Parenting An Autistic Child A literature map is a visual presentation

O R I G I N A L P A P E R

Autism Parenting Stress Index: Initial Psychometric Evidence

Louisa M. T. Silva • Mark Schalock

Published online: 10 May 2011

� Springer Science+Business Media, LLC 2011

Abstract Data validating the Autism Parenting Stress

Index (APSI) is presented for 274 children under age six.

Cronbach’s alpha was .827. As a measure of parenting

stress specific to core and co-morbid symptoms of autism,

the APSI is unique. It is intended for use by clinicians to

identify areas where parents need support with parenting

skills, and to assess the effect of intervention on parenting

stress. Mean parenting stress in the autism group was four

times that of the typical group and double that of the other

developmental delay group [F(2,272) = 153; p \ 001]. An exploratory factor analysis suggested three factors

impacting parenting stress: one relating to core deficits, one

to co-morbid behavioral symptoms, and one to co-morbid

physical symptoms.

Keywords Autism � Parenting stress � Validation study � Assessment tool

Introduction

Higher levels of parenting stress have been found in par-

ents of young children with autism than in other disabilities

(Estes et al. 2009). This is due to the challenges imposed by

co-morbid behavioral and physical symptoms as well as

core symptoms (Phetrasuwan and Miles 2009; Johnson

et al. 2009). The most common co-morbid symptoms in

young children with autism are abnormal sensory responses

(90%) (Leekam et al. 2007), sleep disruption (86%) (Liu

et al. 2006), and gastrointestinal disorders (70%) (Ibrahim

et al. 2009), followed by self-injurious behavior (34%)

(Hartley et al. 2008), and aggression/irritability (22%)

(Hartley et al. 2008). Between core and co-morbid symp-

toms almost every aspect of the child’s functioning can be

affected; this can challenge the coping skills and affect the

mental health of parents (Montes and Halterman 2007). As

such, it is of interest to clinicians and researchers to be

aware of how parents are coping with the manifold

demands of caring for a child with autism.

It is beneficial for parents to be involved in intervention

strategies to help their children’s disability, both for the

benefit of increased coping skills, and for reduced stress

(Diggle et al. 2003). There are several general measures of

parenting stress available to evaluate the impact of inter-

vention strategies on parenting stress (Abidin 1983; Berry

1995; Oster et al. 2002). But there is no measure of par-

enting stress that permits an analysis of the impact on the

range of core and co-morbid symptoms seen in autism.

A 10-year research stream investigating the outcome of

a 5-month, parent-delivered intervention for young chil-

dren with autism demonstrated success in improving core

and co-morbid symptoms, and reducing parenting stress in

two randomized controlled trials (Silva et al. 2009; Silva

et al., in press). The research is based on a model for autism

that includes co-morbid as well as core symptoms with

treatment directed at both. The model proposes that

co-morbid sensory and self-regulatory symptoms are pri-

mary in autism, and core social/language delays and

abnormal behaviors are secondary. Published outcomes

data supports the model (Silva et al., in press). The research

required the development and validation of two

L. M. T. Silva (&) Teaching Research Institute, Western Oregon University,

PO Box 688, Salem, OR 97308, USA

e-mail: [email protected]

M. Schalock

Teaching Research Institute, Western Oregon University,

345 Monmouth Avenue, Monmouth, OR 97361, USA

e-mail: [email protected]

123

J Autism Dev Disord (2012) 42:566–574

DOI 10.1007/s10803-011-1274-1

instruments: (1) a caregiver report of core and co-morbid

symptoms, the Sense and Self-Regulation Checklist (Silva

and Schalock, in press); and (2) a parent/caregiver measure

that could measure the outcome of intervention on the

severity of parenting stress relative to these symptoms.

This article presents validation data and findings relative

to the second measure—the Autism Parenting Stress Index

(APSI)—in 274 children under six. Three research ques-

tions were explored:

Question 1 Do factor analyses support a core autism and

co-morbid symptom structure for the sources of parenting

stress in children with autism?

Question 2 Does the APSI produce reliable scores for

parenting stress for children with autism?

Question 3 What is the prevalence and degree of par-

enting stress on each item of the APSI? Does the APSI

discriminate between children with autism, children with

other developmental disabilities and typically developing

children on the basis of degree of parenting stress, as found

in previously published research (Estes et al. 2009)?

Methods

Instrument Development

The APSI was designed for clinical use to identify areas

where parents need support with parenting skills, and to

assess the effect of intervention on parenting stress. The

items were developed and refined over a five-year period in

conjunction with the development of a parent/caregiver

measure assessing core and co-morbid symptoms in aut-

ism, the Sense and Self-Regulation Checklist (Silva and

Schalock, in press). APSI items were informed by a

knowledge of the normal developmental trajectory for self-

regulatory milestones in the first three years of life,

including self-regulation of sleep, digestion, self-soothing,

orientation/attention, and the beginning of self-regulation

of emotions and behavior in response to parental cues

(Posner and Rothbart 2009). The areas in question were

selected through an iterative process by conducting a

review of over 100 interviews of parents with young

autistic children, in which parents were asked to talk about

areas of their children’s functioning that were stressful to

manage, and to name the three most stressful. Items fell

into three categories: the core social disability, difficult-to-

manage behavior, and physical issues. The formulation of

the stress ratings was influenced by the excessively high

rates of stress that were reported by parents in some areas,

and were ranked from ‘Not stressful’, ‘Sometimes creates

stress’, ‘Often creates stress’, ‘Very stressful on a daily

basis’, to ‘So stressful that sometimes we feel we cannot

cope.’

Participants

Data from 274 children ages 24 months to 72 months was

collected for this study including: 107 children with Aut-

ism Spectrum Disorder (ASD), 28 children with other

developmental delays (other DD), and 139 children who

were developing typically. All projects took place with

Institutional Review Board approval.

Data Collection

Autism Parenting Stress Index data on children with autism

was collected from children receiving services for autism

in state-sponsored, early intervention programs in multiple

counties across Oregon over a period of 7 years. Data was

collected as part of sequential research projects evaluating

a parent-delivered intervention methodology. Inclusionary

criteria for the autism group were: age under six, receiving

state-sponsored early intervention services for autism,

absence of other severe disability such as cerebral palsy,

not planning on introducing new autism therapies for the

duration of the study, and no psychotropic medication.

Children were recruited from six regional early interven-

tion programs in Oregon by invitation letter to all children

in the program receiving services for autism and meeting

age criteria. The primary researcher confirmed the diag-

nosis of autism received in previous diagnostic autism

evaluations by DSM-IV criteria. A wide range of severity

of ASD is represented in the sample. Because of the criteria

excluding families who were planning on introducing new

autism therapies during the duration of our studies, families

entering our studies tended to not to be engaged in sup-

plementary therapies outside of the early intervention

program.

Data for the other DD group was obtained from a pre-

vious study investigating the effect of a parent-delivered

intervention methodology in young children under six

receiving early intervention services from state-sponsored

programs for developmental delay and motor tone disor-

ders. In that study, children meeting inclusion criteria were

recommended to the study by the therapists serving chil-

dren in the agencies where the study was carried out.

Parents of typically developing children were recruited

to complete the surveys from one childcare center, three

mother support groups, and one toddler drop-in play center

in Oregon. Parents completed the surveys on a convenience

basis. Inclusionary criteria for the children included: (1)

between the age of three to six; (2) no educational or

medical diagnosis of autism; (3) an absence of

J Autism Dev Disord (2012) 42:566–574 567

123

developmental delay; and (4) an absence of chronic ill-

nesses or medical conditions.

Table 1 provides demographic information on each

group. The gender ratio for the autism group reflects the

typical male-to-female gender ratio in ASD of 4:1. The

gender ratio for the typical group is 1:1 as would be

expected. And the male-to-female gender ratio for the other

DD group is 1.5:1, which is consistent with that reported

for children with developmental disabilities other than

autism (Eme 1992).

Results

Question 1: Do factor analyses support a core autism and

co-morbid symptom structure for the sources of parenting

stress in children with autism?

Factor analysis was conducted in order to evaluate

relationships between items and nature of stressors for

parents of children with autism. Principal Axis extraction

was utilized, iterating to communalities, and the extracted

factors were subsequently obliquely rotated via Varimax

rotation with Kaiser normalization. The four-factor solu-

tion derived for the sample of 107 parents of children with

autism is presented in Table 5.

The first factor contained loadings for social develop-

ment, communication, feeling close to child, acceptance by

others, and future independence, and appeared to represent

a broad dimension of core social and communication def-

icits in autism.

The second factor included loadings for tantrums/melt-

downs, aggressive behaviors, self-injurious behaviors and

difficulty making transitions. The second factor was con-

sistent with typical co-morbid behaviors in autism.

Two additional factors emerged that were both related to

co-morbid physical symptoms: bowel problems and toilet

training delay, two areas of co-morbid physical symptoms;

and sleep problems and diet/appetite problems, also com-

mon co-morbid physical symptoms in autism.

The results of the factor analysis were generally con-

sistent with observations in the initial parent interviews

carried out during the instrument development phase of the

study, when it was noticed that the three main areas of

concern to parents were the core social problems, difficult-

to-manage behaviors, and physical problems. The core

autistic social and co-morbid behavior problems were well

supported. Co-morbid physical problems as a factor was

less cohesive as two separate factors emerged in these data.

For analyses in Questions 2 and 3 we combine these two

factors into one construct.

Question 2 Does the APSI produce reliable scores for

parenting stress for children with autism?

Both internal consistency and test–retest stability were

assessed for the APSI. Internal consistency estimates

(Cronbach’s Alpha) were calculated for the overall ques-

tionnaire for each population as well as for the three fac-

tors. These results are shown in Table 2. Overall scale

alphas ranged from .732 for children with other develop-

mental disabilities to .834 for typically developing chil-

dren. Alpha was .827 for children with Autism Spectrum

Disorder. At the construct level, alphas were generally

lower. For parents of children with autism, the alphas were

.792, .758 and .667 on the factors of core autism behaviors,

co-morbid behaviors and co-morbid physical issues.

Test–retest stability estimates were calculated for the

overall questionnaire with a sub-sample of parents of 18

children with autism at a 4-month interval. The test–retest

coefficient was .882. Mean scores on the two administra-

tions were stable across time at 22.22 and 22.28.

With this initial small sample, the overall APSI scale

score demonstrates acceptable internal consistency and

test–retest stability for parents of children with autism and

other developmental disabilities. Internal consistency esti-

mates at the factor level are approaching an acceptable

level for core autism behaviors and co-morbid behaviors.

Larger samples are needed to confirm these results and to

determine whether the two physical factors should be

combined or separated.

Table 1 Demographic data

Demographic

variable

Autism

n = 107 Typical

n = 139 Other developmental

disabilities n = 28

Age

Mean 3.85 3.98 2.64

Range 2–6 3–6 2–5

Gender

Male 87 71 17

Female 20 68 11

Table 2 Internal consistencies of domains by autism spectrum dis- order (ASD), typically developing, and other developmental disabil-

ities (other DD)

Domain Cronbach’s alpha Number

of items Reliability

ASD

Reliability

typical

Reliability

other DD

Overall parental stress

scale

.827 .834 .732 13

Core autism symptoms .792 .703 .659 5

Co-morbid behaviors .758 .710 .845 4

Co-morbid physical

issues

.667 .650 .141 4

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Question 3 What is the prevalence and degree of par-

enting stress on each item of the APSI? Does the APSI

discriminate between children with autism, children with

other developmental disabilities and typically developing

children on the basis of degree of parenting stress, as found

in previously published research (Estes et al. 2009)?

The distribution of responses on the APSI instrument for

each group is shown in Table 3. Prevalence of stress was

determined by the percentage of responses at ‘‘Often Cre-

ates Stress’’ or higher. Parents of children with autism have

a higher prevalence of stress overall, on each factor, and on

each item compared to the parents of other children.

Overall, half (50.4%) of the parents of children with autism

indicated that they were ‘‘stressed.’’ This compares to 7.1%

of parents of typically developing children and 23.6% of

parents of children with other developmental disabilities.

At the factor level, nearly 60% of parents of children

with autism indicated being stressed around the core autism

behaviors. This is roughly twice as high an incidence as for

parents of children with other developmental disabilities

(32.9%) and nearly twenty times that for parents of typi-

cally developing children (3.5%). The prevalence of stress

around co-morbid behaviors and physical problems in

parents of children with autism was not quite so pro-

nounced, but significant differences exist between the three

groups on these factors as well.

Specific items about which the majority of parents

expressed significant stress included: Social development,

communication, tantrums/meltdowns, transitions, diet,

acceptance and future independence. Stress for parents of

children with autism was highest on items related to the

ability of their child to communicate (77.6%) and accep-

tance of their child by others (72.2%). These parents were

least stressed about feeling close to their child and their

child’s self-injurious behavior (19.6%), though still one in

five parents felt stress about these issues.

A similar pattern was seen in parents of children with

other developmental disabilities, though a smaller percent-

age of these parents expressed significant levels of stress.

Parent of typically developing children were considerably

less stressed on all items, though one in five (22.2%) did

express significant stress about their child’s tantrum or

meltdowns. On average, parents of children with autism

rated 1.34 items as a ‘‘5’’ (so stressful sometimes we feel we

can’t cope). This compares to an average of .08 items for

parents of typically developing children and .21 items for

children with other developmental delays. The top two items

rated ‘‘5’’ for the autism group were tantrums/meltdowns,

and concern for the future of your child living independently.

These results are shown in Table 4.

To determine whether gender or age confounded these

findings for each disability, group separate two-way

ANOVAs were run. Neither gender nor age was found to

be significantly related to parenting stress. For gender,

neither gender [F(1,273) = 2.15, p = .144] nor the gender

by disability interaction [F(2,272) = .247, p = .782] were

significant. For age, neither age [F(4,270) = 2.34, p =

.056] or the age by disability interaction [F(7,267) = 1.31,

p = .247] were significant. Age is a stronger correlate with

parental stress, as several of the items address issues that

are developmental in nature. Within the group of children

identified as having autism, a wide range of severity

existed. To further investigate the relationship between

parental stress and severity of autism, scores from the APSI

were correlated with a well-established measure of autistic

behaviors, the Pervasive Developmental Disorders Behav-

ior Inventory (PDDBI). A positive and significant corre-

lation between parental stress and the Autism Composite

score from the PDDBI was found (r = .443, p \ .001). The discriminatory ability of the APSI was evaluated

with ANOVAs, which showed significant group differ-

ences across total scale [F(2,272) = 153.0; p \ .001]. To determine whether the APSI discriminated across

groups at the factor level, a MANOVA was run on all

factors. The MANOVA showed an overall significant

group difference across factors using Pillai’s Trace

[F(6,540) = 51.9; p \ .001]. Post-hoc univariate ANO- VAs indicated significant differences for each of the four

factors, with F’s ranging from 37.0 to 188.7.

An ANOVA was conducted at the item level. Each

item also discriminated across groups, with Fs ranging

from 12.9 (p \ .001) on aggressive behaviors to 166 (p \ .001) on ability to communicate. Post-hoc Scheffe- test comparisons show that the APSI differentiates

between parents of children with autism and typically

developing children on every item with mean scores for

the parents of children with autism being two to five times

those of typically developing children. No significant

differences were found between the parents of children

with autism and children with other developmental dis-

abilities for issues related to self-injurious behaviors, sleep

problems, or bowel problems. Significant differences were

found for the remaining eight items. These results are

shown in Table 5.

Discussion

In this paper, we demonstrate that the APSI is a reliable

instrument for measuring parenting stress in young children

with autism with alphas that compare favorably with three

other instruments in common use (Abidin 1983; Berry

l995; Oster et al. 2002). The results reported here are

consistent with reports that parenting stress is significantly

J Autism Dev Disord (2012) 42:566–574 569

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Table 3 Item description and prevalence in children with autism. (ASD Autism Spectrum Disorder)

Item Stress ratings Prevalence of stress

for families of children

with ASD (%)Not stressful (%) Sometimes

creates

stress (%)

Often creates

stress (%)

Very stressful

on a daily

basis (%)

So stressful

sometimes we feel

we can’t cope (%)

Overall scale

Normally developing 68.7 24.2 5.1 1.4 .6 7.1

Autism 24.4 25.2 20.7 19.3 10.4 50.4

Other developmental disabilities 48.4 28.0 11.8 10.2 1.6 23.6

Core autism behaviors

Normally developing 78.3 18.3 2.6 .7 .1 3.5

Autism 16.4 23.7 24.5 23.9 11.4 59.8

Other developmental disabilities 35.0 32.1 19.3 12.1 1.4 32.9

Co-Morbid behaviors

Normally developing 44.3 27.1 6.2 1.6 .9 8.6

Autism 20.2 23.7 15.1 13.3 7.7 36.1

Other developmental disabilities 45.0 23.6 4.3 5.7 1.4 11.45

Co-Morbid physical issues

Normally developing 56.0 17.7 4.5 1.3 .6 6.3

Autism 26.9 17.9 14.2 13.1 7.9 35.1

Other developmental disabilities 45.7 17.1 7.1 8.6 1.4 17.1

Your child’s social development

Normally developing 61.9 34.5 2.9 .7 .0 3.6

Autism 5.6 29.9 37.4 19.6 7.5 64.5

Other developmental disabilities 35.7 39.3 10.7 14.3 .0 25.0

Your child’s ability to communicate

Normally developing 69.8 27.3 2.2 .7 .0 2.9

Autism 3.7 18.7 24.3 38.3 15.0 77.6

Other developmental disabilities 7.1 50.0 32.1 10.7 .0 42.9

Tantrums/meltdowns

Normally developing 20.1 57.6 16.5 3.6 2.2 22.3

Autism 7.5 25.2 24.3 20.6 22.4 67.3

Other developmental disabilities 32.1 42.9 10.7 10.7 3.6 25.0

Aggressive behavior

Normally developing 43.2 41.7 10.8 2.9 1.4 15.1

Autism 30.8 29.0 16.8 15.9 7.5 40.2

Other developmental disabilities 71.4 14.3 .0 14.3 .0 14.3

Self-injurious behavior

Normally developing 94.2 5.0 .7 .0 .0 .7

Autism 52.3 28.0 7.5 8.4 3.7 19.6

Other developmental disabilities 75.0 14.3 7.1 .0 3.6 10.7

Difficulty making transitions

Normally developing 64.0 30.9 2.9 1.4 .7 5.0

Autism 10.3 36.4 27.1 21.5 4.7 53.3

Other developmental disabilities 46.4 46.4 3.6 3.6 .0 7.1

Sleep problems

Normally developing 64.0 27.3 7.9 .7 .0 8.6

Autism 38.3 25.2 15.0 12.1 9.3 36.4

Other developmental disabilities 60.7 14.3 10.7 10.7 3.6 25.0

570 J Autism Dev Disord (2012) 42:566–574

123

higher for autism than other groups (Estes et al. 2009) and

provide information about why that is so.

In particular, the APSI reported a mean parenting stress

level in the autism group that was four times higher than

the typical group, and twice as high as the other DD group.

The factor analysis indicated three variables impacting

parenting stress: one related to core symptoms, and two

encompassing the full range of symptoms representing

delays and difficulties in achieving self-regulatory mile-

stones (tantrums, aggression, self-injurious behavior and

difficulty making transitions; appetite/digestion, sleep and

toilet training delays) (Posner and Rothbart 2009).

Our validation study for the Sense and Self-Regulation

Checklist (SSC) was conducted with the same cohorts of

children as this APSI validation study. In the SSC study, we

found that the autism group was distinguished from the other

groups by virtue of global self-regulatory delay (Silva et al.,

in press). In young children, unfolding self-regulatory

abilities are supported by the parenting role, which

is required to monitor and respond to the child’s needs,

and stand in for the child’s inability to regulate their envi-

ronment and behavior. Consequently, it is not surprising to

see that global self-regulatory delay on the SSC is associated

with global parenting stress on the APSI. And while there is

variability in parental interpretation of parenting stress, it is

important to recognize that parenting stress is compounded

when there are self-regulatory delays in multiple areas, and

situations arise that are inherently stressful. For example, if

a child has chronically disturbed sleep, then the parent is

chronically sleep-deprived. If a child is sleep deprived, they

are more prone to tantrums, which are harder to manage if

the parent is sleep deprived, and the child has no language.

When that child goes to preschool, difficulties in managing

tantrums in a child without language can result in the child

being sent home, which causes the parent to miss work, and

results in increased parenting stress relative to sleep, tan-

trums, language, and concern for future independence.

The main difference between the APSI and general

measures of parenting stress is that, recognizing the par-

enting skills required to manage the complex core and

Table 3 continued

Item Stress ratings Prevalence of stress

for families of children

with ASD (%)Not stressful (%) Sometimes

creates

stress (%)

Often creates

stress (%)

Very stressful

on a daily

basis (%)

So stressful

sometimes we feel

we can’t cope (%)

Your child’s diet

Normally developing 61.2 29.5 6.5 2.2 .7 9.4

Autism 17.8 25.2 24.3 19.6 13.1 57.0

Other developmental disabilities 46.4 25.0 10.7 17.9 .0 28.6

Bowel problems (diarrhea, etc.)

Normally developing 84.2 10.8 2.2 2.2 .7 5.0

Autism 19.5 18.7 16.8 9.3 5.6 31.8

Other developmental disabilities 53.6 28.6 7.1 10.7 .0 17.9

Potty training

Normally developing 70.5 20.9 5.8 1.4 1.4 8.6

Autism 29.0 20.9 15.0 24.3 11.2 50.5

Other developmental disabilities 67.9 17.9 7.1 3.6 3.6 14.3

Not feeling close to your child

Normally developing 86.5 10.1 2.9 1.4 .0 4.3

Autism 57.9 22.4 9.3 5.6 4.7 19.6

Other developmental disabilities 92.9 3.6 .0 3.6 .0 3.6

Concern for the future of your child being accepted by others

Normally developing 77.0 17.3 4.3 .7 .7 5.8

Autism 6.5 21.5 28.0 32.7 11.2 72.0

Other developmental disabilities 17.9 32.1 32.15 14.3 3.65 50.0

Concern for the future of your child living independently

Typically developing 97.1 2.2 .7 .0 .0 .7

ASD 8.4 26.2 23.45 23.45 18.7 65.4

Other developmental disabilities 21.4 35.7 21.4 17.9 3.6 42.9

Prevalence is defined as having a score higher than of the mean of the normally developing population plus 1 SD

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co-morbid multiplicity of symptoms seen in young children

with autism, it asks for parenting stress levels relative to

specific symptom areas. Other measures of parenting stress

focus on parent factors, such as loneliness and marital

satisfaction (Berry l995), or child factors, such as child

distractibility or demandingness (Abidin 1983), but none

focus on the particularities and complexities of caring for a

child with autism. The APSI is not intended to diagnose

dysfunction in the parent–child relationship, or to be a

screening tool of parental mental health problems. Instead, it

is designed to provide clinicians with an overview of how

well parents are coping with the demands of autism care in

its manifold aspects, in order to allow attention to be directed

to areas where parents need additional support and skills.

Within that overview, the category ‘‘so stressful that at times

we cannot cope’’ can function as a red flag for clinicians.

Currently the clinical management of core and

co-morbid symptoms in autism is parceled out to different

specialties, and information pertaining to how the parent is

coping with the different aspects of the child’s function is

not collected in one place. One advantage of the APSI is it

assesses parenting stress related to multiple aspects of

autism, opening up a view of parenting stress not possible

in a world of assessment where these questions are typi-

cally asked in isolation. The APSI, if widely used, would

bridge the worlds of professionals who tend to focus on

sleep and digestive symptoms (e.g. pediatricians), with

those focusing on problem behaviors (e.g. psychologists

and psychiatrists), sensory problems (e.g. occupational

therapists, early interventionists), and language/social skills

(e.g. speech therapists, early interventionists). All members

of the team could thus be in a position to benefit from an

overview of the how the child’s particular constellation of

symptoms is impacting parenting stress.

Although there can be little doubt that co-morbid

symptoms are an important part of autism, the under-

standing of co-morbid symptoms and their relationship to

core features of autism is still evolving and there is no

widely accepted theory of autism that includes co-morbid

with core symptoms. The structure of the APSI permits an

assessment of the large degree to which co-morbid

Table 4 Significant population comparisons: autism spectrum dis- order (N = 107); other developmental disability (N = 28); typically developing (N = 139)

Autism

spectrum

disorder

Other

developmental

disability

Normally

developing

F

Stress total

M 22.93 11.75 5.41 153.0 ***

SD 10.43 6.73 5.18

Core autism behaviors

M 10.07 5.71 1.32 188.7 ***

SD 4.93 3.23 1.86

Co-Morbid behaviors

M 6.61 2.82 2.42 52.5 ***

SD 4.19 3.42 2.22

Co-Morbid physical issues

M 6.24 3.21 1.67 62.1 ***

SD 4.31 2.47 2.15

Your child’s ability to communicate

M 2.57 1.46 .34 166.0 ***

SD 1.33 .79 .56

Tantrums/meltdowns

M 2.48 1.14 a

1.12 a

37.6 ***

SD 1.60 1.21 .92

Aggressive behavior (siblings, peers)

M 1.48 0.57 a

0.79 a

12.85 ***

SD 1.45 1.07 .92

Self-injurious behavior

M 0.87 a

0.46 ab

0.06 b

26.08 ***

SD 1.24 1.07 .28

Difficulty making transitions from one activity to another

M 1.79 0.64 a

0.45 a

64.7 ***

SD 1.17 .73 .73

Sleep problems

M 1.38 a

0.86 ab

0.45 b

19.5 ***

SD 1.55 1.33 .67

Your child’s diet

M 1.98 1.00 a

.53 a

46.3 ***

SD 1.54 1.16 .81

Bowel problems (diarrhea, constipation)

M 1.08 a

0.75 ab

0.25 b

18.9 ***

SD 1.40 1.01 .71

Potty training

M 1.79 0.61 a

0.44 a

37.8 ***

SD 1.61 1.17 .86

Not feeling close to your child

M .81 0.14 a

0.20 a

15.3 ***

SD 1.28 .59 .55

Concern for the future of your child being accepted by others

M 2.32 1.57 .32 115.6 ***

SD 1.32 1.69 .70

Table 4 continued

Autism

spectrum

disorder

Other

developmental

disability

Normally

developing

F

Concern for the future of your child living independently

M 2.36 1.50 .04 149.1 ***

SD 1.55 1.23 .22

Degrees of freedom were (2, 272) for all comparisons; means sharing

common superscripts letters a, b are not significantly different *** p \ .001, all two-tailed tests

572 J Autism Dev Disord (2012) 42:566–574

123

symptoms impact parenting stress: two-thirds of the APSI

items, and two out of three of the APSI factors refer to

co-morbid rather than core features of ASD. Because the

parent is the main resource for the child, and because of the

chronic nature of the disability, it is important for clinicians

to be aware of the contribution of co-morbid symptoms to

parenting stress, and to provide prioritized support and

intervention accordingly. Among other things, this offers

the hope of providing intervention before parenting stress

reaches crisis proportion.

One of the limitations of this study is that all data was

collected in Oregon. Given that it was drawn from multiple

counties across Oregon we are confident that it represents

Oregon well but it may or may not be representative of the

broader population. Further study of a wider geographic

area with evaluation of the demographic characteristics of

the respondents is planned. In addition, given the wide

variety of severity and symptom presentation of children

on the autism spectrum, more APSI data must be gathered

on a larger number of families to more fully develop the

factor analysis and understand the impact of core and

co-morbid symptoms on parenting stress.

Acknowledgments The authors wish to gratefully acknowledge the families and early intervention programs that participated in our

research. In addition, we wish to thank the Curry Stone Foundation

and Northwest Health Foundation whose generous support made this

research possible. Finally, we would like to thank Sharon Kadell,

Nancy Ganson and Kristen Gabrielsen for their assistance with data

collection and project management.

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Table 5 Factor analyses for APSI

Extraction method: principal

component analysis

Rotation method: varimax with

kaiser normalization. Rotation

converged in six iterations

Component

1 2 3 4

Your child’s social development .623

Your child’s ability to communicate .571

Tantrums/meltdowns .808

Aggressive behavior (siblings, peers) .764

Self-injurious behavior .597

Difficulty making transitions from one activity to another .773

Sleep problems .580

Your child’s diet .767

Bowel problems (diarrhea, constipation) .840

Potty training .827

Not feeling close to your child .598

Concern for the future of your child being accepted by others .828

Concern for the future of your child living independently .795

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