Shamash, E., & Martin, A. (2015)

Shamash & Martin Volume 5, Issue 1, Spring 2015 39

__________

Direct correspondence regarding this article to: Dr. Alyson Martin, Ed.D., Assistant Professor, Graduate Program in

Special Education, Graduate School of Education and Allied Professions, Canisus 219. Phone: 203-254-4000

x3024; email: [email protected] or to: Dr. Emily R. Shamash, Ed.D., Teachers College, Columbia University,

Department of Health and Behavior Studies, Programs in Intellectual Disability/Autism, Office of Special

Education, Box 223, 525 W. 120th Street, New York, NY 10027. Phone: 212-678-3453; email:

[email protected]

© 2015 Delta State University

Delta Journal of Education ISSN 2160-9179

Published by Delta State University

Predictors of Stress among Parents of Preschool Aged Children with Autism Spectrum Disorders

Emily Shamash

Teachers College, Columbia University

and

Alyson M. Martin

Fairfield University

Abstract

The present study examined factors that contributed to the perceived family stress and disability

stress of 72 parents of preschool aged children with Autism Spectrum Disorder (ASD). Parents

reported on their self-efficacy, belief in the efficacy of their child’s intervention approach,

perception of child progress, knowledge of autism, and five indicators of program satisfaction:

cultural sensitivity, access, appropriateness, participation in treatment, outcome and

demographic/treatment specific characteristics. The best set of predictors for perceived stress

included parental efficacy, belief in the efficacy of intervention, satisfaction with the access to

services, as well as level of satisfaction with those services, and whether or not parents were

participating in a live support group or using respite services. The best predictors for disability

stress were parental self-efficacy, program satisfaction (particularly the appropriateness of

services), and if parents did not participate in a live support group. The discussion considers the

implications for program development and implementation based on these findings.

Keywords: parental stress, Autism Spectrum Disorder, early intervention

mailto:[email protected]

mailto:[email protected]

Shamash & Martin Volume 5, Issue 1, Spring, 2015 40


Predictors of Stress among Parents of Preschool Aged Children

with Autism Spectrum Disorders

Parents of young children with autism spectrum disorder (ASD) are more involved than

ever in their children’s treatment and education. Part C of the Individuals with Disabilities

Education Act (IDEA) (2004), mandates that early intervention programs in the United States

must treat children in their “natural environment,” often including the parent or primary

caregiver as central to the treatment program (Jones, 2009). The requirement to provide services

in the natural environment has caused a shift in service delivery over the past decade. Parent

training and carryover of goals and strategies in the home and community settings have become

the norm for families with preschoolers diagnosed with ASD. These children typically qualify

for Applied Behavior Analysis (ABA), a treatment based on the principles of behavior that uses

various techniques and principles to bring about meaningful and positive changes in behavior.

Many states offer parent training for all children that receive ABA (e.g.,

https://www.health.ny.gov/community/infants_children/early_intervention/disorders/autism/ch4_

pt2.htm). The expectation is for parents to carry over both treatment goals and strategies into

everyday activities. In some instances, parents may even provide the ABA services directly to

their child. Accordingly, parents of children with ASD play an increasingly prominent role in

the education of their children (Granger, Rivieres-Pigeon, Sabourin, & Forget, 2010; Keen,

Couzens, Muspratt & Rodger, 2010; McConachie & Diggle, 2007).

While it is clear that parent involvement has become a key aspect of special education,

there are factors that can interfere with a parent’s ability to play an integral and effective role in

his or her child’s education. Parent stress can greatly affect the ability of parents to be

effectively involved in their child’s education (Solish & Perry, 2008).

Researchers have found that parents of children with ASD experience higher levels of

stress when compared with parents of children with other developmental disabilities due to their

unique set of challenges (Bouma & Schweitzer, 1990; Estes, Munson, Dawson, Koehler, Zhou &

Abbot, 2009; Hare, Pratt, Burton, Bromley, & Emerson, 2004). Specifically, mothers of children

with ASD report higher levels of depression, burnout and symptoms of anxiety (Baker-Ericzen,

Brookman-Frazee & Stahmer, 2005; McKinney & Peterson, 1987; Seymour, Wood, Giallo &

Jellet, 2013; Weiss, 2002). Furthermore, in a comparison of parents of children with autism and

parents of children with cystic fibrosis, parents of children with autism reported higher levels of

stress than parents of children with cystic fibroses; a chronic physical illness (Bouma &

Schweitzer, 1990). Importantly, researchers have found that stress proliferation (the tendency

for stressors to lead to additional stressors) contributes to depression among caregivers of

children with ASD (Benson & Karlof, 2009).

Studies documenting high levels of stress for parents of children with ASD are many

(Baker–Ericzen et al., 2005; Bouma & Schweitzer, 1990; Cassidy, McConkey, Truesdale-

Kennedy & Slevin, 2008; Estes et al., 2009; Hastings & Johnson, 2001; Stejin, Oerlemans, Aken,

Buitelaar & Rommelse, 2014; Walsh, Mulder & Tudor, 2013; Weiss, 2002; Weiss, MacMullin,

Viecili, & Lunsky, 2012). There remains a need, however, to understand the predictors of both

perceived family stress and disability stress in order to inform interventions for parents and

families coping with a child who has a disability. This study extends current research by

https://www.health.ny.gov/community/infants_children/early_intervention/disorders/autism/ch4_pt2.htm

https://www.health.ny.gov/community/infants_children/early_intervention/disorders/autism/ch4_pt2.htm



assessing both forms of stress to determine if significant differences emerge between perceived

family stress and disability stress. The potential outcomes may lead to further research questions

about how to assist families with coping and living with various forms of stress.

Few studies examine the relationship between parent stress and parent self-efficacy,

belief in intervention, knowledge of autism, and their perception of the child’s progress in the

program, especially when appraising progress related to early interventions in preschool children

with ASD. The present study examined the potential relationship between parent stress of

children diagnosed with ASD and the above variables in order to identify which aspects to parent

experiences in early intervention programs are most salient to their stress. For this study, there

are two categories of parental stress: perceived stress and disability stress. Perceived stress

relates to general life stresses, while disability stress concerns stress directly related to having a

child with a disability.

This study aimed to investigate two primary research questions. First, what are the inter-

correlations among the independent variables (parent’s degree of self-efficacy, belief in

intervention, autism knowledge, perception of their child’s progress and their satisfaction with

the program) and perceived Stress and disability Stress as measured by the Family Stress and

Coping Interview (FSCI) and the Perceived Stress Scale (PSS)? Second, among parents of

preschool aged children with ASD, what is the best set of predictors for disability Stress and

perceived Stress?

Method

Participants

Seventy-two parents of children (64 mothers and 8 fathers) ages 18 months to five years

with ASD (including diagnosis of autism, PDD-NOS and Rett Disorder), from New York,

Massachusetts, and Connecticut, participated in an online survey. Either a mother or father

completed each survey. Once the research team secured Institutional Review Board (IRB)

approval, a researcher recruited parents through preschool administrators and online support

groups and sent a link to the online survey. Sixty-four (88.9%) participants had one child

diagnosed with ASD spectrum disorder, seven (9.7%) had two children diagnosed with ASD and

one (1.4%) had three children diagnosed with ASD. Table 1 provides a complete list of

participant demographic characteristics.



Table 1. Demographic Characteristics of Parent Sample

f % f %

Gender

Female 64 88.9 Number of Children in Household

Male 8 8.3 One 24 33.3

Age Two 37 51.4

45 or > 6 8.3 Three 8 11.1

40 to 44 17 23.6 Four or > 3 4.2

35 to 39 28 38.9 Other Child with Disability

30 to 34 17 23.6 Yes 16 22.2

25 to 29 3 4.2 No 56 77.8

24 or < 1 1.4 Type of Disability

State Physical 1 1.4

New York 42 58.3 Visual 1 1.4

Connecticut 12 16.7 Learning 2 2.8

Massachusetts 18 18 Developmental Delay 9 12.5

Race/Ethnicity ADD/ADHD 2 2.8

White 61 84.7 Other 1 1.4

Black or African American 4 5.6 Number of Children with ASD

Asian 7 9.7 One 64 88.9

Marital Status Two 7 9.7

Married 68 94.4 Three 1 1.4

Single 3 4.2 Type of Support

Divorced 1 1.4 Live Group 26 36.1

Level of Education Online Group 32 44.4

High school or GED 9 12.5 Counseling 12 16.7

Associates/2 yr. Degree 10 13.9 Parent Training 40 55.6

Four year Degree 16 22.2 Respite 8 11.1

Masters Degree 33 45.8

Professional Degree (MD/JD) 4 5.6 Measures

Demographic Characteristics

A demographic questionnaire designed by the researcher provided relevant information

about each parent participant and his/her child. The demographic variables included in the main

analyses were number of children in household, diagnosis, current age of child, intervention

environment, type of parent support (including respite and support groups) and number of hours

of intervention per week. The remaining demographic information did not enter in to the

analysis due to the low variability among responses. Tables 2 and 3 provide a list of relevant

child characteristics.



f %

Intervention Environment

Center-based class 39 54.2

Home-based 10 13.9

Center-based 1:1 6 8.3

Home-based and center-based class 15 20.8

Home-based and center-based 1:1 2 2.8

Primary Intervention

ABA 44 61.1

Discrete trials 4 5.6

TEACCH 2 2.8

Floortime 6 8.3

RDI 12 16.7

PECS 4 5.6

Intervention Implemented by:

Teacher/Therapist 51 70.8

Teacher/Therapist and Parent 17 23.6

Parent 4 5.6

Private Pay

Yes 8 11.1

No 64 88.9

Hours /Week Intervention

10 or < 5 6.9

10 to 20 15 20.8

20 to 30 43 59.7

30 or > 9 12.5

Table 3. Child Treatment Characteristics

Parent Stress

The Perceived Stress Scale (PSS) (Cohen, Kamarck & Mermelstein, 1983) measures

perceived stress. Questions about general and overall stress in one’s life constitute the perceived

stress scale. The PSS is a 14 item self-report test that measures the degree to which situations in

an individual’s life are stressful. Overall, the items look at how unpredictable, uncontrollable,

and overloaded respondents find their lives. Additionally, at the items assess current levels of

experienced stress and ask participants about feelings and thoughts in the last month. Cohen et

al. (1983) documented adequate internal and test-retest reliability and validity for the PSS

instrument. Coefficient alpha reliability in the three samples Cohen et al. (1983) assessed were

.84, .85 and .86. For this study, the Cronbach alpha of the PSS was .87.

The Family Stress and Coping Interview (FSCI) measures disability stress (Nachshen,

Woodford & Minnes, 2003). Parents answered questions about stress particularly related to the

disability of the child such as difficult behaviors, and expectations for adult independence. The



FSCI consists of a 23 item quantitative and 5 qualitative items. Nachshen et al. (2003) found the

FSCI had adequate reliability and validity with Cronbach’s alpha equal to .89. The present study

only used the quantitative scale, and the Cronbach Alpha was .91.

Self-Efficacy

The Early Intervention Parenting Self-Efficacy Scale (EIPSES) is a 16-item Likert scale

used to measure the independent variable of self-efficacy. It assesses early intervention-related

competence beliefs of parents of children with disabilities (Guimond, Wilcox & Lamorey, 2008).

In the current study, the scale measured parent perceptions of self-efficacy. The EIPSES has a

Cronbach alpha) of .80. For this study, the Cronbach Alpha for the EIPSES was also .80.

Parent “Buy-In” for Intervention

The Belief in Intensive Behavioral Intervention (BIBI) scale measures the independent

variables of general parent belief in intervention and belief in intervention for the child for their

child (“My Child”). General belief in intervention, a subscale of the BIBI, measures general

beliefs about the current and primary method of intervention implemented with the parent’s

child. Belief in intervention for my child measures the degree to which the parent believes the

method is appropriate and beneficial for one’s child. This Likert scale is an adaptation of the

scale that Hastings and Johnson (2001) created and used by Solish and Perry (2008). The BIBI

scale has excellent internal consistency with a Cronbach alpha value of .88. For the present

study, the reliability (Cronbach Alpha) for the BIBI was .88. The reliability for the six item

general belief in intervention scale was .77 and the reliability for the seven-item belief in

intervention for my child scale was .84.

Autism Knowledge

The Autism Knowledge scale (Solish and Perry, 2008) measures autism knowledge by

asking questions about autism spectrum disorders. Questions relate to the core signs, symptoms,

traits, and play skills that most individuals with ASD present. This scale is reliable and valid

with a Cronbach alpha of .83 (Solish & Perry, 2008). The Autism Knowledge scale measures

the level of knowledge an individual about the symptoms, diagnosis and deficits of children

diagnosed with ASD. Using a true/false format, participants have three choices “true”, “false”,

or “don’t know” for each of the 10 statements.

Perception of Child Progress

The Perception of Child Progress (PCP) Likert scale (Solish &Perry, 2008) provides a

measure the perceptions of parents regarding the degree of improvement of his or her child’s

skills in social, play, academic, self-help, problem behaviors, and communication domains since

the start of their primary intervention. The scale is reliable and valid with a Cronbach alpha of

.86 (Solish & Perry, 2008). In the current study, the reliability (Cronbach Alpha) for the PCP

scale was .87.



Program Satisfaction

The Youth Services Survey for Families (YSSF) developed by Riley, Stromberg and

Clark (2005) measures the independent variables related to program satisfaction: Cultural

sensitivity, access, participation in treatment, appropriateness and outcome on a Likert scale.

This scale measures parent satisfaction with service delivery (Riley et al., 2005). The scale is

reliable with a Cronbach alpha of .94 (Riley et al., 2005). For this study, the reliability

(Cronbach Alpha) for the YSSF was .94.

Table 4 presents descriptive statistics for all study variables.

Table 4. Summary of Measures, Score Ranges, Items and Variables

Measure Score Range # of items Variable

Perceived Stress Scale

Perceived Stress 0-56 14 DV

Family Stress and Coping Interview

Disability Stress 0-51 17 DV

EI Parenting Self-Efficacy Scale

Self-Efficacy 16-112 16 IV

Belief in Intensive Behavioral Intervention Scale

General Belief in Intervention 0-24 6 IV

Belief in Intervention for My Child 0-28 7 IV

Autism Knowledge Scale

Autism Knowledge 0-10 10 IV

Perception of Child Progress Scale

Perception of Child Progress 5-25 5 IV

Youth Services Survey for Families Scale

Program Satisfaction

Cultural Sensitivity 5-25 5 IV

Access 3-15 3 IV

Participation in Treatment 3-15 3 IV

Appropriateness 10-50 10 IV

Outcome 7-35 7 IV

***IV- Independent Variable; DV- Dependent Variable

Subscales in italics

Procedure

Upon IRB approval and permission from three local special education preschool sites, 65

parents received the notice of the opportunity to participate in the study by paper memo. The

memo contained a link to the survey via www.surveymonkey.com that provided electronic

access to the survey. In addition, electronic letters including the survey link appeared in four

online groups’ websites for parents of children with ASD. Participants received a five-dollar gift

card upon completion of the survey. The survey took approximately 25 minutes to complete.



Results

For this study, Pearson correlations assessed the degree of relationship between variables

allowing for the identification of associations within the variable set, and the identification of

any potential demographic covariates that may exist. Tables 5 and 6 present the results of these

analyses. The independent variable of autism knowledge did not enter into the analysis due to

the extremely high scores (8-10) for 84.7% of the participants.

To establish the best set of predictors for perceived stress of parents of children with

ASD, those independent and demographic variables significantly correlated with perceived stress

entered into the hierarchical regression analysis. Tables 5 and 6 provide a summary of the

correlations among variables.

Measure 1 2 3 4 5 6 7 8 9 10 11

1.PS 1

2.DS .610** 1

3.SE -.438** -.407** 1

4.GBII -.184 -.185 .081 1

5.BIIMC -.248* -.166 .078 .715** 1

6. PCP -.057 -.145 .076 .541** .533** 1

7. CS -.150 -.220 .434** .066 .17 .043 1

8. AC -.240* -.279* .397** .216 .295* .081 .639** 1

9. PT -.111 .013 .316** .260* -.307** .218 .364** .288* 1

10. AP -.371** -.387** .372** .439** .501** .342** .661** .718** .474** 1

11. OU -.332** -.324** .308** -.584** .638** .519** .448** .485** .451** .838** 1

Table 5. Correlation Matrix for Dependent and Independent Variables:

Note: Dependent variables in bold text

* = p < .05; ** = p < .01

KEY:

1. PS = PERCEIVED STRESS

2. DS = DISABILITY STRESS 3. SE = SELF-EFFICACY

4. GBII = GENERAL BELIEF IN INTERVENTION

5. BIIMC = BELIEF IN INTERVENTION FOR MY CHILD

6. PCP = PERCEPTION OF CHILD PROGRESS

7. CS = CULTURAL SENSITIVITY

8. AC = ACCESS

9. PT = PARTICIPATION IN TREATMENT

10. AP = APPROPRIATENESS

11. OU = OUTCOME



Measure 1 2 3 4 5 6 7 8 9 10 11 12 13

1.PS 1

2. DS .610** 1

3. NCH .059 .012 1

4.DIA .039 .118 .013 1

5. CAG .025 .003 -.077 .108 1

6. AGD -.025 -.102 -.019 .022 .498** 1

7. IEN -.034 .034 -.031 .024 -.065 -.028 1

8. SGL .236* .293* .146 .07 .203 .012 .082 1

9. SGO .231 .206 -.015 .006 .094 .064 .052 .091 1

10. COU .105 .091 -.077 .047 -.059 -.113 -.111 -.026 -.250* 1

11. PT -.011 .144 -.124 .207 -.135 .064 .036 .091 -.212 -.125 1

12. RESP .291* .149 .085 .065 -.088 -.051 .021 .286* -.049 -.04 .049 1

13. HRI -.103 -.134 -.019 .173 .087 -.095 .023 .074 .127 .008 .137 -.068 1

Table 6. Correlation Matrix for Demographic/ Characteristic Variables and Dependent Variables:

Note: Dependent variables bolded

* = p < .05; ** = p < .01

KEY:

1. PS = PERCEIVED STRESS

2. DS = DISABILITY STRESS 3. NCH = NUMBER CHILDREN IN HOUSEHOLD

4. DIA = DIAGNOSIS

5. CAG = CHILD AGE

6. AGD = AGE DIAGNOSED

7. IE = INTERVENTION ENVIRONMENT

8. SGL = SUPPORT GROUP LIVE

9. SGO = SUPPORT GROUP ONLINE

10. COU = COUNSELING

11. PT = PARENT TRAINING

12. RESP = RESPITE

13. HRI = HOURS OF INTERVENTION

Results of the hierarchical multiple regression for Perceived Stress indicated that the full

model accounted for 33.8% of the variance (r² = .338; p < .001), with the variable support group

live alone accounting for 5.6% of the variance (r²∆ = .056; p < .05), respite accounting for 5.4%

of the variance (r²∆ = .054; p <.05), self-efficacy accounting for 15.8% of the variance (r²∆ =

.158; p < .001), belief in intervention for my child accounting for 3.7% of the variance (r²∆ =

.037; p <. 001), appropriateness accounting for 1.3% of the variance (r²∆ = .013; p < .001), and

access accounting for 2.1% (r²∆ = .021; p < .001) of the variance. See Table 7 for a summary of

the hierarchical regression analysis for perceived stress.



Source r2 r

2Δ SS df MS F

Support Group Live 0.056 256.526 1 256.526 4.113**

Support Group Live Respite 0.11 0.054 508.417 2 254.209 4.264**

Support Group Live

Respite Self-Efficacy 0.268 0.158 1236.391 3 412.13 8.278***

Support Group Live

Respite Self-Efficacy

BII for My Child 0.305 0.037 1407.859 4 351.965 7.337***

Support Group Live


BII for My Child Appropriateness 0.317 0.013 1466.735 5 293.347 6.136***

Support Group Live


BII for My Child Appropriateness

Access 0.338 0.021 1564.043 6 260.674 5.541***

* p<.10** p<.05, ***p<.001

Table 7. Hierarchical Regression for Perceived Stress

Next, we conducted a hierarchical regression analysis of the independent variables

significantly correlated with disability stress: Support group live, self-efficacy, appropriateness,

access, and outcome. The analysis indicated that the variables making up the full model

included support group live, self-efficacy and appropriateness. Results of the hierarchical

multiple regression indicated that accounted for variance was 27.7% (r² = .277; p < .01) in the

full model with support group live accounting for 8.6% (r²∆ = .086; p < .05), self-efficacy

accounting for 14.1% (r²∆ = .141; p < .001) and appropriateness accounting for 4.9% (r²∆ =

.049; p < .001). See Table 8 for a summary of the hierarchical regression analysis for disability

stress.

Source r2 r

2Δ SS df MS F

Support Group Live 0.086 757.782 1 757.782 6.576**

Support Group Live

Self-Efficacy 0.227 0.141 2005.379 2 1002.689 10.146***

Support Group Live

Self-Efficacy

Appropriateness 0.277 0.049 2441.629 3 813.879 8.670***

* p<.10** p<.05, ***p<.001

Table 8. Hierarchical Regression for Disability Stress



Discussion

The results of this study indicated that the best set of predictors of perceived stress were

whether or not parents participated in a live support group or used respite care, parent self-

efficacy, parent belief in the efficacy of the primary intervention approach used with their child,

satisfaction with the appropriateness of treatment services, as well as satisfaction with access to

treatment services. The results of this study also indicated that the best predictors of Disability

Stress were participation in a live support group, parent self-efficacy and satisfaction with the

appropriateness of treatment services.

Interpretation of results

The purpose of this study was to examine relationships and to determine the best

predictors of perceived stress and disability stress for parents of children with ASD. The

Perceived Stress Scale measured perceived stress and the Family Stress and Coping Inventory

measured disability stress. The independent variables, including self-efficacy, general belief in

intervention, belief in intervention for my child, perception of child progress, program

satisfaction, cultural sensitivity, access, appropriateness, participation in treatment and outcome,

served as potential predictors of perceived stress and disability stress. The number of children in

household, diagnosis of child, child age, age when diagnosed, intervention environment, support

group live, support group online, counseling, parent training, respite and number of hours of

intervention, were also examined as possible predictors.

Preliminary analyses determined significant correlations between a number of the

independent variables and perceived stress. The results indicated a significant positive

correlation between support group live participation and perceived stress, indicating that higher

levels of perceived stress associated with participation at live support groups. Results indicated a

significant positive correlation (r = .291; p < .05) between respite and perceived stress, indicating

that higher levels of perceived stress accompanied the use of respite services. A significant

negative correlation (r = - .248; p < .05) between perceived stress and belief in intervention for

my child, indicated that higher levels of belief in intervention for one’s child related to lower

levels of perceived stress. The significant negative correlation between self-efficacy and

perceived stress (r = - .438; p < .01) suggested that lower levels of perceived stress correlated

with higher levels of self-efficacy. Access (r = - .240; p < .05), appropriateness (r = - .371; p <

.01) and outcome (r = - .371; p < .01) also significantly negatively correlated with perceived

stress, indicating that lower levels of satisfaction regarding access, appropriateness and outcome

of services, all associated with higher levels of perceived stress. Furthermore, the results

indicated a significant positive correlation between support group live and disability stress (r =

.293; p < .05), suggesting that higher levels of disability stress accompanied the attending of a

live support group. In addition, a significant negative correlation between disability stress and

self-efficacy (r = - .407; p < .01) indicated that lower levels of disability stress correlated with

higher levels of self-efficacy. Access (r = -.279; p < .05), appropriateness (r = - .387; p < .01)

and outcome (r = - .324; p < .01) significantly negatively correlated with Disability Stress,

suggesting that lower levels of disability stress was a factor leading to higher levels of

satisfaction for access, appropriateness, and outcome of services. Based on the correlational

analysis, all of the independent variables significantly correlated with the dependent variables



entered into a hierarchical multiple regression to determine the best set of predictors of perceived

stress and disability stress.

The results of the hierarchical regression indicated that the variables of support group

live; respite, self-efficacy, and belief in intervention for my child, appropriateness and access

were the best set of predictors for perceived stress and accounted for 33.8% of the variance.

These results indicated that attendance at live support groups and the use of respite services were

associated with higher perceived stress levels. Furthermore, the lower the level of perceived

stress reported, the greater the levels of self-efficacy, belief in intervention applied with one’s

child, satisfaction with the appropriateness of and access to current treatment services, and

satisfaction with access to treatment services experienced by the participants. A second multiple

regression analysis indicated that support group live, self-efficacy and appropriateness were the

best set of predictors for disability stress and accounted for 27.7% of the variance. These results

indicated an association between attendance at live support groups and higher levels of disability

stress levels. When lower levels of disability stress occurred, higher levels of self-efficacy and

programming appropriateness also occurred.

Implications for early intervention services to families

The results of this study provide a preliminary framework for additional research on

stress of parents of preschool aged children with ASD and social support, respite, self-efficacy,

parent belief in intervention, and satisfaction of appropriateness of services and access to

services.

Self-Efficacy

The most important finding was that parent self-efficacy was the most significant

predictor of both general perceived stress and stress related to child disability. The variable of

self-efficacy examines parent competence and belief in one’s self as being able to influence

positive change in his/her child. While strengthening levels of self-efficacy may be possible,

another option is for parents to change their level of program satisfaction by switching agencies

that provide different treatment, schools and/or schedules. Self-efficacy may be more

challenging to change than external factors. Parents may not believe they can make a change in

their competence and ability to influence outcomes in their child. This can be difficult to address

since it is an internal experience. However, finding new service providers is easier to control,

change and act on since these are external changes for the parent. This finding can be beneficial

to early intervention and preschool services for children with ASD on a number of levels. First,

self-efficacy information on a case-by-case basis can be valuable to service coordinators as they

create the Individualized Family Service Plan (IFSP) for families entering or continuing in early

intervention programs and for preschools teams as they create the Individualized Education Plan

(IEP) with families of children with ASD. Consideration of parental interventions such as parent

training support groups and counseling, all geared towards meeting parents’ individualized

needs, is recommended. In addition, direct service providers can provide customized levels of

support based on parent self-efficacy reports. Coleman and Karakker (1998) suggest that in

order for parents to increase levels of self-efficacy, they must be able to alleviate stress for their

child, set age-appropriate limits, have confidence in their own abilities to take action, believe



their child will respond to their actions, and believe their community will be supportive of their

efforts. In addition, researchers have found that parent training with particular focus on how to

imbed strategies that target behavioral and developmental skills relates to the self-efficacy for

parents of children with developmental disabilities and ASD (Hastings & Symes, 2002; Keen et

al., 2010). In family-centered early intervention programs, insight into parent self-efficacy levels

can lead administrators, teachers, and related service providers to provide parents with

appropriate supports rather than a one-size fits all approach to family intervention. It can allow

them to achieve best practice guidelines for family-centered intervention.

Parent “Buy-In” and Program Satisfaction

The findings in the current study suggest that further investigation into the area of parent

belief in intervention would be worthwhile. By understanding the concept of parent belief in the

particular treatment method used with ASD, providers can gain insight into parents’ experiences

and their commitment to the carryover of therapeutic methods with their child.

Paying particular attention to parent satisfaction of appropriateness of services as well as

satisfaction with access to services can be a guide to reach quality expectations for early

intervention and preschool education for families of children with ASD, and to achieve a greater

understanding of parent experiences. By collecting and reviewing parent program satisfaction,

program designers and evaluators can better recognize what to emphasize when considering

parent goals, needs and expectations in early intervention and preschool programs. When

parents express dissatisfaction with treatment and services, it is often difficult to pinpoint where

the dissatisfaction lies. This type of survey can help to customized programs and alter them in

particular areas for individual families.

Parent Supports

The results of this study may aid in the development of programs for special education

teacher programs and related service providers such as speech, occupational and physical

therapists and social workers. While current special education teacher preparation programs

address family needs, the main emphasis tends to be on direct child services. Early intervention

is a family-based intervention. It could be beneficial for these programs to focus on teaching

special educators how to address parent understanding and commitment to treatment methods,

increase self-efficacy, and be sensitive towards parent needs, desires and experiences with

particular emphasis on the needs of families of preschoolers with ASD.

It is crucial to investigate further the specific type of supports used by parents (Hare et

al., 2004). Participation in support groups and the use of respite services may influence parent

experiences in early intervention and preschool programs (Harper, Dyches, Harper, Roper, &

South, 2013). The particular aspects related to support groups need greater examination to better

the design and implementation of programs for families o children with ASD. Programs should

further examine the focus on parent grouping by age or child characteristics, frequency, and

duration, as well as professional facilitation among these types of groups. It is important to

consider whether the focus of these groups is sharing information among parents or facilitating

parent-driven solutions to the stressors of having a child with ASD. They are important aspects



to consider. The association of parent perceived stress and respite services is one that needs

increased attention. Programs should examine the frequency and duration of intervention

services based on family characteristics to assure that family needs to assure the meeting of

family needs.

Limitations

There were a few limitations to this study. First, since this was an online study, only

parents with computer access were eligible for this study. As a result, parents with computer

access could participate in the study, while those without computer access could not. Secondly,

parent self-reports formed the basis for this study--there were no measures of actual child

functioning, only parental perceptions of function. This study asked parents to indicate the

specific diagnosis of their child with ASD and the type of professional who diagnosed the child,

but there was no formal verification of each diagnosis. It is impossible to know whether actual

child functioning in this sample related to parent stress. Third, this study focused on a specific

group of possible predictors (self-efficacy, belief in intervention, autism knowledge, perception

of child progress and program satisfaction: cultural sensitivity, access, participation in treatment,

appropriateness and outcome) of parent stress; it did not measure other internal family or

external factors that may contribute to stress in parents of preschool aged children with ASD.

Other factors that may be worthy of investigation are financial and health stressors within the

family and challenging child behaviors.

Implications for Future Research

The findings in the current study could have implications for ensuring that early

intervention and preschool services are family-aligned, as well as strongly family-centered. It

appears that participation in live support groups and the use of respite services as well as levels

of self-efficacy, belief in the efficacy of intervention for one’s child, satisfaction with

appropriateness of services and access to services, have strong implications for perceived stress

for parents of preschool aged children with ASD. The present study adds to the body of research

on parent stress and ASD, yet raises new questions in regard to the connection between parent

stress and how it relates to parent belief or ‘buy-in’ to treatment methods, particularly in

relationship to child disability. Both parent belief in the efficacy of the intervention approach

and parent satisfaction of child and parent services with particular focus on appropriateness and

access to services, are currently under-researched areas. The relationships among them indicated

in this study provide initial findings to investigate further in additional populations and locations.

Considerable research exists regarding stress in parents of children with ASD. However,

the various predictors of parent stress and how parents view the services they receive warrant

further investigation across intervention programs. The current body of research emphasizes the

relationship between stress and child variables such as problem behavior and severity of ASD

(Osborne & Reed, 2009; Walsh et al., 2013; Weiss et al., 2012). However, in regards to early

intervention and preschool programs for children with ASD, very few studies examined parent

attitudes, beliefs, and specific aspects of the parent’s experiences as predictors of stress. In

addition, the type of stress, whether general or related to disability, is information that can be

useful for early intervention and preschool program development. Finally, while researchers



have found that parent self-efficacy is lower for parents who have high levels of stress, program

intervention does not typically provide customized parent training based on evidence based

parent report.

We recommend conducting additional research on parent supports, parent self-efficacy,

belief in the efficacy of the primary intervention approach used, and program satisfaction in

ethnically and socio-economically diverse communities. This will help to gather more

information on the needs of various populations. Continuous evaluation of parent experiences

specifically related to parent competence, commitment to current intervention, and satisfaction

should be conducted upon entrance, during program implementation, and at discharge. This may

allow for changes in program delivery on a case-by-case basis instead of adherence to a general

prescription for all families based on a child’s diagnosis. Administrators and service providers

can gear their practice to treat families depending on their needs. Parents can also identify and

understand why they are or are not receiving particular services. This may help to alleviate

parent confusion and comparison with other families in treatment programs.

Furthermore, it would be beneficial to add a qualitative analysis to the current research.

This would provide the opportunity for parents to elaborate more on their experiences and

feelings, and be able to identify and emphasize stressors not mentioned in the current study.

While the design of the self-efficacy scale and disability stress scale is for parents in early

intervention programs, the parent satisfaction scale was a scale measuring satisfaction of services

in general. A qualitative analysis could help identify specific issues related to early intervention

program satisfaction that were not included in this survey.

Based on the findings that participation in live support groups associates with higher

stress levels, it is crucial that early intervention and preschool programs take a closer look at how

they facilitate support groups and if the goal of providing a supportive environment for parents is

being met. The use of respite services should be investigated in terms of which parents are

offered this type of support and which components of these programs are utilized by parents. By

conducting this type of research, program developers can begin to understand parent supports at

a more detailed level, which can lead to providing the best social supports possible for parents of

children with ASD.

Based on the current study, it is clear that parent competence, belief in the efficacy of the

intervention, program satisfaction with specific emphasis on the appropriateness of services, and

access to services can lead to increasing the quality of early intervention and preschool services

for children with ASD. However, the questions of who will recognize the need for customized

family intervention, moving away from a one size fits all treatment program for children with

ASD and when we will begin to recognize parent influence on the effectiveness of both parent

and child outcomes and experiences, remain unanswered.

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Shamash, E., & Martin, A. (2015)