Journal of Autism and Developmental Disorders (2020) 50:4176–4182

https://doi.org/10.1007/s10803-020-04455-x

BRIEF REPORT

Brief Report: Stress and Perceived Social Support in Parents

of Children with ASD
Kateryna Drogomyretska1 · Robert Fox2 · Dylan Colbert1

Published online: 21 March 2020

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Previous literature has indicated that perceptions of social support (PSS) may be an important predictor of parental stress
levels, particularly for parents of children diagnosed with autism spectrum disorders (ASD). The current study implemented
structural equation modelling to further investigate the relationship between PSS and parental stress in a sample of 454
parents of children diagnosed with ASD. Results indicate that PSS derived from friends was the most important factor in
protecting against stress, with PSS from both a significant other and family appearing to be less pervasive in this regard. In
addition, the importance of PSS was further underlined by the finding that it remained a significant predictor of parental
stress after controlling for the absence/presence of professional support.

Keywords  Autism spectrum disorder · Social support · Stress · Structural equation modeling · Parental stress · Professional
support

Introduction 1984; Gottlieb 2007; Neece et al. 2012; Sameroff 2009).

While the exact mechanism underpinning this relationship
One of the most common disorders currently being diag- has been challenged (see Totsika et al. 2013), elevated paren-
nosed in children is Autistic Spectrum Disorder (ASD), tal stress levels can encourage poorer adaptive functioning
with estimates of prevalence ranging from .7 to 3.3% across (Cuzzocrea et al. 2016; Hall and Graff 2011, 2012) and thus
the United States and Europe (Baio 2012; Baio et al. 2018; may serve to exacerbate core and comorbid symptomology
Christensen et al. 2016; Irish Department of Health 2018; associated with ASD.
Kim et al. 2011; Waugh 2017; Zablotsky et al. 2015). Due to Social support has been found to be an important pro-
the unique developmental, behavioural and social challenges tective factor against parental stress and its entailed issues
associated with ASD, parents of diagnosed children tend to when raising neurotypical children (Farel and Hooper 1998;
report higher levels of stress than parents of neurotypical Koeske and Koeske 1990; Saisto et al. 2008) and children
children (Barroso et al. 2018; Estes et al. 2009; Johnson with additional needs, such as autism (Halstead et al. 2018;
et al. 2009; Lee et al. 2017; Montes and Halterman 2007; Handley and Chassin 2008; Onyedibe et al. 2018; Sharpley
Phetrasuwan and Shandor Miles 2009; Rivard et al. 2014) et al. 1997; Ullrich et al. 2015). Numerous analyses (e.g.
and children with other intellectual or developmental disor- Boyd 2002; Gouin et al. 2016; Herman and Thompson 1995)
ders (Griffith et al. 2010; Gupta 2007; Schieve et al. 2007). have indicated that informal social support (i.e. from family,
Parental stress and child developmental/behavioural issues friends etc.) may be more effective than formal professional
have been proposed to interact in a bidirectional or transac- support in protecting against elevated levels of parental
tional manner across childhood (Baker et al. 2003; Belsky stress. In addition, of great import to the current discussion
is the recurrent finding that subjective, rather than objec-
* Dylan Colbert tive, evaluations of social support (i.e. perceived social sup-
[email protected] port vs. actual social support) may exhibit superior validity
with regard to predicting psychological wellbeing (Barrera
1
Department of Psychology, Dublin Business School, 73/83 1981; Brandt and Weinert 1981; Ke et al. 2010; Sarason
South Georges Street, Dublin 2, Ireland
et al. 1985; Siedlecki et al. 2014; Solomon et al. 1987; Wil-
2
Department of Psychology, Maynooth University, Maynooth, cox 1981).
Co. Kildare, Ireland

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Due to the role that perceived social support may exert physical problem subscale was below satisfactory; however,
in diminishing parental stress (and its entailed impact upon this is likely to be underestimated due to the Cronbach’s
child functioning), the importance of further investigating alpha statistic favouring measures with a larger number of
the dynamics of this relationship, particularly for parents items (Graham 2006).
of children with additional needs, cannot be understated.
Therefore, the current analysis will employ structural equa- Multidimensional Scale of Perceived Social Support
tion modelling (SEM) to examine the relationship between (MSPSS; Zimet et al. 1988)
perceived social support and parental stress in a sample
of parents with children diagnosed with ASD, while also The MSPSS is a 12-item Likert-style questionnaire which
investigating the role of a number of relevant covariates (i.e. aims to measure an individual’s perception of support from
presence of professional support, age and gender of child, Family (3 items), Friends (3 items) and a Significant Other
number of children with ASD in household, ASD severity (3 items). All questionnaire items present participants with a
level) in influencing this relationship. statement related to self-rated levels of support, commitment
and reliability felt from each of these three sources (e.g. “My
family really tries to help me”) alongside a 7-item scale of
Method agreement ranging from 1 (very strongly disagree) to 7 (very
strongly agree). Previous research has demonstrated satis-
Participants factory internal consistency for the MSPSS (Stewart et al.
2014). Similarly, the Cronbach’s alpha in the current study
The current sample consisted of 454 adults, all of whom had was excellent (αc = .94), as were the different domains (sig-
at least one child diagnosed with ASD. Participants were nificant other = .94; family = .95; friends = .94).
asked only to participate if their child was under 18, was
living at home and had been clinically diagnosed with ASD. Procedure

Materials Participants were sourced through advertisement on social

media support groups for parents of children with ASD liv-
Autism Parenting Stress Index (APSI; Silva and Schalock ing in Ireland. Upon consenting to participate, participants
2012) were required to complete a small number of demographic
questions (i.e. age and gender of child, number of children
The APSI is a 13-item Likert-style questionnaire designed with ASD, parent-rated diagnosis severity and whether pro-
to measure the impact of specific core and co-morbid symp- fessional support is being received), followed by the APSI
toms associated with ASD on the stress levels of a parent. and MSPSS questionnaires. Overall administration time was
While the APSI was originally conceived as a three-factor approximately 10 min, with all questionnaires being com-
model, consisting of stress caused by core autism behav- pleted via an online link.
iours (e.g. social development issues, communication skills,
social acceptance), co-morbid behaviours (e.g. self-injuri- Analytical Plan
ous behaviours, aggressive behaviour, difficulty making
transitions) and co-morbid physical problems (e.g. sleep, Structural equation modelling (SEM) was used to examine
toilet training, dietary issues), exploratory factor analysis the relationship between perceived social support (’signifi-
conducted by Silva and Schalock (2012) indicated a four- cant other’, ‘family’, and’friends’) and parental stress (rela-
factor model, with co-morbid physical problems being sub- tive to ‘core autism behaviours’, ‘co-morbid behaviours’,
divided in two separate factors (bowel/toilet training issues and ‘co-morbid physical issues’). SEM is advantageous as
and sleep/dietary issues) adequately represented the struc- it attempts to parse out measurement error, thus providing
ture. All items require the parent to rate the degree of stress more accurate parameter estimates (Bollen 1989). Following
that they experience as a result of such issues on a 5-point the guidelines set forth by Anderson and Gerbing (1988), it
scale ranging from 0 (not stressful) to 5 (so stressful some- was first necessary to establish the validity of the measure-
times we feel we can’t cope). Initial validation of the APSI ments models using a series of confirmatory factor analyses
found a satisfactory internal consistency (Cronbach’s alpha) (CFA), before assessing the structural model.
except for the co-morbid physical problems factor (αc = .67; Data was analysed using Mplus 7.4 (Muthén and
Silva and Schalock 2012). In the current study, the internal Muthén 2012) and the models were estimated using
consistency of the global scale was .85 (core autism behav- the robust maximum likelihood (MLR) estimator. In
iour = .78; co-morbid behaviours = .80; co-morbid physical order to determine the adequacy of the measurement
problems = .65). The internal reliability of the co-morbid and structural models, multiple goodness-of-fit indices

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4178 Journal of Autism and Developmental Disorders (2020) 50:4176–4182

(Hu and Bentler 1999) were assessed. A non-significant Results

χ2 indicates excellent model fit, however, this test is
heavily influenced by sample size therefore a signifi- Descriptive Statistics
cant result (p < .05) should not lead to the rejection of
a model (Tanaka 1987). Comparative Fit Index (CFI; Table 1 summarises the descriptive statistics for the con-
Bentler 1990) and Tucker-Lewis Index (TLI; Tucker tinuous variables of the model (i.e. mean, median, standard
and Lewis 1973) values > .90 are indicative of adequate deviation [SD], and range).
model fit and values > .95 indicate excellent model fit.
Additionally, Root Mean Square Error of Approximation Measurement Model: Multidimensional Scale
(RMSEA; Steiger 1990) and Standardised Root-Mean- of Perceived Social Support (MSPSS)
Square Residual (SRMR; Jöreskog and Sörbom 1981)
values < .08 and < .05 suggest adequate and excellent The three-factor model (‘significant other’, ‘family’,
model fit, respectively. A number of covariates were also and ‘friends’) of the MSPSS provided an excellent fit to
included: child’s age, child’s sex, parent-rated severity the data (χ2[51] = 148.27, p < .001; CFI = .97; TLI = .96;
of ASD (mild, moderate, or severe), currently receiving RMSEA = .07 [90% CI .06, .08]; SRMR = .03). Inter-factor
professional support, and having > 1 child with ASD. correlations ranged from .49 to .70, and the standardised
The proportion of missing data for all of the individual factor loadings for all items were statistically significant
study variables ranged from 0 to 8.8%, with a mean of (p < .001), ranging from .85 to .93.
3.6%. Missing data were found to be missing completely
at random (MCAR), as indicated by Little’s MCAR test Measurement Model: Autism Parenting Stress Index
(χ2 [1019, N = 454] = 1082.65, p = .081). Missing values (APSI)
were handled using the robust full information maximum
likelihood procedure, as this allows parameters to be esti- The APSI has been conceptualised as a three-factor
mated using all information available. model, however, was also found to represent a four-fac-
tor structure. Therefore, both the three- and four-factor

Table 1  Sample characteristics Sample characteristic % (n) Mean (95% CI) Median SD Range
and descriptive statistics of the
current study Social support
 Significant other 17.32 (16.56/18.08) 18.00 7.79 4–28
 Family 14.64 (13.89/15.40) 14.00 7.79 4–28
 Friends 13.19 (12.50/13.87) 12.50 7.12 4–28
ASD parental stress
 Core autism behaviours 11.47 (11.02/11.92) 11.00 4.75 0–25
 Co-morbid behaviours 7.40 (6.99/7.80) 7.00 4.31 0–20
 Co-morbid physical issues 6.40 (6.16/6.79) 6.00 4.15 0–20
Child’s age 8.17 (7.78/8.57) 7.00 4.30 2–29
Child’s sex
 Male 75.7 (337)
 Female 24.3 (108)
ASD severity
 Mild 41.0 (186)
 Moderate 43.2 (196)
 Severe 12.6 (57)
Professional support
 No 43.6 (198)
 Yes 55.7 (253)
Number of children with ASD
 1 81.7 (371)
 > 1 18.3 (83)

95% CI 95% confidence intervals, SD standard deviation

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models were evaluated. It was found that both the three- relative to ‘co-morbid behaviours’, and 33% of variance rela-
factor (χ 2[62] = 345.13, p < .001; CFI = .83; TLI = .79; tive to ‘co-morbid physical issues’.
RMSEA = .10 [90% CI .09, .11]; SRMR = .10) and four- While controlling for covariates, perceived social sup-
factor (χ 2[59] = 339.85, p < .001; CFI = .84; TLI = .78; port from friends was inversely associated with parental
RMSEA = .10 [90% CI .09, .11]; SRMR = .10) solutions stress relative to all three latent factors: i.e. ‘core autism
did not adequately represent the data. After inspection of behaviours’ (β = − .22, p = .002); ‘co-morbid behaviours’
the modification indices, it was found that this model misfit (β = − .15, p = .024); ‘co-morbid physical issues’ (β = − .19,
was largely due to a substantial residual covariance between p = .025). Moreover, perceived social support from an indi-
item 13 (“Concern for the future of your child living inde- vidual’s significant other was also inversely associated
pendently”) and item 12 (“Concern for the future of your with parental stress relative to ‘co-morbid physical issues’
child being accepted by others”). This residual covariance (β = − .22, p = .014). For all parameter estimates see Table 2.
was believed to be substantively meaningful and thus, the
model was re-specified to include the residual covariance
between the two items. Due to the similar model fit between
the three- and four-factor models, the model was re-eval- Discussion
uated as a three-factor model (‘core autism behaviours’,
‘co-morbid behaviours’, and ‘co-morbid physical issues’) The current analysis reports a significant association
on the grounds of parsimony. The majority of model fit between perceived social support and levels of parental
indices indicated adequate fit to the data (χ2[61] = 222.50, stress for those raising children diagnosed with ASD. Spe-
p < .001; CFI = .91; TLI = .88; RMSEA = .08 [90% CI .07, cifically, it appears that the most pervasive source of support
.09]; SRMR = .06). Inter-factor correlations ranged from .66 may be derived from friends, as there was an inverse asso-
to .73, and the standardised factor loadings for all items were ciation between perceived friend support and all three APSI
statistically significant (p < .001), ranging from .48 to .86. factors (i.e. core autism behaviours, co-morbid behaviours,
co-morbid physical issues). In contrast, perceived support
Structural Model: Perceived Social Support from a significant other was only inversely associated with
and Parental Stress one of these three factors (co-morbid physical issues), while
perceived family support was not associated with any APSI
The SEM model of perceived social support and parental factor. The current results therefore strongly emphasise the
stress provided satisfactory fit to the data (χ2[369] = 765.38, relative importance of perceived friend support, which is
p < .001; CFI = .94; TLI = .93; RMSEA = .05 [90% CI .05, of particular interest due to the fact that much of the previ-
.06]; SRMR = .06) and explained 27% of variance in parental ous research in this field tends to centre upon the influence
stress relative to ‘core autism behaviours’, 13% of variance of spousal/partner and/or family as the primary sources of

Table 2  Standardised and unstandardised parameter estimates for the effects of perceived social support and covariates on parental stress (APSI)
Core autism behaviours Co-morbid behaviours Co-morbid physical issues
B (SE) β (SE) B (SE) β (SE) B (SE) β (SE)

Perceived social support

 Significant other − .06 (.04) − .13 (.09) − .06 (.05) − .09 (.08) − .12* (.05) − .22 (.09)
 Family .01 (.04) .03 (.10) − .02 (.06) − .03 (.09) .05 (.05) .11 (.10)
 Friends − .12** (.04) − .22 (.07) − .12* (.05) − .15 (.07) − .11* (.05) − .19 (.08)
Covariates
 Child’s age − .01 (.01) − .04 (.06) − .01 (.02) − .04 (.05) − .04** (.01) − .19 (.07)
 Child’s ­sexa − .02 (.10) − .01 (.05) − .22 (.14) .00 (.05) .07 (.13) .03 (.06)
 ASD severity .49*** (.08) .40 (.06) .36*** (.10) .21 (.06) .53*** (.09) .37 (.06)
 Professional ­supportb − .14 (.09) − .08 (.05) − .26* (.12) − .11 (.05) − .27* (.11) − .14 (.06)
 > 1 child with A­ SDc .21 (.13) .10 (.06) .40* (.17) .13 (.06) .34* (.15) .14 (.06)

Statistical significance: *p < .05; **p < .01; ***p < .001

B unstandardised estimates, β standardised estimates, SE standard error
a
 Sex coded as 0 = male, 1 = female
b
 Professional support coded as 0 = not currently receiving professional support, 1 = currently receiving professional support
c
 Number of children with ASD coded as 0 = one child with ASD, 1 = more than one child with ASD

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4180 Journal of Autism and Developmental Disorders (2020) 50:4176–4182

social support (e.g. Ekas et al. 2010; Goedeke et al. 2019; negative implications for the psychological wellbeing of par-
Herman and Thompson 1995) (Fig. 1). ents (Konstantareas and Homatidis 1989; Smith et al. 2012).
Upon analysis of covariates, ASD severity was found to There are several limitations associated with the above
significantly predict parental stress derived from all three findings that should be acknowledged. First, the CFA results
factors. Stress derived from co-morbid behaviours was revealed concerns regarding the validity of the APSI, largely
associated with raising more than one child with ASD, and due to a residual covariance between items 13 and 12. Future
negatively associated with receiving professional support. studies should aim to address this issue, perhaps by removal
Stress derived from co-morbid physical issues was nega- or rephrasing of the item(s), to further enhance the psycho-
tively associated with the presence of professional support metric attributes of this measure. Second, the current study
and child age, the latter of which may be explained by the was cross-sectional in nature, thus precluding any causal
relative pertinence of toilet training issues for younger chil- inferences regarding the temporal ordering of the model
dren. This APSI factor was also positively associated with assessed (i.e. poor social support leads to increased parental
number of ASD children being raised. stress). Future studies may investigate the role of parental
Further underlining the relative importance of perceptions factors, such as general psychological wellbeing, personal-
of social support (Barrera 1981; Brandt and Weinert 1981; ity variables and gender, as well as the role non-specific
Sarason et al. 1985; Solomon et al. 1987; Wilcox 1981), stressors (e.g. financial stress, relationship satisfaction).
the current analysis found that perceived social support Third, only self-report measures were used for the purposes
remained a consistent significant predictor of parental stress, of this study. Despite the previously discussed advantages of
despite the presence of professional support. In addition, it is administering subjective measures in this domain, it could
also important to note that professional support was not pre- be argued that the administration of both subjective and
dictive of reduced stress relating to core autism behaviours. objective indices of parental stress (such as biomarkers),
In terms of stress levels, Silva and Schalock (2012) report autism severity and professional support (such as detailed
that these are the two areas in which ASD parents tend to data on service access) may have provided a slightly more
differ most significantly from parents of both neurotypical nuanced treatment of the research question.
children and children with other developmental disabilities. In conclusion, the current investigations harbours impli-
Therefore, the finding that receipt of professional support cations of great importance to clinical interventions aimed
was not associated with reduced stress levels regarding such at reducing levels of stress experienced by parents of chil-
issues is noteworthy. This may be rendered more significant dren with ASD. The current results indicate that perceived
due to the finding that when professional support is provided informal social support, particularly that received from
but not deemed useful or beneficial, there may be further friends, can exert a substantial positive effect in alleviating

Fig. 1  Structural model illustrating the association (standardised ‘co-morbid behaviours’, and ‘co-morbid physical issues’). Individual
estimates) between social support (‘significant other’, ‘family’, and exogenous covariate pathways are omitted for visual clarity. Statisti-
‘friends’) and parental stress (relative to ‘core autism behaviours’, cal significance: *p < .05; **p < .01; ***p < .001

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levels of parental stress commonly associated with rais- Boyd, B. A. (2002). Examining the relationship between stress and
ing a child with ASD. Not only was this source of support lack of social support in mothers of children with autism. Focus
on Autism and Other Developmental Disabilities, 17, 208–215.
found to outperform formal professional support in this Brandt, P. A., & Weinert, S. C. (1981). The prq, a social support meas-
regard, but furthermore, the current results suggest that ure. Nursing Research, 30(5), 277–280.
such professional support may be proving inadequate in Christensen, D. L., Baio, J., Van Naarden Braun, K., Bilder, D.,
contributing to the maintenance of the psychological well- Charles, J., Constantino, J. N., et al. (2016). Prevalence and char-
acteristics of autism spectrum disorder among children aged 8
being of parents of children with ASD. years: Autism and developmental disabilities monitoring network,
11 sites, United States, 2012. MMWR Surveillance Summaries,
61, 1–19.
Author Contributions  KD and DC conceived and designed the study, Cuzzocrea, F., Murdaca, A. M., Costa, S., Filippello, P., & Larcan,
with KD completing data collection and preliminary analyses. DC R. (2016). Parental stress, coping strategies and social support
functioned research supervisor, corresponding author and was pri- in families of children with a disability. Child Care in Practice,
marily responsible for writing and submitting the manuscript. RF 22(1), 3–19.
conducted the statistical analysis and composed the results section of Department of Health. (2018). Estimating Prevalence of Autism Spec-
the manuscript. All authors contributed to responding to peer review trum Disorders (ASD) in the Irish Population: A review of data
recommendations. sources and epidemiological studies. Retrieved from https​://healt​
h.gov.ie/wp-conte​nt/uploa​ds/2018/12/ASD-Repor ​t-Final​-19112​
018-For-publi​catio​n.pdf.
Compliance with Ethical Standards  Ekas, N. V., Lickenbrock, D. M., & Whitman, T. L. (2010). Optimism,
social support, and well-being in mothers of children with autism
Conflict of interest  The authors declare no conflict of interest in rela- spectrum disorder. Journal of Autism and Developmental Disor-
tion to the current study. ders, 40(10), 1274–1284.
Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., & Abbott,
Ethical Approval  This current design was approved by the ethical R. (2009). Parenting stress and psychological functioning among
review board of the first and third authors’ affiliated institution and mothers of preschool children with autism and developmental
was conducted in line with ethical guidelines as outlined by the Psy- delay. Autism, 13(4), 375–387.
chological Society of Ireland. Farel, A. M., & Hooper, S. R. (1998). Relationship between the mater-
nal social support index and the parenting stress index in moth-
ers of very-low-birthweight children now age 7. Psychological
Reports, 83(1), 173–174.
Goedeke, S., Shepherd, D., Landon, J., & Taylor, S. (2019). How per-
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