Parenting An Autism Child

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

Maternal Parenting Behavior and Child Behavior Problems in Families of Children and Adolescents with Autism Spectrum Disorder

Jarymke Maljaars • Hannah Boonen •

Greet Lambrechts • Karla Van Leeuwen •

Ilse Noens

Published online: 24 July 2013

� Springer Science+Business Media New York 2013

Abstract Parents of a child with autism spectrum disorder

(ASD) face specific challenges in parenting, but concrete

parenting behavior has never been properly investigated in

these families. This exploratory questionnaire study compared

parenting behaviors among mothers of children and ado-

lescents with ASD (n = 552) and without ASD (n = 437)

and examined associations between child behavior problems

and parenting behavior. Results showed that mothers of

children with ASD reported significantly lower scores on

Rules and Discipline and higher scores on Positive Parent-

ing, Stimulating the Development, and Adapting the Envi-

ronment. Age was differently related to parenting behavior in

the ASD versus control group. Furthermore, distinctive

correlation patterns between parenting behavior and exter-

nalizing or internalizing behavior problems were found for

both groups.

Keywords Parenting behavior � Autism spectrum disorder � Externalizing behavior problems � Internalizing behavior problems

Introduction

Parents of a child with autism spectrum disorder (ASD) are

confronted with specific challenges in raising their child.

These challenges are partly due to the core behavioral

characteristics of children with ASD. The features of ASD

are impairments in social interaction and communication

along with restricted, repetitive, and stereotyped patterns of

behavior, interests, and activities (APA 2000). The mani-

festation of symptoms varies widely, depending on several

factors such as age and level of functioning (Shattuck et al.

2007). Impairments in communication and social interaction

clearly complicate the relation between parents and children

(Seltzer et al. 2001). Moreover, children with ASD are at

increased risk of developing additional externalizing and

internalizing behavior problems compared to children

without ASD (Kanne and Mazurek 2011). The goals of the

present exploratory study are to examine parenting behavior

among mothers of a child with ASD compared to mothers of

a child without ASD across childhood and adolescence and

to explore whether there is a relation between parenting

behavior and child behavior problems.

The focus of this study is on the concrete, behavioral

aspects of parenting. Concrete observable parenting behav-

ior can be distinguished from parenting styles or dimensions.

A parenting style can be defined as the global family climate

and is thought to be built from the combination of two or

more dimensions. A broad parenting dimension comprises

more specific, elementary parenting behaviors (Van Leeu-

wen et al. 2004). The most commonly identified dimensions

of parenting are parental support or warmth and parental

control (Barber et al. 2005). Parental support refers to the

affective component of the parent–child relationship indi-

cated by parenting behaviors such as acceptance, positive

affect, and involvement (Cummings et al. 2000). Parental

control can be subdivided into behavioral and psychological

control. Behavioral control concerns attempts to control,

manage, and regulate child behavior through monitoring and

limit setting (Steinberg 1990). Psychological control

J. Maljaars (&) � H. Boonen � G. Lambrechts � K. Van Leeuwen � I. Noens Parenting and Special Education Research Unit, University

of Leuven (KU Leuven), Leopold Vanderkelenstraat 32,

Box 3765, 3000 Leuven, Belgium

e-mail: [email protected]

J. Maljaars � H. Boonen � G. Lambrechts � I. Noens Leuven Autism Research (LAuRes), Leuven, Belgium

123

J Autism Dev Disord (2014) 44:501–512

DOI 10.1007/s10803-013-1894-8

encompasses a more intrusive type of control by psycho-

logical means such as love withdrawal or guilt induction

(Barber et al. 2005). Recently, autonomy support is often

mentioned as an additional dimension of parenting. Giving

choices or allowing child input into rule making are exam-

ples of parenting behaviors which belong to this dimension

(Soenens et al. 2007). In the past, parenting styles were the

centre of attention in the vast majority of parenting studies.

However, this approach has an important disadvantage in

that the contribution of individual parenting dimensions and

associated parenting behaviors cannot be isolated. Currently,

research on separate dimensions and parenting behaviors is

favored above parenting style approaches (Barber et al.

2005).

Parenting behavior can function as a risk factor, but also as

a protective factor in the development of behavior problems

in children (Patterson et al. 1992). Theoretical models sug-

gest a reciprocal relationship in which child behaviors

actively shape parenting behaviors as well as the other way

around (Berg-Nielsen et al. 2002; Burke et al. 2008). Several

studies have indicated that specific parenting behaviors, such

as inconsistent or harsh discipline strategies (Kawabata et al.

2011; Weiss et al. 1992), love withdrawal or guilt induction

(Barber et al. 2005; Finkenauer et al. 2005), or limited

positive involvement (Caron et al. 2006) are risk factors for

the development and maintenance of externalizing problems

in children. Whereas a relatively large body of literature

considered the relation between parenting and externalizing

behavior problems, only little research focused on the rela-

tion with internalizing problems. Some studies observed a

relation between internalizing problems and excessive

parental control (Caron et al. 2006; Wood et al. 2003) or love

withdrawal (Barber et al. 2005). Positive parenting behavior,

e.g., positive affect, parental sensitivity, or acceptance, may

protect children from developing negative behavior out-

comes (Barber et al. 2005; Finkenauer et al. 2005; Kawabata

et al. 2011). One of the main theoretical mechanisms

underlying the association between parenting behaviors and

externalizing behavior problems is the coercion theory

(Patterson 1982; Patterson et al. 1992). The central idea is

that in a coercive cycle, aversive child behaviors reciprocally

influence parenting behavior, in which negative reinforce-

ment results in maintenance of undesirable behaviors in both

child and parent (Reid et al. 2002).

Currently, there is only little research focusing on con-

crete parenting behavior in families of a child with ASD,

probably because of sensitivity to inaccurate, psychogenic

theories about the origin of the disorder and the accompa-

nying legacy of blaming the parents (Seltzer et al. 2001;

Siller and Sigman 2002). However, parents raising a child

with ASD have to deal with challenges that are not shared by

parents of typically developing children. Because of the

heterogeneity of the disorder and alteration of problems at

different ages, an overwhelming volume of information is

available for parents. Many parents have problems with

assessing its relevance and applicability to their own children

(Whitaker 2002). Families that include a child with ASD are

confronted with extraordinary demands on their time and

energy (Barbaresi et al. 2006). It often takes a great effort to

help a child with ASD acquiring specific skills. From a

family genetic point of view, they may also face the chal-

lenge of raising multiple children with ASD, as there is a

higher recurrence risk for siblings of children with ASD

compared to the general population (Ozonoff et al. 2011), in

combination with an elevated risk of having communicative

and social difficulties themselves or their spouse (Bernier

et al. 2012; Ruser et al. 2007). So far, most research on

parenting in families of a child diagnosed with ASD has been

focusing on cognitive and affective components of parent-

ing, including parenting stress and coping strategies. Rela-

tively little is known about parenting behaviors that are

exhibited by parents of children with ASD, and whether

these parenting behaviors differ from those of parents in the

general population (Osborne and Reed 2010). A recent

explorative study by Lambrechts et al. (2011) showed that

parents of a child with ASD (8–18 years old) reported that

they use less punishment and more explicitly stimulate their

child’s development and adapt the environment in compar-

ison with parents of a child without ASD.

As children grow older, they develop additional skills and

greater independence, requiring changes in parenting

behavior in response. During adolescence, important cog-

nitive, biological, and social changes occur. Peers become

more and more important as a source for adjustment (Laible

et al. 2000). As a result, the relationship between parents and

children changes during this stage (Collins 1990). However,

children with ASD are expected to be dependent on envi-

ronmental support for longer and requiring qualitatively and

quantitatively different support from typically developing

children (Seltzer et al. 2001). It is not clear how parenting

behaviors in case of ASD change over time as no studies have

examined parenting across childhood and adolescence.

Several studies showed a modest decrease of autism symp-

toms from childhood to adolescence (McGovern and Sigman

2005; Shattuck et al. 2007), but improvement is often limited

to one domain and seldom leads to levels of functioning in

the normal range (Seltzer et al. 2004). Also an overall decline

in externalizing and internalizing behavior problems is

mentioned, although levels of behavior problems remained

high during adolescence and improvement was not seen in all

adolescents with ASD (Gray et al. 2012). By contrast, there is

evidence of an increase in parental stress during adolescence

(Seltzer et al. 2001).

Children with ASD have a greater risk for developing

psychopathology and behavior problems compared to

children without ASD. According to a study of Simonoff

502 J Autism Dev Disord (2014) 44:501–512

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et al. (2008), about 70 % of the children with ASD have an

additional DSM-IV diagnosis, e.g., ADHD, anxiety disor-

der, or OCD. Besides the higher levels of psychopathology,

internalizing and externalizing behavior problems are also

more prevalent in children with ASD (Kanne and Mazurek

2011; Mazurek and Kanne 2010). The consequences of the

presence of behavior problems in ASD are substantial.

Behavior problems interfere with day-to-day functioning

and restrict access to or minimize opportunities in educa-

tional, vocational, and community settings (Sturmey et al.

2008; Taylor and Seltzer 2011). Behavior problems can

form an important source of stress for parents (Estes et al.

2009), often even more than the core ASD symptoms

(Tomanik et al. 2004), especially in case of externalizing

behavior problems (Lecavalier et al. 2006). Higher levels of

parenting stress possibly reduce the parents’ ability to

accommodate and respond adequately to their children’s

behavior (Osborne and Reed 2010). Problem behavior can

serve different functions, such as getting attention, avoiding

or escaping nonpreferred or difficult demands, or getting a

desirable object or activity (O’Neill et al. 1997). Despite the

large empirical body of literature on the presence and

function of behavior problems or challenging behavior in

autism spectrum disorders, little attention has been given to

family processes involved in the development and mainte-

nance of such difficulties. An observational study of

Lucyshyn et al. (2004) showed that coercive family pro-

cesses also exist in families of young children with devel-

opmental disabilities (ASD and/or intellectual disability)

and behavior problems. Both attention-driven and escape-

driven coercive processes were observed in which parents

submitted to their child’s problem behavior. These findings

were replicated in an intervention study which also dem-

onstrated possibilities to reshape these coercive processes

into constructive processes (Lucyshyn et al. 2007).

Although autism spectrum disorders have a neuro-bio-

logical basis, there is some evidence that variations in

parenting behavior may have an effect on the subsequent

development of children with ASD (Siller and Sigman

2002). It is important to study the relationship between

different aspects of parenting behavior and child charac-

teristics in order to improve parent-focused interventions

and possible long-term outcomes (Wachtel and Carter

2008). The first objective of this study is to explore dif-

ferences in parenting behavior among mothers of children

with ASD or without ASD in association with the child’s

age. It is expected that both similarities and differences are

present in general parenting behavior between mothers of a

child with or without ASD, and that mothers of a child with

ASD show more ASD-adapted parenting behavior in

stimulating the development of their child and adapting the

environment compared to parents of a child without ASD

(Lambrechts et al. 2011). No studies have explicitly

explored parenting behavior in relation to the child’s age.

The second objective is to examine whether and how

maternal parenting behavior is related to the child’s

externalizing and internalizing behavior problems. The

questionnaire used to measure parenting behaviors was

developed within the social learning framework on the

relationship between anti-social behavior and parenting

behaviors (Patterson et al. 1992). Based on a study by Van

Leeuwen et al. (2004) in a general population sample and

the study of Lucyshyn et al. (2004) in children with

developmental disabilities, we hypothesize the strength of

the link between general parenting behaviors and exter-

nalizing behavior to be higher than for internalizing

behavior, because of the theoretical and empirical under-

pinnings of the parenting questionnaire.

Methods

Participants

A total of 989 families from a Dutch-speaking context

(Flemish part of Belgium and the Netherlands) participated

in this study. Families of a child with ASD (n = 552) were

compared with a control group of families with a child

without (suspected) ASD (n = 437). Parents indicated on a

questionnaire whether their child had received a clinical

ASD diagnosis based on DSM-IV-TR criteria for Autistic

Disorder, Asperger syndrome, or PDD-NOS by qualified

professionals. Information regarding year and site of

diagnosis was available. A large part of the participating

families were member of a parent association for children

with ASD. Other families were recruited through special

schools where a formal DSM-classification by an inter-

disciplinary team is a condition for admittance. Eight

children with suspected ASD without formal diagnosis

were excluded from both the experimental and the control

group. The control group consisted of children without

ASD diagnosis. Some children in the ASD and control

group had an (additional) diagnosis, such as ADHD or

dyslexia. Children with intellectual disability (IQ \ 70) were excluded from this study. In both groups, children

were between 6 and 18 years old. Table 1 shows the

demographic characteristics of the samples.

Of the mothers, the majority was married or cohabiting

with a partner. The remaining was divorced, widowed,

separated, or single. The level of education was generally

high, with more than half of the mothers having graduated

from university (bachelor’s or master’s degree).

The ASD and control group differed on child charac-

teristics as shown in Table 1. Age and gender were co-

varied in subsequent analyses when they correlated sig-

nificantly with the dependent variable.

J Autism Dev Disord (2014) 44:501–512 503

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Instruments

Parenting Behavior

The Parental Behavior Scale-short version (PBS, Van

Leeuwen and Vermulst 2004, 2010) was used to measure

general parenting behavior, in combination with additional

subscales to measure specific parenting behavior relevant to

children with ASD (PBS-A, Van Leeuwen and Noens 2013).

The PBS comprises five subscales: Positive Parenting (11

items), Discipline (6 items), Harsh Punishment (5 items),

Material Rewarding (4 items), and Rules (6 items). The two

additional subscales are: Stimulating the Development (11

items) and Adapting the Environment (9 items). All items are

formulated as statements about concrete parenting behavior

in everyday life towards one specific child, for example

‘‘When my child has to complete a task (e.g., homework), I

restrict distraction to a minimum’’. The frequencies of these

behaviors are rated on a 5-point Likert scale (1 = (almost)

never, 2 = rarely, 3 = sometimes, 4 = often, and

5 = (almost) always). Internal reliability was acceptable to

good for all subscales. Confirmative factor analyses sup-

ported structural validity (Lambrechts et al. 2011).

Child Behavior Problems

The Strengths and Difficulties Questionnaire (Goodman

1997) is a brief behavioral screening questionnaire which

evaluates child behavior. Mothers were asked to indicate the

degree to which different statements were true about the

child’s behavior within the previous 6 months using a

3-point rating scale ranging from ‘not true’ to ‘certainly

true’. Besides negative attributes of behavior, also some

positive attributes are questioned. Norms are available for

4–16 year olds. The age range of our participants slightly

exceeds the age range of the available SDQ norms, however,

analyses were based on the raw scores only. The 25 items are

divided between five subscales: (1) emotional symptoms, (2)

conduct problems, (3) hyperactivity/inattention, (4) peer

relationship problems, and (5) prosocial behavior. Several

measures indicated a good reliability of the parent version.

The psychometric properties of the parent-report version of

the SDQ were also proven satisfactory in Dutch and Flemish

samples (Muris et al. 2003; Van Leeuwen et al. 2006). In the

current study the first four subscales were used, creating two

composite scores for internalizing behavior problems

(emotional and peer items) and externalizing behavior

problems (conduct and hyperactivity items). Factor analyses

generally supported second-order internalizing and exter-

nalizing factors. Especially in general population samples it

is better to use these broadband scales instead of the five-

subscale division (Goodman et al. 2010).

Procedure

Parents were approached through the news letter from the

Flemish and Dutch parent associations for autism and later

contacted via an e-mail with a direct link to give permis-

sion to participate in this study. The remainder (12 % of

the ASD sample) was included via five special schools for

Table 1 Demographic characteristics of the ASD and

control group

Control

(n = 437)

ASD

(n = 552)

Test

statistic

p

Mother characteristics

Education level

No college 46 % 42 % V(1) 2

= 2.36 .12

Completed college 54 % 58 %

Marital status

Single-parent 14 % 15 % V(1) 2

= .26 .61

Two parents 86 % 85 %

Family characteristics

No of children

Range 1–6 1–7

M (SD) 2.4 (.8) 2.4 (.9) t(987) = -.25 .80

Child characteristics

Age

Range 6–18 6–18 t(987) = 1.77 .08

M (SD) 12.1 (3.5) 11.7 (2.7)

Gender

Boys 55 % 83 % V(1) 2

= 88.39 .001

Girls 45 % 17 %

504 J Autism Dev Disord (2014) 44:501–512

123

children with ASD. Participants for the control group were

recruited from 13 primary and 4 secondary schools. After

informed consent was given, parents completed the ques-

tionnaires online or filled out the paper and pencil versions

of the questionnaires. The Flemish data on parenting

behavior have previously been analyzed in a study by

Lambrechts et al. (2011), but in the current study only the

questionnaires filled out by mothers were used.

Analyses

All statistical tests were performed using IBM SPSS Statis-

tics 19. A MANOVA was conducted in order to compare

means on the parenting behavior domains with groups based

on diagnosis (ASD vs. control), gender, and age (6–12 vs.

13–18 years) as factors. Age could not be added as a

covariate, as there was no homogeneity of regression slopes.

The assumption of homogeneity of covariance matrices was

also not met (Box’s M test: F = 1.37, p \ .001). However, when larger sample sizes produce unequal covariances,

rather conservative significance values should be expected

(Tabachnick and Fidell 2007). Pearson correlations were

calculated between the different parenting domains and the

SDQ composite scores. Next, partial correlations analyses

controlling for age or gender were performed. The partial

correlation coefficients only differed from the zero-order

correlation coefficients on adapting the environment asso-

ciated with externalizing behavior problems in children with

ASD. For all other correlations, the partial correlation

coefficients (controlling for age or gender) were essentially

the same value as the bivariate coefficients. Correlation

patterns in the ASD and the control group were compared by

using a Fisher’s Z transformation. Effect sizes were calcu-

lated using Eta squared values, with .01–.06 indicating a

small effect, .06–.14 a medium effect, and[.14 a large effect or Cohen’s d with .10, .30, and .50 as values for small,

medium, or large effects (Cohen 1988).

Results

Parenting Among Mothers of Children with ASD

During Childhood and Adolescence

Our first aim was to examine differences in parenting

behavior between mothers of children with and without

ASD (Table 2).

Analyses of the different domain scores suggested that

mothers of children with ASD exhibited different parenting

behavior in several domains, in general parenting as well as

ASD-adapted parenting behavior, compared to mothers of

children without ASD. Mothers of children with ASD

reported lower scores on Rules and Discipline, and higher

scores on Positive Parenting, Stimulating the Development,

and Adapting the Environment (see Table 2). However,

group differences on Positive Parenting and Stimulating

the Development can only be interpreted in relation to the

child’s age.

Main effects for gender cannot be interpreted, because of

the unequal distribution of boys and girls over the control and

ASD group. Independent t-tests on the subscales Positive

Parenting, Discipline, and Stimulating the Development

showed a significant difference between boys and girls

within the control group for Positive Parenting (t(435) =

-2.07, p = .04, Cohen’s d = .20; boys: M = 4.01; girls:

M = 4.10) and Stimulating the Development (t(435) =

-2.69, p = .007, Cohen’s d = .26); boys: M = 3.73; girls:

M = 3.85), and within the ASD group for Discipline

(t(549) = 2.78, p = .006, Cohen’s d = .30; boys: M = 2.65;

girls: M = 2.43).

A general age trend was present regarding Adapting the

Environment (Fig. 1a; F(1, 980) = 26.97, p \ .001, g 2

= .02).

This parenting behavior was reported to a lesser extent in

adolescence compared to childhood, both in the control and

ASD group. For three domains interaction effects between

diagnosis and age groups were found. In the control group,

mothers of adolescents reported less Positive Parenting than

mothers of children aged 6–12 years, but this difference was

not seen in the ASD group (Fig. 1b; F(1, 980) = 6.68, p = .01,

g2 = .01). In the control group the mean score for Material Rewarding was higher in adolescence compared to childhood,

whereas the opposite pattern was seen in the ASD group

(Fig. 1c; F(1, 980) = 5.80, p = .02, g 2

= .01). During child-

hood, Stimulating the Development was as often reported in

the ASD group as in the control group. In the adolescent age

range, however, mothers of children with ASD showed more,

whereas mothers of children without ASD reported less of this

parenting behavior (Fig. 1d; F(1, 980) = 6.13, p = .01,

g2 = .01).

Parenting and Behavior Problems

Significantly more behavior problems, both externalizing and

internalizing, were reported in the ASD group compared to the

control group (Externalizing: F(1, 958) = 223.1, p \ .001, g2 = .18; Internalizing: F(1, 958) = 660.1, p \ .001, g2 = .41). A significant interaction effect between diagnosis and age for externalizing problems indicated that there were

less externalizing behavior problems observed in childhood

than in adolescence in the ASD group (F(1, 958) = 7.75,

p = .005, g2 = .01). Bivariate coefficients between parenting and behavior problems are presented in Table 3.

In general, only weak correlations were found between

behavior problems and maternal parenting behavior. The

correlation patterns were comparable between the control

and ASD group, as all comparisons between correlations

J Autism Dev Disord (2014) 44:501–512 505

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were nonsignificant (except for Positive Parenting in relation

with externalizing behavior problems, see Table 3). Differ-

ent parenting behavior patterns were seen for externalizing

versus internalizing behavior problems. Externalizing

behavior problems were related to general parenting

behaviors. In both groups externalizing behavior problems

were positively correlated with Discipline and Harsh Pun-

ishment. These processes went together with less positive

parenting in the control group, while more rule setting was

only present in the ASD group. Internalizing problems were

correlated with ASD-adapted parenting behaviors: Adapting

the Environment in the control group and both Stimulating

the Development and Adapting the Environment in the ASD

group.

Discussion

Although many parent interventions and practical hand-

books or guidelines are available for parents of a child with

ASD, concrete parenting behavior has seldom been

empirically studied in this group. Previous studies on par-

enting in ASD mainly focused on perceptions, cognitions,

and coping of parents. Our study extends previous findings

and contributes to our knowledge about parenting in ASD

by focusing on general and specific parenting behaviors in

relation to child’s age and behavior problems.

The first goal of this study was to examine similarities

and differences in parenting behavior between mothers of a

child with or without autism spectrum disorder and how

these differences are related to or interact with the child’s

age. As expected, significantly more ASD-adapted par-

enting behaviors were reported in the group of mothers

with a child with ASD, but also differences in general

parenting behavior were present.

Mothers of a child with ASD were setting fewer rules and

utilized less discipline than the control group during child-

hood as well as adolescence. As for rules, mothers of a child

with ASD put less emphasis on stimulating their child to

adhere to specific rules at school or at home compared to

mothers of a child without ASD, whereas during adoles-

cence these differences are only seen for rules at home.

Harsh punishment was comparable between groups and only

scarcely reported in both groups. Although the results of this

study showed that children with ASD exhibit much more

behavior problems than children without ASD, mothers of

children with ASD seem to be less strictly controlling. On

the one hand, this may be due to the fact that behavior

problems in children with ASD are interpreted differently by

parents (Reese et al. 2005). Aversive behaviors often cannot

be labeled unwillingness or misbehavior on purpose, and

parents may search for preceding events (e.g., unpleasant

sensory stimuli, unexpected change, or unstructured time)

that might provide insight into the behavior of their child. As

a result, mothers of children with ASD probably are more

focusing on changing the antecedents of their child’s

behavior or showing and explaining children how to behave,

rather than paying attention to the consequences of their

negative behavior. On the other hand, an alternative expla-

nation can be given in line with the findings of Lucyshyn

et al. (2004). If parents start to set fewer rules and lessen

their discipline after behavior problems occur, this process

can be seen as consistent with the coercion theory. When

parents reduce or withdraw their demands in this situation,

the child’s behavior problems will be negatively reinforced.

If subsequently the child’s aversive behavior ceases, the

child negatively reinforces parental submission (Lucyshyn

et al. 2009).

This study further revealed a significant diagnosis versus

age group interaction for material rewarding and positive

Table 2 Group differences in parenting behavior between the ASD and control group

Control

(n = 437)

ASD

(n = 552)

MANOVA Dx: ASD versus control Other significant

effects a

M (SD) M (SD) F p g2

General parenting behavior

Positive Parenting 4.05 (.45) 4.09 (.40) 5.48 .02 \.01 gender, age, dx*age Material Rewarding 2.44 (.59) 2.48 (.60) .01 .92 – dx*age

Rules 4.29 (.47) 4.13 (.46) 22.63 \.001 .02b – Discipline 2.85 (.69) 2.62 (.71) 31.89 \.001 .03b gender Harsh Punishment 1.36 (.41) 1.33 (.36) 1.44 .23 – –

ASD-adapted parenting behavior

Stimulating the Development 3.79 (.45) 3.87 (.45) 13.38 \.001 .01b gender, dx*age Adapting the Environment 2.83 (.54) 3.41 (.57) 204.93 \.001 .17c age

dx = diagnosis a

No significant interaction effects for diagnosis*gender, age*gender, and age*gender*diagnosis were found; b

small effect size; c

large effect

size

506 J Autism Dev Disord (2014) 44:501–512

123

parenting. In the control group an increase in material

rewarding and a decrease of positive parenting was seen in the

transition from childhood to adolescence. Additional analyses

at item level showed that rewarding strategies in the control

group have a more social nature during childhood (e.g., verbal

praise, pat on the back, which are part of the Positive Parenting

subscale), and parents switch to more material, mainly mon-

etary, rewarding during adolescence (items of the Material

Rewarding subscale). During childhood, a higher level of

material rewarding was reported in the ASD group compared

to the control group. The largest difference was seen for the

item about the use of reinforcement systems. It is assumed that

children with ASD are less responsive to social incentives

because of a reduced social motivation (Chevallier et al.

2012). Behavioral treatment programs have demonstrated that

children with ASD particularly benefit from tangible rein-

forcers, such as tokens, money, and food in comparison to

social rewards (Matson et al. 1996). As opposed to the control

group, no increase in the use of monetary rewarding was seen

during adolescence. Although mothers in the control group

showed less positive parenting during adolescence compared

to childhood, the level of positive parenting remained the

same in the ASD group. The positive parenting subscale not

only refers to social rewarding, but also includes items about

positive involvement and problem solving (Van Leeuwen

et al. 2004). The results suggest that mothers of adolescents

without ASD are less directly involved in for example prob-

lem solving for their children, whereas adolescents with ASD

are or are expected to be more dependent on their mother’s

involvement and guidance. However, these results may also

reflect a sampling bias, as most of the parents belonged

to a parent support group, and possibly have specific

characteristics.

As expected, mothers of children with ASD were more

likely than the control group to adapt the environment and

stimulate the development of their child. The most striking

difference between the control and ASD group was found for

the domain of adapting the environment to their children’s

needs. Children with ASD are often easily distracted by visual

or auditory stimuli, making it difficult for them to identify or

attend to relevant cues. Blocking out extraneous distracting

stimuli, can help them focus on their activities (Mesibov et al.

1994). Furthermore, mothers of children with ASD report that

they modify their communication towards their child with

ASD, for example by simplifying verbal questions and

instructions or the use of augmentative communication. The

questionnaire used in this study, however, only encompasses

questions about more positively labeled adaptations. From

literature it is known that parents of children with ASD also

tend to make other adaptations, for example avoiding

demands, routines or activities in which behavior problems

are likely to occur, such as taking the child to a birthday party

or a grocery store (Lucyshyn et al. 2009).

The subscale about stimulating the development mainly

focuses on the parent’s efforts to improve their child’s

social and daily living skills. Differences between mothers

a

b

c

d

Fig. 1 Parenting behavior (a Adapting the Environment, b Positive Parenting, c Material Rewarding, and d Stimulating the Develop- ment) across childhood and adolescence for the control and ASD

group

J Autism Dev Disord (2014) 44:501–512 507

123

of children with ASD opposed to children without ASD

were only present during adolescence. The results indicate

that mothers of older children with ASD stimulate the

development of their child even more compared to younger

children with ASD. This might be due to the fact that the

demands for and complexity of social interactions and

daily living skills increase during adolescence (Shattuck

et al. 2007) or parents expectations about when their

children are able to master these skills. Overall, differences

at item level suggest that the development of children with

ASD is delayed on several domains and mothers of a child

with ASD pay more attention to the development of these

skills in a later age phase compared to the control group.

Mothers of an adolescent with ASD stimulate their child

more often to make their own choices, to develop problem

solving skills, or to plan activities compared to mothers of

younger children with ASD. In contrast, mothers of a child

without ASD stimulate these skills more often during

childhood compared to adolescence. In the ASD group,

mothers explain emotions of others in both age groups,

whereas in the control group mothers stimulate these skills

during childhood and less during adolescence. As social

difficulties are one of the core problems of children with

ASD, children with ASD often need a lot of guidance and

explanation in daily social contexts to learn how to respond

appropriately in different situations (Howlin 1998). Social

skills are also often addressed in individual or group

training programs for children with ASD, but children with

ASD frequently have difficulty generalizing skills from one

setting to another setting or context. Practice at home is

therefore important (Krasny et al. 2003). Impaired execu-

tive function in children with ASD may interfere with

many daily activities in the home situation, such as prac-

ticing personal hygiene, completing household tasks, or

doing homework (Gilotty et al. 2002). Children with ASD

often need extensive instructions to master these daily

living skills (Carothers and Taylor 2004).

The second purpose of the current study was to examine

the relation between parenting behaviors and behavior

problems in the ASD and control group. The results of the

correlation analyses demonstrated rather comparable asso-

ciations between maternal parenting behavior and child

behavior problems among both groups and the associations

were independent of age and gender. With respect to exter-

nalizing behavior problems, increased reports of behavior

problems went along with a rise in more negative, controlling

parenting behaviors, i.e., discipline and harsh punishment for

both groups, and a converging decrease of positive parenting

in the control group. These correlation patterns provide

support for the possible presence of coercive family processes

in both groups. As described in the coercion theory (Patterson

et al. 1992), the negative reinforcement of externalizing

behavior may increase the frequency and intensity of this

problem behavior. However, based on this cross-sectional

study, only cautious conclusions are allowed. Coercive

family processes can only be detected in a longitudinal study.

By contrast, internalizing problems were not related to

general parenting behaviors, but to both ASD-adapted

parenting behavior subscales in the ASD group and to

adaptation of the environment in the control group. The

internalizing problem factor of the SDQ not only includes

emotional problems, but also social problems with peers,

which are related to the core problems of children with

ASD. Not surprisingly, a rise in ASD-adapted parenting

was seen with increasing internalizing problems.

However, the direction of the relationship between

parenting behavior and children’s behavior problems is not

apparent from the analyses and only weak correlations

were found. The failure to find strong correlations between

parent behavior and child behavior problems is perhaps

Table 3 Pearson correlations between parenting behavior and child behavior problems for the ASD and control group

Externalizing problems Internalizing problems

Control (n = 430) ASD (n = 536) z p Control (n = 430) ASD (n = 536) z p

General parenting behavior

Positive Parenting -.15* n.s. -2.74 \.01 n.s. n.s. -1.76 .08 Material Rewarding n.s. n.s. .43 .33 n.s. n.s. -.34 .73

Rules n.s. .16* -1.02 .30 n.s. n.s. 1.08 .28

Discipline .18* .25* -1.14 .25 n.s. n.s. .45 .65

Harsh Punishment .16* .27* -1.76 .08 n.s. n.s. 1.92 .06

ASD-adapted parenting behavior

Stimulating the Development n.s. n.s. -1.53 .13 n.s. .12* -1.07 .28

Adapting the Environment n.s. n.s. a

-.28 .78 .18* .17* .22 .83

* p \ .007 after Bonferroni correction a

No significant correlation after controlling for age and gender

508 J Autism Dev Disord (2014) 44:501–512

123

caused by the measures used in this study. The SDQ is a

very short screening questionnaire and probably not sen-

sitive enough to differentiate in degree of behavior prob-

lems within the ASD group (mainly higher end of the

scale) and within the control group (mainly lower end of

the scale). The subscales about parenting behavior could be

influenced by socially desirable responding, because of the

use of self-report measures.

Limitations and Directions for Future Research

The potential limitations of this study provide suggestions for

further research. A first and major limitation of the present

study is its cross-sectional design. Possible cohort effects

might obscure the relation between parenting behavior and the

child’s age. Further, it is impossible to formulate conclusions

about directionality between parenting behavior and child

behavior problems, because both variables were assessed

concurrently. Longitudinal study of these construct would

allow for better understanding of any possible causal path-

ways. Also direct observations of parental behaviors with the

children would have helped in the interpretation of the com-

plex relation between parent and child variables. Another

limitation of the present study is a possible sample selection

bias. Recruitment mainly took place via ASD parent associ-

ations. Members of such support groups can often be char-

acterized as highly motivated and positively involved in

raising a child with ASD. Moreover, parent associations

provide information about ASD, how to obtain services, and

how to cope with the child’s behavior. This limitation might

put constraints on the generalization of our results. A final

limitation in interpreting the findings is that there are likely to

be other variables that moderate or mediate the relationship

between parenting behavior and children’s behavior problems

that were not measured in the current study and could not be

controlled for. Variables that possibly influence parenting

behavior are for example parenting stress (Hastings 2002),

parental psychopathology (Berg-Nielsen et al. 2002), several

other child factors, such as severity of ASD symptoms, or

contextual factors. Future research needs to take them into

consideration and examine their influence.

Clinical Implications

Examining parenting behavior in ASD and identifying the

association between parenting and child behavior problems

could be especially helpful for professionals interested in

designing better and more comprehensive interventions

that include a parent training component. Attention for

parents and parenting skills is important in the assessment

process. Assessment procedures only focusing on child

characteristics are not sufficiently informative to recom-

mend the most appropriate intervention program.

The current results suggested that autism related par-

enting is present in most of the families with a child with

ASD, in other words many mothers reported important

strengths in adjusting their behavior to the diagnosis of

ASD for their child. We do not know whether this is a

result of parent involved interventions or whether mothers

spontaneously attune and respond to their child behavioral

cues. However, probably not all parents manage to adapt

their parenting behavior to the specific needs of their child

with ASD. The study of Welterlin et al. (2012) showed that

parents can learn to (physically) structure the environment

and to create learning opportunities for the child, when

appropriate training is available. Recent studies emphasize

the importance of parents in stimulating the development

of the child, because they can guide their child in everyday

situations and offer a lot of learning opportunities to

encourage generalization and overall improvement (Burrell

and Borrego 2012).

Another implication of our findings is the need for ser-

vices and training to support parents of children with ASD

with accompanying behavior problems, as severity of

behavior problems is greater in children with ASD. More-

over, the results suggest the presence of coercive patterns in

parent–child interactions. Problem behavior is typically

purposeful, and functional assessment of problem behavior

can be helpful to ascertain the function of the behavior, to

unravel the presence of coercive processes, and to develop

effective interventions (Gavidia-Payne and Hudson 2002;

Repp and Horner 1999). There is considerable evidence that

behavior problems can be reduced successfully through

parent interventions; reduction in negative parenting and

improvement of positive parenting can result in improve-

ment in child behavior (Beauchaine et al. 2005; Gardner

et al. 2010; Lucyshyn et al. 2007). Although parent training

is more and more considered as an essential component of

successful intervention programs for children with ASD

(Ingersoll and Wainer 2011), there is a lack of availability of

formal parent training services (Thomas et al. 2007). Parent

training may not only help them to manage their child’s

behavior more successfully, but can also improve self-effi-

cacy and reduce parental stress (Burrell and Borrego 2012).

However, prospective studies are needed to determine

whether behavioral changes resulting from parent training

cause long-term improvements in parent and child behavior

in particular in case of ASD.

Conclusions

Despite the abovementioned limitations, this study fills an

important gap in the literature. The study represents one of

only a few studies that has examined concrete parenting

behavior among mothers of children and adolescents with

J Autism Dev Disord (2014) 44:501–512 509

123

ASD and the link between parenting behavior and behavior

problems. These results suggest that parenting behavior

may be important to consider in problem behavior in

children with ASD and the effectiveness of interventions

focused on parent behavior merits further examination.

Acknowledgments This research was funded by grants from the Marguerite-Marie Delacroix Support Fund, the Research Council of the

KU Leuven (IDO/08/013), and the Fund for Scientific Research Flan-

ders (FWO). Furthermore, we thank all the participating families and

schools, as well as the Flemish and Dutch parent associations for ASD.

Conflict of interest The authors declare that they have no conflict of interest.

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