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Journal of Child and Family Studies (2019) 28:1445–1460
https://doi.org/10.1007/s10826-019-01412-w
REVIEW PAPER
Parental Behavior Comparisons Between Parents of Children with
Autism Spectrum Disorder and Parents of Children Without Autism
Spectrum Disorder: A Meta-analysis
Byungmo Ku1●Jodi Dawn Stinson1●Megan MacDonald1
Published online: 18 April 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Objectives Parental behavior plays an important role in child development. Given inconsistent findings in the literature
related to parental behaviors or parents of children with autism spectrum disorder (ASD) and those without, the purpose of
this study was to conduct a meta-analysis to examine whether parenting behavior differences existed between parents of
children with and without ASD. In addition, this meta-analysis examined the moderation effect of child development (e.g.,
global and language development) and parental communication style (verbal only and verbal/non-verbal interactions
combined) on the parental behavior differences between parents of children with and without ASD.
Methods A systematic database and manual search identified 16 observational studies, which met predetermined inclusion
criteria. Observable parental behaviors were categorized into four globally identifiable parental dimensions (parental
warmth/support, parental behavioral control, parental negativity and neutral parental behavior) to capture the fundamental
parental behaviors.
Results There were no significant parental supportive/warmth and neutral behavior differences between the two groups.
However, parents of children with ASD showed more controlling and negative behaviors compared to parents of children
without ASD. The parental communication style was a significant moderator in the parental supportive/warmth dimension.
Additionally, a child’s developmental ability was a significant moderator in the parental control dimension.
Conclusions These parental behavior differences between parents of children with and without ASD should be considered
when creating and developing family-related interventions for children with ASD.
Keywords ASD ●Parent–child with ASD Interaction ●Parenting ●Children without disabilities ●Parenting behaviors
Parental behavior plays an important role in child devel-
opment (National Institute of Child Health and Human
Development (NICHD) Early Child Care Research Network
2002). Parental behaviors such as high levels of sensitivity,
stimulation, and support have been indicated to have posi-
tive impacts on the development of children’s language and
social skills, and have been indicated to reduce negative
behaviors in children (NICHD, Early Child Care Research
Network 2002). A longitudinal study confirmed that par-
ental behaviors of synchrony, facilitation, and positive
affect, when the child was 2 years of age, was a significant
predictor of their child’s development (i.e., language skills,
academic skills, and fewer problem behaviors) at 7 years
(Treyvaud et al. 2016). Similarly, parents with higher levels
of synchronization (the degree to which the parent dis-
played interest by explaining or directing towards objects
which the child was already engaged in) during play,
longitudinally predicted higher levels of joint attention and
language skills in children with autism spectrum disorder
(ASD) over a period of 1, 10, and 16 years (Siller and
Sigman 2002). Thus, positive parental behaviors have
important impacts on the development of children with and
without ASD.
Although positive parenting has been clearly indicated to
have positive impacts on child development, known dif-
ferences exist in the parenting behaviors of parents of
children with ASD compared to parents of children without
*Byungmo Ku
kub@oregonstate.edu
1College of Public Health and Human Sciences, Oregon State
University, 8D Women’s Building, Corvallis, OR, USA
1234567890();,:
1234567890();,:
ASD (Baker et al. 2010; Kasari et al. 1988; Lambrechts
et al. 2015; Wan et al. 2012). Seltzer and colleagues (2000)
indicated that the social interaction and communication
deficits in children with ASD may impede communication
with others, including the relationship between the parent
and child. Moreover, parents of children with ASD may
adapt their interaction style based on their child’s known
needs in the area of social communication (Baker et al.
2010). These empirical research findings are consistent with
the Belsky’s(1984) parenting model, which indicated child
characteristics as one of the factors that determine parenting
behaviors. In addition to child characteristics, parent-related
factors such as parenting stress may influence the parental
behaviors of parents of children with ASD (Abidin 1992).
In Abidin’s parenting model, parenting stress was a strong
factor that directly and indirectly influenced parenting
behaviors. Parents of children with ASD encounter higher
levels of parenting stress compared to parents of children
with other disabilities (e.g., Down syndrome and cerebral
palsy) and parents of children without disabilities (Hayes
and Watson 2013), and this may lead to differences in
parenting behavior and styles among parents of children
with and without ASD.
A large body of literature has examined differences in
parental behaviors of parents of children with ASD com-
pared to parents of children without ASD. However, find-
ings among these empirical studies have been somewhat
inconsistent. Some studies have indicated that parental
behaviors such as supportive/warmth behaviors, between
parents of children with ASD and parents of children
without disabilities were not significantly different (Baker
et al. 2010; Kasari et al. 1988). Kasari et al. (1988),
examined parental responsiveness, the extent to which
parents nurtured, showed affection, were involved, and
supported in the child rearing process, of parents of children
with ASD by comparing them to two groups, parents of
children with other developmental disabilities and parents
of children without disabilities. The findings of this study
indicated that parental responsiveness across the three
groups was not statistically different. More recently, Baker
et al. (2010) found no significant differences in maternal
sensitivity between parents of toddlers with emergent ASD
and parents of toddlers without ASD.
On the contrary, several studies have found parenting
differences between parents of children with ASD and
parents of children without ASD (Lambrechts et al. 2015;
Wan et al. 2012). Stimulating development and discipline in
mothers of children with ASD were lower compared to
mothers of children without ASD (Lambrechts et al. 2015).
Moreover, lower parental sensitivity and higher directive
interaction styles were found in mothers of infant siblings at
risk for ASD (infants at a higher risk of developing ASD
based on the presence of an older sibling diagnosed with
ASD) compared to mothers of children without ASD (Wan
et al. 2012).
Although parental behaviors of children with ASD
have been readily studied, varying results make it difficult
to interpret how the behaviors of parents of children with
ASD might differ behaviorally from parents of children
without ASD. In addition, there are known factors that
may have influenced these inconsistent results, such as a
child’s chronological age, a child’s developmental ability
(e.g., child’s IQ, mental age, or language skills) and
parental communication style (e.g., verbal comments
versus a combination of verbal and non-verbal commu-
nication). When considering child development as a factor
in parenting behavior, a child’s chronological age can
influence parenting behaviors (Bornstein 2011). Parental
behaviors can vary based on parenting demands and tasks
that occur across the developmental period. A child’s
developmental ability has been indicated as an influencing
factor of parental behaviors (Baker et al. 2003;Herman
and Shantz 1983). Delayed cognitive development may
lead parents to show higher commanding behaviors and
provide fewer opportunities to their child to independently
problem solve (Herman and Shantz 1983). This may be
because parents tried to compensate for their child’s
unexpected behaviors, due to possible delayed cognitive
development, by redirecting their child’s behavior in a
controlling matter (Kasari et al. 1988).
Since intellectual disability (ID) is a common associated
condition of ASD (Braun et al. 2015), it is difficult to
confirm whether core characteristics of ASD (e.g., social
communicative deficits and restricted or repetitive beha-
viors), influence parental behaviors, or if the combination of
ASD and ID impact parental behaviors. Thus, some studies
have matched groups (ASD and TD) based on child’s
developmental ability (e.g., child’s IQ, mental age, or lan-
guage skills) to control for the effects of delayed child
development when comparing parental behaviors (Blacher
et al. 2013; Freeman and Kasari 2013; Meirsschaut et al.
2011; Siller and Sigman 2002). Parents of children with
ASD showed more negative (Blacher et al. 2013), and
commanding (Freeman and Kasari 2013) parental behaviors
and were less responsive (Meirsschaut et al. 2011) com-
pared to parents of children without ASD. Conversely Siller
and Sigman (2002) found that parents of children with and
without ASD showed similar synchronized verbal commu-
nication to their child’s actions during play. Together, these
studies suggest that child development may be an influential
factor impacting the parental behaviors of children with and
without ASD.
Another factor that appears to impact the parental
behaviors of parents of children with ASD is parental
communication. As children with ASD experience deficits
and atypicalities in social and communication skills
1446 Journal of Child and Family Studies (2019) 28:1445–1460
(American Psychiatric Association [APA] 2013), the com-
munication signals of children with ASD may be weak,
poorly timed or parent–child communication may be non-
reciprocal (Sigman et al. 1986). This can result in the par-
ents having difficulty in matching their communication style
to their child, and parents may try to adapt their commu-
nication style based on their child’s needs. Thus, parents of
children with ASD may use a combination of verbal and
non-verbal approaches, rather than verbal communication
alone. Some studies examining the verbal language of
parents of children with ASD found that parents of children
with ASD used less demanding verbalizations (i.e., verba-
lization forcing parent’s idea to their child; Siller and Sig-
man 2002), synchronized comments (i.e., comments within
the child’s attention; Strid et al. 2013) and follow-in utter-
ances (i.e., utterance following the child’s interest; Walton
and Ingersoll 2015) compared to parents of children without
ASD. However, other studies examining the non-verbal
language of parents of children with ASD and parents of
children without disabilities found no parental behavior
differences between the two groups (Doussard-Roosevelt
et al. 2003; Lemanek et al. 1993).
Given inconsistent findings in the literature related to
parental behaviors or parents of children with ASD and
those without, the purpose of this meta-analysis was to 1)
examine the parental behaviors of parents of children with
ASD compared to parents of children without ASD and 2)
examine the effects of child’s chronological age, child’s
developmental ability and parental communication style on
parental behaviors. It was hypothesized that the parental
behaviors of children with ASD would be different from the
parental behaviors of children without disabilities. More
specifically, it was hypothesized that the parental control
and negativity behaviors in parents of children with ASD
would be higher compared to parents of children without
ASD. Moreover, it was hypothesized that the child’s
chronological age, child’s developmental ability, and par-
ental communication style would serve as moderators to the
difference between parental behaviors of parents of children
with and without ASD.
Method
Study Inclusion Criteria
Inclusion criteria for this meta-analysis were as follows: a)
peer-reviewed article, b) printed in English, c) a publication
date between January 1990 and September 2017, d) pre-
sence of parent-related terms and behavior-related terms
(e.g., mother, father, maternal, paternal, and a parental
behavior) in the title and/or abstract, e) concrete observable
parental behavior outcomes, f) sufficient statistical
information reported (e.g., a minimum of the mean(s),
standard deviation(s), and sample size), and g) children
aged from 1 year and 6 months to 9 years and 11 months.
Search Strategy
The guidelines for the Preferred Reporting Items for Sys-
temic Reviews and Meta-Analysis (PRISMA) were used.
Literature searches were conducted in the electronic data-
bases, Academic search premier, Psycinfo, and Medline.
The search terms used for this study across databases
included: (“autistic child*”OR “child* with autism”OR
“child* with ASD”) AND (“parent*”OR “mother*”
OR “father*”) AND (“behavior*”OR “interaction*”OR
“style*”) AND (“typical* develop*”OR “without autism”
OR “without ASD”OR “non-clinical”). The initial search
provided 991 articles. In addition to articles from the sys-
tematic search, another three articles (Blacher et al. 2013;
Lemanek et al. 1993; Meirsschaut et al. 2011) from a
manual search (i.e., reviewing reference lists and cross-
referencing) were included. Two authors (B.K., J.D.S.)
worked independently for the removal of duplicate manu-
scripts, this included the process of title/abstract screening,
and a full text review. If there was a disagreement between
article inclusion/exclusion, a discussion occurred, and the
authors reviewed and discussed the articles together and
then the articles agreed upon by two authors were included
in the final analysis. Author agreement was calculated using
Cohen’s kappa at each step. The results of Cohen’s kappa
for duplication removal, title and abstract screening, and full
text review were k=0.98, p< 0.001; k=0.89, p< 0.001,
and k=0.78, p< 0.001, respectively.
Figure 1outlines the search process. The number of
articles included in the full text review was n=39. A sec-
ondary review of all articles was conducted by two authors
(B.K., J.D.S.). This secondary review process led to the
exclusion of 26 articles that did not meet eligibility criteria
to be in this study (e.g., self-report or interview study design
[n=12], parental behaviors were not directly measured
[n=12], and no available statistical information [e.g., mean
or standard deviation] of parental behaviors [n=2]). In
cases where studies did not provide enough statistical
information (e.g., means and SD), the corresponding author
of the article was contacted by email for additional infor-
mation. One study provided additional information
(Adamson et al. 2012) but two studies did not reply thus
were excluded from the meta-analysis.
Data Extraction
Background and demographic information was extracted
from each article and included: a) parent years of education
and/or socio-economic status; b) number of participants; c)
Journal of Child and Family Studies (2019) 28:1445–1460 1447
child chronological age; d) child development-related age/
score (e.g. IQ, language age, mental age, developmental
score); e) parent age; f) parent ethnicity; g) observed/mea-
sured parenting behavior(s); h) type of observation setting;
i) measurement tool(s) used to assess parental behaviors; j)
duration of observation. All studies except one study
(Blacher et al. 2013) were cross-sectional. The longitudinal
study was included in this meta-analysis (Blacher et al.
2013), however only baseline data were used in the
analysis.
Parental Behaviors Selection
This study specifically targeted observable parental
behaviors to capture individualized or habitual comments
and reactions (Richman et al. 1994). Observable parental
behaviors were categorized into three globally identifiable
parental dimensions (parental warmth/support, parental
behavioral control and parental negativity) to capture
the fundamental parental behaviors (Van Leeuwen and
Vermulst 2004). Moreover, neutral parental behavior was
included. The following definitions were used for each
parenting behavior category: 1) Parental warmth/support
referred to affective and child-centered types of parental
behaviors observed when the parent was interacting with
their child (Tarnow and Thomas 2002), 2) Parental
behavioral control encompassed parental behaviors that
controlled, and regulated child behavior by directing and
limiting the child’s environment (Grolnick 2002), 3)
Parental negativity encompassed behaviors of aversion,
hostility, and overt communication of negative feelings
(Skinner et al. 2005), and 4) Neutralparentalbehavior
included descriptions of the child’s or parents’sactions
that additionally had no clear evidence of being suppor-
tive, controlling, or negative (Meirsschaut et al. 2011;
Watson 1998).
If a measured behavior was not included in these cate-
gories such as parent’s autonomy support and creativity,
these behaviors were excluded in the current study. Two
authors (B.K., J.D.S.) independently categorized parental
behaviors, within each manuscript that met inclusion cri-
teria, into the parental dimensions indicated. When there
was disagreement the authors reviewed and then discussed
the behaviors of the manuscript to arrive at a consensus.
Cohen’s kappa revealed a significant agreement between the
two reviewing authors, thus ‘good’criteria between the two
coders was achieved (k=0.78, p< 0.001). When a study
measured multiple parental behaviors within the same
dimension, they were synthesized into the same category
(e.g., parental affective behaviors and encouragement were
combined into parental supportive dimension). It is impor-
tant to note that some studies observed parental behaviors in
two different types of settings (free play and structured play
settings). For those studies (Blacher et al. 2013; Boonen
et al. 2015; Freeman and Kasari 2013; Hirschler-Guttenberg
et al. 2015), parental behaviors in a free play setting were
selected to capture the most natural parental behaviors for
the purpose of the current study.
Data Analysis
Calculation of effect size
Effect size was calculated for each study using Hedge’sg,
described as the difference between the means of two
compared groups (e.g., parents of children with ASD vs.
parents of children without ASD) divided by the pooled
standard deviation (Cooper et al. 2009). The effect sizes
were interpreted based on Cohen’s guidelines (Cohen
1992), thus an effect size of 0.10 was considered small, 0.30
medium, and above 0.50 was observed as large. Within the
meta-analysis, the effect sizes of parental supportive/
warmth and control dimensions displayed heterogeneity,
thus a random effects model was used. This model allowed
the correction of overestimations related to small sample
sizes (Borenstein et al. 2011a,2011b). Parental behaviors
are a multi-dimensional construct, and multiple parental
Identification
Search Terms:
("autistic child*" OR "child* with autism" OR “child* with ASD”)
AND (“parent*” OR “mother*”) AND (“behavior*” OR
“interaction*”) AND ("typical* develop*" OR “without autism”
OR “without ASD” OR “non-clinical”)
Eligibility
Duplicated papers removed (excluded; n = 441)
Screening
Total (n = 994)
Database Search Results (n = 991)
Academic Search Premier (n=261) (peer-reviewed)
PsycInfo (n=423) (peer-reviewed)
Medline (n=307) (peer-reviewed)
Manual search (n = 3)
Title and Abstract Screening
Absence of key words in title and abstract (excluded; n = 511)
Full text screening (n = 42)
Secondary audit by primary researchers
Self-report or interview study design (excluded; n =12)
Not directly measured parental behaviors (excluded; n =12)
Not available statistical information (e.g., mean or standard
deviation) of parental behaviors (excluded; n = 2)
Inclusion
Articles included in review (n = 16)
Fig. 1 Search process
1448 Journal of Child and Family Studies (2019) 28:1445–1460
behaviors were investigated within studies. Based on
Rosenthal’s suggestion for sustaining independent samples
in the meta-analysis (Rosenthal 1991), the effect sizes of the
variables were averaged to structure one variable per study.
All data analysis was conducted using the Comprehensive
Meta-Analysis program (Borenstein et al. 2011a,2011b).
Heterogeneity
To identify heterogeneity of effect sizes, Q statistics were
implemented with α≤0.05. This creates the ability to
examine whether there is dispersion in the effect sizes
related with heterogeneity (Huedo-Medina et al. 2006). In
addition to Q statistics, an I2statistic was conducted to
observe the effect of heterogeneity (Higgins and
Thompson 2002). Moreover, in cases of detected sig-
nificant heterogeneity, Moderation analyses were imple-
mented to describe dispersions in effect sizes across
studies. Three possible moderators were selected; 1)
child’s chronological age 2) child’s developmental ability
and 3) parental communication style.
The included studies were divided into two groups based
on the mean chronological age of children which is five
years old. (i.e., below 5 vs. above 5) and used as a mod-
erator. Child’s developmental ability included their IQ,
developmental age, or language skills (verbal reasoning and
verbal mental score). Some studies matched child’s devel-
opmental ability between groups to control its effects on
parental behaviors (i.e., chronological age of children with
ASD was higher than of children without ASD when their
developmental abilities were matched between groups).
However, other studies matched child’s chronological age
between groups, which resulted in significant differences
with developmental ability of children with ASD being
lower than the developmental ability of children without
ASD. If studies did not report child’s developmental ability,
they were not included in the moderation analysis. For more
information, see Table 1. In addition, parental commu-
nication style was selected as a potential moderator. Some
studies only measured parental verbal utterances/comments
and other studies measured combination of verbal and non-
verbal communication based on their research topic and
how they defined parental behaviors.
Publication bias
To account for publication bias, “fail-safe N”was con-
ducted (Rosenthal 1995), followed by visual inspection of
the data using a Funnel plot. In addition, Kendall’s tau was
implemented to check whether there was a significant cor-
relation between the standardized effect size and its related
variance (Field and Gillett 2010). Egger’s test was also
conducted to detect asymmetry in the Funnel plot (Egger
et al. 1997).
Study quality
The Standard Quality Assessment Criteria for Evaluating
Primary Research Papers from a Variety of Fields (Kmet
et al. 2004) was used to assess the quality of the studies
used in this meta-analysis. A question in the assessment (“if
interventional and blinding of subjects to intervention was
possible, is it reported?”) was removed as this question was
not applicable to the purpose of this current study. A higher
score indicated a higher quality study. All studies received
scores which ranged from 18 to 23 out of a maximum of 26.
When a study specifically targeted parental behavior dif-
ferences between parents of children with and without ASD,
those studies used well-developed study designs such as
controlling for confounding factors and blinding coders
from the diagnosis of children with ASD (Boonen et al.
2015; Guo et al. 2017; Hirschler-Guttenberg et al. 2015;
Meirsschaut et al. 2011). These studies received higher
scores compared to a study examining the relationship
between parental behaviors and child development (com-
paring parental behaviors was a part of their study).
Moreover, reporting some estimate of variance (confidence
intervals or standard errors) and a detailed description of
participant characteristics were the main factors influencing
the quality of all studies.
Results
Demographic Information
16 studies were included in this meta-analysis. Table 1
explains demographic information across the identified
studies. Specific measurement information of each included
study can be found in Table 2.
Effect Size of Parental Behaviors by Dimension
Table 2indicates which behaviors were categorized into
which dimensions. The combined effect size (random effect
model) displayed that parental supportive/warmth dimen-
sions of parents of children with and without ASD were not
significantly different (Hedge’sg=0.004, 95% CI: −0.31,
0.31; z=0.02; p=0.98) but the parental control dimen-
sions of parents of children with and without ASD were
significantly different (Hedge’sg=0.53, 95% CI: 0.13,
0.93; z=2.60; p=0.009). Parents of children with ASD
showed more controlling behaviors than parents of children
without ASD. Moreover, the combined effect size (fixed
Journal of Child and Family Studies (2019) 28:1445–1460 1449
Table 1 Demographic information of studies
Study Parent (n) Parent age in
years M (SD)
Child chronological
age in months M (SD)
Child developmental
score
Child
gender
Parent
education
years
Parent
ethnicity
Quality
score
Adamson et al.
(2012)
Parents of ASD
(23)
N/A 30.8 (4.6) N/A Boys 20
Girls 3
N/A EA: 83%
AA: 0
HP: 13%
18
Parents of TD
(56)
32.5 (N/A) 18.1 (0.3) N/A Boys 28
Girls 28
76%aEA: 79%
AA: 16%
HP: 4%
Blacher et al.
(2013)
Mothers of ASD
(12)
35.5 (6.0) 35.6 (2.9) 57.6 (8.7)b* Boys 12
Girls 0
15.6 CC: 75.5% 20
Mothers of TD
(115)
34.1 (5.8) 34.8 (3.1) 104.3 (11.9)b* Boys 58
Girls 57
15.7 CC: 60.9%
Boonen et al.
(2015)
Mothers of ASD
(30)
40.1 (4.5) 9.5 (1.0)y 107.1 (10.1)cBoys 24
Girls 6
57%aN/A 23
Mothers of TD
(39)
40.2 (3.7) 9.2 (1.0)y 110.9 (11.1)cBoys 22
Girls 17
92%a
Bentenuto et al.
(2016)
Mothers of ASD
(25)
36.8 (3.7) 43.3 (7.6) 24.2 (9.8)dN/A 37.8 (13.2)eN/A 18
Mothers of TD
(25)
25.4 (6.1) 20.0 (0.2) 20.0 (0.2)dN/A 21.4 (5.5)eN/A
Doussard-
Roosevelt et al.
(2003)
Mothers of ASD
(24)
38 (N/A) 51.0 (N/A) N/A Boys 18
Girls 6
Well-educated EA: 67%
AA: 13%
HP: 10%
ASA: 4%
ME: 6%
19
Mothers of TD
(24)
51.8 (N/A) N/A Boys 14
Girls 10
EA: 67%
AA: 13%
HP: 10%
ASA: 4%
ME: 6%
Freeman and Kasari
(2013)
Parents of ASD
(16)
N/A 49.5 (11.8) 39.8 (13.6)dBoys 12
Girls 4
81%aN/A 20
Parents of TD
(16)
28.5 (8.8) 36.1 (11.5)dBoys 9
Girls 7
81%aN/A
Haven et al.
(2013)
Parents of ASD
(21)
N/A 69.5 (11.1) 69.5 (14.8)fBoys 18
Girls 3
67%aCC: 57% 18
Parents of TD
(21)
56.62 (10.4) 63.0 (17.0)fBoys 14
Girls 7
91%aCC: 91%
Lemanek et al.
(1993)
Parents of ASD
(18)
N/A 4.6 (0.9)y 54.5 (17.1)c* Boys 14
Girls 4
N/A AA: 6%
CC: 28%
HP: 44%
Other: 22%
18
Parents of TD (16) 4.4 (1.1)y 99.8 (14.9)c* Boys 10
Girls 6
AA: 0%
CC: 31%
HP: 63%
Other: 6%
Meirsschaut et al.
(2011)
Parents of ASD
(16)
33.58 (3.76) 38.43 (10.9) N/A Boys 13
Girls 3
42.27 (12.91)eN/A 22
Parents of TD
(15)
35.17 (5.13) 41.11 (5.23) N/A Boys 10
Girls 5
46.64 (11.24)eN/A
Siller and Sigman
(2002)
Parents of ASD
(25)
N/A 50.3 (11.7) 24.2 (8.4)dBoys 20
Girls 5
13.3 (1.6) N/A 20
Parents of TD
(18)
21.8 (6.8) 25.2 (8.9)dBoys 14
Girls 4
15.0 (2.1) N/A
Strid et al. (2013) Parents of ASD
(20)
N/A 66.8 (17.3) 45.2 (19.4)dBoys 18
Girls 3
N/A N/A 18
Parents of TD
(23)
34.7 (5.20) 37.0 (8.9)dBoys 12
Girls 11
N/A
Van IJzendoorn
et al. (2007)
Parents of ASD
(21)
N/A 28.4 (4.9) N/A N/A N/A N/A 18
Parents of TD
(15)
N/A N/A
Watson (1998) Parents of ASD
(14)
N/A 51.7 (11.7) 19.0 (8.1)dBoys 11
Girls 3
14.4 (N/A) EA: 85%
AA: 15%
18
Parents of TD
(14)
18.5 (8.5) 20.1 (10.5)dBoys 11
Girls 3
15.1 (N/A) EA: 85%
AA: 15%
1450 Journal of Child and Family Studies (2019) 28:1445–1460
effect model) displayed that parental negativity dimensions
of parents of children with ASD compared to parents of
children without ASD were significantly different (Cohen’s
d=0.31, 95% CI: 0.01, 0.62; z=2.03; p=0.04). Parents
of children with ASD displayed more negative behaviors
than parents of children without ASD. Parental neutrality
dimensions of parents of children with and without ASD
were not significantly different (Cohen’sd=0.21, 95% CI:
−0.04, 0.47; z=1.60; p=0.10). Table 3demonstrates the
effect size of all four parental behavior dimensions.
Heterogeneity
The heterogeneity analyses revealed that parental suppor-
tive/warmth and control dimensions significantly indicated
potential heterogeneity (Supportive−warmth: Q(13) =
49.47, p< 0.001, I2=73.72%; control: Q(9) =39.85, p=
0.001, I2=77.41%). Other dimensions (negative and neu-
tral behaviors) did not reveal significant heterogeneity
(negativity: Q(2) =0.83, p=0.66, I2=00.00%; neutral: Q
(5) =6.09, p=0.29, I2=17.91%).
Moderation Analysis
Parental support/warmth and parental control dimensions
revealed significant heterogeneity, thus per the analytic plan
moderation analyses were conducted to examine the effects
of the planned moderator on the parental dimensions. In the
parental supportive/warmth dimension, parental commu-
nication style was a significant moderator effect (Qb=5.11;
p=0.02) suggesting that parental behavior differences
between parents of children with and without ASD varied
based on parental communication style. Parents of children
with ASD tended to use less supportive/warmth verbal
comments/utterances compared to parents of children
without ASD (mean ES =−0.52; p=0.05; N=4). There
was no statistically significant difference in verbal and non-
verbal interactions between groups. In the parental control
dimension, child’s developmental ability showed a sig-
nificant moderation effect (Qb=9.70; p=0.008) indicating
that parents of children with ASD displayed more control-
ling behaviors than parents of children without ASD when
their child’s developmental ability between groups was not
Table 1 (continued)
Study Parent (n) Parent age in
years M (SD)
Child chronological
age in months M (SD)
Child developmental
score
Child
gender
Parent
education
years
Parent
ethnicity
Quality
score
Walton and
Ingersoll (2015)
Mothers of ASD
(28)
N/A 48.29 (13.06) 26.62 (6.61)dBoys 24
Girls 4
N/A N/A 21
Mothers of TD
(16)
24.13 (4.31) 26.13 (4.44)dBoys 9
Girls 7
N/A
Guo et al. (2017) Mothers of ASD
(47)
36.29 (5.34) 5.27y (1.42) N/A Boys 35
Girls 12
89.13%aEA: 44%
ASA: 15%
HP: 24%
ME: 17%
21
Mothers of TD
(26)
35.47 (5.89) 4.34y (1.12) Boys 17
Girls 9
100%aEA: 46%
ASA: 23%
HP: 7%
ME: 24%
Hirschler-
Guttenberg et al.
(2015)
Parents of ASD
(40)
One child with
mother and father
Mother: 37.6
(4.45)
Father:
40.34 (5.33)
63.38 (12.3) 14.15 (4.08)gBoys 35
Girls 5
Mother:
15.94 (2.47)
Father:
15.97 (3.71)
N/A 21
Parents of TD (40)
One child with
mother and father
Mother: 36.14
(4.39)
Father:
38.6 (4.86)
53.56 (13.8) 15.51 (5.9)gBoys 34
Girls 6
Mother:
16.59 (2.28)
Father:
16.87 (2.85)
N/A
CC Caucasian, EA European American/Caucasian, AA African American, HP Hispanic, ASA Asian American/Asian, ME mixed ethnicity
aCompledted college
bDevelopmental age
cIQ
dMental age
eSocioeconomic score
fVerbal mental score
gVerbal reasoning score
*Developmental ability was statistically significantly different between groups
Journal of Child and Family Studies (2019) 28:1445–1460 1451
Table. 2 Included parental behaviors and measurement of the behaviors
Study Measured parental
behaviors
Behavior
measurement tool
Observation place
and types of play
setting
Observation protocol
Adamson et al.
(2012)
•Scaffoldinga
•Symbol highlightinga
•Following in on
child’s focusa
•Parent affective
communicationa
Own created scaleb•Laboratory
•Semi-structure
Communication play
protocol (Adamson
et al. 2001)
Blacher et al.
(2013)
•Positive parentinga
(age of 3, 4, 5)
(positive affect,
sensitivity, stimulation of
cognition, detachment
reverse coded)
•Negative parentingc
(age of 3, 4, 5)
(maternal negativity,
intrusiveness)
Parent–child interaction
rating systemb
•Laboratory
•Unstructured
•Structured
10 min play
Boonen et al.
(2015)
•Warmtha
•Negativityd
•Investmentc
•Provision of structurec
•Sensitivitya
•Creativitye
•Autonomy supporte
Parenting rating scaleb•Home
•Unstructured
•Structured
15 min play
Bentenuto et al.
(2016)
•Exploratory playf
•Symbolic playfPlay codeg•Intervention
center
•Unstructured
10 min play
Doussard-
Roosevelt et al.
(2003)
•Social verbalf
•Social nonverbalf
•Physical proximitya
•Physical contactc
•Object verbalf
•Object nonverbalf
•Intensitye(low)
•Intensitye(mid)
•Intensityc(high)
Approach-withdrawal
interaction coding
systemb
•Laboratory
•Unstructured
10 min play
Freeman and
Kasari (2013)
•Parental schemesf
•Parental Suggestionsa
•Parental commandsc
•Parental repetitive actsc
DPA instrument
sequence of categoriesb
•Laboratory
•Unstructured
•Structured
10–20 min play
Haven et al.
(2013)
•Positive affecta
•Emotional supportaThe system for coding
interactions and family
functioningb
•Laboratory
•Structured
(reading books)
5 min play
(Hirschler-
Guttenberg et al.
(2015)
•Parental sensitivitya
•Parental intrusivenessc
•Parental warm limit
settinga
The coding interactive
behaviorb
•Home visits
•Unstructured
•Structured (led
by researcher)
2h
Lemanek et al.
(1993)
•Verbal Attentiona
•Nonverbal Attentiona
•Proximitya
•Nonverbal Promptc
Own created scaleb•Laboratory
•Structured (doing
specific
activities)
8 min play
Meirsschaut et al.
(2011)
•Declarative initiativea
•Imperative initiativec
•Neutral initiativef
•Confirming responsea
•Non-confirming
Responsed
•Neutral responsef
Frequency of
behaviorsb
•Laboratory
•Unstructured
7 min (then 13 min still-
face manipulation)
Siller and Sigman
(2002)
•Indicating behaviorf
•Verbalizationf
•Synchronization
- Undemandinga
Frequency of
behaviorsg
•University
Playroom
•Unstructured
4 min
Strid et al. (2013)•Synchronized commenta
•Unsynchronized
commentc
Frequency of
commentsg
•Laboratory
•Semi structured
24 min (last 8 min
coded)
Van IJzendoorn
et al. (2007)
Parental sensitivityaThe Emotional
Availability Scalesb
•Laboratory
•Unstructured
10 min
1452 Journal of Child and Family Studies (2019) 28:1445–1460
matched between groups (mean ES =1.33; p< 0.001; N=
2). The mean of child’s chronological age was not con-
sidered as a significant moderator in both supportive/
warmth (Qb=0.94; p=0.33) and control (Qb=0.53; p=
0.46) dimensions. Moderation analyses were not conducted
for the negative and neutral parental dimensions because
they did not show heterogeneity.
Publication Bias
Three different analyses were implemented to measure
publication bias (fail safe N, Kendall’s tau and Egger’s test)
for each parental dimension including overall parental
behaviors. The results of the fail safe Ntest were 14 (sup-
portive/warmth), 78 (control), 17 (negative), and 20 (neu-
tral). Kendall’s tau revealed that there were no significant
differences in results suggesting that studies with small
sample sizes were publishable in this area. Moreover,
Egger’s test revealed that there were no significant results
for parental dimensions indicating the estimates of these
studies may not be impacted by publication bias. For more
details, see Table 4.
Discussion
This meta-analysis confirmed that parental control and
negativity dimensions in parents of children with ASD are
different from parents of children without ASD, but parental
support/warmth and neutral dimensions in parents of chil-
dren with and without ASD are not different. Moreover, a
moderation analysis with three potential moderators
revealed that child’s developmental ability acted as a
moderator of the parental control dimension, and parental
communication style served as a moderator of the parental
supportive/warmth dimension. The mean of child’s chron-
ological age was not a significant moderator in either the
warmth/supportive or control dimensions.
Parents of children with ASD exhibited significantly
more controlling behaviors than parents of children without
ASD (Hedge’sg=0.53, 95% CI: 0.13, 0.93; z=2.60; p=
0.009). Parental controlling behaviors include, but are not
limited to, physical contact, intrusiveness, imperative
initiatives, and unsynchronized comments. A potential
explanation may be deficits in social skills and commu-
nication that are present in children with ASD. If there is a
Table 2 (continued)
Study Measured parental
behaviors
Behavior
measurement tool
Observation place
and types of play
setting
Observation protocol
Watson (1998)•Child-focused utterancea
•Out of focus Utterancec
•Neutral utterancef
Systematic analysis of
language transcripts
softwaresg
•Laboratory
(USA)
•Classroom
(Canada)
30 min
Walton and
Ingersoll (2015)
•Demanding utterancec
•Non-demanding
utterancea
•Follow-in utterancee
•Non-follow in utterancee
Frequency of utteranceg•Laboratory
•Semi-structured
10 min
Guo et al. (2017)•Visits
•Child positive/mother
negativityd
•Child negative/mother
positivee
•Mutual positivee
•Mutual negativityd
•Quality and quantity
of emotion-
engagement state and
state space grid
measuresg
•Home visits
•Semi-structured
play
10 min
Duration
•Child positive/mother
negativityd
•Child negative/mother
positivee
•Mutual positivee
•Mutual negativityd
aParental warmth/positive dimension
bCombination of verbal and non-verbal interactions (measuring tool)
cParental control dimension
dParental negative dimension
eNot-included behaviour
fParental neutral dimension
gVerbal comment only (measurement tool)
Journal of Child and Family Studies (2019) 28:1445–1460 1453
Table 3 The effect size of each parental dimension
1454 Journal of Child and Family Studies (2019) 28:1445–1460
lack of communication between the parent and child, a
parent may shift to a non-verbal social interaction such as
physical contact or a high-intensity approach, which fun-
damentally leads to increased parental controlling behaviors
(Doussard-Roosevelt et al. 2003). Lemanek et al. (1993)
confirmed that children with ASD adjusted their behaviors
less frequently based on prompts from their parent’s com-
pared to children without ASD and children with ID. This
led parents of children with ASD to use more nonverbal
prompts and nonverbal cues and signs compared to com-
parison groups such as parents of children with language
delay or children without disabilities. Moreover, it may be
challenging for parents of children with ASD to accurately
interpret their child’s needs, which may result in controlling
behaviors with their child (e.g., out-of-focus verbal lan-
guage: suggesting ideas without understanding child’s
wants) (Watson 1998).
In addition to ASD-related behaviors, there may be other
factors that influence parental behaviors of parents of chil-
dren with ASD. In this meta-analysis, the child’s develop-
mental ability was a significant moderator in the parental
control dimension (Qb=9.70; p=0.008). When child
developmental ability (e.g., child’s IQ, mental age, or lan-
guage skills) in the ASD group was significantly lower than
that of the comparison group (Blacher et al. 2013; Lemanek
et al. 1993), parents of children with ASD displayed more
controlling behaviors. However parental control behaviors
between groups were not significantly different when a
child’s developmental score was similar between groups
(children with and without ASD).
This result is consistent with previous studies confirming
that a child’s developmental ability is an influencing factor
of parental behaviors. Some studies suggest that parents of
children with developmental delay (DD) display higher
levels of controlling behaviors (e.g., directness or intru-
siveness) during interactions with their children compared
to parents of children without disabilities (Fenning et al.
2007; Herman and Shantz 1983; Marfo 1992). A research
conducted by Blacher et al. (2013) compared parental
behaviors of parents of children with DD to parental
behaviors of parents of children without disabilities in
structured (i.e., goal-directed play) and unstructured (i.e.,
free play) settings. In this study, parents of children with
DD showed more controlling behaviors in an unstructured
play setting than parents of children without disabilities and
this difference increased in a structured setting. This result
indicates that child’s developmental ability is a factor that
influences parental controlling behaviors. Moreover, parents
of children with DD also displayed more direct conversa-
tions than parents of children without disabilities (Wieland
et al. 2014). This may be because parents of children with
DD tried to compensate for their child’s unexpected beha-
viors by directing their behavior (Kasari et al. 1988). Yet,
parental control may be activating or limiting certain child
behaviors to a level commensurate with the parent expec-
tations of the child’s ability.
In addition, if an individual has both ASD and a low
developmental ability, the child may present more chal-
lenges and deficits of behaviors and skills than an individual
who has only ASD or only low developmental ability
(Boucher et al. 2008). The combination of ASD and ID may
lead parents of children with ASD to direct and control their
child’s behavior both verbally and physically. As ID often
co-occurs with ASD (Lecavalier et al. 2011), it is difficult to
accurately differentiate and identify which specific char-
acteristics influence parental control behaviors of parents of
children with ASD and low developmental ability. How-
ever, based on the results of this meta-analysis, it is likely
that parents may display more controlling behaviors when
their child has both ASD and a lower developmental ability
compared to parents of children without ASD. Since the
child’s chronological age was not a significant moderator in
this meta-analysis, it is important to match child’s devel-
opmental ability between groups instead of the child’s
chronological age when comparing parental controlling
behaviors between parents of children with and
without ASD.
In addition to parental control behaviors, this meta-
analysis confirmed that there was a statistically significant
difference in the parental negativity dimension between
groups. The negativity dimension refers to parents’verbal
and non-verbal expressions of anger and rejection of the
child’s ideas. One potential reason for this difference is
parenting stress. Parenting stress is associated with emo-
tional dysregulation that may influence parenting (Crandall
et al. 2016). Fenning et al. (2007) also suggest that parents
with high parenting stress show diminished sensitivity and
diminished positive parenting styles compared to parents
Table 4 Publication biases of each parental dimension
Types of parental dimension Fail safe N (r=0.05) Kendall’s tau with continuity correction Egger’s test
Supportive/warmth 17 0.08p =0.66 β=2.02 (−5.30, 9.36) p=0.55
Control 78 0.4p =0.10 β=6.36 (−1.15, 13.89) p=0.08
Negative 20 0.00p =1.00 β=−2.77 (−25.28, 19.73) p=0.36
Neutral 17 0.46p =0.25 β=5.17 (−4.90, 15.25) p=0.22
Journal of Child and Family Studies (2019) 28:1445–1460 1455
with low parenting stress. Moreover, it was indicated that
parents with high parenting stress levels were less likely to
be involved with their child. However, in the current meta-
analysis, no study controlled parental stress levels when
observing parental behaviors. Thus, the specific role of
parenting stress is an area of further investigation.
Unlike the parental control and negativity behaviors, the
current meta-analysis found that supportive/warm parental
behaviors were not different between groups. However, the
moderation analysis revealed that parental communication
style was a significant moderator (Qb=5.11; p=0.02)
indicating that parental use of verbal comments/utterances
was different between groups (mean ES =−0.52; p=0.05;
N=4). Parents of children with ASD displayed less sup-
portive/warmth verbal comments than parents of children
without ASD. Supportive/warmth verbal behavior mostly
consisted of synchronized and child-focused comments/
utterances. Since children with ASD experience deficits in
social communication (APA 2013), it makes sense that
parents of children with ASD provide unsynchronized
comments, as they may not effectively interpret their child’s
cues or signs.
In addition, the child’s language level may have an
influence on parental supportive/warmth verbal comments.
In Watson’s(1998) study, no synchronized comment dif-
ferences were found between parents of verbal children with
ASD and parents of children without ASD. Moreover, in
another study (Strid et al. 2013), parents of verbal children
with ASD showed more synchronized comments compared
to parents of non-verbal children with ASD. As only a few
studies (Strid et al. 2013; Watson 1998) have differentiated
the child’s language ability (verbal vs. non-verbal), sub-
group analysis was not conducted in this current study.
In addition to child communication deficits, a parent’s
own interaction style may be a possible explanation for the
supportive/warmth verbal behavior difference between the
two groups. It is recommended for parents of children with
ASD to use simple language and exaggerated gestures when
interacting with children with ASD (Volkmar and Wiesner
2009). This approach may be advantageous and support
positive interactions and communication with children with
ASD and for the child’s language development. Thus,
parents of children with ASD may adapt their supportive/
warmth behaviors, making their language simple and
shorter based on this recommendation. This may result in
differences in supportive/warmth verbal comments in par-
ents of children with ASD compared to parents of children
without ASD.
In sum, this meta-analysis confirmed similarities and
differences of parental behaviors between parents of chil-
dren with and without ASD. Parental behavior dimensions
of supportive/warmth and neutral were not different
between parents of children with and without ASD.
However, the parent’s interaction style acted as a moderator
for parental supportive/warmth behaviors. Parental control
and negativity behaviors were different between groups,
and child development was a significant moderator, indi-
cating that parents of children with ASD showed more
controlling behaviors when their child additionally had a
lower developmental ability compared to children without
ASD. Because family, especially parents, serves as a
building block for the development of social skills in chil-
dren (Odom et al. 1992), this result is especially important
for families of children with ASD who experience social-
interaction and communication skill deficits.
Parental controlling behaviors such as intrusiveness and
directiveness are a widely known factor that negatively
influences a child’s social and emotional development
(Barber et al. 2005; Grusec and Davidov 2010). Parents
who have high controlling behaviors tend to overwhelm the
child with multiple requests and may not support their
child’s self-oriented play (Ispa et al. 2004). These char-
acteristics are associated with high behavior problems
(Barnett et al. 2010), and anxiety in children (Hurrell et al.
2015) as well as negatively influence the child’s cognitive
development (i.e., executive function) (Valcan et al. 2018).
Unfortunately, it is still not clear about the effect of high
controlling behaviors in parents on the development of
children with ASD because of the very scarce literature, but
this literature has indicated that parental intrusiveness and
directiveness negatively influenced social skill development
of children with developmental delays (Marfo 1992;
Stevenson and Crnic 2013). Even though children with
ASD and children with developmental delays are not etio-
logically the same, they share common characteristics such
as delayed development, adaptive functioning, and chal-
lenging behaviors (Matson and Shoemaker 2009). Thus, it
is reasonable to suggest that the high controlling behaviors
in parents of children with ASD may have negative impacts
on their children’s development.
Therefore, it is recommended for parents of children with
ASD to encourage and support their children, while not
directing and/or interrupting their children’s behaviors. It
would be helpful for parents of children with ASD to use a
variety of strategies such as scaffolding positive behaviors,
offering praise for small or new tasks and understanding the
child’s independent abilities to set goals that set the child up
for success.
Furthermore, the results of this study should be used as a
resource to create and develop parent-centered interventions
for parents of children with ASD. Especially, interventions
should not only consider the child’s ASD-related char-
acteristics, but additionally consider and focus on how the
child’s developmental ability significantly influences the
parent’s controlling behaviors and provide strategies to
promote supportive and warm and parenting practices. For
1456 Journal of Child and Family Studies (2019) 28:1445–1460
example, intervention developers should extensively
explain the importance of meeting the child at the child’s
developmental ability, and not their chronological age, to
aid parents in effectively interpreting and responding to
their children’s behaviors.
Limitations
Limitations of the current meta-analysis are not with-
standing. This meta-analysis only included observational
studies. Thus, it may not represent all parental behaviors of
parents of children with ASD because of the presence of a
researcher observing the interaction. The survey studies
examining parental style and/or parenting strategies were
not included in this meta-analysis because it could contain
self-report bias (Donaldson and Grant-Vallone 2002) which
are different from concrete, observable parental behaviors
(Aunola and Nurmi 2005; Van Leeuwen et al. 2004).
Additionally, this study did not include studies investigating
parental behaviors of parents of adolescents and of infants.
With children’s developmental ability influencing parental
behaviors, parental behaviors of parents of adolescents with
ASD or infants at risk of ASD may be different from par-
ental behaviors of parents of children with ASD. Although
the familial aspect of autism and the broader autism phe-
notype can influence parental behaviors, the studies inclu-
ded in the current study did not control this factor so it
could not be used as a moderator.
Another limitation is that studies using term, “matched
normative control group”are not included in the search
term of the current study. In addition, keywords, including
Asperger(s) and Pervasive Developmental Disorder were
not included in this present study’s search term, which may
have resulted in some studies being missed. Few studies
used the search term “children on the autism spectrum”or
“children with autism spectrum disorder”but those studies
may have additionally been missed in the current study.
However, the two authors of the present study manually
cross-referenced the included articles to confirm that there
were no related-studies missed from using the present
study’s search term. In turn, three articles were included in
the present study. Thus, it is expected that potentially
missed articles do not significantly impact the quality and
direction of this present study.
This study could not confirm the overall effect size of the
father’s behaviors because of a lack of information. Many
of the studies only focused on the mother’s behaviors, and
there were only a few studies that included both mothers
and fathers, so further analysis could not be made about the
mothers’or fathers’independent behaviors. In addition to
the parent factor, we could not make any conclusions about
how the severity of ASD impacts parental behaviors. A few
studies (Doussard-Roosevelt et al. 2003; Van IJzendoorn
et al. 2007) categorized participants into groups based on
their language or developmental level, but many of the
studies did not include the severity of ASD as a covariate in
analysis.
Each study included in this meta-analysis used different
protocols and measurement tools to observe parental
behaviors, which may cause heterogeneity of results.
Interestingly, no study included in the current study used
overlapping measurement tools. This may represent the
complexity of parental behaviors. Reed and Osborne (2014)
indicated that one reason parental behaviors of parents of
children with ASD have not been extensively studied is
because it is difficult to agree about the definitions of par-
enting and set up distinct boundaries between each specific
parenting behavior. To move forward, clear definitions of
parental behaviors in the context of raising a child with
ASD and a standardized measurement tool for observing
concrete parental behaviors are needed.
In addition to the measurement tool issue, the measure-
ment issue itself needs to be considered. Every behavioral
researcher may agree that behavior is bidirectional and not
unidirectional. However, when measuring the parental
behaviors of parents of children with ASD, most studies
focus on unidirectional parental behaviors. To more accu-
rately observe and interpret parental behaviors, focus needs
to examine parent–child interactive behaviors. For example,
it is different that parents show positive behaviors when
their child displays negative behaviors than when the child
displays positive behaviors. Thus, if observations specifi-
cally target parent-child interactive behaviors, it may cap-
ture a parent’s individual or habitual comments and
reactions toward his or child’s behavior.
Acknowledgements We would like to acknowledge all the authors of
the studies included in this meta-analysis.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Ethical Approval This article does not contain any studies with human
participants or animals performed by any of the authors. All included
studies in this current meta-analysis were anonymized.
Publisher’s note: Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
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