An Integrative Review of Parenting Stress in Mothers of Children with Autism in Japan

Abstract

Parents of children with autism experience elevated stress that may be influenced by specific characteristics of the child and parent, including cultural norms and beliefs about parenting. However, there is little research on families of children with autism from cultural perspectives. The purpose of this integrative review is to identify factors influencing parenting stress in mothers of children with autism in Japan. A final sample of 15 primary research articles (2000–2015) on parenting stress in mothers of Japanese children with autism was selected using several databases. The findings suggested that these mothers experience much greater parenting stress than mothers of typically developing children and children with other disabilities. Japanese mothers also demonstrate stress related to attachment difficulties, low parenting efficacy and lack of support, reflecting Japanese parenting styles and gender ideology. Parent-directed and culturally calibrated interventions are needed to support parents of children with autism, especially cultural minority parents.     

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

BackgroundChildren exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers’ perceptions of what helps their children cope throughout this experience.ObjectiveThe aim of the study was to explore mothers’ perceptions of their children’s resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience.MethodsIn depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience.ResultsWomen discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children’s resilience. Mothers also spoke about the ways they tried to reduce their child’s direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress.ConclusionsThis study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.     

Sibling Adjustment and Maternal Well-Being: An Examination of Families With and Without a Child With an Autism Spectrum Disorder

Differences in sibling social, behavioral, and academic adjustment and maternal well-being in families with (n = 20) and without (n = 23) a preschooler with autism spectrum disorder (ASD) were explored. Results are interpreted to suggest that mothers of children with autism report more daily hassles, life stress, and depression than mothers without a child with ASD. There were no significant differences in parent and teacher reports of older siblings' social, behavioral, and academic adjustment in families with and without a child with ASD. Sibling behavioral adjustment was, however, significantly related to maternal well-being. Because families with children with ASD often experience more parenting stress and depression, siblings may be more vulnerable to the cumulative risks over time.     

Links between parenting styles,parent–child academic interaction,parent–school interaction,and early academic skills and social behaviors in young children of English-speaking Caribbean immigrants

This study examined the influence of parenting styles, parent–child academic involvement at home, and parent–school contact on academic skills and social behaviors among kindergarten-age children of Caribbean immigrants. Seventy immigrant mothers and fathers participated in the study. Hierarchical regression analyses revealed that fathers’ authoritarian parenting style was negatively associated with and father–school contact was positively associated with receptive skills, vocabulary, and composite scores over and above that of mothers’ contributions in these areas. Fathers’ authoritative parenting style and father–child academic interaction at home were positively related to children's social behaviors. Mothers’ authoritarian parenting style was negatively and mother–school contact was positively associated with children's social behaviors. Analyses indicated that fathers’ parenting carried the weight of influence over mothers’ parenting for facilitating both child academic skills and social behaviors. The roles of parenting styles, parent–academic activities, and parent–school contacts in early schooling are discussed.     

UK parents’ beliefs about applied behaviour analysis as an approach to autism education

Research into factors underlying the dissemination of evidence-based practice is limited within the field of Applied Behaviour Analysis (ABA). This is pertinent, particularly in the UK where national policies and guidelines do not reflect the emerging ABA evidence base, or policies and practices elsewhere. Theories of evidence-based practice in education and policy suggest that decision makers’ ‘perceptions’ of evidence are significant factors in dissemination. For professionals, scientific evidence is often critical. For others, including parents, experiential and anecdotal evidence can be as important. Within autism education, parents are often, and not necessarily by choice, key decision makers. This study is the first to try to identify and quantify UK parents’ beliefs about ABA in the education and support of children with autism. We developed and tested, using an internet survey method, the Parental Beliefs about ABA and Autism scale (P-BAA). Current and/or past use by parents of any behaviorally based approach including ABA was a significant predictor of P-BAA scores as were parent education, household income and child diagnosis: experience of a behaviorally based approach, higher levels of education and income and children at the more ‘severe’ end of the autism spectrum were associated with more positive beliefs about ABA.     

Parenting stress and child maltreatment in drug-exposed children.

This study was conducted to examine the relationship between prenatal exposure to drugs and parenting stress and child maltreatment. The sample was comprised of 48 subjects including 24 drug-exposed children and a comparison group of 24 non-drug-exposed children matched on age, race, gender and socioeconomic status. The subjects' age ranged from 1 to 33 months with a mean of 13 months. As predicted, mothers who used drugs during pregnancy reported higher levels of stress than foster mothers and comparison mothers on total parenting stress, child related stress, and parent related stress as measured by the Parenting Stress Index (Abidin, 1990). Biological mothers and foster mothers of drug-exposed infants scored higher than comparisons on child-related stress, most notably in the areas of hyperactivity, distractability and adaptability. A strong association was found between maternal use of drugs and child maltreatment serious enough to necessitate removal of the children by CPS. Over 40% of the drug-exposed children were in foster care, most often with maternal grandmothers. Most mothers who used drugs during pregnancy were polysubstance abusers and 21% were intravenous drug users increasing the risk of HIV infection for mothers and children. Implications for intervention are discussed.     

The impact of culture upon child rearing practices and definitions of maltreatment

OBJECTIVE: The aim of the present study was to assess the relationship between a childhood history of abuse that a parent may have experienced and the cultural beliefs/factors that an individual may subscribe to with current parenting behaviors and attitudes. It was hypothesized that cultural factors would be more predictive of parenting behaviors and attitudes than ethnicity as a demographic label. METHOD: Using a survey design, 150 parents of Hispanic, African American and European American descent participated. Participants completed the Conflict Tactics Scale, a Familism Scale, a Machismo Scale, a Valuing Children Scale, the Childhood Trauma Questionnaire, and assigned seriousness ratings to vignettes depicting child maltreatment. RESULTS: A history of childhood abuse was found to be predictive of the use of both physical and verbal punishment by mothers, but not for fathers. Cultural factors/beliefs were predictive of fathers' parenting behaviors, but not mothers'. Ethnicity, as a demographic variable, continued to be a significant predictor of parenting behaviors and attitudes for all parents, controlling for cultural factors. DISCUSSION: The present study adds to our understanding of diverse parenting styles, of definitions of child abuse and neglect, and of ethnicity. The findings indicate that ethnicity is a complex factor, one demanding further examination with regard to its components.     

Parents' and Children's Perceptions of Parental Behavior: Associations with Children's Psychosocial Adjustment in the Classroom

Objective. We examined correspondence in parents' and children's perceptions of parenting and associations between these perceptions and children's social adjustment in the classroom. Design. The sample included 214 children (M age = 9) from third to fifth grades and their parents. Children and parents reported on parenting behavior. Results. Parents' self-reports and children's reports about parents showed systematic differences, with parents perceiving themselves as more supportive than children perceived them to be. Direction of discrepancy between child and parent reports appeared to be more important than size of discrepancy in predicting child outcomes. Hierarchical regression analyses showed that parents' self-perceptions of parenting and children's perceptions of parenting were predictive of different measures of child psychosocial adjustment. Conclusions. The results of this study support the assumption that parents' self-perceptions and children's perceptions of parenting provide unique views of the family and unique relations to children's psychosocial adjustment.     

Coping with sexual abuse: development and evaluation of a videotape intervention for nonoffending parents

OBJECTIVE: The aims of the study were: (1) to develop, apply, and evaluate a videotape intervention that targeted the development of supportive behaviors in mothers of children who were being examined because of suspected molestation; and (2) to examine the relationship between mothers' reported responses to and beliefs about the molestation and their children's perceptions of support. METHOD: Mothers (N = 87) who had children 4 to 12 years of age were recruited and randomly assigned to view either a treatment or control videotape during the time when their child was being examined. Observers who were blinded to this assignment observed and rated parent-child interactions in the waiting room prior to and again after the mothers viewed the videotape. One week after this brief intervention, 64 of the mothers and 30 of the children (8- to 12-years-old) were interviewed. RESULTS: Mothers who viewed the treatment tape were more likely to engage in supportive behaviors with their child immediately after viewing the tape, and were able to identify more supportive behaviors at the 1-week followup. In addition, mothers' reports of how they responded to the molestation (including perceived blame) was related to child perceptions of parental support. CONCLUSIONS: The findings indicate that children who have been sexually molested are sensitive to the initial reactions of their nonoffending parent to the disclosure. In addition, there is some evidence that we can design and deliver cost-effective interventions during the early disclosure period that promote more positive (or supportive) responses by the nonoffending parent.     

Predicting Mothers' Beliefs about Preschool-Aged Children's Social Behavior: Evidence for Maternal Attitudes Moderating Child Effects

Maternal beliefs about children's social behavior may be important contributors to socialization and development, but little is known about how such beliefs form. Transactional models suggest that children's characteristics may influence parents. At 2 years of age, the shy and aggressive behaviors of 65 toddlers (28 females) were observed during interactions with an unfamiliar peer; as well, mothers described the extent to which they advocated protective and authoritarian childrearing attitudes. These variables were used to predict mothers emotions, attributions, parenting goals, and socialization strategies in response to vignettes depicting aggressive and withdrawn child behaviors 2 years later. Most child effects were moderated by maternal attitudes or gender effects. Authoritarian mothers of aggressive toddlers were most likely to report high control and anger, to blame their children for aggression, and to focus on obtaining compliance rather than teaching skills to their children. Protective mothers reported that they would use warmth and involvement to comfort withdrawn children, especially their daughters.     

Ugandan households: A Study of parenting practices in three districts

Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children’s future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children’s future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son’s torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children’s well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children’s education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.     

Factors discriminating among profiles of resilience and psychopathology in children exposed to intimate partner violence (IPV)

ObjectiveTo evaluate the social and emotional adjustment of 219 children in families with varying levels of intimate partner violence (IPV) using a model of risk and protection. To explore factors that differentiate children with poor adjustment from those with resilience.MethodologyMothers who experienced IPV in the past year and their children ages 6–12 were interviewed. Standardized measures assessed family violence, parenting, family functioning, maternal mental health, and children's adjustment and beliefs.ResultsUsing cluster analysis, all cases with valid data on the Child Behavior Checklist, Child Depression Inventory, General Self-Worth and Social Self-Competence measures were described by four profiles of children's adjustment: Severe Adjustment Problems (24%); children who were Struggling (45%); those with Depression Only (11%); and Resilient (20%) with high competence and low adjustment problems. Multinomial logistic regression analyses showed children in the Severe Problems cluster witnessed more family violence and had mothers higher in depression and trauma symptoms than other children. Resilient and Struggling children had mothers with better parenting, more family strengths and no past violent partner. Parents of children with Severe Problems were lacking these attributes. The Depressed profile children witnessed less violence but had greater fears and worries about mother's safety.ConclusionFactors related to the child, to the mother and to the family distinguish different profiles of adjustment for children exposed to IPV who are living in the community. Resilient children have less violence exposure, fewer fears and worries, and mothers with better mental health and parenting skills, suggesting avenues for intervention with this population.Practice implicationsFindings suggest that child adjustment is largely influenced by parent functioning. Thus, services should be targeted at both the child and the parent. Clinical interventions shaped to the unique needs of the child might also be tested with this population.     

A Person-Centered Approach to Child Temperament and Parenting

The aim of this study was to examine how variations in children's temperamental reactivity and mothers’ parenting stress relate to parenting behavior. A sample of 3,001 mother–child dyads was assessed when children were 14, 24, 36, and 54 months. Latent profile analysis identified a group of temperamentally “easy” children whose mothers experienced little parenting stress, along with two groups of highly reactive children differentiated by mothers’ stress levels. Maternal negative regard over time was highest in the group of reactive children with highly stressed mothers. Mothers in this group also perceived more child behavior problems and had less knowledge of child development. Results are discussed relative to Person × Environment interactions and the complex interplay between parent and child characteristics.     

Differential responsiveness to a parenting intervention for mothers in substance abuse treatment

This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent–child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social–emotional development. Additionally, clinicians provided assessments of the parent–child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal–Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent–child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social–emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress.     

Maternal Beliefs as Long-Term Predictors of Mother-Child Interaction and Report

2 kinds of parental beliefs: endorsed rearing philosophy (authoritative-authoritarian dimension) and affective attitude toward child (positive-negative affect dimension) were examined in 20 normal and 36 depressed mothers as long-term predictors of their rearing behaviors and interaction patterns with their children, and of their ratings of child externalizing problems (Achenbach CBCL). The beliefs were measured when the children were toddlers (Time 1), and maternal behaviors 2-3 years later (Time 2). Mothers' endorsement of the belief in authoritative parenting predicted their frequent avoidance of prohibitive interventions. It also predicted maternal autonomy-granting to the child (more compliant and liberal responses to child-initiated control interventions). Endorsed child-rearing philosophy was a relatively more important predictor of behavior for normal mothers, and affective attitude toward child for the behavior of depressed mothers. Both actual child noncompliance and parental beliefs predicted mothers' ratings of externalizing problems in their children. The former was relatively more important for normal and latter for depressed mothers.     

Maternal Emotions During Mother-Toddler Interaction: Parenting in Affective Context

Objective. This study explored the emotional experiences of mothers in interacting with their 2-year-old children and examined interrelations among maternal emotion, family distress, and observations of parenting sensitivity. Design. Sixty mothers and their 2-year-old children were observed interacting during both enjoyable (free play) and challenging (waiting) interaction tasks, and mothers provided self-report information about their emotional experiences during each task. Mothers also completed self-report measures to assess family distress. Results. Mothers experienced and expressed a range of positive and negative emotions during interactions with their toddlers, however, mothers' expressed (observed) and experienced (self-reported) emotions were generally uncorrelated. Mothers reported experiencing more positive emotion during interactions characterized by less child negativity and less negative emotion during interactions characterized by child expressions of positive emotion. Mothers' self-reported emotional experiences during interactions with their children moderated the associations between family distress (as reported by mothers) and sensitive parenting behaviors (as observed during parent-child interaction). Conclusions. Findings support a conceptualization of parenting as multiply determined by child, parent, and family contextual factors, with emotion serving an integral role. Results are also discussed with regard to parenting emotion as a potential target for intervention in distressed families.     

Theories of change and outcomes in home-based Early Head Start programs

Programs to promote children's early development are based on a set of assumptions, explicit or implicit, about intended outcomes and how the program will effect change. The “theories of change” were examined in ten home-based programs in the Early Head Start Research and Evaluation Project (EHSREP), using data collected through multiple interviews with program staff. All home-based programs indicated that parenting outcomes were among their highest three priorities, while only 4 of 10 programs said that child outcomes were in their top priorities. The pattern of outcome differences between randomly-assigned program and control group participants reflected the programs’ theories of change in several ways. Early Head Start home-based programs showed positive impacts on 9 of 9 parenting outcomes, including parental supportiveness, home language and learning supports, emotional responsiveness, and family conflict when children were 24 months of age. Significant program impacts on child cognitive skills (Bayley MDI scores) and social behavior (observed child engagement of parent during play) were found when children were 36 months of age. Mediation analyses showed that the 54% of the program impact on 36-month child cognitive scores was mediated by 24-month program impacts on parental supportiveness, language and learning support, emotional responsiveness, and family conflict, and 47% of the program impact on 36-month child engagement of parent was mediated by 24-month impacts on parental supportiveness, language and cognitive stimulation, and emotional responsiveness. Results from mediation analyses were consistent with these home-based programs’ theories of change, supporting the efficacy of focusing on parent change as a mechanism for child outcomes in home visiting programs.     

The relationship between sexual abuse during childhood and parenting outcomes: modeling direct and indirect pathways

OBJECTIVE: This study examined the association between childhood sexual abuse (CSA) and parenting outcomes including parenting stress, feelings of competence and discipline strategies. Maternal depression and current partner violence were hypothesized to be mediators of the association between CSA and parenting. METHOD: This study is based on secondary data analysis of archived data. The participants were 263 primiparous mothers (107 with a history of CSA and 156 comparison mothers recruited from a prenatal clinic prior to the birth of their first child. Mothers were interviewed twice: once when they were between 28 and 32 weeks gestation and again when their child was between 2 and 4 years of age. During the first interview, women were asked about childhood experiences of sexual abuse. During their second interview, they were asked about current symptoms of pathology and experiences with partner violence and parenting beliefs and practices. RESULTS: Structural Equation Modeling indicated that the relationship between CSA and punitive discipline was mediated by maternal depression and current partner violence. CSA was associated with higher maternal depression and higher partner violence. CSA, maternal depression, and current partner violence were associated with more negative parental perceptions and higher punitive discipline. Once maternal depression and current partner violence were in the model, the relationship between CSA and parenting outcomes was no different from zero. CONCLUSION: These results highlight the risks associated with CSA for parenting outcomes and suggest two potential pathways for this increased risk.     

Perceptions of parenting versus parent-child interactions among incest survivors

OBJECTIVES: Although women with histories of child sexual abuse (CSA) perceive themselves as less competent mothers and report greater parenting difficulties than nonabused women, few investigators have actually observed the parenting behaviors of CSA survivors. The primary aim of this study was to examine whether incest history was related to maternal perceptions of parenting efficacy and interactional patterns with their children. The secondary aim of this study was to explore the constructs of internal working models of relationships and maternal psychological adjustment as potential mediators of the relation between incest history and parenting. METHODS: A community sample of 17 incest survivors, 18 nonabused women and their 3-6 year-old children participated. Mothers completed self-report measures of parenting efficacy, parental bonding (i.e., internal working models of relationships), and psychological adjustment. In addition, mothers interacted with their children in a problem-solving task. RESULTS: Although incest survivors reported less parenting self-efficacy than did nonabused mothers, their interactional styles with their children were positive overall and comparable to those of nonabused mothers. Specifically, survivors displayed moderate to high levels of support, assistance, and confidence, and their children showed high levels of affection towards their mothers. Incest survivors reported less bonding with their own mothers in childhood and poorer current psychological adjustment. CONCLUSIONS: Findings suggest that incest survivors' perceptions of their parenting abilities may be more negative than their actual parenting behaviors.