The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder.
TL;DR: Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.
Abstract: Researchers commonly report that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities [e.g., Down syndrome (DS), cerebral palsy, intellectual disability]. The authors reexamined the research using comparison groups to investigate parenting stress and conducted a meta-analysis to pool results across studies. The experience of stress in families of children with ASD versus families of TD children resulted in a large effect size. Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.
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TL;DR: This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available to help the reader identify topic areas within the report.
Abstract: Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnosticcriteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child’s function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
582 citations
TL;DR: The results revealed that parents usually waited a year from when they first had concerns about their child’s development before they sought professional help, and just over half of the parents surveyed were dissatisfied with the diagnostic process as a whole.
Abstract: A sample of 1047 parents completed an online survey about their experiences and opinions regarding the process of attaining a diagnosis of autism spectrum disorder for their children. The results revealed that parents usually waited a year from when they first had concerns about their child's development before they sought professional help. On average, there was a delay of around 3.5 years from the point at which parents first approached a health professional with their concerns to the confirmation of an autism spectrum disorder diagnosis. Just over half of the parents surveyed were dissatisfied with the diagnostic process as a whole. Several factors predicted parents' overall levels of satisfaction with the diagnostic process, including the time taken to receive a diagnosis, satisfaction with the information provided at diagnosis, the manner of the diagnosing professional, the stress associated with the diagnostic process and satisfaction with post-diagnostic support. Post-diagnosis, the support (if any) that was provided to parents was deemed unsatisfactory, and this was highlighted as an area of particular concern among parents.
337 citations
TL;DR: For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear.
Abstract: RESULTS At week 24, the Aberrant Behavior Checklist–Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, −3.9; 95% CI, −6.2 to −1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire–Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, −0.7; 95% CI, −1.1 to −0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression– Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). CONCLUSIONS AND RELEVANCE For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.
284 citations
TL;DR: Mothers in Mindfulness-Based Stress Reduction versus Positive Adult Development had greater improvements in anxiety, depression, sleep, and well-being, and future studies are warranted on how trained mentors and professionals can address the unmet mental health needs of mothers of children with developmental disabilities.
Abstract: BACKGROUND: Compared with other parents, mothers of children with autism spectrum disorder or other neurodevelopmental disabilities experience more stress, illness, and psychiatric problems. Although the cumulative stress and disease burden of these mothers is exceptionally high, and associated with poorer outcomes in children, policies and practices primarily serve the identified child with disabilities.
METHODS: A total of 243 mothers of children with disabilities were consented and randomized into either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice). Well-trained, supervised peer mentors led 6 weeks of group treatments in 1.5-hour weekly sessions, assessing mothers 6 times before, during, and up to 6 months after treatment. Mothers had children with autism (65%) or other disabilities (35%). At baseline, 85% of this community sample had significantly elevated stress, 48% were clinically depressed, and 41% had anxiety disorders.
RESULTS: Using slopes-as-outcomes, mixed random effects models, both treatments led to significant reductions in stress, depression, and anxiety, and improved sleep and life satisfaction, with large effects in depression and anxiety. Mothers in Mindfulness-Based Stress Reduction versus Positive Adult Development had greater improvements in anxiety, depression, sleep, and well-being. Mothers of children with autism spectrum disorder improved less in anxiety, but did not otherwise differ from their counterparts.
CONCLUSIONS: Future studies are warranted on how trained mentors and professionals can address the unmet mental health needs of mothers of children with developmental disabilities. Doing so improves maternal well-being and furthers their long-term caregiving of children with complex developmental, physical, and behavioral needs.
253 citations
TL;DR: Overall, parenting stress levels were higher for parents ofChildren with ASD/DD compared to parents of children from other clinical groups, and the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples.
Abstract: Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.
212 citations
References
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TL;DR: A convenient, although not comprehensive, presentation of required sample sizes is providedHere the sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests.
Abstract: One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
38,291 citations
"The impact of parenting stress: a m..." refers background in this paper
...In general, an effect size is a standardized indicator of the strength of the relationship between two outcome variables and allows for comparison of measures that employ different scales (Cohen 1992; Field and Gillett 2010)....
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...Calculation of Effect Sizes In general, an effect size is a standardized indicator of the strength of the relationship between two outcome variables and allows for comparison of measures that employ different scales (Cohen 1992; Field and Gillett 2010)....
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...According to Cohen (1992), an effect size of 0.10 is considered small, 0.30 is medium, and anything above 0.50 is large....
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TL;DR: It is concluded that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity, and one or both should be presented in publishedMeta-an analyses in preference to the test for heterogeneity.
Abstract: The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
25,460 citations
"The impact of parenting stress: a m..." refers methods in this paper
...According to the classification system proposed by Higgins and Thompson (2002), the I2 indexes calculated for the analyses comparing families of children with ASD to TD children or to another diagnosis of disability, indicated low heterogeneity (approximately 16–17 % of the variability of effect…...
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...In addition, the I2 statistic was calculated (Higgins and Thompson 2002) as an indicator of the impact of heterogeneity and as a compliment to the Q statistic (Huedo-Medina et al. 2006)....
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Book•
27 Apr 200910,518 citations
Book•
01 Jan 1985
TL;DR: In this article, the authors present a model for estimating the effect size from a series of experiments using a fixed effect model and a general linear model, and combine these two models to estimate the effect magnitude.
Abstract: Preface. Introduction. Data Sets. Tests of Statistical Significance of Combined Results. Vote-Counting Methods. Estimation of a Single Effect Size: Parametric and Nonparametric Methods. Parametric Estimation of Effect Size from a Series of Experiments. Fitting Parametric Fixed Effect Models to Effect Sizes: Categorical Methods. Fitting Parametric Fixed Effect Models to Effect Sizes: General Linear Models. Random Effects Models for Effect Sizes. Multivariate Models for Effect Sizes. Combining Estimates of Correlation Coefficients. Diagnostic Procedures for Research Synthesis Models. Clustering Estimates of Effect Magnitude. Estimation of Effect Size When Not All Study Outcomes Are Observed. Meta-Analysis in the Physical and Biological Sciences. Appendix. References. Index.
9,769 citations
"The impact of parenting stress: a m..." refers background or methods in this paper
...Also known as Hedges’ g, this procedure is preferred when there are uneven sample sizes between groups as it corrects any overestimate associated with small sample sizes while having a minor effect on larger studies (Hedges and Olkin 1985)....
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...Method of Meta-analysis A random-effects model was assumed and methodology outlined by Hedges and colleagues (Hedges and Olkin 1985; Hedges and Vevea 1998) and Field and Gillett (2010) was followed....
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...The effect size d was calculated and used in the analysis as recommended by Hedges and Olkin (1985) as an unbiased estimate....
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TL;DR: In this paper, the authors present a model for estimating the effect size from a series of experiments using a fixed effect model and a general linear model, and combine these two models to estimate the effect magnitude.
Abstract: Preface. Introduction. Data Sets. Tests of Statistical Significance of Combined Results. Vote-Counting Methods. Estimation of a Single Effect Size: Parametric and Nonparametric Methods. Parametric Estimation of Effect Size from a Series of Experiments. Fitting Parametric Fixed Effect Models to Effect Sizes: Categorical Methods. Fitting Parametric Fixed Effect Models to Effect Sizes: General Linear Models. Random Effects Models for Effect Sizes. Multivariate Models for Effect Sizes. Combining Estimates of Correlation Coefficients. Diagnostic Procedures for Research Synthesis Models. Clustering Estimates of Effect Magnitude. Estimation of Effect Size When Not All Study Outcomes Are Observed. Meta-Analysis in the Physical and Biological Sciences. Appendix. References. Index.
7,063 citations