Parenting An Autism Child

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

Correlates of Attachment Perceptions in Parents of Children with Autism Spectrum Disorders

Sabrina J. Goodman • David S. Glenwick

Published online: 2 February 2012

� Springer Science+Business Media, LLC 2012

Abstract This study explored the relationship between

parents’ perceptions of their child’s attachment to them and

parents’ own affective attachment to their child, as well the

relationship of these constructs to parenting stress, parent-

rated child functional impairment, and parenting sense of

competence. Mothers (n = 76) and fathers (n = 30) of

children ages 2–10 with autism spectrum disorders partic-

ipated. Overall, parents’ affective attachment to their child

was more consistently related to other aspects of their

parenting experiences than were their perceptions of their

child’s attachment to them. Also, perceptions of child-to-

parent attachment were related to other aspects of parenting

for fathers more than for mothers. Implications for par-

enting interventions and future research, such as longitu-

dinal investigations, are discussed.

Keywords Autism spectrum disorders � Attachment � Parenting stress � Parent cognitions � Parent perceptions

Introduction

In part due to their distinctive needs and pervasive deficits, the

parenting of children with autism spectrum disorders (ASDs)

presents unique challenges. Certain aspects of these parents’

experiences (e.g., parenting stress) have been addressed

substantially in the literature, while other important aspects

have been neglected. This includes parents’ attachment-related

perceptions and experiences, as well as the correlates of these.

Consistent with the broader attachment literature, most

attachment research involving children with ASDs has focused

on child-to-parent attachment and typically on children’s rela-

tionships with their mothers. Typically, researchers have

investigated the behavioral (rather than the emotional or

affective) component of attachment, assessing for the presence,

quality, or security of the child’s attachment. This research has

discredited previous beliefs that children with autism could not

form attachments to others. For instance, children with autism

have been able to differentiate their parents from others and to

direct increased social behaviors toward them following a

separation (e.g., Buitelaar 1995). In fact, it has been reported

(Rutgers et al. 2004) that many children with ASDs display

secure attachments to their parents.

Parental Perceptions of Child Attachment

Little research has focused on parents’ perceptions of their

child’s attachment to them. Hoppes and Harris (1990)

compared mothers of children with autism and Down

syndrome on their perceptions of their child’s attachment

and their feelings of maternal gratification. Mothers of

children with autism perceived their children to be signif-

icantly less attached to them than did mothers of children

with Down syndrome. A study by VanMeter (1995)

revealed that parents of children with autism reported that

their children displayed significantly fewer attachment

behaviors than did parents of children with mental retar-

dation. In addition, Sakaguchi and Beppu (2007) reported

that mothers of preschool-aged children with autism had

significantly higher scores on children’s reported lack of

attachment behavior than did mothers of preschool-aged

S. J. Goodman � D. S. Glenwick Psychology Department, Fordham University, Bronx,

NY 10458, USA

e-mail: [email protected]

S. J. Goodman (&) Department of Psychiatry, Mount Sinai School of Medicine,

1160 Fifth Avenue, New York, NY 10029, USA

e-mail: [email protected]

123

J Autism Dev Disord (2012) 42:2056–2066

DOI 10.1007/s10803-012-1453-8

children with other disabilities. Thus, research has revealed

that parents of children with autism may perceive their

children to be less attached to them than do parents of

children with other disabilities.

There are a number of potential implications of parents

perceiving their children to be less attached to them. For

example, parents may experience greater stress or may feel

less competent as parents (e.g., if they interpret their

child’s lower degree of attachment to them as a reflection

on their parenting). As a result, parenting behavior may be

negatively impacted (e.g., parents may be less effective in

implementing behavioral interventions with their children,

which is a common component of treatment for children

with ASDs). Thus, both parents’ subjective experiences

and their parenting behavior may be impacted by their

perceptions of their child’s level of attachment to them.

Parents’ Affective Attachment to their Child

Much of the research that has been conducted on parent-to-

child attachment in nonclinical populations has been in the

nursing literature and has focused on mothers’ prenatal or

postnatal attachment in the first 1–2 years of life. As with

child attachment, maternal attachment often has been

studied behaviorally, such as by observations of mother-

infant interactions (e.g., Becker and Becker 1994). In

addition to methodological issues with behavioral mea-

sures of attachment, there is theoretical support for inves-

tigating the less commonly studied affective component of

attachment, with researchers calling for increased attention

to this topic (e.g., Condon and Corkindale 1998; Zeanah

and Benoit 1995). For instance, Müller (1996) proposed

that gaining a better understanding of attachment from a

mother’s perspective would help identify ways to foster an

increase in mothers’ affection toward their children and to

support a positive long-term attachment relationship.

Similarly, Slade (2009) argued that inadequate attention

had been paid to the subjective experiences of parents of

children with ASDs and described what can be a painful

struggle for these parents to feel attached to a child who

may display little ‘‘reciprocity and mutuality’’ (p. 19), and

thus can be experienced as very rejecting. She noted that

children’s reciprocity can be essential to parents’ feelings

of satisfaction. Finally, Seskin et al. (2010) suggested that

consideration of parents’ attachment representations could

be valuable in helping parents interpret their children’s

attachment needs and managing parenting stress.

Relationship Between Perceptions of Child Attachment

and Parental Affective Attachment

The research to date on the relationship between parental

perceptions of child attachment and parental affective

attachment mainly has focused on parents of typically

developing children (e.g., Feldstein et al. 2004; Robson and

Moss 1970). There are theoretical reasons to expect a

relationship between these constructs. The development of

attachment is an interactive, reciprocal process between

parent and child (e.g., Condon and Corkindale 1998;

Feldstein et al. 2004; Howe 2006). Because children with

autism often evidence developmental delays and do not

exhibit signs of social reciprocity, there may be a relative

lack of social reinforcement experienced by parents, hin-

dering the development of their feelings of closeness to

their child (Slade 2009). Reviewing the literature on

attachment and parent–child interaction in children with

disabilities, Howe (2006) noted that when a child appears

unresponsive, parents might feel rejected. In like fashion,

Talay-Ongan and Wood (2000) hypothesized that the

sensory difficulties of children with autism might interfere

with their level of responsiveness to others, causing

mothers to ‘‘feel and act dejected’’ (p. 209) due to per-

ceived rejection. They proposed that, in contrast to the long-

discredited notion of a ‘‘‘refrigerator mother’’’ (p. 210)

playing a role in the etiology of autism, parental distance may

be a result of the disorder.

Given the paucity of research on the topic, as well as

theoretical underpinnings for its potential importance, the

present study investigated the relationship between the

perceptions of child attachment for parents of children with

ASDs and their own affective attachment to their child. In

addition, associations between these two sets of attachment

perceptions and three potential correlates (parenting stress,

child functional impairment, and parenting sense of com-

petence) also were explored.

Parenting Stress

There is evidence that parents of children with autism show

significantly elevated levels of stress (e.g., Kuhn and Carter

2006; Tomanik et al. 2004), levels that are greater than

parents of typically developing children (e.g., Baker-Ericzén

et al. 2005; Bouma and Schweitzer 1990) and parents of

children with other disabilities, such as Down syndrome

(Holroyd and McArthur 1976). Little research has addres-

sed parenting stress in relation to perceptions of child

attachment or parental affective attachment for parents of

children with ASDs. However, Sakaguchi and Beppu

(2007) reported an association between children’s lack of

attachment behavior and the stress responses of mothers of

preschool-aged children with autism and other disabilities.

Others have recognized that the lack of social reciprocity of

children with ASDs can be stressful for parents (e.g., Siklos

and Kerns 2006). Hoffman et al. (2009) found, unexpect-

edly, that mothers of children with autism had higher stress

levels than mothers of typically developing children on all

J Autism Dev Disord (2012) 42:2056–2066 2057

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areas of the Parenting Stress Index except for the Attach-

ment subscale, concluding that mothers of children with

autism are able to sustain close relationships with their

children, despite such high stress levels.

Child Functional Impairment

Given that children on the autism spectrum often display

difficulties with social interaction (e.g., eye contact, deficits

in joint attention) and communication skills (e.g., impair-

ment in functional language), which typically are used to

demonstrate attachment to other people, it was expected

that parents might interpret the absence of or relative

deficit in these behaviors as an indication of their child’s

lack of attachment or weaker attachment to them. Although

research has not directly assessed the relationship between

parent perceptions of child functional impairment and

parents’ affective attachment to their child, studies (e.g.,

Condon and Corkindale 1998; Edhborg et al. 2005)

examining related constructs provided reason to expect a

negative relationship between the two in the present

investigation. Also, theoretically, given that the attachment

relationship consists of reciprocal, interactive processes, it

was anticipated that parents may find it more challenging to

feel attached to a child whom they perceive to be more

impaired in the social domain (e.g., unaware of or unre-

sponsive to their social and affective gestures). Alterna-

tively, it is possible that lower feelings of attachment to

one’s child may lead to perceptions of the child’s greater

functional impairment.

Parenting Sense of Competence

Research has shown that parents of children with autism

feel less competent in the parenting role than do parents of

typically developing children and parents of children with

other disabilities (Fisman et al. 1989; Rodrigue et al. 1990).

Regarding parenting sense of competence and attachment,

Hoppes and Harris (1990) found a significant positive

relationship between maternal perceptions of child attach-

ment and maternal feelings of gratification. Research also

has suggested a relationship between parenting sense of

competence and parental affective attachment (e.g., Mercer

and Ferketich 1990, 1994), but prior to the current study,

research had not examined this relationship for parents of

children with ASDs. Researchers (e.g., Meirsschaut et al.

2010) have argued that clinicians should consider mothers’

‘‘feelings and cognitions’’ (p. 668), such as low self-effi-

cacy, as they may interfere with positive intervention

outcomes.

It was hypothesized that there would be a significant

positive relationship between parents’ perceptions of their

child’s attachment to them and the parents’ own affective

attachment to their child. It also was hypothesized that

there would be a significant negative relationship between

both attachment constructs (i.e., parents’ perceptions of

their child’s attachment and their own affective attachment

to their child) and parenting stress, as well as between both

attachment constructs and parent-rated child functional

impairment. In addition, it was expected that both attach-

ment constructs would be significantly positively related to

parenting sense of competence. Finally, it was hypothe-

sized that parents’ perceptions of their child’s attachment

to them, parents’ affective attachment to their child, and

child functional impairment would contribute significantly

to the variance in parenting stress and parenting sense of

competence above and beyond the variance accounted for

by child age, diagnosis, and the social desirability of par-

ents’ responses.

Method

Participants

The participants were parents of children between the ages

of 2 and 10 years old with ASDs, including Autistic Dis-

order, Asperger’s Disorder, and Pervasive Developmental

Disorder Not Otherwise Specified (PDD-NOS). The par-

ents were recruited from seven organizations and schools

in the New York metropolitan area (i.e., urban and subur-

ban) serving children on the autism spectrum and their

families. Four of the sites provided autism-specific edu-

cational services to children, two provided information and

supportive services (e.g., parent support groups) to families

of children on the spectrum and/or associated profession-

als, and one site was a pediatric therapy center for children

with various difficulties (not exclusively ASDs). Mothers

(n = 76) were the main population of interest, as they are

often the primary caregivers of children with ASDs (Moes

et al. 1992). Data also were collected from a subsample of

fathers (n = 30).

The children’s mean age was 5.51 years (SD = 2.47).

The sample consisted of about five times more parents of

boys (n = 89; 84.0%) than parents of girls (n = 17;

16.0%), which reflects the prevalence rates in the general

population (DSM-IV-TR; APA 2000). The children’s

diagnoses, as reported by their parents, were: 46 (43.4%)

children were diagnosed with Autistic Disorder, 45

(42.5%) with PDD-NOS, 7 (6.6%) with Asperger’s Dis-

order, 4 (3.8%) with both Autistic Disorder and PDD-NOS,

2 (1.9%) ‘‘other diagnosis,’’ and 2 omissions.

Eighty-five (80.2%) parents were 35 years of age or

older, 18 (17.0%) were between 25 and 34, and 3 (2.8%)

were 24 or younger. With respect to ethnicity, 69 (65.1%)

of the parents were Caucasian, 16 (15.1%) were Hispanic,

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9 (8.5%) were African American, 8 (7.5%) were Asian, and

4 (3.8%) endorsed ‘‘other.’’ The average Socioeconomic

Index score (Nakao and Treas 1992, 1994), based on

income and education, fell into the upper-middle class

socioeconomic status (SES) categories.

Instruments

Maternal Perception of Child Attachment (MPCA)

The MPCA (Hoppes and Harris 1990) was used to mea-

sure the degree to which the parents perceived that their

child was attached to them. Specifically, the items assess

the extent to which a mother (a) views her child as initi-

ating different types of contact (e.g., verbal, physical) and

(b) believes that her child identifies with and imitates her,

is sensitive to her feelings, and is able to engage in reci-

procal intimacy. The scale consists of 23 items rated on a

5-point scale, with higher scores reflecting perceptions of

stronger child attachment (Hoppes and Harris 1990).

Sample items include ‘‘When my child is hurt or in pain,

s(he) comes to me for comfort and help,’’ ‘‘My child

seems to seek my attention mostly when s(he) wants me to

give him/her something’’ (reverse-scored), and ‘‘When my

child and I are reunited after having been apart for a few

hours, my child will demonstrate a lot of pleasure in

seeing me again (greeting me with a warm smile, moving

close to me, touching me, etc.).’’ (Hoppes 1988). Hoppes

and Harris (1990) reported data supporting the measure’s

construct validity, including its theoretically expected

relationship with their Maternal Gratification scale. The

scale’s internal consistency in the current study was ade-

quate at a = .86–.87.

Postnatal Attachment Questionnaire (PAQ)

The PAQ (Condon and Corkindale 1998) was utilized to

measure the parents’ affective attachment to their child. It

consists of 19 items (e.g., ‘‘When I have been away from

the child for a while and I am about to be with him/her

again, I usually feel…’’) assessing the frequency or inten- sity of parents’ responses to their child. Each item has

between two and five response choices, and each item is

scored from 1 (low attachment) to 5 (high attachment),

regardless of the number of response choices, so that all the

items are equally weighted in the total score (Scopesi et al.

2004). The items are summed to calculate the total score,

with higher scores reflecting greater parental attachment

(Condon and Corkindale 1998). Because the original PAQ

was designed to measure parents’ attachment during their

child’s first year, in the present study the word ‘‘baby’’ was

replaced with ‘‘child’’ to make the wording applicable for

all children. Corkindale (personal communication, March

5, 2007) reported that the MPAQ and PPAQ have been

used with infants/toddlers over 1 year of age, translated

into other languages, and adapted by other researchers to

meet their needs. Also, the item content generally refers to

parents’ feelings and is therefore applicable to parents of

older children. Past research has demonstrated adequate

internal consistency for the maternal version of the PAQ

(a = .77–.79; Condon and Corkindale 1998; Feldstein et al. 2004; Scopesi et al. 2004), and the paternal version of

the PAQ (a = .78–.85; Condon et al. 2008; Feldstein et al. 2004). Although previous research did not report the psy-

chometric properties of the instrument for parents of chil-

dren older than 15 months, the current study demonstrated

adequate internal consistency for both mothers (a = .77) and fathers (a = .88). In addition, research has demon- strated the PAQ’s construct validity (e.g., significant neg-

ative correlations with measures of parental depression and

anxiety; Condon and Corkindale 1998).

Parenting Stress Index/Short Form (PSI/SF)

The PSI/SF (Abidin 1995) was employed to measure par-

enting stress. The Total Stress score, used in the current

study, is a sum of the three subscale scores (12 items each)

and yields an assessment of overall level of parenting

stress. Thirty-three of the items are rated on the same

5-point Likert-type scale, and the remaining three employ a

different format (e.g., choosing from five statements).

Higher scores indicate higher levels of parenting stress.

The PSI/SF is the most widely utilized measure of par-

enting stress and has demonstrated satisfactory reliability

and validity in numerous studies, including several studies

involving parents of children with ASDs (e.g., Tobing and

Glenwick 2006). The current study revealed high levels of

internal consistency for mothers (a = .89) and fathers (a = .94). Tobing and Glenwick’s (2006) study demon- strated the measure’s construct validity by demonstrating a

significant positive relationship to children’s functional

impairment.

Childhood Autism Rating Scale-Parent Version (CARS-P)

The CARS-P (Bebko et al. 1987) assessed parents’ per-

ceptions of their children’s functional impairment. It is a

measure of symptom severity that was adapted from the

Childhood Autism Rating Scale (CARS; Schopler et al.

1980) for parent, as opposed to professional, completion.

The CARS-P contains 14 out of the 15 original CARS

items, with each item rated on a 4-point scale. Items are

summed to yield a Total score, with higher scores reflect-

ing perceptions of greater functional impairment. The

CARS-P has demonstrated good internal consistency (e.g.,

a = .86; Tobing and Glenwick 2002), including for the

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current study (a = .89 for mothers, a = .85 for fathers). Tobing and Glenwick (2002) also demonstrated support for

the CARS-P’s validity, finding that mothers of children

with autism rated their children’s symptom severity as

greater than did mothers of children with PDD-NOS.

Parenting Sense of Competence Scale (PSOC)

The PSOC (Johnston and Mash 1989) was used to measure

the parents’ feelings of self-esteem in the parenting role. Its

16 items (e.g., ‘‘I meet my own personal expectations for

expertise in caring for my child.’’) are rated on a 6-point

Likert-type scale. There are 9 items on the Satisfaction

subscale and 7 items on the Efficacy subscale. The items of

the Efficacy subscale are reverse-scored, with higher scores

reflecting higher parenting self-esteem. Johnston and Mash

(1989) reported adequate internal consistency for the Total

score of the PSOC (a = .79), as was also found for the current study (a = .83 for mothers, .82 for fathers). In support of the PSOC’s construct validity, Tobing and

Glenwick (2006) found that parenting sense of competence

was significantly negatively related to level of psycholog-

ical distress for mothers of children with ASDs.

Paulhus Deception Scales (PDS)

The PDS (Paulhus 1998) was included as a measure of

social desirability bias. The items are designed to assess

whether individuals’ responses are characterized by faking

or lying (Impression Management scale) and/or display an

unintentional bias toward presenting themselves in a positive

light (Self-Deceptive Enhancement scale) (Paulhus and

John 1998). There are 40 items, rated from 1 (not true) to 5

(very true), with each subscale comprised of 20 items. Only

extreme responses receive a point; thus, for the IM scale,

only responses of 1 or 2, or 4 or 5 (depending on the item)

receive a point. For the SDE scale, only scores of 1 or 5

(depending on the item) receive a point. The total PDS raw

score is the sum of all 40 items, and can range from 0 to 40.

Raw scores are then converted to T-scores on the scoring

page of the record form. Although cutoff scores are pro-

vided for high or low subscale scores, Paulhus (1998)

recommended interpreting the PDS scores as continuous;

thus, the higher one’s PDS score, the greater the likelihood

of socially desirable responding. Paulhus (1998) reported

adequate internal consistency for the total PDS (a = .83– .86). For the current study, the internal consistencies were

a = .78 for mothers, and a = .61 for fathers. Paulhus (1998) reported support for the measure’s construct valid-

ity, including a positive correlation of .73 between total

PDS scores and scores on the Marlowe–Crowne Social

Desirability Scale (Crowne and Marlowe 1960).

Information Form

A short information form created for the current study

included questions regarding the child (e.g., age, sex, and

diagnosis) and the participating parent (e.g., age, ethnicity,

and occupation).

Procedure

Multiple recruitment methods were employed, including

sending research packets home in children’s school bags,

distributing study announcements to organizations’ elec-

tronic listserves, inviting parents to participate in person at

support groups, and posting a flyer with the study

announcement. Depending upon the data collection site,

parents received either self-addressed, stamped envelopes

to return the consent form and questionnaires by mail or

envelopes in which to return them in the children’s school

bags. Parents were informed that the purpose of the

research was to learn more about the experiences of parents

of children with ASDs in order to better inform future

interventions for families of children with autism and

related disorders.

Results

Independent-samples t tests were conducted to assess for

potential differences based on child gender or child

diagnosis on the primary variables of interest. Zero-order

correlations were calculated among the variables of

interest, with partial correlations calculated, when neces-

sary, to control for the potential impact of social desir-

ability. Finally, hierarchical regression analyses were

conducted with parenting stress and parenting sense of

competence as the criterion variables. The regression

analyses assessed whether parental perceptions of child

attachment, parental affective attachment, and parental

perceptions of child functional impairment contributed to

the abovementioned criterion variables above and beyond

the child’s age and diagnosis and the social desirability of

parents’ responses.

Correlational Analyses

Independent-samples t tests revealed that there were no

significant child gender or diagnostic differences on the

primary variables of interest. Zero-order correlations were

calculated between the variables of interest, as well as

between the variables of interest and child age. For both

mothers, r(74) = .34, p = .003, and fathers, r(28) = .37,

p = .04, functional impairment was significantly positively

related to child age. Also, fathers’ perceptions of their

2060 J Autism Dev Disord (2012) 42:2056–2066

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child’s attachment were significantly negatively related to

child age, r(28) = -.41, p = .02.

There was a significant positive relationship between

parents’ perceptions of their child’s attachment to them and

parents’ own affective attachment to their child for fathers,

r(28) = .43, p = .02, but not for mothers, r(74) = .19,

p = .11. Similarly, there was a significant negative rela-

tionship between parents’ perceptions of their child’s

attachment to them and parenting stress only for fathers,

r(28) = -.42, p = .02; mothers showed a trend toward

significance, r(74) = -.21, p = .07. There was a significant

negative association between parents’ affective attachment

to their child and parenting stress for both mothers,

r(74) = -.70, p \ .001, and fathers, r(28) = - .63, p \ .0 01. These correlations remained significant when controlling

for social desirability bias for mothers. (Partial correlations

were not conducted for fathers because there were no sig-

nificant relationships between these, or any other, variables

of interest and social desirability for fathers.)

There was a significant negative relationship between

parents’ perceptions of their child’s attachment and their

perceptions of their child’s level of functional impairment,

for both mothers, r(74) = -.42, p \ .001 (which remained significant when controlling for social desirability), and

fathers, r(28) = -.57, p = .001. For mothers, but not

fathers, there was a significant negative correlation between

parents’ affective attachment to their child and parents’

perceptions of their child’s level of functional impairment,

r(74) = -.39, p \ .001, which remained significant when partialling out the contribution of social desirability.

The relationship between parents’ perceptions of their

child’s attachment and parenting sense of competence was

not significant for either mothers or fathers. However, there

was a significant positive relationship between parents’

affective attachment to their child and parenting sense of

competence for both mothers, r(74) = .66, p \ .001 (which remained significant when controlling for social

desirability), and fathers, r(28) = .71, p \ .001.

Regression Analyses

A series of hierarchical regression analyses were conducted

for mothers and fathers separately, with parenting stress

and parenting sense of competence as the criterion vari-

ables. The child’s age and diagnosis and the social desir-

ability of parents’ responses were entered in the first step of

the regression. The second step included parental percep-

tions of child attachment, parental affective attachment,

and parental perceptions of child functional impairment as

predictors.

For mothers, the regression analysis revealed that the

first step of predictors accounted for a significant amount of

the variance in parenting stress, R2 = .21, F(6, 69) = 3.00,

p = .01. As hypothesized, the second step of predictors

accounted for a significant proportion of the variance in

parenting stress above and beyond the variables in Block 1,

R2 change = .35, F(3, 66) = 17.04, p \ .001. Taken together, all of the predictors in the model accounted for

55% of the variance in parenting stress (i.e., R2 = .55).

An examination of each predictor individually revealed

that mothers’ affective attachment, b = -.59, t(66) = -.52, p \ .001, and mothers’ perceptions of their child’s functional impairment, b = .25, t(66) = 2.29, p = .03, but not mothers’ perceptions of their child’s attachment to

them, contributed significantly to the variance in parenting

stress.

For fathers, the first step of predictors did not account

for a significant amount of the variance in parenting stress.

The second step of predictors, though, contributed to the

variance in parenting stress above and beyond the predic-

tors in Block 1, R2 change = .43, F(3, 21) = 8.18, p =

.001. Taken together, all of the predictors accounted for

63% of the variance in parenting stress.

Regarding individual predictors, both fathers’ affective

attachment, b = -.54, t(21) = -3.53, p = .002, and fathers’ perceptions of their child’s functional impairment,

b = .52, t(21) = 2.64, p = .02, but not fathers’ percep- tions of their child’s attachment to them, contributed sig-

nificantly to the variance in parenting stress.

With parenting sense of competence as the criterion

variable, the results for mothers revealed that the first step

of predictors accounted for a significant amount of the

variance, R2 = .38, F(6, 69) = 6.9, p \ .001. In addition, the second step of predictors contributed to the variance in

parenting sense of competence while controlling for Step 1

variables, R2 change = .16, F(3, 66) = 7.63, p \ .001. Taken together, the predictors accounted for 54% of the

variance in parenting sense of competence.

Regarding individual predictors, mothers’ affective

attachment accounted for a significant amount of the variance

in parenting sense of competence, b = .53, t(66) = 4.62, p \ .001, but mothers’ perceptions of their child’s attach- ment to them and mothers’ perceptions of their child’s level

of functional impairment did not.

For fathers, Step 1 variables did not account for a sig-

nificant amount of the variance in parenting sense of

competence. However, the second step of predictors, taken

together, contributed to the variance in parenting sense of

competence above and beyond the Step 1 variables, R 2

change = .60, F(3, 21) = 16.21, p \ .001. The predictors accounted for 74% of the variance in parenting sense of

competence.

With respect to individual predictors, fathers’ affective

attachment accounted for a significant amount of the var-

iance in parenting sense of competence, b = .74, t(21) = 5.75, p \ .001, as did their perceptions of their child’s

J Autism Dev Disord (2012) 42:2056–2066 2061

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functional impairment, b = -.53, t(21) = -3.21, p = .004. The contribution of fathers’ perceptions of their

child’s attachment to them to their parenting sense of

competence approached significance, b = -.31, t(21) = -2.00, p = .06.

Discussion

The current study examined the relationship between par-

ents’ perceptions of their child’s attachment to them and

their own affective attachment to their child, as well as the

relationship of these constructs to parenting stress, parents’

perceptions of their child’s functional impairment, and

parenting sense of competence. In so doing, this research

built upon the extant, small literature on the attachment

perceptions of parents of children with ASDs by investi-

gating affective parent-to child perceptions in this popu-

lation and including the experience of fathers. Such

research complements the typical focus on the behavioral

assessment of attachment and is in line with recent research

(e.g., Phetrasuwan and Miles 2009; Slade 2009) that has

called attention to the importance of the subjective expe-

riences of parents of children with ASDs as well as the

related implications for treatment.

The results showed that, overall, parents’ perceptions of

their affective attachment to their child were more consis-

tently related to other aspects of their parenting experiences

than were their perceptions of their child’s attachment to

them. As such, there were significant relationships between

parents’ affective attachment to their child and both par-

enting stress and parenting sense of competence. There was

also a significant relationship between mothers’ (but not

fathers’) affective attachment to their child and perceptions

of their child’s functional impairment. The results revealed

that perceptions of child attachment were related to other

aspects of parenting for fathers more than for mothers; for

fathers only, there were significant relationships between

perceptions of child attachment and both affective attach-

ment and parenting stress. Both mothers’ and fathers’ per-

ceptions of their child’s attachment were significantly

related to their perceptions of their child’s functional

impairment. On the other hand, neither mothers’ nor fathers’

perceptions of their child’s attachment to them were related

to their parenting sense of competence. Finally, for both

mothers and fathers, perceptions of child attachment, par-

ents’ affective attachment to their child, and perceptions of

child functional impairment contributed significantly to the

variance in parenting stress and parenting sense of compe-

tence above and beyond the child’s age, diagnosis, and the

social desirability of parents’ responses.

The differences between mothers and fathers with

respect to the relationship between parents’ perceptions of

their child’s attachment to them and their own affective

attachment to their child could reflect mothers’ greater

ability to separate their own feelings of attachment from

their experience of their child’s attachment to them.

Mothers may be better able to differentiate these attach-

ment perceptions because typically they are with their

children more often than are fathers.

Similarly, with respect to mothers’ and fathers’ differ-

ences in the relationship between their perceptions of their

child’s attachment and their levels of parenting stress, it

could be that mothers and fathers make different attribu-

tions to help explain or understand their child’s degree of

attachment to them. For instance, if mothers make more

external attributions (e.g., related to their child’s greater

functional impairment) for their child’s lower degree of

attachment, they may experience it as less of a stressor than

if they made more personal attributions (e.g., related to

their parenting skills). This potential explanation is sup-

ported by the finding that mothers’ perceptions of their

child’s level of attachment were related to their perceptions

of their child’s functional impairment but not to their sense

of parenting competence.

In general, the results suggest that parents’ affective

attachment to their child is more consistently related to

other aspects of their parenting experiences than are their

perceptions of their child’s attachment to them. For

example, the anticipated negative association between

parents’ affective attachment and their feelings of parent-

ing stress was supported for both mothers and fathers.

Parents may feel less stressed because they feel more

attached to their child, or, alternatively, they may be able to

experience a greater attachment to their child because they

experience less parenting stress.

The expected significant positive relationship between

parents’ perceptions of their child’s attachment and their

feelings of parenting competence was not supported by the

mothers’ or fathers’ data. For mothers, the same possible

explanation for the lack of relationship between parents’

attachment perceptions and their feelings of stress may

apply. That is, if mothers do, in fact, make more external

attributions (e.g., related to their child’s functional

impairment or diagnosis) for their child’s lower degree of

perceived attachment, they may be able to separate these

perceptions from their sense of competence as a parent,

rather than concluding that their child is not as attached to

them because of a deficit in their parenting skills. On the

other hand, fathers may not regard their child’s attachment

to them as being related to their parenting abilities. For

instance, they may anticipate that their children should

naturally be attached to them, regardless of their own

contributions to the relationship.

Child age was significantly positively correlated with

perceptions of functional impairment for both mothers and

2062 J Autism Dev Disord (2012) 42:2056–2066

123

fathers. This suggests that parents of older children tend to

perceive their children as having greater functional

impairment. It may be that parents’ expectations of their

children’s functioning and their children’s actual func-

tioning become more discrepant as the children get older,

due to parents’ expectations increasing with child age. In

addition, parents may expect their children to outgrow

behaviors that appear to be atypical. Previous research

regarding the relationship between child age and parents’

ratings of their child’s functional impairment has been

inconsistent, with some studies (e.g., Konstantareas and

Homatidis 1989) supporting a positive relationship and

others (e.g., Bebko et al. 1987) suggesting a negative one.

These inconsistent findings suggest that there may be

additional factors that influence the relationship between

these two variables. For instance, Tobing and Glenwick

(2002) found that the significance of the (positive) rela-

tionship between child age and parents’ perceptions of

functional impairment varied by child diagnostic group.

The number of significant relationships between social

desirability and the variables of interest suggests that

mothers of children with ASDs are, in some way, influ-

enced by a desire to present themselves favorably to others

(e.g., by disclosing greater feelings of parenting compe-

tence than they actually experience). Previous research on

gender differences in socially desirable reporting has

revealed mixed results, with some studies (e.g., Ones and

Viswesvaran 1998) suggesting that men exhibit a greater

social desirability bias than do women and others (e.g.,

Bernardi and Guptill 2008; Dalton and Ortegren 2011)

finding that women display greater socially desirable

responding than do men. It may be that gender differences

in social desirability vary based upon the aspect of social

desirability being measured. For instance, there is evidence

that although females may score higher than (Bernardi and

Guptill 2008) or not significantly differently than males

(Riketta 2005) on impression management, males may

score higher on self-deceptive enhancement (e.g., Musch

et al. 2002, as cited in Riketta 2005). However, scores on

both PDS subscales were higher for mothers in the current

study, suggesting that patterns of socially desirable

responding may be different for parents of children with

ASDs compared to nonparent populations.

The contrasting findings in the present study for mothers

and fathers with respect to social desirability are in line with

Feldstein et al.’s (2004) proposition that society places

greater pressure on mothers than fathers to express positive

feelings about their children. Although some recent research

suggests that (a) views on parental roles have shifted to be

more egalitarian and to call for greater paternal involvement

in child rearing (e.g., Diehnart 2001) and (b) expectations of

mothers have been raised and broadened (e.g., to join the

workforce), their familial responsibilities have not changed

(e.g., Hochschild and Machung 2003; Perkins and DeMeis

1996) and they continue to spend significantly more time

with their children than do fathers (Pleck and Masciadrelli

2004). Accordingly, mothers of children with ASDs are

often their primary caregivers (Moes et al. 1992). Therefore,

mothers may still maintain expectations of themselves that

are consistent with more traditional parental roles and

societal expectations, and thus may be more motivated than

fathers to present their parenting experiences in a more

positive light.

Clinical Implications

The significant relationship between affective attachment

and parenting stress for both mothers and fathers suggests

that targeting parents’ affective attachment to their child

may be a beneficial area of intervention. It may be that not

feeling attached to one’s child contributes to feelings of

parenting stress, and addressing factors related to lower

feelings of attachment may help decrease parents’ stress

levels. On the other hand, as noted above, it may be that

parents’ feelings of stress contribute to lower feelings of

affective attachment to their child. In that case, interven-

tions targeted at lowering parenting stress might specifi-

cally consider their potentially positive effect on parents’

attachment to their child.

The significant association between both parents’

affective attachment and their feelings of parenting com-

petence suggests that intervening to help increase parents’

feelings of attachment to their child also may have positive

implications for their feelings of competence. On the other

hand, in a similar manner as with parenting stress,

addressing parents’ sense of competence may help increase

their feelings of attachment to their child.

Because the current findings suggest that mothers and

fathers of children with ASDs differ somewhat in how their

attachment perceptions relate to various cognitions and

perceptions, it may be worthwhile to tailor interventions to

the unique experiences of mothers and fathers of children

on the autism spectrum, rather than applying the same

intervention goals and components to both. Other

researchers (Bloch and Weinstein 2010; Keen et al. 2010;

Tehee et al. 2009) also have suggested the importance of

considering the unique needs of, and intervention impli-

cations for, mothers and fathers.

Directions for Future Research

Due to the present study’s cross-sectional design, it was not

possible to make directional inferences regarding causal

relationships among variables. Longitudinal research

would be valuable in assessing the direction of influence

among the constructs of interest.

J Autism Dev Disord (2012) 42:2056–2066 2063

123

Future research examining parents’ attributions regard-

ing their child’s degree of attachment to them could help

shed light on differences found between mothers and

fathers. For example, mediation by parents’ attributions of

the relationship between parents’ perceptions of their

child’s attachment and their feelings of parenting stress

could explain why a significant relationship between these

variables was uncovered for fathers but not for mothers.

The current study shed light on potential relationships

between the existing attachment perceptions and experi-

ences of parents of children with ASDs and various aspects

of their parenting experiences (e.g., parenting stress).

Research might profitably investigate the impact of dif-

ferent therapeutic approaches (e.g., applied behavior anal-

ysis as compared to the Developmental Individual

Difference Relationship-based [DIR] approach) on parents’

attachment perceptions. Such research could have valuable

clinical implications with respect to fostering parents’ well-

being and the quality of the parent–child relationship.

Limitations

One limitation of this study was the relative homogeneity

of the sample (i.e., mostly Caucasian, at least 35 years of

age, well-educated, and of upper-middle SES). Therefore,

the external validity of the current results with parents of

different ethnic, socioeconomic, and age groups warrants

investigation. Relatedly, because the parents were recruited

from the New York metropolitan (i.e., urban and suburban)

area, one cannot assume that the results would generalize

to parents of children with ASDs from rural areas. For

instance, the parents in the current sample may benefit

from more protective factors (e.g., higher SES and greater

access to support/treatment resources) than do other par-

ents and may experience less parenting stress. However,

given that the current sample’s stress level for both mothers

and fathers was still considerably high (exceeding the 90th

percentile, which reflects clinically significant stress levels;

Abidin 1995), our findings may be considered, if anything,

conservative. Thus, one would expect the clinical impli-

cations of the current results to be not only applicable to,

but even more salient for, parents with fewer resources and

higher stress levels.

Another limitation is that the parents who chose to par-

ticipate in the research may have differed on the variables of

interest from those parents who declined to participate. For

instance, given that parents of children with ASDs comprise

a highly stressed population, the parents who did participate

may have lower stress levels relative to those parents who

did not participate, or they may be better able to manage

their stress. It is also possible that responding parents are

more open to sharing their parenting experiences than are

nonresponding parents. The finding that the main results

remained significant after controlling for the social desir-

ability of parents’ responses supports this possibility.

Finally, information was not obtained regarding family

size. Such information could be helpful in determining

whether parents’ responses vary depending on the number

of children they have (e.g., parents of an only child com-

pared to parents of multiple children).

Conclusions

It is clear from the existing literature that parents of chil-

dren with ASDs are a highly stressed population faced with

many daunting challenges. Despite the recognition of the

often overwhelming demands of raising a child on the

autism spectrum, there is a relative paucity of research

addressing these parents’ subjective experiences. Further-

more, interventions often neglect to address the needs and

experiences of these parents, which warrant attention in

their own right, and also have implications for the treat-

ment and outcomes of these children. Given the primary

deficits of children with ASDs in social relatedness and

communication, skills fundamental to the development and

expression of attachment, the current study focused on

parents’ attachment perceptions and experiences. This

seemed to be an important gap in the literature, given the

typical focus of attachment research on behaviorally

measured child-to-parent attachment. The present results

support the value of this line of research, which will

hopefully result in a more comprehensive understanding of,

and more efficacious interventions with, this population.

Acknowledgments This study is based on Sabrina J. Goodman’s doctoral dissertation under the supervision of David S. Glenwick. The

authors thank Pat Schissel and the Asperger Syndrome and High

Functioning Autism Association (AHA); Marty Schwartzman and the

members of his listserve; Dr. Lauren Tobing-Puente, Daniel Szulkin,

Huck Ho, Kristin Srp, and the Early Intervention Center of Brooklyn

(EICB); Dr. Lauren Tobing-Puente and the Rebecca School; Chris

Petrosino and the Nassau Suffolk Chapter of the Autism Society of

America; Dr. Kristen DuMoulin, Madelyn Wolfin, and Quality Ser-

vices for the Autism Community (QSAC); Dr. Kim James and the

Developmental Disabilities Institute (DDI); and Shirael Pollack and

Watch Me Grow. The authors also thank Charles Lewis for his

guidance with the statistical analyses. Finally, the authors express

their appreciation to the parents who participated in the research.

References

Abidin, R. R. (1995). Parenting Stress Index manual (3rd ed.). Odessa, FL: Psychological Assessment Resources.

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., TR). Washington, DC: American Psychiatric Association.

Baker-Ericzén, M. J., Brookman-Frazee, L., & Stahmer, A. (2005).

Stress levels and adaptability in parents of toddlers with and

2064 J Autism Dev Disord (2012) 42:2056–2066

123

without autism spectrum disorders. Research & Practice for Persons with Severe Disabilities, 30, 194–204. doi:10.2511/rpsd. 30.4.194.

Bebko, J. M., Konstantareas, M. M., & Springer, J. (1987). Parent and

professional evaluations of family stress associated with char-

acteristics of autism. Journal of Autism and Developmental Disorders, 17, 565–576. doi:10.1007/BF01486971.

Becker, G., & Becker, C. (1994). The Maternal Behavior Inventory:

Measuring the behavioral side of mother-to-infant attachment.

Social Behavior and Personality, 22, 177–194. doi:10.2224/sbp. 1994.22.2.177.

Bernardi, R. A., & Guptill, S. T. (2008). Social desirability response

bias, gender, and factors influencing organizational commitment:

An international study. Journal of Business Ethics, 81, 797–809. doi:10.1007/s10551-007-9548-4.

Bloch, J. S., & Weinstein, J. D. (2010). Families of young children

with autism. Social Work in Mental Health, 8, 23–40. doi:10.10 80/15332980902932342.

Bouma, R., & Schweitzer, R. (1990). The impact of chronic childhood

illness on family stress: A comparison between autism and cystic

fibrosis. Journal of Clinical Psychology, 46, 722–730. doi:10.1002/ 1097-4679(199011)46:6\722:AID-JCLP2270460605[3.0.CO;2-6.

Buitelaar, J. K. (1995). Attachment and social withdrawal in autism:

Hypotheses and findings. Behaviour, 132, 319–350. doi:10.1163/ 156853995X00595.

Condon, J. T., & Corkindale, C. J. (1998). The assessment of parent-

to-infant attachment: Development of a self-report questionnaire

instrument. Journal of Reproductive and Infant Psychology, 16, 57–76. doi:10.1080/02646839808404558.

Condon, J. T., Corkindale, C. J., & Boyce, P. (2008). Assessment of

postnatal paternal-infant attachment: Development of a ques-

tionnaire instrument. Journal of Reproductive and Infant Psychology, 26, 195–210. doi:10.1080/02646830701691335.

Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability

independent of psychopathology. Journal of Consulting Psychology, 24, 349–354. doi:10.1037/h0047358.

Dalton, D., & Ortegren, M. (2011). Gender differences in ethics

research: The importance of controlling for the social desirability

bias. Journal of Business Ethics, 103, 73–93. doi:10.1007/s 10551-011-0843-8.

Diehnart, A. (2001). Make room for daddy: The pragmatic potentials

of a tag-team structure for sharing parenting. Journal of Family Issues, 22, 973–999. doi:10.1177/019251301022008002.

Edhborg, M., Matthiesen, A., Lundh, W., & Widström, A. (2005).

Some early indicators for depressive symptoms and bonding

2 months postpartum—a study of new mothers and fathers.

Archives of Women’s Mental Health, 8, 221–231. doi:10.1007/ s00737-005-0097-5.

Feldstein, S., Hane, A. A., Morrison, B. M., & Huang, K. (2004).

Relation of the Postnatal Attachment Questionnaire to the

Attachment Q-Set. Journal of Reproductive and Infant Psychol- ogy, 22, 111–121. doi:10.1080/0264683042000205972.

Fisman, S. N., Wolf, L. C., & Noh, S. (1989). Marital intimacy in

parents of exceptional children. The Canadian Journal of Psychiatry, 34, 519–525. Retrieved from http://publications.cpa -apc.org/browse/sections/0.

Hochschild, A. R., & Machung, A. (2003). The second shift. New York, NY: Penguin.

Hoffman, C. D., Sweeney, D. P., Hodge, D., Lopez-Wagner, M. C., &

Looney, L. (2009). Parenting stress and closeness: Mothers of

typically developing children and mothers of children with

autism. Focus on Autism and Other Developmental Disabilities, 24, 178–187. doi:10.1177/1088357609338715.

Holroyd, J., & McArthur, D. (1976). Mental retardation and stress on

the parents: A contrast between Down’s syndrome and childhood

autism. American Journal of Mental Deficiency, 80, 431–436.

Hoppes, K. (1988). Maternal perceptions of child attachment and

maternal gratification among mothers of autistic children.

Dissertation Abstracts International, 50 (03),1133B. (UMI No. 8911258).

Hoppes, K., & Harris, S. L. (1990). Perceptions of child attachment

and maternal gratification in mothers of children with autism and

Down syndrome. Journal of Clinical Child Psychology, 19, 365–370. doi:10.1207/s15374424jccp1904_8.

Howe, D. (2006). Disabled children, parent-child interaction and

attachment. Child and Family Social Work, 11, 95–106. doi: 10.1111/j.1365-2206.2006.00397.x.

Johnston, C., & Mash, E. J. (1989). A measure of parenting

satisfaction and efficacy. Journal of Clinical Child Psychology, 18, 167–175. doi:10.1207/s15374424jccp1802_8.

Keen, E., Couzens, D., Muspratt, S., & Rodger, S. (2010). The effects

of a parent-focused intervention for children with a recent

diagnosis of autism spectrum disorder on parenting stress and

competence. Research in Autism Spectrum Disorders, 4, 229– 241. doi:10.1016/j.rasd.2009.09.009.

Konstantareas, M. M., & Homatidis, S. (1989). Assessing child

symptom severity and stress in parents of autistic children.

Journal of Child Psychology and Psychiatry, 30, 459–470. doi: 10.1111/j.1469-7610.1989.tb00259.x.

Kuhn, J. C., & Carter, A. S. (2006). Maternal self-efficacy and

associated parenting cognitions among mothers of children with

autism. American Journal of Orthopsychiatry, 76, 564–575. doi: 10.1037/0002-9432.76.4.564.

Meirsschaut, M., Roeyers, H., & Warreyn, P. (2010). Parenting in

families with a child with autism spectrum disorder and a

typically developing child: Mothers’ experiences and cognitions.

Research in Autism Spectrum Disorders, 4, 661–669. doi: 10.1016/j.rasd.2010.01.002.

Mercer, R. T., & Ferketich, S. L. (1990). Predictors of parental

attachment during early parenthood. Journal of Advanced Nursing, 15, 268–280. doi:10.1111/j.1365-2648.1990.tb01813.x.

Mercer, R. T., & Ferketich, S. L. (1994). Maternal-infant attachment

of experienced and inexperienced mothers during infancy.

Nursing Research, 43, 344–351. doi:10.1097/00006199-1994 11000-00005.

Moes, D., Koegel, R. L., Schreibman, L., & Loos, L. M. (1992).

Stress profiles for mothers and fathers of children with autism.

Psychological Reports, 71, 1272–1274. doi:10.2466/PR0.71.8. 1272-1274.

Müller, M. E. (1996). Prenatal and postnatal attachment: A modest

correlation. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 25, 161–166. doi:10.1111/j.1552-6909.1996.tb02420.x.

Nakao, K., & Treas, J. (1992). The 1989 socioeconomic index of occupations: Construction from the 1989 occupational prestige scores (General Social Survey Methodological Report No. 74). Chicago: University of Chicago, National Opinion Research

Center.

Nakao, K., & Treas, J. (1994). Updating occupational prestige and

socioeconomic scores: How the new measures measure up. In

P. Marsden (Ed.), Sociological methodology (pp. 1–72). Wash- ington, DC: American Sociological Association.

Ones, D. S., & Viswesvaran, C. (1998). The effects of social desirability and faking on personality and integrity assessment for personnel selection, 11, 245–269. doi:10.1080/08959285. 1998.9668033.

Paulhus, D. L. (1998). Paulhus Deception Scales (PDS): The Balanced Inventory of Desirable Responding-7. North Tona- wanda, NY: Multi-Health Systems.

Paulhus, D. L., & John, O. P. (1998). Egoistic and moralistic biases in

self-perception: The interplay of self-deceptive mechanisms with

basic traits and motives. Journal of Personality, 66, 1025–1060. doi:10.1111/1467-6494.00041.

J Autism Dev Disord (2012) 42:2056–2066 2065

123

Perkins, H. W., & DeMeis, D. K. (1996). Gender and family effects

on the ‘‘second-shift’’ domestic activity of college-educated

young adults. Gender and Society, 10, 78–93. doi:10.1177/0891 24396010001006.

Phetrasuwan, S., & Miles, S. M. (2009). Parenting stress in mothers of

children with autism spectrum disorders. Journal for Specialists in Pediatric Nursing, 14, 157–165. doi:10.1111/j.1744-6155. 2009.00188.x.

Pleck, J. H., & Masciadrelli, B. P. (2004). Paternal involvement by

U.S. residential fathers: levels, sources, and consequences. In

M. E. Lamb (Ed.), The role of the father in child development (4th ed., pp. 222–271). Hoboken, NJ: Wiley.

Riketta, M. (2005). Gender and socially desirable responding as

moderators of the correlation between implicit and explicit self-

esteem. Current Research in Social Psychology, 11, 14–28. Retrieved from http://www.uiowa.edu/*grpproc/crisp/crisp. html.

Robson, K. S., & Moss, H. A. (1970). Patterns and determinants of

maternal attachment. Journal of Pediatrics, 77, 976–985. doi: 10.1016/S0022-3476(70)80080-4.

Rodrigue, J. R., Morgan, S. B., & Geffken, G. (1990). Families of

autistic children: Psychological functioning of mothers. Journal of Clinical Child Psychology, 19, 371–379. doi:10.1207/s153744 24jccp1904_9.

Rutgers, A. H., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H.,

& van Berckelaer-Onnes, I. A. (2004). Autism and attachment: A

meta-analytic review. Journal of Child Psychology and Psychi- atry, 45, 1123–1134. doi:10.1111/j.1469-7610.2004.t01-1-00 305.x.

Sakaguchi, M., & Beppu, S. (2007). Structure of stressors in mothers

of preschool children with autism. Japanese Journal of Special Education, 45, 127–136.

Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980).

Toward objective classification of childhood autism: Childhood

Autism Rating Scale (CARS). Journal of Autism and Develop- mental Disorders, 10, 91–103. doi:10.1007/BF02408436.

Scopesi, A., Viterbori, P., Sponza, S., & Zucchinetti, P. (2004).

Assessing mother-to-infant attachment: The Italian adaptation of

a self-report questionnaire. Journal of Reproductive and Infant Psychology, 22, 99–109. doi:10.1080/0264683042000205963.

Seskin, L., Feliciano, E., Tippy, G., Yedloutschnig, R., Sossin, K. M.,

& Yaski, A. (2010). Attachment and autism: Parental attachment

representations and relational behaviors in the parent-child dyad.

Journal of Abnormal Child Psychology, 38, 949–960. doi: 10.1007/s10802-010-9417-y.

Siklos, S., & Kerns, K. A. (2006). Assessing need for social support in

parents of children with autism and Down syndrome. Journal of Autism and Developmental Disorders, 36, 921–923. doi: 10.1007/s10803-006-0129-7.

Slade, A. (2009). Mentalizing the unmentalizable: Parenting children

on the spectrum. Journal of Infant, Child, and Adolescent Psychotherapy, 8, 7–21. doi:10.1080/15289160802683054.

Talay-Ongan, A., & Wood, K. (2000). Unusual sensory sensitivities

in autism: A possible crossroads. International Journal of Disability, Development and Education, 47, 201–212. doi: 10.1080/713671112.

Tehee, E., Honan, R., & Hevey, D. (2009). Factors contributing to

stress in parents of individuals with autistic spectrum disorders.

Journal of Applied Research in Developmental Disabilities, 22, 34–42. doi:10.1111/j.1468-3148.2008.00437.x.

Tobing, L. E., & Glenwick, D. S. (2002). Relation of the Childhood

Autism Rating Scale-Parent version to diagnosis, stress, and age.

Research in Developmental Disabilities, 23, 211–223. doi: 10.1016/S0891-4222(02)00099-9.

Tobing, L. E., & Glenwick, D. S. (2006). Predictors and moderators

of psychological distress in mothers of children with pervasive

developmental disorders. Journal of Family Social Work, 10, 1–22. doi:10.1300/J039v10n04_01.

Tomanik, S., Harris, G. E., & Hawkins, J. (2004). The relationship

between behaviors exhibited by children with autism and

maternal stress. Journal of Intellectual and Developmental Disability, 29, 16–26. doi:10.1080/13668250410001662892.

VanMeter, L. A. (1995). Attachment and social relatedness in autism (Doctoral dissertation). Retrieved from ProQuest Dissertations &

Theses. (Order No. 9539530).

Zeanah, C. H., & Benoit, D. (1995). Clinical applications of a parent

perception interview in infant mental health. Child and Adoles- cent Psychiatric Clinics of North America, 4, 539–554. Retrieved from http://www.childpsych.theclinics.com/.

2066 J Autism Dev Disord (2012) 42:2056–2066

123

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