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Autism Spectrum and Developmental Disorders

(PS3-B39) Mental Health in Parents of Children with ASD: Impact on Parent Stress, Child Behavior, and Interest in Therapy

Friday, November 17, 2023
11:30 AM – 12:30 PM PST
Location: Regency Ballroom, Level 7


Background: Children with autism spectrum disorder (ASD) have elevated rates of externalizing behaviors, including aggression and defiance, that impact parental stress levels. Parents of children with ASD experience higher rates of mental health diagnoses (Schnabel et al., 2020) and higher levels of stress than parents of children without ASD (Hoffman et al., 2009). Parent-Child Interaction Therapy (PCIT) is an effective treatment for disruptive behaviors in children with ASD (Allen et al., 2022; Sudder et al., 2019), but parental engagement in therapy remains a challenge, with completion failure rates ranging from 18%-36% (Nathanson et al., 2021). Given engagement concerns, more work is needed to examine the impact of parent stress and mental health on interest in PCIT across various delivery formats (group, tele-health). This study aims to a) examine how parent psychopathology relates to parent stress and child behavior problems, b) examine the association between parent psychopathology and interest in PCIT, c) examine how parents’ diagnoses relate to interest in different treatment modalities of PCIT and examine moderators of this association.

Methods: Participants included parents (M = 36.56 years) of 501 children with ASD (M = 5.16 years) enrolled in the Simons Foundation Powering Autism Research for Knowledge (SPARK) registry. Parents completed an online survey on child behavior, engagement with behavioral parent training, and parent factors.

Results: Parent mental health diagnosis was significantly associated with higher parenting stress (t = 4.61, p < .001) and child disruptive behavior (t = 6.04, p < .001). Parents with internalizing diagnoses reported significantly higher levels of stress (t = 4.55, p < .001) and child behavior problems (t = 5.81, p < .001) than those without diagnoses. Parents with externalizing diagnoses reported significantly higher levels of child behavior problems (t = 4.09, p < .001) but did not differ significantly on stress levels (t = 1.66, p = .10) than those without diagnoses. All further analyses controlled for child behavior and parent stress. Parent report of any diagnosis predicted interest in participating in PCIT (b = .10, p< .05). Although parent internalizing psychopathology was not associated with higher interest in participating in tele-PCIT (b = .06, p = .21) or group-based PCIT (b = -.002, p = .97), moderation analyses revealed a significant interaction between parent internalizing diagnosis and parent age predicting interest in receiving PCIT in a group format. For parents with an internalizing diagnosis, higher age was associated with greater interest in group-based PCIT (t = 2.42, p < .05). However, for parents without a diagnosis the relationship was inverse, such that lower age was associated with greater interest in group therapy (t = -2.03, p < .05).

Conclusion: Parental mental health impacts both child behavior and parenting stress and has important implications for interest in PCIT. Parental age interacted with mental health diagnoses such that older parents with internalizing diagnoses were more interested in group-based PCIT. Future studies may explore matching participants to different treatment modalities using parent factors to improve engagement with PCIT.