Psychology, Faculty of Graduate Studies
University of Calgary

Deborah Dewey
Departments of Pediatrics and Community Health Sciences, University of Calgary
Calgary, Canada
and Behavioural Research Unit, Alberta Children's Hospital
Calgary, Canada

Corresponding Author: Deborah Dewey, Ph.D., Behavioural Research Unit, Alberta Children's Hospital
Email: Deborah.Dewey@calgaryhealthregion.ca
2888 Shaganappi Trail N.W., Calgary, Alberta Canada, T3B 6A8, Tel: (403) 955-7394 Fax: (403) 955-2772

Acknowledgements

This study was partially supported by grants from the Alberta Children's Hospital Foundation, Surrey Place Centre Foundation and the Canadian Institutes of Health Research. The authors extend their appreciation to the parents who participated in this project. The authors would like to extend a special thank-you to Susan Crawford for her assistance with the statistical analyses.

 

International Journal of Disability, Community & Rehabilitation
Volume 7, No. 1
www.ijdcr.ca
ISSN 1703-3381
  

  
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