Parenting Stress and Closeness Mothers of Typically Developing Children and Mothers of Children With Autism

Abstract

Mothers of children diagnosed with autism (N = 104) reported higher levels of stress than mothers of typically developing children (N = 342) on 13 of 14 subscales of the Parenting Stress Index. The only scores that did not differ were from the Attachment subscale, which indicates lack of emotional closeness and rather cold patterns of parent-child interaction. Mean Child Domain subscale scores for mothers in the autism group were at the 99th percentile; mean scores on the Attachment subscale were at about the 50th percentile for both groups. Despite substantial stress, mothers of children with autism report close relationships with their children. Results substantiate the need to develop interventions to help these mothers reduce their stress.

Full text

178
Focus on Autism and Other
Developmental Disabilities
Volume 24 Number 3
September 2009 178-187
© 2009 Hammill Institute on
Disabilities
10.1177/1088357609338715
http://focus.sagepub.com
hosted at
http://online.sagepub.com
Parenting Stress and Closeness
Mothers of Typically Developing Children
and Mothers of Children With Autism
Charles D. Hoffman
Dwight P. Sweeney
Danelle Hodge
California State University
Muriel C. Lopez-Wagner
Pitzer College
Lisa Looney
California State University
Mothers of children diagnosed with autism (N = 104) reported higher levels of stress than mothers of typically developing
children (N = 342) on 13 of 14 subscales of the Parenting Stress Index. The only scores that did not differ were from the
Attachment subscale, which indicates lack of emotional closeness and rather cold patterns of parent-child interaction. Mean
Child Domain subscale scores for mothers in the autism group were at the 99th percentile; mean scores on the Attachment
subscale were at about the 50th percentile for both groups. Despite substantial stress, mothers of children with autism report
close relationships with their children. Results substantiate the need to develop interventions to help these mothers reduce
their stress.
Keywords: autism; maternal stress; parenting; attachment
Authors’ Note: Address correspondence to Charles D. Hoffman,
PhD, Department of Psychology, 5500 University Parkway, San
Bernardino, CA 92407 (choffman@csusb.edu).
The unique challenges associated with parenting a
child with a developmental disability have been
found to be particularly stressful for parents, with these
parents reporting greater levels of stress than parents of
typically developing children (Abbeduto et al., 2004;
Baker, Blacher, Crnic, & Edelbrook, 2002; Higgins,
Bailey, & Pearce, 2005; Innocenti, Huh, & Boyce, 1992;
Perry, 2005). The characteristics of autism have been
found to be especially challenging (Hastings, 2002;
Koegel et al., 1992; Perry, Harris, & Minnes, 2005), with
parents of children with autism reporting higher levels of
stress than parents of children with Down syndrome,
developmental disabilities, or other psychiatric difficul-
ties (Bouma & Schweitzer, 1990; Duarte, Bordin, Yazigi,
& Mooney, 2005; Eisenhower, Baker, & Blacher, 2005;
Fisman, Wolf, & Noh, 1989; Kasari & Sigman, 1997;
Konstantareas, 1991; Norton & Drew, 1994). A number
of studies have suggested a relationship between the
behavior of children with autism and parents’ stress (e.g.,
Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001; Tomanik,
Harris, & Hawkins, 2004). Furthermore, symptoms asso-
ciated with the disorder, such as the children’s language
and communication difficulties, cognitive impairments,
reactivity to frustration, and repetitive, self-stimulatory
behavior (American Psychiatric Association [APA],
2000), also have been found to be related to parents’
stress (Bebko, Konstantareas, & Springer, 1987;
Donenberg & Baker, 1993; Gabriels, Cuccaro, Hill, Ivers,
& Goldson, 2005; Norton & Drew, 1994).
There is evidence of an association between the sever-
ity of behavior problems and level of parental distress for
parents of children with developmental disabilities
(Abbeduto et al., 2004; Baker et al., 2002; Hastings,
2002; Minnes et al., 1989; Perry et al., 2005). Three stud-
ies found limited evidence of a relationship between the
severity of children’s autism and parental stress (Bebko
et al., 1987; Freeman, Perry, & Factor, 1991; Konstantareas
& Homatidis, 1989). Tobing and Glenwick (2002)
attempted to address methodological restrictions of these
earlier studies and used the Childhood Autism Rating
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Hoffman et al. / Parenting Stress and Closeness 179
Scale–Parent Version (CARS-P; Bebko et al., 1987) to
examine severity of children’s symptomology. They
used the Parenting Stress Index (PSI; Abidin, 1995) as an
inclusive and widely used instrument to measure parents’
stress. They found that the severity of children’s impair-
ment was related to mothers’ stress for their pervasive
developmental disorders–not otherwise specified group
(N = 19) but not for their autism group (N = 22), although
they reported a trend in this direction for the latter group.
The limitations of the study included the small sample
examined; furthermore, the sample was obtained from a
subset of 30% of surveys returned by mothers from par-
ent organizations providing support services for children
with pervasive developmental disorders. These mothers
reported their children’s diagnosis for the study. Notably,
the CARS-P is not norm-referenced and had not been
updated to reflect the APA (2000) revisions at the time
Tobing and Glenwick conducted their study.
The present investigation addresses methodological
limitations in the literature. It is the first to compare the
stress levels reported by mothers of children with autism
by using a larger number of participants for both groups
than used in earlier studies of stress in mothers of chil-
dren with developmental disabilities. Furthermore, the
sample consisted of children independently diagnosed
with autism as a criterion for mothers’ inclusion in the
autism group. It was anticipated that mothers of children
with autism would report more stress on the Child
Domain subscales of the PSI than mothers of typically
developing children. No prediction was made for the
Parent Domain of the PSI, which assesses stress related
to parent functioning. Prior research has indicated higher
levels of stress than norms reported by Abidin (1995) for
parents of children with disabilities on Child Domain
scores but not on Parent Domain scores (see Innocenti
et al., 1992; Keller & Honig, 2004). Predictions related
to mothers’ stress also were limited to the Child Domain
of the PSI as it provides an estimate of stress resulting
from the specific needs of the child, with mothers’
reports of their child’s problematic behavioral character-
istics seen as serving as the major factors contributing to
the overall stress in the parent-child system (Abidin,
1995; see also Tobing & Glenwick, 2002). In this regard,
for the autism group, the relationship between the sever-
ity of children’s autistic symptoms and mothers’ stress
levels was examined with the expectancy that severity
would be related to PSI Child Domain stress scores.
Other methodological concerns were addressed in the
design of this investigation. For inclusion in the autism
group, in addition to mothers having a child with an
independent diagnosis of autism, their children were also
required to have a Gilliam Autism Rating Scale, Second
Edition (GARS-2) Autism Index (AI) score ≥ 85, indicat-
ing a high likelihood of the disorder (Gilliam, 2005). The
AI is a total score assessing the probability of autism,
with higher scores indicating a greater degree of severity.
This newly revised, norm-referenced measure of autism
was used to assess the severity of children’s symptoms in
this study. As in the Tobing and Glenwick (2002) study,
the PSI was used here to measure mothers’ stress.
Mothers were the focus of the present study as they tend
to have primary responsibility for child care in families
with children with developmental disabilities (e.g.,
Milgrim & Atzil, 1988) and they are the most adversely
affected by the negative impact associated with their
child’s disability (Abbeduto et al., 2004; Fisman et al.,
1989; Freeman et al., 1991).
Method
Participants and Procedures
Autism group. Participants in the autism group were
104 mothers (and their children) drawn from a larger,
ongoing program of research and evaluation based on the
model suggested by Sweeney and Hoffman (2004). The
research program is integrated with an established center-
based, supplemental behavioral intervention and parent
education program located on a university campus in
inland southern California. Parents and consumer chil-
dren attend weekly 2½-hr sessions during which children
receive one-to-one behavioral treatment while parents
attend a support group. Families typically attend the pro-
gram for 2 years. The local California State Regional
Center refers and provides funding for qualified con-
sumer children and/or adolescents with developmental
disabilities and their families who receive treatment ser-
vices at the center (California Department of Developmental
Services, 2002). Fully 161 of the 165 mothers attending
the treatment program at the time of data collection vol-
unteered to participate in the research and evaluation
program. Of these volunteers, data were analyzed for those
with children who met the indicated selection criteria,
had completed the data collection process at the time of
the study, and had met the established criteria for non-
missing data (N = 104; 65%).
All mothers of children selected for participation in
the autism group had children referred to the center with
an independent Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR; APA, 2000) diagnosis of
autism (provided by the referring state agency and/or
local school district). As indicated previously, each of
these children also had GARS-2 AI scores ≥ 85, with the
scores ranging from 85 to 139 (M = 102.13, SD = 12.7).
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180 Focus on Autism and Other Developmental Disabilities
For GARS-2 subscale standard scores, Stereotyped
Behavior ranged from 5 to 18 (M = 10.18, SD = 2.8)
and Social Interaction ranged from 5 to 16 (M = 9.89,
SD = 2.4); Communication subscale scores (available for
70 children in this sample) ranged from 5 to 18 (M = 11.36,
SD = 2.8). Diagnostic information, provided by the refer-
ring agency for the autism group, indicated that 48 chil-
dren had a diagnosis of autism only, 40 had a diagnosis
of autism with mental retardation, and 16 had autism
with at least one other coexisting condition.
Initial behavioral and diagnostic information regard-
ing children in the autism group was collected from the
state agency during the referral process. Additional child
and family information was obtained from parents and
existing agency records. Parents and children were
assessed in a three-phase process, with specially trained
research assistants or center staff completing the first
phase of the assessment (including the GARS-2) at the
parents’ home. During this home visit, parents were given
an intake packet containing an overview of the programs
of treatment, evaluation, and research. Informed consent
was obtained from parents at this time. The second phase
of the intake process took place at the treatment center.
During the second phase, the child was observed by the
clinical staff with the child’s parent(s) present to answer
any questions that arose from the in-home or in-center
observations. For the third phase of the assessment pro-
cess, mothers met individually with research assistants
(unassociated with the treatment program at the Center)
to complete demographic indices as well as the PSI and
other measures that were part of the ongoing research
and evaluation program. These other assessment materi-
als (presented in one of two different random orders)
included measures assessing mothers’ reports of their
children’s sleep and their own sleep problems, their well-
being, and family processes. These assessment sessions
typically lasted 1½ hrs, with the trained researcher pre-
senting all assessment materials orally to individual
mothers. To protect participant anonymity at the Center,
answer sheets were sealed in a plain envelope, identified
with a predetermined code number, and secured in
locked files.
Community group. Mothers (N = 342) were solicited
by trained research assistants from classes at two local
universities, a community college, community organiza-
tions (day care centers and churches), and a variety of
businesses, all of which were located in the same geo-
graphic area as that for the autism sample. Mothers
drawn from classes at the university and community col-
leges (39% of those in the final community group) were
provided with extra class credit for their participation.
All mothers were asked to participate in a study address-
ing sleep problems in children and their parents, parent
stress, family processes, and parent well-being. In the
cover letter for the questionnaire packet, potential volun-
teers who were mothers of boys were especially encour-
aged to participate. Participants also were told that the
information they provided would be anonymous and no
names were obtained for mothers completing the survey
instrument. A total of 425 questionnaire packets, 84% of
the total distributed, were returned; 312 (73%) of those
returned met the study’s established criteria for nonmiss-
ing data; reports on children identified by their parents as
having an exceptionality were excluded. Mothers com-
pleted the questionnaires on their own (taking approxi-
mately 45 minutes to do so) and returned them to the
researchers. All mothers in the community group com-
pleted the same assessment instruments (presented in
one of two different random orders) as mothers in the
autism group. To determine if method of administration
affected results, an additional 32 mothers, who volun-
teered to do so, were tested in one-on-one hour-long
sessions similar to those used for the autism sample.
Data from 30 interviews were used in analysis (one
mother was excluded because her child had a diagnosed
disability and another mother left prior to completing the
task). Statistical examination of the obtained scores for
these two community groups (self-report and interview
format) were compared for both demographic indicators
and on each of the scales utilized. Mean scores for these
two groups did not differ for any of the demographics
or for any of the scales completed by the mothers.
Furthermore, examination of subscale scores on both
Child and Parent Domains of the PSI indicated no differ-
ences between the means for these two groups. Thus, the
data for the groups were combined, yielding a total com-
munity group N of 342 mothers.
The methods and procedures for this investigation
were reviewed and approved for human participant pro-
tections by the campus’s Institutional Review Board.
Characteristics of groups. There were 20 female
(19.2%) and 84 (80.8%) male children in the autism
group; the community group was comprised of 136
(39.8%) female and 205 (59.9%) male children (gender
was not indicated for one child in this latter group).
Children in both groups ranged from 3 to 16 years of age.
The mean age for children in the autism group (M = 8.61,
SD = 2.77) did not differ from the mean age of children
in the community group (M = 8.03, SD = 3.61). The age
of mothers in the groups ranged from 18 to 57 for the
autism group (M = 37.52, SD = 7.63) and from 18 to 63
in the community group (M = 34.85, SD = 8.15). These
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Hoffman et al. / Parenting Stress and Closeness 181
means were found to differ significantly from one
another, independent samples t(424) = 2.89, p < .01.
Additional demographics reported for the autism and the
community groups (by percentage for each) are pre-
sented in Table 1. The obtained distributions for the four
demographic categories indicated did not differ between
the two groups.
Measures
Parenting Stress Index (Abidin, 1995). The PSI is
a standardized measure designed to evaluate stress in
parent-child systems. The PSI consists of 101 items that
parents respond to on Likert-type scales ranging from
strongly agree (1) to strongly disagree (5). The PSI
assesses two domains of stress derived from factor analy-
sis: a Child Domain, with high scores indicating that
parenting stress originates from child characteristics or
behavior problems that make caregiving difficult for the
parent, and a Parent Domain, with high scores indicating
that the source of stress emanates from some parental
functioning, including parent and family context factors
that affect a parent’s ability to function as a competent
caregiver. A total Child Domain score is calculated as the
sum of the following six subscales: Distractibility/
Hyperactivity (9 items; e.g., “My child is so active that it
exhausts me”), Adaptability (11 items; e.g., “It takes a
long time and it is very hard for my child to get used to
new things”), Reinforces Parent (6 items; e.g., “My child
rarely does things for me that make me feel good”),
Demandingness (9 items; e.g., “My child turned out to be
more of a problem than I had expected”), Mood (5 items;
e.g., “My child seems to cry or fuss more often than most
children”), and Acceptability (7 items; e.g., “My child is
not able to do as much as I expected”).
The Parent Domain is calculated as the sum of the fol-
lowing seven subscales: Competence (33 items; e.g.,
“Being a parent is harder than I thought it would be”),
Isolation (7 items; e.g., “I feel alone and without
friends”), Attachment (7 items; e.g., “It takes a long time
for parents to develop close, warm feelings for their chil-
dren”), Health (5 items; e.g., “During the past six months
I have been sicker than usual or have had more aches and
pains than I normally do”), Role Restriction (7 items;
e.g., “Most of my life is spent doing things for my
child”), Depression (9 items; e.g., “When I think about
the kind of parent I am, I often feel guilty or bad about
myself”), and Spouse Related Stress (7 items; e.g.,
“Having a child has caused more problems than I expected
in my relationship with my spouse”).
The PSI also yields a Total Stress Score that is the sum
of Child and Parent Domain scores. Abidin (1995)
reported a .90 internal consistency for both domains and
the Total Stress score. Test-retest reliability ranged from
.63 to .82 in Child Domain scores, .69 to .91 in Parent
Domain scores, and .65 to .88 in Total Stress scores. For
the present study, internal consistencies were .91 and .93
for the Child Domain scores for the autism and commu-
nity groups, respectively, and .93 on the Parent Domain
scores for both groups.
The PSI has been used in numerous studies to exam-
ine the effect of a child with a disability on parent stress
(e.g., Boyce, Behl, Mortensen, & Akers, 1991; Dumas,
Wolf, Fisman, & Culligan, 1991; Innocenti et al., 1992;
Keller & Honig, 2004; Margalit, Raviv, & Ankonina,
1992; Noh, Dumas, Wolf, & Fisman, 1989; Tobing &
Glenwick, 2002).
Gilliam Autism Rating Scale, Second Edition (Gilliam,
2005). The GARS-2, derived from the diagnostic criteria
Table 1
Demographic Information for
Autism and Community Groups (%)
Autism Community
Demographic (N = 104) (N = 342)
Child ethnicity
African American/Black 12.50 9.60
Asian/Pacific Islander 5.80 2.90
Hispanic/Latino 26.00 34.50
White/Caucasian 40.40 38.00
Mixed/Other 14.20 14.10
Information missing 1.00 1.00
Mothers’ marital status
Single 10.60 12.30
Married 69.20 70.50
Divorced 9.60 8.50
Separated 3.80 2.60
Widowed 1.00 1.20
Cohabiting 0.00 4.70
Information missing 5.80 0.30
Mothers’ education
Not high school graduate 11.60 5.00
High school graduate 14.40 10.50
Some college 28.80 27.50
AA degree 12.50 19.60
BA degree 14.40 17.00
Advanced degree 11.50 11.00
Information missing 6.70 9.40
Annual family income
Less than $24,000 17.30 11.70
$24,000 to $35,999 9.60 16.40
$36,000 to $47,999 15.40 15.50
$48,000 to $59,999 4.80 12.90
$60,000 to $71,999 8.70 14.90
Greater than $72,000 25.00 27.50
Information missing 19.20 1.00
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182 Focus on Autism and Other Developmental Disabilities
in the DSM-IV-TR (APA, 2000) and from the Autism
Society of America’s (2003) definition, is a professional
and parent report instrument to evaluate autism symp-
toms. It is used to assess children on each of three domains
associated with the disorder (Stereotyped Behavior,
Communication, and Social Interaction; M = 10 and
SD = 3 for each). The combined scores on these subscales
yield an Autism Index score (M = 100 and SD = 15),
which provides a total score assessing the probability of
autism, with higher scores indicating a greater degree of
severity. Where Communication subscale scores are not
available (N in this sample = 34 children), or when a
child is nonverbal or does not communicate in any other
way, a reliable and valid AI is obtained by computing the
sum of the standard scores of the other two subscales
available in the manual for the test. Gilliam (2005)
reported that standard scores were obtained from a nor-
mative sample of children and young adults diagnosed
with autism (N = 1,107) and that 90% obtained AI scores
≥ 85. Adequate validity and reliability were reported for
each of the test domains and the AI. The GARS
(Gilliam, 1995) was recommended for use in the diag-
nosis of autism (Filipek et al., 2000; National Research
Council, 2001). The GARS-2, used here, was revised to
reflect the most current definition of autism (APA,
2000), and the author addressed psychometric concerns
raised for the original GARS (e.g., Lecavalier, 2005;
South et al., 2002).
Results
Group differences in mothers’ stress. An independent
samples t test indicated that mothers of children with
autism reported higher levels of stress on the Child
Domain of the PSI (M = 147.9, SD = 25.7) than did
mothers of typically developing children (M = 94.79,
SD = 21.7), t(420) = 20.87, p < .001. According to values
reported by Abidin (1995), these means were at the 99th
percentile for mothers in the autism group and (approxi-
mately) at the 40th percentile for mothers in the com-
munity group. An independent samples t test conducted
to compare mean scores on the Parent Domain of the PSI
indicated that mothers in the autism group reported
higher levels of stress (M = 137.41, SD = 31.4) than did
mothers of typically developing children in the commu-
nity group (M = 118.7, SD = 29.3), t(420) = 5.62, p < .001.
Percentiles associated with these respective values, again
as compared to the norms reported by Abidin, were
(approximately) at the 75th percentile for mothers in
the autism group and the 45th percentile for mothers in
the community group.
Two 2 × 2 between-subjects, Group (autism vs. com-
munity) × Child Gender multivariate analyses of vari-
ance (MANOVAs) were carried out to examine
differences in mean scores on the six PSI Child Domain
subscales and, in the second MANOVA, on the seven
Parent Domain subscales; these subscales were treated
as the dependent measures in the respective analyses.
Furthermore, two 2 × 2 (Group × Child Gender) multi-
variate analyses of covariance (MANCOVAs), with
adjustment made for both mothers’ age (which was
significantly different for the two groups) and chil-
dren’s age (a factor found to influence PSI scores;
Abidin, 1995), were conducted for the Child and Parent
Domain subscales, respectively. The mean scores for
each of the Child and Parent Domain subscales of the
PSI for both autism and community groups are indi-
cated in Table 2, along with associated F values (and
significance levels) obtained for the differences between
the means on univariate tests. The table also indicates
(approximate) percentiles associated with the means for
each subscale, which were derived from the norms
reported by Abidin (1995).
The results of the MANOVA for the six Child Domain
subscales indicated significant differences between the
autism and community groups, Wilks’s Lambda = .46,
F(6, 436) = 85.27, p < .001. There was no effect for child
gender and no interactive effect. Univariate between-
subjects effects revealed that the means for the autism
group were significantly higher than those obtained for
the community group for each of the six Child Domain
subscales (ps < .001; see Table 2). The 2 × 2 MANCOVA
carried out on these data, with adjustments made for both
mothers’ and children’s age, obtained the same results:
Only the group effect was significant, Wilks’s Lambda =
.47, F(6, 410) = 78.05, p < .001, with F values for the
obtained differences between the groups on the subscales
each significant, as in the between effects indicated for
the MANOVA, beyond the .001 level.
The results of the MANOVA for the seven Parent
Domain subscales indicated significant differences
between the autism and community groups, Wilks’s
Lambda = .91, F(7, 435) = 6.42, p < .001. No child gender
or interactive effect was obtained. Univariate between-
subjects effects revealed that the means for the autism
group were significantly higher than those obtained for
the community group for six of the seven Parent
Domain subscales (see Table 2). Only the means obtained
for the respective groups on the Attachment subscale of
the Parent Domain were not significantly different from
one another. The 2 × 2 MANCOVA of the Parent Domain
subscale data, with adjustments made for mothers’ and
children’s age, obtained the same results as the MANOVA:
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Hoffman et al. / Parenting Stress and Closeness 183
Only the group effect was significant, Wilks’s Lambda =
.89, F(7, 409) = 7.27, p < .001. F values for the obtained
differences for groups in the univariate between-subjects
analyses on all but the Attachment subscale were sig-
nificant at the same levels as those obtained in the
MANOVA. Again, the means for the autism and com-
munity groups were not significantly different for the
Attachment subscale.
Autism and mothers’ stress. Pearson correlations
examining the relationship between the level of chil-
dren’s autism and mothers’ reports of their stress indi-
cated that GARS AI scores were related to both PSI Child
Domain (r = .33, p < .001) and Parent Domain Stress
(r = .27, p < .01). Children’s Stereotyped Behavior
scores were related to both Child and Parent Domain
Stress (r = .30, p < .01 and r = .21, p < .05, respectively),
as were children’s Social Interaction scores (r = .30, p < .01
and r = .25, p < .05). Communication scores (based on a
smaller N of 70) were not significantly related to these
PSI domain scores. Separate regression analyses indi-
cated that GARS AI contributed to the variance in the
prediction of both mothers’ Child Domain, R2 = .11,
F(1, 102) = 10.21, p < .001, and Parent Domain stress
scores, R2 = .07, F(1, 102) = 8.10, p < .01.
Mothers’ stress and Attachment subscale scores. As
mothers in the autism group report significantly higher
levels of Child Domain and Parent Domain stress than
mothers in the community group, the finding of no dif-
ference between these groups on the Attachment sub-
scale, with mean scores for both groups at about the 50
percentile compared to the norms reported by Abidin
(1995), was unexpected. Abidin reported intercorrela-
tions between the subscales on the PSI and one might
expect higher Attachment subscale scores, indicating
less closeness, particularly for mothers reporting such
very high levels of Child Domain stress.
To explore this finding further, Pearson correlations
between mothers’ PSI Child Domain and Parent Attachment
subscale scores for the community and autism groups were
carried out. Overall Child Domain scores were highly cor-
related with Attachment subscale scores for both the com-
munity (r = .60, p < .001) and the autism groups (r = .60,
p < .001). Correlations between Child Domain subscales
and Attachment subscale scores are indicated in Table 3,
along with correlations reported by Abidin (1995), which
are included for comparison purposes.
These results indicate that mothers’ reports of higher
levels of stress related to the specific domains of their
children’s difficult behavior were indeed related to
higher Parent Domain Attachment subscale scores (i.e.,
mothers’ reports of lower levels of closeness to their chil-
dren). Separate regression analyses, carried out to further
explore the relationship between Child Domain scores
and Attachment subscale scores (as the criterion measure),
Table 2
Means and Standard Deviations for Parenting Stress Index (PSI) Child
and Parent Domain Subscales for Autism and Community Groups
Autism Community
(N = 104) (N = 341)
PSI M SD Percentilea M SD Percentilea F
Child Domain
Distractibility/Hyperactivity 32.48 6.10 95 23.30 5.17 45 77.43***
Adaptability 37.65 7.85 99 22.74 6.38 40 135.32***
Reinforces Parent 13.43 4.97 87 10.10 3.57 65 21.14***
Demandingness 28.48 6.58 97 17.30 5.28 50 105.59***
Mood 13.48 4.12 95 9.49 3.12 55 40.13***
Acceptability 21.74 4.94 99 11.76 4.02 50 154.67***
Parent Domain
Competence 30.02 7.04 60 27.39 6.68 42 4.52**
Isolation 16.06 5.39 77 12.92 4.84 58 10.84***
Attachment 12.56 3.61 53 12.03 3.74 51 ns
Health 14.33 4.08 77 12.15 3.78 60 9.70**
Role Restriction 22.31 6.65 55 17.96 5.71 52 13.85***
Depression 21.65 7.17 64 18.99 6.45 45 4.53**
Spouse 20.36 6.95 74 17.27 5.96 57 7.37***
aPercentiles obtained from norms reported by Abidin (1995) are approximate.
**p < .01. ***p < .001.
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184 Focus on Autism and Other Developmental Disabilities
indicated significant relationships for both the commu-
nity, R2 = .36, F(1, 340) = 193.35, p < .001, and autism
groups, R2 = .23, F(1, 102) = 31.18, p < .001. Finally, for
the autism group, children’s AI scores were significantly
correlated with mothers’ Attachment subscale scores
(r = .21, p < .05). A hierarchical regression analysis
was conducted to explore the relationship between chil-
dren’s AI scores (entered on Step 1) and Child Domain
subscale scores (entered on Step 2) and mothers’
Attachment subscale scores. This analysis revealed that
AI scores predicted Attachment scores on Step 1, R2 = .05,
F(1, 102) = 7.69, p < .01. Child Domain stress scores con-
tributed significantly to the variance on Step 2, R2 = .21,
F(1, 102) = 38.67, p < .001, with AI no longer significant
once Child Domain scores were entered.
Discussion
Mothers of children with autism reported significantly
higher levels of stress than did mothers of typically
developing children. This difference, obtained for each of
the PSI Child subscales, was anticipated and in line with
prior related research. The levels of stress reported by
mothers in the autism group on these subscales were
extremely high, at the 99th percentile for overall Child
Domain stress based on the norms reported by Abidin
(1995). Previous studies indicated higher levels of stress
for parents of children with disabilities than the norms
reported by Abidin on the Child Domain but not on the
Parent Domain of the PSI (e.g., Keller & Honig, 2004).
Here, mothers in the autism group reported higher levels
of stress than mothers in the community group on 6 of
the 7 Parent Domain subscales. Across the 13 subscales
of the PSI, only mean scores for the Attachment subscale
of the Parent domain did not differ for these two groups.
For the autism group, the relationship obtained
between the severity of children’s autistic symptoms and
mothers’ Child Domain stress also was expected (e.g.,
Tobing & Glenwick, 2002) and supports other literature
indicating that greater levels of children’s disabilities are
associated with more parental distress (e.g., Baker et al.,
2002; Minnes et al., 1989). Here, severity of children’s
autistic symptoms was related to mothers’ Parent Domain
stress as well.
Mothers’ reports of their children’s increased prob-
lematic behavior on Child Domain subscales were
related to mothers’ reports of their closeness to their
child on the PSI Parent Domain Attachment subscale.
For mothers in both groups, the more stressful and prob-
lematic they reported their child’s behavior to be, the less
closeness they reported. For the autism group, the sever-
ity of children’s autism was related to mothers’ reports of
less closeness on the Attachment subscale. Hierarchical
regression analysis suggested that it was children’s
higher levels of problematic behavior (indicated by
Children’s Domain scores) and not the level of their
autism per se that was the major factor contributing to
mothers’ reports of less closeness to their children. This
finding may be seen as informing the obtained differ-
ences between the groups in mothers’ reports of their
stress. As indicated, parents of children with more mal-
adaptive behaviors report higher levels of distress
(Abbeduto et al., 2004), and parents of children with
developmental disabilities who evidence significant
behavior problems report levels of stress similar to those
reported by parents of children without disabilities who
evidence significant behavior disorders (Donenberg &
Baker, 1993; Dumas et al., 1991; Floyd & Gallagher,
1997). Other work has indicated that the specific type or
severity of a child’s disability is not related to parents’
reports of their stress (e.g., Keller & Honig, 2004). A rela-
tionship between level of children’s autism and mothers’
reports of their stress on the PSI was obtained here. The
design of the present study does not support further
examination of the relative contributions of children’s
autism and their problematic behavior to mothers’ stress,
and it is suggested that future research attempt to disen-
tangle these relationships.
As indicated, mothers of children with autism reported
greater stress across all of the Child Domains of the PSI
and on six of the seven Parent Domain subscales of the
PSI. Furthermore, mothers’ reports of higher levels of
Child Domain stress were related to their Attachment sub-
scale scores—that is, to their reports of less closeness to
Table 3
Correlations Between Parenting Stress Index (PSI)
Attachment and Child Domain Subscale Scores
Reported by Abidin (1995) and for Community
and Autism Groups in the Present Study
PSI Child Community Autism Abidina
Domain Subscales (N = 342) (N = 104) (N = 447)
Distractibility/ .42** .24* .26
Hyperactivity
Adaptability .45** .19b .35
Reinforces Parent .60** .55** .52
Demandingness .49** .44** .37
Mood .43** .24* .40
Acceptability .51** .52** .51
aAlthough significance levels were not reported by Abidin, for the N
examined each correlation is significant beyond the .01 level.
bp = .056.
*p < .05. **p < .01.
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Hoffman et al. / Parenting Stress and Closeness 185
their children. Although the mean Child Domain score
obtained for mothers in the autism group was at the 99th
percentile, mean scores for mothers in both groups were at
about the 50 percentile and did not differ from one another
on the Attachment subscale. According to Abidin (1995),
high scores on the Attachment subscale suggest that a par-
ent does not feel a sense of emotional closeness to his or
her child and indicates a parent’s inability to observe and
understand the child’s feeling or needs accurately. Abidin
indicated that this lack of emotional closeness may reflect
an absence of emotional bonding and a “rather cold pat-
tern of parent-child interaction” (p. 11). The finding of no
difference between the groups on the Attachment subscale
was unanticipated, and particular attention to this finding
seems warranted from a historical perspective as mothers
of children with autism were once characterized as “refrig-
erator mothers” and blamed for causing their child’s dis-
ability because of their apparently cold manner of relating
to their child (Bettelheim, 1967; Kanner, 1949).
Despite the significantly higher levels of Child Domain
stress reported by mothers of children with autism and
the concomitant correlation between mothers’ reports of
stress and less closeness to their children, mothers of
children with autism did not differ from mothers of typi-
cally developing children with regard to their reports of
their closeness to their children. Perhaps mothers of chil-
dren with the uniquely challenging characteristics of
autism and the behavioral problems associated with this
disorder, despite high levels of stress, adapt to their chil-
dren’s needs with the closeness required to enable them
to respond effectively to their children. Possibly, viewing
a child with autism as “less responsible” for his or her
problematic behavior may serve to support a mother’s
understanding of her child’s feelings or needs accurately
and provide a sense of closeness. In this regard, mothers
of children with autism may not view their children’s
behavior as “bad” but rather as attributable to their chil-
dren’s affliction (e.g., Chavira, Lopez, Blacher, & Shapiro,
2000). Similarly, they may feel partially responsible for
contributing to their children’s disorder (e.g., Affleck,
McGrade, Allen, & McQueeney, 1985; Rodrigue,
Morgan, & Geffken, 1990). Contrariwise, this latter
sense of responsibility may contribute to mothers’ feel-
ings of guilt and thereby lead them to report experienc-
ing levels of closeness that are incommensurate with the
stress they report on the other subscales. This guilt or
perhaps the sensitivity of mothers of children with
autism to the refrigerator mother myth may have affected
them, with social desirability differentially influencing
their responses to parenting items (e.g., Morsbach &
Prinz, 2006) on the Attachment subscale of the PSI (e.g.,
“I expected to have closer and warmer feelings for my
child than I do and this bothers me”). These speculations
are offered to suggest future research avenues as the
present findings with respect to “closeness” are limited,
the result of exploratory analyses of a subscale of the
PSI, an instrument designed to assess mothers’ stress.
Other measures may be used to assess mothers’ self-reports
of closeness to their child in relation to indices of their
child’s difficult behavior in future studies. Nevertheless,
these results may be contrasted with earlier notions that
blamed a mother’s supposed coldness or emotional dis-
tance for her child’s autism.
The Child Domain subscales of the PSI provide indi-
cators of children’s problematic behaviors that are stress-
ful for parents, with higher levels of these behaviors
defining increased parental stress. In addition to the role
children’s autism may have in contributing to mothers
reporting greater stress than mothers of typically devel-
oping children may be seen as reflecting the nature of
this instrument. Several of the subscales of the PSI pro-
vide for parents’ reports of children’s problem behaviors
specifically associated with autism (e.g., Abbeduto et al.,
2004) or perhaps the coexisting disorders associated with
this disorder. By way of example, as Abidin (1995) indi-
cated, high scores on the Distractibility/Hyperactivity
subscale are associated with children who display many
of the behaviors characteristic of attention-deficit/
hyperactivity disorder, and high scores on the Adaptability
subscale are associated with a child’s inability to adjust
to changes in his or her environment. Comorbid condi-
tions may contribute independently to mothers’ stress,
and previous research has not addressed this concern or
included the diagnostic specificity required to examine
these relationships and to advance the field in this regard
(see Sweeney & Hoffman, 2004). Furthermore, although
the PSI is a widely used measure of parental stress, the
present findings are limited in that they are based on
mothers’ self-reports of their children’s behavior.
Although the present findings benefit from the method-
ological approach utilized, it is suggested that future
research use other methods of assessing children’s prob-
lematic behavior and mothers’ stress and closeness,
including direct observations of children’s behavior,
parent-child interactions, and parent interviews.
The results of the present study can be interpreted to
suggest that mothers of children with autism maintain
close relationships with their children despite the stress
of the parenting challenges they face. The very high
levels of stress reported by these mothers on the Child
Domain subscales indicate the importance of effective
interventions to help them to cope successfully with the
demands of parenting a child with autism. Reducing
parental stress should contribute to improving the family
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186 Focus on Autism and Other Developmental Disabilities
climate, to parents’ ability to manage their children’s
behavior, and in turn, to improved outcomes for children
with autism and their families.
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Charles D. Hoffman, PhD, is professor emeritus in psychol-
ogy at California State University, San Bernardino. He serves
as the director of research at the on-campus University Center
for Developmental Disabilities. His current interests include
sleep problems in children with autism, intervention efficacy,
and parent, family, and child functioning in families of chil-
dren with autism.
Dwight P. Sweeney, PhD, is a professor in educational psy-
chology and counseling at California State University, San
Bernardino. He serves as the director of the on-campus
University Center for Developmental Disabilities. His current
interests include assessment and sleep problems in children
with autism. He also is interested in intervention efficacy and
parent, family, and child functioning in families of children
with autism.
Danelle Hodge, PhD, is a lecturer in psychology at California
State University, San Bernardino. She serves as the associate
director of research at the on-campus University Center for
Developmental Disabilities. Her current interests include sleep
problems in children with autism and parent, family, and child
functioning in families of children with autism.
Muriel C. Lopez-Wagner, MA, is director of institutional
research and assessment at Pitzer College. Her current inter-
ests include her dissertation research related to intervention
efficacy and parent, family, and child functioning in families
of children with autism.
Lisa Looney, PhD, is a lecturer in psychology at California
State University, San Bernardino. Her current interests include
parent, family, and child functioning in families of children
with autism and other developmental disabilities.
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