Parenting An Autism Child

ORIGINAL PAPER

Mothers’ Parenting Behaviors in Families of School-Aged Children with Autism Spectrum Disorder: An Observational and Questionnaire Study

Hannah Boonen1,2 • Lotte van Esch1,2 • Greet Lambrechts1,2 • Jarymke Maljaars1,2 •

Inge Zink3 • Karla Van Leeuwen1 • Ilse Noens1,2

Published online: 23 June 2015

� Springer Science+Business Media New York 2015

Abstract Although parents of children with ASD face

specific challenges in parenting, only a few studies have

empirically investigated parenting behaviors among these

parents. The current study examined differences in par-

enting behaviors between mothers of school-aged children

with ASD (n = 30) and mothers of typically developing

children (n = 39), using both an observational measure

and a self-report questionnaire. Results indicated that

mothers of children with ASD obtained significantly lower

scores on Sensitivity and Provision of structure as mea-

sured during the observation. They reported significantly

higher scores on Material rewarding and Adapting the

environment on the questionnaire. When controlling for

parenting stress, the group differences on Sensitivity and

Material rewarding did not remain significant.

Keywords Autism spectrum disorder � Parenting behaviors � Observation � Questionnaire � Parenting stress

Introduction

While all parents encounter the challenge of adapting their

parenting strategies to the needs of their own child, parents

of children with autism spectrum disorder (ASD) face

various and specific challenges in parenting that are not

shared by parents of typically developing children. Over

the last several decades, a relatively large body of research

has focused on the experiences of parents of children with

ASD, using both quantitative and qualitative research

designs. One of the most widely investigated topics is

parenting stress. Parents of a child with ASD consistently

report increased levels of parenting stress and psycholog-

ical distress compared to parents of both typically devel-

oping children and children with other developmental

disabilities (for a recent meta-analysis, see Hayes and

Watson 2013). Other difficulties experienced by these

parents are a decreased parenting self-efficacy (i.e., feel-

ings of competence in the caregiving role), and an increase

in mental and physical health problems (Karst and Van

Hecke 2012). Another area of interest is the impact of

having a child with ASD on the broader family context and

the family’s quality of life. For example, higher rates of

divorce are found for parents of children with ASD com-

pared to families of typically developing children (Hartley

et al. 2010). Furthermore, parents of children with ASD

face a wide range of practical challenges, such as time

pressure, financial burden, fewer opportunities to work, and

the need to provide support and accommodations for their

child’s education (Lord and Bishop 2010). Despite these

challenges, parents of a child with ASD also report a

variety of positive experiences, such as personal growth

and enrichment (Bayat 2007; Phelps et al. 2009).

However, the concrete, observable parenting behaviors

exhibited by parents of children with ASD have long been

This article is part of the doctoral dissertation of the first author.

& Hannah Boonen [email protected]

1 Parenting and Special Education Research Unit, KU Leuven,

Leopold Vanderkelenstraat 32, Box 3765, 3000 Leuven,

Belgium

2 Leuven Autism Research (LAuRes), Leuven, Belgium

3 Department of Neurosciences, ExpORL, KU Leuven, O&N II

Herestraat 49, Box 721, 3000 Leuven, Belgium

123

J Autism Dev Disord (2015) 45:3580–3593

DOI 10.1007/s10803-015-2506-6

neglected by the scientific community. This topic has only

recently received more research attention. Reed and

Osborne (2014) formulate three possible explanations for

this lack of research attention during the past decades.

Firstly, they refer to the history of inaccurate, psychogenic

theories about the origin of ASD and the accompanying

‘‘scapegoating’’ of parents. Negative reactions towards

these claims may have hindered development in this

research area. Secondly, they argue that parenting is a very

complex topic, which challenges researchers to develop a

clear set of well-defined concepts. Thirdly, as a conse-

quence, parenting researchers are confronted with several

measurement difficulties. The present study aims to address

this gap in the literature by focusing on the behavioral

aspects of parenting children with ASD. Building on the

idea of bidirectionality in parenting and child behavior

(Pettit and Loulis 1997), we can assume that the behaviors

associated with the child’s ASD phenotype, such as

impairments in social communication and interaction and

restricted or repetitive behaviors and interests, may influ-

ence parenting behaviors. On the other hand, the way in

which parents adapt their parenting strategies to the

specific needs of their child with ASD can influence child

development over time.

Many researchers have studied parenting behaviors

among parents of typically developing children, focusing on

the role of parenting in the socialization of children, or the

way in which children acquire the social, emotional, and

cognitive skills to function in the social community (Grusec

and Davidov 2010). Similar parenting behaviors can be

captured in terms of broader parenting dimensions. In gen-

eral, three global, relatively independent dimensions of

parenting are identified: support or warmth, behavioral

control, and psychological control (Barber et al. 2005;

Galambos et al. 2003). Parental support refers to the affective

nature of the parent–child relationship and encompasses

parenting behaviors such as acceptance, positive affect,

involvement, and responsiveness to the child’s needs.

Behavioral control concerns parental attempts to influence

and control the child’s behavior, such as supervision, rule

setting, and punishment. Psychological control refers to a

more intrusive type of control in which parents attempt to

restrict children’s psychological and emotional development

by manipulating their thoughts and feelings, and using

strategies such as love withdrawal or guilt induction (Jans-

sens et al. 2014). More recently, autonomy support is also

considered to be a primary dimension of parenting. This

fourth dimension encompasses parenting behaviors such as

showing empathy for the perspective of the child, giving

choices, and encouraging the child to act on the basis of

intrinsic satisfying motives (Soenens et al. 2007).

In recent years, the literature on parenting behaviors

among parents of children with ASD has grown

considerably, but these studies mainly focus on (a) one

specific aspect of parenting, such as parental synchrony or

parents’ sensitive responsiveness towards their child,

which are related to the support dimension of parenting, or

(b) broader parent–child social–communicative interac-

tions in a specific age range of young children with or at

risk for ASD. Several studies have investigated maternal

sensitivity and its association with language growth and

positive child behavior outcomes. The pioneers in this

research field are Siller and Sigman (2002), who found that

parents of young children with ASD did not differ from

parents of children with other developmental delays or

typically developing children in the ability to synchronize

both their verbal and nonverbal behavior with their child’s

attention and activity. Moreover, maternal synchrony was

positively associated with children’s communication skills

1, 10, and 16 years later. These initial findings were

replicated and extended by several prospective longitudinal

studies of young children with ASD (e.g., Baker et al.

2010; Siller and Sigman 2008). More recently, a random-

ized clinical trial of an experimental treatment aimed at

enhancing responsive parental communication (FPI) was

conducted. Findings revealed a conditional effect of FPI on

children’s expressive language outcomes at 12-month fol-

low up, suggesting that children with baseline language

skills below 12 months are most likely to benefit from

treatment (Siller et al. 2013). A recent longitudinal study of

Midouhas et al. (2013) examined whether maternal warmth

and involvement could buffer the effect of poverty on

psychopathology among young children with ASD. They

found that maternal warmth was associated with fewer

conduct problems and less hyperactivity, and with an

annual decrease in peer and conduct problems. Regarding

the broader parent–child social–communicative interac-

tions, mothers of young children with or at risk for ASD

seem to adapt their interaction style by using more direc-

tive strategies and more high-intensity approach behaviors,

in order to get higher engagement and responsiveness from

their child (e.g., Doussard-Roosevelt et al. 2003; Lemanek

et al. 1993; Meirsschaut et al. 2011; Wan et al. 2012).

A few studies have investigated parenting behavior in a

more comprehensive way, by focusing on multiple par-

enting dimensions. To our knowledge, only one observa-

tional study has been conducted that included different

aspects of parenting behavior (Blacher et al. 2013). Posi-

tive and negative parenting behaviors were investigated

among mothers of children in different diagnostic groups

(ASD, cerebral palsy, Down syndrome, or undifferentiated

developmental delay). Mothers of children in all diagnostic

groups showed more negative parenting behaviors (Nega-

tive affect, Intrusiveness, and Detachment) compared to

mothers of typically developing children. Less positive

parenting (Positive affect, Sensitivity, and Stimulation of

J Autism Dev Disord (2015) 45:3580–3593 3581

123

cognition) was observed in the different diagnostic groups

at child age 3, but not at subsequent ages. The authors also

investigated whether these parenting behaviors differed by

the observational context (structured task situation vs.

unstructured free-play situation). In this study, mothers

displayed more positive parenting behaviors in the

unstructured or free play context and more negative par-

enting behaviors in the structured context (Blacher et al.

2013).

Besides this observational study, there are also some

studies that investigated parenting behaviors by means of a

self-report questionnaire (e.g., Beurkens et al. 2013;

Lambrechts et al. 2011; Maljaars et al. 2014; Osborne et al.

2008; Osborne and Reed 2010). These studies have shown

that general parenting dimensions are also recognizable

among parents of children and adolescents with ASD.

Using the Parent–Child Relationship Inventory (PCRI;

Gerard 1994), Beurkens et al. (2013) showed that parents

of children with ASD aged between 4 and 14 years

reported scores in the typical range on the parenting

domains Involvement, Limit setting, and Autonomy and

lower scores on Communication, which is consistent with

the expectations given that communication difficulties are

characteristic of ASD. Lambrechts et al. (2011) and Mal-

jaars et al. (2014) used the Parental Behavior Scale-ASD

(PBS-A, Van Leeuwen and Noens 2013), which contains—

next to subscales measuring general parenting behaviors—

two subscales measuring ASD-adapted parenting behaviors

(Stimulating the development and Adapting the environ-

ment). As expected, parents of 6–18 year old children with

ASD reported significantly more ASD-adapted parenting

behaviors in comparison with parents of typically devel-

oping children, but also fewer rules and discipline, and

more positive parenting. Furthermore, recent findings

revealed significant age and diagnostic Group by Age

interaction effects for ASD-adapted as well as several

general parenting dimensions (Maljaars et al. 2014).

Theoretical models suggest a relationship between par-

enting stress and different parenting dimensions (Abidin

1992; Deater-Deckard 1998, 2005). Few studies have

already investigated this association among parents of

children with ASD. Mothers of children with ASD with

higher levels of emotional distress, for example, were more

intrusive during mother–child play sessions than mothers

who reported lower levels of distress, even when control-

ling for the child’s responsiveness and involvement (Dolev

et al. 2009). Parenting stress was also found to be associ-

ated with lower levels of self-reported Limit setting among

parents of children with ASD (Osborne and Reed 2010).

Moreover, parenting stress seems to be associated with

the presence of the broader autism phenotype (BAP) in

parents (Ingersoll and Hambrick 2011). Parents of children

with ASD may have ASD themselves or show subthreshold

(BAP) symptoms of ASD (Piven et al. 1997; Szatmari et al.

2000, van Steijn et al. 2013). These parental ASD symp-

toms could be reflected in their parenting behaviors. In

particular, impairments in social responsiveness may hin-

der parents to flexibly and sensitively adapt their parenting

strategies towards the needs of their child with ASD (Reed

and Osborne 2014; van Steijn et al. 2013). To our knowl-

edge, very few studies have investigated the association

between ASD-like features and parenting behaviors among

parents of children with ASD.

Currently, there is only little research focusing on the

behavioral aspects of parenting a child with ASD, taking

into account multiple dimensions of parenting. Moreover,

very few studies have directly compared parenting behav-

iors of parents of children with ASD with parents of typ-

ically developing children using observational methods.

Furthermore, research on parenting in families of children

with ASD has mainly focused on very young children, or

on a broader age range. The main purpose of the current

study is to examine whether there are differences in par-

enting behaviors among mothers of school-aged children

with ASD compared to typically developing children. Our

study is one of the first to combine a self-report question-

naire (PBS-A) and an observational measure to investigate

parenting behaviors among mothers of children with ASD.

We have chosen to focus only on mothers’ parenting

behaviors in this study, since we learned from previous

research that it is hard to motivate fathers to participate in

this kind of time-consuming studies. However, we are

aware of the importance of including fathers in further

research, especially since studies have shown differences in

parenting behaviors between mothers and fathers (Janssens

et al. 2014; Simons and Conger 2007). Secondly, this study

aims to investigate whether parenting behaviors among

mothers of a child with ASD and mothers of a typically

developing child differ across specific observational con-

texts (structured and unstructured). A third goal is to

examine the association between parenting stress, maternal

ASD characteristics and parenting behaviors.

Methods

Participants

Sixty-nine children aged between 7 and 11 years and their

mothers were included in this study. The ASD group

comprised 30 children with ASD, who all had received a

formal diagnosis of ASD according to DSM-IV-TR criteria

(American Psychiatric Association 2000) prior to the study.

Diagnoses were confirmed with the Autism Diagnostic

Observation Schedule (ADOS; Gotham et al. 2007) and the

Diagnostic Interview for Social and Communication

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Disorders-version 11 (DISCO-11; Wing 2006). Twenty-

eight children had an algorithm score above the cut-off for

autism spectrum disorder on the ADOS Module 3. Mean

ADOS severity scores, which are calibrated scores between

1 and 10 (Gotham et al. 2009), are shown in Table 1.

Severity scores of 4 and higher are considered to be rep-

resentative of an ASD classification. All children had a

classification of autism spectrum disorder based on the

ICD-10 algorithm for the DISCO-11. The typically devel-

oping (TD) group comprised 39 children without a known

child psychiatric disorder, as reported by the parents. In

both participant groups, intelligence was estimated with an

abbreviated version (Sattler and Saklofske 2001) of the

Wechsler Intelligence Scale for Children, Third Edition

(WISC-III-NL; Wechsler 1992), which consisted of the

subtests Vocabulary, Block design, Picture completion, and

Table 1 Demographic and other characteristics of the ASD

and TD group

TD

(n = 39)

ASD

(n = 30)

Test statistic p

Child characteristics

Age

Range 7–11 8–11 t(67) = 1.49 .14

M (SD) 9.2 (1.0) 9.5 (1.0)

Gender

Boys 54 % 80 % v2ð1Þ = 5.11 .04

Girls 46 % 20 %

VIQ

Range 84–141 81–135 t(67) = -2.17 .03

M (SD) 116.08 (14.23) 109.00 (12.27)

PIQ

Range 68–126 80–137 t(67) = -0.17 .87

M (SD) 105.79 (12.04) 105.27 (14.05)

FSIQ

Range 81.5–132 80.5–122 t(67) = -1.44 .15

M (SD) 110.94 (11.11) 107.18 (10.16)

SRS a

Range 1–58 45–129 t(39.3) = 13.29 \.001 M (SD) 23.72 (13.03) 82.57 (23.05)

ADOS severity scores

Range N/A 3–10 N/A N/A

M (SD) N/A 6.6 (1.71)

Mother characteristics

Age

Range 29–49 29–49 t(67) = -0.11 .91

M (SD) 40.2 (3.7) 40.1 (4.5)

Education level

No college 8 % 43 % v2ð1Þ = 12.09 \.01

Completed college 92 % 57 %

Family characteristics

No. of children

Range 1–5 1–5 t(67) = -2.60 .01

M (SD) 2.8 (0.8) 2.2 (0.9)

Marital status

Single-parent 13 % 17 % v2ð1Þ = 0.20 .74

Two parents 87 % 83 %

VIQ verbal IQ, PIQ performance IQ, FSIQ full scale IQ, N/A not applicable a SRS data of two children with ASD were missing

J Autism Dev Disord (2015) 45:3580–3593 3583

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Similarities. For all children, intelligence scores fell within

the typical range (Full Scale IQ, Performance IQ and

Verbal IQ C 70). ASD characteristics were measured by

means of the Dutch version of the Social Responsiveness

Scale (SRS; Roeyers et al. 2011). In the TD group, only

one participant scored above the cut-off score of T70

(T = 72), in the ASD group 79 % of the children scored

above the cut-off. Demographic and other characteristics of

the ASD and TD group are shown in Table 1.

The gender ratio was significantly different in the ASD

group compared to the TD group. Consistent with the

skewed gender ratio in diagnosed ASD, significantly more

boys than girls with ASD participated in this study. For this

reason, all analyses were controlled for gender, but

revealed the same results as the primary analyses, which

are reported here. There were no differences between the

ASD and TD group concerning maternal age and marital

status. Both groups differed significantly on the education

level of the mother and the number of children in the

family. In the TD group, families were slightly larger and

the level of education among mothers was higher, with

almost all of them having completed college (i.e., received

a bachelor’s or master’s degree). Mothers’ level of edu-

cation in the ASD group, with 57 % bachelor or master’s

degrees, represented better the general Flemish population

of females between 25 and 64 years old (Research

Department of the Flemish Government 2011).

Procedure

Families of children with ASD were recruited via the

Flemish parent association for autism (n = 14), four spe-

cial needs schools for children with ASD (n = 11) and the

Autism Expertise Centre of the Leuven University Hospital

(n = 5). The TD group was recruited via four regular

primary schools. When parents gave informed consent, we

contacted them by telephone to make an appointment for a

home visit and an individual assessment of their child.

During the home visit, we observed mother–child interac-

tions and we interviewed the mother using the DISCO. The

observation consisted of an unstructured task (free-play)

and two more structured tasks (drawing and problem-

solving task). For the free-play task, mother and child

could choose one out of three bags with different play

materials (an unfamiliar board game, several hand puppets,

or a large search and find book). They were asked to play

with the materials of their choice for 15 min. For the

drawing task, mother and child were instructed ‘to draw an

island’ on a large paper in 5 min. The problem-solving task

consisted of a challenging 3D-puzzle (Bedlam cube),

which mother and child had to solve in 10 min. After each

task, the mother asked the child to clean up. The obser-

vation was video recorded. In addition, mothers completed

self-administered questionnaires. During the individual

assessment that took place at school, at home, or at the

research center, we assessed all children with the abbre-

viated WISC-III-NL. Additionally, we evaluated children

in the ASD group with the ADOS. This study was reviewed

and approved by the Ethics Committee of the Faculty of

Psychology and Educational Sciences of the KU Leuven.

Instruments

Parenting Behavior

Self-report The Parental Behavior Scale-ASD (PBS-A;

Van Leeuwen and Noens 2013) is a 52-item questionnaire

with items describing observable parenting behaviors.

Mothers indicated the frequency of their parenting behav-

iors towards one specific child on a 5-point Likert scale

ranging from 1 ((almost) never) to 5 ((almost) always). The

questionnaire comprises five subscales to measure general

parenting behavior (Van Leeuwen and Vermulst 2004,

2010) and two subscales to measure specific parenting

behavior relevant to children with ASD. The general sub-

scales are: (a) Positive parenting (11 items, e.g., ‘‘I make

time to listen to my child, when he/she wants to tell me

something’’), (b) Material rewarding (four items, e.g., ‘‘I

give my child candy as a reward for good behavior’’),

(c) Rules (six items, e.g., ‘‘I teach my child to be polite at

school’’), (d) Discipline (six items, e.g., ‘‘When my child

has been disobedient, I give him/her a chore for punish-

ment’’), and (e) Harsh punishment (five items, e.g., ‘‘I

spank my child when he/she is disobedient or naughty’’).

The two additional ASD-adapted subscales are: (f) Stimu-

lating the development (11 items, e.g., ‘‘I explain about

feelings to my child’’), and (g) Adapting the environment

(nine items, e.g., ‘‘I only give my child one task at a time’’).

Confirmatory factor analyses supported structural validity

(Lambrechts et al. 2011). Internal consistency of the sub-

scales was acceptable to good, with Cronbach’s alpha’s in

the current sample ranging from 0.76 to 0.83.

Observations To assess maternal parenting behavior, the

video-taped records were coded with two different coding

systems. First, we used the Parenting Rating Scale of

Karreman et al. (2008), based upon McHale’s Coparenting

and Family Rating System (CFRS; McHale 1995). Seven

dimensions of maternal parenting behavior were rated on a

7-point Likert scale. Warmth indicates the frequency and

intensity of affect shown towards the child by the mother,

such as encouragement, smiles, eye contact, and physical

affection. Negativity encompasses the degree of the

mother’s criticizing, ignoring the child, and being annoyed

during the session. Investment indicates the extent to which

the mother is involved with the child and concerned that

the child behaves or performs tasks correctly. Limit setting

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measures the extent to which the mother prevents the child

from wandering away from assigned tasks. Sensitivity

refers to the timing and quality of the mother’s interven-

tions with the child. Provision of structure refers to the

extent to which the mother structures the task and provides

information about it. Creativity indicates the extent to

which the mother participates with the child in a way that

animates objects and activities (Karreman et al. 2008,

2010).

Second, the coding system of Whipple et al. (2011) was

used to measure maternal autonomy support. Maternal

behaviors were coded on four scales on a 5-point Likert

scale ranging from 1 (not autonomy-supportive) to 5 (ex-

tremely autonomy-supportive). The four scales were

developed based on Grolnick et al.’s (1984) rating system.

Concern for child’s sense of competence measures the

extent to which the mother intervenes according to the

infant’s needs and adapts the task to create an optimal

challenge for the child. Mother’s verbalizations indicates

the extent to which the mother encourages her child in the

pursuit of the task, gives useful hints and suggestions, and

uses a tone of voice that communicates to the child that she

is there to help. Flexibility and perspective-taking encom-

passes the degree to which the mother takes her child’s

perspective and demonstrates flexibility in her attempts to

keep her child on task. Following child’s pace and giving

child opportunity to make choices measures the extent to

which the mother follows her child’s pace, provides the

child with the opportunity to make choices, and ensures

that the child plays an active role in the completion of the

task (Whipple et al. 2011). The rating scales for autonomy

support were forward and back-translated by a graduate

English student.

For all three tasks, the parenting dimensions were rated

on the basis of 1-min intervals: the first, middle, and last

minutes of each task. Thus, for each mother–child dyad,

nine ratings per dimension were created. All parent–child

interaction videos were rated by two coders blind to all

other information about the dyads. Coders were trained by

watching videotaped home observations until reliability

was established, defined as reaching a criterion over 70 %

exact agreement with the primary coder. Inter-rater relia-

bility was evaluated by means of the percentage agreement

within one scale point and ranged from .76 (Negativity and

Concern for child’s sense of competence) to .97 (Warmth

and Investment). The parenting dimensions of Limit setting

and Flexibility and perspective-taking were excluded from

the analyses given their low prevalence rate. These

dimensions could only be coded if the child showed dis-

obedient behavior or behavior that deviated from the task

during the observation. Given the inter-correlations

between the three other scales to measure maternal

autonomy support (ranging from .61 to .69), they were

averaged to obtain a mean autonomy-support score

(a = .85).

Maternal Parenting Stress

The degree of maternal stress related to parenting is mea-

sured by the Nijmegen Parental Stress Index-Short

(NOSIK; de Brock et al. 1992). The Nijmegen Parental

Stress Index (NOSI) is based upon the Parenting Stress

Index (PSI; Abidin 1983). The NOSIK comprises 25 items

to be rated on a 6-point Likert scale ranging from 1 (totally

disagree) to 6 (totally agree), i.e., items of both the parental

and child domain of the NOSI that load highly on the

general factor parenting stress. In the parental domain, the

NOSIK consists of items from the NOSI factors Sense of

competence (six items), Attachment (one item), Depression

(three items), and Parental health (one item). In the child

domain, the NOSIK contains items from the NOSI factors

Adaptability (one item), Mood (two items), Distractibility/

Hyperactivity (two items), Demandingness (five items),

Reinforces parent (one item), and Acceptability (three

items). The NOSIK has shown excellent internal reliability

(a = .92–.95), and differentiates between clinical and nonclinical groups (de Brock et al. 1992). In the current

sample, internal consistency was high (.96).

Maternal ASD Characteristics

The adult version of the Dutch Social Responsiveness

Scale (SRS-A; Noens et al. 2012) is a 64-item self-report

questionnaire to assess specific behaviors that are associ-

ated with the full range of ASD symptomatology (includ-

ing items tapping social interaction, communication, and

restricted/repetitive patterns of behavior). Psychometric

studies indicate that scores are continuously distributed

across the general population, and demonstrate good test–

retest and inter-rater reliability, as well as discriminant and

concurrent validity (Constantino et al. 2003; Noens et al.

2012).

Data Analyses

All analyses were performed using IBM SPSS Statistics 22.

First, we conducted correlational analyses, by calculating

Pearson correlations between mothers’ self-reported and

observed parenting behavior, and between parenting stress,

maternal ASD characteristics and mothers’ self-reported

and observed parenting behavior. Given the significant

correlations between parenting stress and parenting

behavior, parenting stress was entered in the subsequent

analyses as a covariate. To compare means on the NOSIK

for the ASD versus TD group, an independent samples

T test was performed. Next, we conducted a 3 9 3 repeated

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measures ANCOVA in order to examine differences

between the ASD and TD group on mother’s observed

parenting behavior, with task situation and minutes as

within-subject factors. This way of analyzing the data

enabled us to examine whether parenting behaviors dif-

fered across the three task situations (free-play, drawing

task and problem-solving task) and minutes. Finally, we

conducted a MANCOVA in order to compare means on the

self-reported parenting behavior domains between the ASD

and TD group. Prior to analyses, the assumptions under-

lying MANOVA (i.e., normality, homogeneity of variance,

independence) were checked and proven satisfactory. The

assumption of homogeneity of regression slopes underlying

ANCOVA was also met. Effect sizes are indicated by Eta

squared values, with .01–.06 indicating a small effect, .06–

.14 a medium effect, and [ .14 a large effect (Cohen 1988).

Results

Correlational Analyses

Self-Reported and Observed Parenting Behavior

Initial analyses addressed whether mothers’ parenting

behavior measured by a self-report questionnaire (PBS-A)

or observations were associated. In general, only weak

correlations were found (see Table 2).

Parenting Stress and Parenting Behavior

Prior to the main analyses, we examined if parenting stress

of the mother was associated with mothers’ self-reported

and observed parenting behavior. Mothers in the ASD

group had a significantly higher level of parenting stress

compared to mothers in the TD group (t(47.38) = 5.37;

p \ .001). Pearson correlations indicated that there were various significant correlations between parenting stress of

the mother and mothers’ self-reported and observed par-

enting behavior (see Table 3). Positive correlations were

found between parenting stress and the self-reported par-

enting subscales Material rewarding and Harsh punish-

ment. Concerning observed parenting behavior, parenting

stress correlated negatively with the parenting dimensions

Provision of structure, Sensitivity, and Creativity. A posi-

tive correlation was found with Negativity. For this reason,

parenting stress was entered in the subsequent analyses as a

covariate.

Maternal ASD Characteristics and Parenting Behavior

Pearson correlations indicated that associations between

characteristics of ASD among mothers in the ASD group

and mothers’ self-reported and observed parenting behav-

iors were rather limited (see Table 3).

Parenting Differences

Observed Parenting Behavior

Our main goal was to examine differences in parenting

behavior between mothers of children with ASD and typ-

ically developing children. With regard to observed par-

enting behavior, analyses of the different parenting

dimensions suggested that mothers of children with ASD

exhibited different parenting behavior in two parenting

dimensions compared to mothers of typically developing

children. Mothers of children with ASD scored lower on

the dimensions Provision of structure and Sensitivity.

There was also a trend towards a significant group differ-

ence on Warmth, with mothers of children with ASD

Table 2 Pearson correlations between observed and self-reported parenting behavior (n = 69)

Observed parenting

behavior

Self-reported parenting behavior

Positive

parenting

Material

rewarding

Rules Discipline Harsh

punishment

Stimulating the

development

Adapting the

environment

Warmth .12 -.29* -.02 -.34** -.24* .03 -.17

Negativity -.12 .10 .01 .11 .21 ( * )

.09 -.02

Investment .20 ( * )

.04 .13 -.19 -.05 .24 ( * )

.00

Provision of structure .07 -.28* .06 .06 -.00 .08 -.24*

Sensitivity .01 -.27* .02 -.29* -.19 -.10 -.30*

Creativity .09 -.31** .06 -.36** -.23 ( * )

.04 -.24*

Autonomy support .05 -.28* -.19 -.33** -.17 -.15 -.18

( * ) p \ .10; * p \ .05; ** p \ .01

3586 J Autism Dev Disord (2015) 45:3580–3593

123

obtaining lower scores compared to mothers of typically

developing children (see Table 4).

Our second goal was to examine whether mothers’

observed parenting behavior differed across the three task

situations and minutes. There was a main effect of task

situation for the dimensions Investment (F(2, 134) = 8.14;

p \ .001), Provision of structure (F(1.76, 117.8) = 16.01; p \ .001), Sensitivity (F(2, 134) = 19.42; p \ .001), Creativity (F(2, 134) = 16.03; p \ .001), and Autonomy support (F(2, 134) = 7.03; p = \ .01). In general, mothers obtained lower scores during the problem-solving task

compared to the other two task situations, except for the

dimension of Investment. For this dimension, mothers

scored higher during the problem-solving task compared to

the other two task situations. There was a main effect of

minutes for the dimensions Warmth (F(2, 134) = 10.69;

p \ .001), Investment (F(2, 134) = 11.53; p \ .001), Pro- vision of structure (F(1.76, 117.8) = 3.41, p = .04), Sensi-

tivity (F(2, 134) = 6.96; p = \ .01), and Autonomy support (F(2, 134) = 13.00; p \ .001). For these dimensions, mothers obtained the highest scores in the first minute of

each task situation. Only for Sensitivity there was a sig-

nificant interaction between group and task situation

(F(2, 134) = 3.40; p = .04). Whereas mothers in the TD

group obtained higher scores in the free-play situation

compared to mothers in the ASD group, the difference in

scores between the two groups almost disappeared in the

problem-solving task.

Table 3 Pearson correlations between parenting stress, maternal ASD characteristics and parenting behavior

Parenting stress Maternal ASD

characteristics

Total group

(n = 69)

TD

(n = 39)

ASD

(n = 30)

ASD

(n = 28)

Self-reported parenting behavior

Positive parenting -.09 .07 -.21 -.26

Material rewarding .32** -.04 .49** -.43*

Rules -.06 -.10 .11 -.23

Discipline .01 .05 -.01 -.30

Harsh punishment .49** .26 .56** -.38*

Stimulating the development -.02 -.04 -.01 -.15

Adapting the environment .21 -.12 .11 -.00

Observed parenting behavior

Warmth -.19 .01 -.21 .34 ( * )

Negativity .24* -.03 .37* -.15

Investment -.07 .04 -.06 .08

Provision of structure -.27* .05 -.13 -.00

Sensitivity -.30* -.15 -.25 .12

Creativity -.29* -.33* -.18 .24

Autonomy support -.13 .05 -.26 .15

( * ) p \ .10; * p \ .05; ** p \ .01

Table 4 Group differences in observed parenting behavior

between the TD and ASD group

TD

(n = 39)

M (SD)

ASD

(n = 30)

M (SD)

3 9 3 Repeated measures ANOVA

F p g2

Warmth 4.30 (0.43) 4.13 (0.34) 3.25 .08 –

Negativity 1.38 (0.43) 1.51 (0.44) 1.67 .20 –

Investment 4.75 (0.30) 4.70 (0.28) 0.61 .44 –

Provision of Structure 5.78 (0.22) 5.52 (0.44) 10.65 \.01 .14a

Sensitivity 5.04 (0.45) 4.83 (0.37) 4.70 .03 .07 a

Creativity 1.76 (0.40) 1.63 (0.42) 1.86 .18 –

Autonomy Support 3.57 (0.45) 3.50 (0.37) 0.50 .48 –

a Medium effect size

J Autism Dev Disord (2015) 45:3580–3593 3587

123

Our third aim was to examine possible effects of par-

enting stress on the parenting differences. A repeated

measures analysis of covariance, with parenting behavior

as the dependent variable, group as the categorical pre-

dictor variable, and parenting stress as a covariate, was

conducted. After controlling for the effect of parenting

stress, there was only a significant group difference on the

parenting dimension Provision of structure (F(1, 66) = 5.46;

p = .02). The covariate, parenting stress, was significantly

related to the dimension of Creativity (F(1, 66) = 4.00;

p = .05).

Self-Reported Parenting Behavior

With regard to self-reported parenting behavior, analyses

of the different parenting behavior subscales indicated both

similarities and differences between mothers in the ASD

group and TD group (Table 5). Concerning the general

parenting subscales, there was only a significant difference

on Material rewarding, with mothers in the ASD group

reporting higher scores compared to mothers in the TD

group. With respect to ASD-adapted parenting behavior,

mothers in the ASD group scored higher on Adapting the

environment. After controlling for the effect of maternal

parenting stress, there was only a significant group differ-

ence on the subscale Adapting the environment

(F(1, 66) = 6.17; p = .02). Parenting stress was signifi-

cantly related to the subscale Harsh punishment

(F(1, 66) = 18.03; p \ .001).

Discussion

Although parents of children with ASD face specific chal-

lenges in parenting, only a few studies have empirically

investigated parenting behaviors among these parents.

Moreover, these studies have seldom incorporated various

dimensions of parenting. The current study extends previous

findings by comparing parenting behaviors between mothers

of a school-aged child with ASD and mothers of a typically

developing child, measuring multiple dimensions of par-

enting behavior both directly (observational measure) and

more indirectly (self-report questionnaire).

Prior to our main research aims, we examined whether

mothers’ parenting behaviors measured by a self-report

questionnaire and observations were associated. In general,

only weak correlations between these two assessment

methods were found, suggesting that both methods may

each provide unique information on parenting behaviors.

Studies that investigated the degree of convergence

between observational and self-report measures of parent-

ing constructs revealed mixed findings, with a large amount

of studies finding only weak correlations between these

measures (Gardner 2000). An important difference

between these methods is the perspective from which

parenting behaviors are assessed. In a self-report ques-

tionnaire, parents are the principal informant, and their

view on their own parenting behaviors becomes central,

whereas observations are conducted by more neutral

observers. Questionnaire data reflect behaviors that parents

recognize or value (Karreman et al. 2008). Observational

data are obtained by trained coders, which perhaps could

give a more objective view on the actual behaviors parents

are performing. Furthermore, parental reports take into

account parenting across many contexts and over time,

whereas an observation is more momentary and situation-

bound. On the other hand, observations can give us more

in-depth information (Gardner 2000; Smith 2011; Zaslow

et al. 2006). In this respect, both assessment methods can

be informative, and the combination of both methods may

offer a more complete understanding of parenting (Zaslow

et al. 2006).

The first aim of this study was to examine similarities

and differences in observed and self-reported parenting

behaviors between mothers of a child with or without ASD,

by taking into account various dimensions of parenting.

Four broader parenting dimensions were measured in this

Table 5 Group differences in self-reported parenting behavior

between the TD and ASD group

TD

(n = 39)

M (SD)

ASD

(n = 30)

M (SD)

ANOVA

F p g2

Positive parenting 4.07 (0.39) 4.06 (0.47) 0.01 .91 –

Material rewarding 2.37 (0.72) 2.77 (0.56) 6.17 .02 .08 a

Rules 4.31 (0.42) 4.17 (0.55) 1.43 .24 –

Discipline 2.95 (0.70) 2.94 (0.74) 0.00 .96 –

Harsh punishment 1.30 (0.25) 1.46 (0.52) 2.84 .10 –

Stimulating the development 3.83 (0.42) 3.83 (0.48) 0.01 .94 –

Adapting the environment 2.93 (0.53) 3.38 (0.67) 9.72 \.01 .09a

a Medium effect size

3588 J Autism Dev Disord (2015) 45:3580–3593

123

study, i.e., maternal support, control, autonomy support and

ASD-adapted behavior.

With regard to the first dimension of maternal support,

mothers in the ASD group obtained lower scores on Sen-

sitivity than mothers of typically developing children. On

the PBS-A, mothers of children with ASD scored higher on

Material rewarding compared to mothers in the TD group.

No differences were found on the Warmth, Investment and

Creativity subscales of the observational measure and the

Positive parenting subscale of the PBS-A.

At first sight, it seems to be contradictory that mothers

of a child with ASD showed less sensitivity during the

observation, but reported to use as much positive parenting

as mothers of a typically developing child. The Positive

parenting subscale of the PBS-A encompasses a broad

range of parenting behaviors, such as items on social

rewarding, involvement and problem solving and covers

multiple situations (Van Leeuwen et al. 2004), whereas the

subscale Sensitivity is more narrowly defined and situation-

bound. On the other hand, the self-reported Positive par-

enting subscale could be influenced by more socially

desirable responding.

In the literature, there is no clear evidence for the sug-

gestion that mothers of children with ASD exhibit less

sensitive behaviors (Reed and Osborne 2014). Blacher

et al. (2013), for example, found that mothers of 3-year old

children with ASD showed less positive parenting behav-

iors (i.e., Positive affect, Sensitivity, and Stimulation of

cognition) compared to mothers of typically developing

children, but at subsequent child ages, these differences

disappeared. Moreover, the observational study of Siller

and Sigman (2002) revealed no differences in maternal

synchronicity, a construct related to sensitivity, between

mothers of preschool children with ASD and typically

developing children. We should note, however, that the

group of children with ASD included in our study differs

substantially from the group of children included in the

former studies with regard to the children’s chronological

and developmental age.

Both child and maternal characteristics may impact

upon mothers’ ability to sensitively respond towards the

behaviors of their child with ASD. The lower scores on

maternal Sensitivity might be associated with the specific

behavioral phenotype of children with ASD, especially

their impairments in social interaction and communication.

These difficulties might challenge mothers’ ability to read

the signals of their child and respond to them effectively

(Dolev et al. 2009). Moreover, from a social-learning

perspective, mothers may have experienced that their child

with ASD does not respond positively towards their sen-

sitive behaviors, and in this way, mothers’ sensitive

behaviors may not have been reinforced by the reactions of

their child. As a consequence, mothers may have learned

over the years to decrease their use of sensitive behaviors.

Furthermore, characteristics of the mother could also

impact upon her ability to show sensitive behaviors. In our

study, mothers of children with ASD showed higher levels

of parenting stress compared to mothers of typically

developing children. Besides stress related to the caregiv-

ing role, mothers may also face other sources of stress,

such as work-related stress, or stress related to the ASD

symptoms of themselves or their partner. When we con-

trolled for parenting stress, the group difference on sensi-

tivity did not remain significant. For this reason, parenting

stress seems to explain this lower score on Sensitivity.

The finding that mothers of children with ASD reported

to use more material rewarding compared to the control

group is in line with the findings of Maljaars et al. (2014).

In their study a much larger sample of participants was

included, which adds to the generalizability of this finding.

They refer to the limited responsiveness of children with

ASD to social incentives because of a reduced social

motivation as a possible explanation for the higher use of

material rewarding among mothers of school-aged children

with ASD.

With regard to the control dimension, mothers of chil-

dren with ASD differed only on Provision of structure as

measured during the observation. There were no differ-

ences on observed Negativity and self-reported Rules,

Discipline and Harsh punishment. The finding that mothers

of children with ASD were observed to provide less

structure is surprising, given the fact that most children

with ASD benefit from a structured environment (Volkmar

et al. 2014). However, the subscale Provision of structure

in our study is defined in a specific way. High scores on this

subscale are defined as structuring the task in a direct way,

by giving clear instructions, but without leaving room for

the child to wander away or to redefine a task. In our

sample, children with ASD often followed their own track

when conducting a task, and they did not always comply

with the requests and suggestions of their mother. Possibly,

mothers have learned to not immediately intervene in these

situations in order to prevent frustration of their child and

escalation of the situation. Besides this specific finding

concerning provision of structure, mothers of children with

ASD seem to control the behaviors of their child to the

same extent as mothers of typically developing children, as

measured by the PBS-A. This is in contrast with the find-

ings of Maljaars et al. (2014), who found that mothers of a

child with ASD were setting fewer rules and utilized less

discipline than mothers of the control group during child-

hood as well as adolescence based on the same self-report

questionnaire. A possible explanation for this discrepancy

in findings is that their results were based upon a larger

sample, which might have revealed more subtle differences

in parenting behaviors.

J Autism Dev Disord (2015) 45:3580–3593 3589

123

The third dimension, autonomy support, was only

assessed during the observation. No differences were found

between mothers in the ASD and TD group on this par-

enting dimension. We should note that our study is one of

the first to investigate differences in maternal autonomy

support between mothers of children with ASD and typi-

cally developing children. Our results suggest that mothers

of children with ASD are supporting the autonomy of their

child to the same extent as mothers of typically developing

children.

With regard to the fourth dimension, ASD-adapted

behavior, mothers of children with ASD scored higher on

Adapting the environment. There was no difference on the

subscale Stimulating the development. These findings

correspond with the results of Maljaars et al. (2014). In

comparison with the control group, mothers of a child with

ASD reported more often that they adapt the environment

towards the needs of their child with ASD by for example

blocking distracting stimuli, or by modifying their com-

munication towards their child.

The second aim of this study was to explore whether

parenting behaviors differed across the specific observa-

tional context (unstructured vs. more structured). Certain

dimensions of parenting behavior differed by the specific

task situation (free-play, drawing task, and problem-solv-

ing task). For the subscales Provision of structure,

Creativity, and Autonomy support mothers in both groups

obtained lower scores during the problem-solving task

compared to the other two task situations. For Investment,

the opposite pattern was found. Furthermore, there was a

significant interaction between group and task situation for

Sensitivity. Whereas mothers of typically developing

children were observed to be more sensitive in the free-

play situation compared to mothers in the ASD group, the

difference in scores between the two groups almost dis-

appeared in the problem-solving task. This finding indi-

cates that the observed difference in sensitivity between

mothers of children with ASD and typically developing

children was only present during the free-play situation.

This could be due to the fact that it might be more chal-

lenging for mothers to interpret the needs of their child

with ASD during a free-play task compared to more

structured tasks. It is important to acknowledge that child

behavior may also vary across specific tasks, and this may

impact upon mothers’ parenting behaviors (Gardner 2000).

Moreover, in our study mothers in both groups obtained

higher scores for certain parenting dimensions at the

beginning of each task situation. Mothers may need to use

more of these parenting behaviors to start up a task.

Another explanation is that at the beginning of the obser-

vation, mothers may be more aware of the fact that they are

being observed. These findings show the importance of

incorporating both unstructured and more structured tasks

in an observational study of maternal parenting behaviors.

The third aim of this study was to investigate the asso-

ciation between parenting stress, maternal ASD charac-

teristics and parenting behaviors. In line with general

theories on parenting stress, various significant correlations

were found between parenting stress and self-reported and

observed parenting behaviors. Moreover, when we con-

trolled for parenting stress, many of the group differences

in parenting behaviors did not remain significant. Con-

versely, only weak associations were found between

maternal ASD characteristics and observed and self-

reported parenting behaviors. This is not surprising, given

the fact that ASD characteristics are more often present or

diagnosed among fathers compared to mothers (De la

Marche et al. 2012). In our study only mothers were

included, which can limit the variability in scores on this

measure.

Some limitations of our study need to be acknowledged.

Firstly, we should be careful when making assumptions

about the ecological validity of our observational measure.

During the observations, very few children with ASD

showed disobedient behavior or behavior that deviated

from the task, whereas many of these children were

reported to exhibit behavior problems based upon their

scores on the Child Behavior Checklist (i.e., 52 % of the

children have a total problem score within the clinically

significant range). Gardner (2000) points out the potential

influence of imposing tasks during an observational study

on the ecological validity of the instrument. The tasks we

used may not have been challenging enough to elicit more

natural child behavior. In future research, it would be

interesting to add more naturalistic task situations, such as

family mealtimes, in which mother–child interactions can

be observed during more natural conditions. Secondly, the

coding system we used solely focused on mothers’ par-

enting behaviors, without taking child behaviors into

account. For this reason, we were not able to investigate

bidirectional influences between mother and child behav-

iors, which could further shed light on the meaning of

certain parenting behaviors. Thirdly, the sample size in this

study was rather small, which limits statistical power to

detect group differences. Although we found a few group

differences, further study with larger samples might reveal

more subtle differences in parenting behaviors. A final

limitation concerns the high level of education among

mothers in the control group. The control group was

recruited in the region of Leuven, which is a university

city. This could explain the very high amount of mothers

with a bachelor’s or master’s degree in this group. In the

ASD group, recruited throughout Flanders, the level of

education is more equally divided among mothers, with

3590 J Autism Dev Disord (2015) 45:3580–3593

123

only half of them having completed college. In this respect,

we should interpret our results with caution.

Despite these limitations, the current study represents an

important step in extending our understanding of parenting

behaviors among mothers of school-aged children with

ASD. The combination of an observational and self-report

measure of parenting behaviors and the focus on multiple

parenting dimensions (i.e., maternal support, control,

autonomy support and ASD-adapted behaviors) are

important strengths of this study. Moreover, this study is

one of the first to examine the relationship between

mothers’ parenting stress and parenting behaviors in fam-

ilies of children with ASD. Our results indicate that par-

enting stress and parenting behaviors are associated, and

parenting stress seems to explain most of the differences in

parenting behaviors between mothers of children with ASD

and typically developing children. However, studies with a

longitudinal design are needed to reveal possible causal

pathways. For professionals working with families of

children with ASD, it seems to be important to acknowl-

edge this relationship between mothers’ parenting stress

and parenting behaviors, by incorporating both elements in

intervention programs.

Acknowledgments We would like to acknowledge the families who donated their time to participate in this study. This research was

funded by grants from the Marguerite-Marie Delacroix Support Fund

and the Research Fund KU Leuven, University of Leuven. We would

also like to thank Eva Ceulemans for her statistical support.

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

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