“The Impact of Parenting Stress: A Meta-analysis of Studies Comparing the Experience of Parenting Stress in Parents of Children With and Without Autism Spectrum Disorder”

Article written by Stephanie A. Hayes and Shelley L. Watson

Published online July 13 2012

Reviewed by Chelsea Graham

This article is a ‘meta-analysis’ of studies. A ‘meta-analysis’ is the statistical procedure for combining data from multiple studies. When the treatment effect (or effect size) is consistent from one study to the next, metaanalysis can be used to identify this common effect. The authors reviewed studies about Parenting Stress in parents of children WITH ASD and parents of children WITHOUT ASD.

Prior to explaining their methods of search and selection criteria for the studies included in this meta-analysis, the authors defined ‘Parenting Stress’ and summarized the research regarding the impact of ASD on Parenting Stress.  The discussion detailing the definition of stress raised interesting ideas. Stress results from the interaction of a family and their environment. When stressors occur, a family will use their existing coping mechanisms in attempts to return the family to a functional place.  If their coping mechanisms are not sufficient, the outcome is stress.

Why do a meta-analysis? The authors gave several rationale for completing a systematic review of the parenting stress literature comparing families of children with autism to children with typical development or those with other disabilities.  Firstly, it has not been done. Secondly, it can provide researchers with guidance for where further research is needed. Thirdly, to summarize the variability among the outcomes of stress as reported by families. And fourthly, to answer questions about the magnitiude, variability, and generalizability of findings.

This meta-analysis selected only studies that measured parental stress, and not depression. The included studies used the following established measures of parenting stress: Family Impact Questionnaire, Questionnaire on Resources and Stress (QRS) and Parenting Stress Index (PSI).

After selecting the studies to include in the analysis, the effect size was calculated. The effect size is an indicator of the strength of the relationship between two outcome variables and allows for comparison of measures that employ different scales.  The effect size was calculated comparing the Parents of Children with ASD and the comparison group (typically developing children or those with other disabilities). Mathematical equations were used to establish effect sizes for each study, so that the outcomes of the studies could be compared.

Results of the Meta-Analysis:

In comparing outcome measures and effect size of numerous studies regarding  parenting stress among parents of children with ASD vs parents of typically developing children, the authors concluded there is a ‘true difference between the experience of parents of children with ASD in comparison to those with children who have typical development on comprehensive measures of parenting stress,’ AND there is also a true difference between ASD parents in comparison to parents of children with other disabilities.

“The overall effect size calculated was large,” and “suggests that parenting stress in families with a child diagnosed with ASD is a significant experience that warrants attention and intervention.”

Suggestions for further research were proposed by the authors. Not many studies differentiated between the different stress experiences of fathers vs mothers of children with ASD. Research should focus on differentiating the levels of ASD and the reported stress for each level. Often children with ASD have co-morbid conditions, could these conditions be affecting the stress levels?


My initial reaction to reading this article was less about the content of the analysis, and more related to the EFFORT it took to read this type of research. I needed to reset my brain back to my grad school days when I was a bit sharper, and in the practice of interpreting academic language. After preparing myself for the rigors of reading and interpreting the data, I was able to make connections between the results of the studies and my professional experiences.

In response to the content and results of the meta-analysis, I’m not surprised with the outcome. Providing speech therapy to a child with ASD is frequently stressful, I had no doubt that parents would report high levels of stress.

This meta-analysis was an important review because of the conclusions it was able to draw for further research. We all know parents of children with ASD are stressed, but HOW CAN WE HELP? That’s the research and evidence based practice we need.



7 thoughts on ““The Impact of Parenting Stress: A Meta-analysis of Studies Comparing the Experience of Parenting Stress in Parents of Children With and Without Autism Spectrum Disorder”

  1. Holly Hamill says:

    Yes, I too found that reading research took a different kind of concentration from my brain! We can all agree that parents raising children with ASD are under a great deal of stress. Reading this information has helped bring light on the types of things that bring stress. Unless you are living with this day to day, it can be easy to overlook common sources of stress. The symptoms of ASD can bring much disruption to daily routines for the family trying to cope. We all tend to go back to our known ways of coping when problems arise, just as this article states that families try to use former coping strategies to repair family discord. It seems to me that more education for families addressing how to best handle the intensity and constant stress that an ASD diagnosis brings to the family is needed. Everyone in the family is feeling the impact of the stress, therefore, I feel family counseling/education/classes would be warranted.

  2. Margaret Hockenbury says:

    I have to first off agree with resetting the brain back to grad school to read the article. I had to do that as well. It takes a different mindset to read studies and correctly take away what the message is. I liked the scope of this study that was able to be done because of the meta analysis. Once again, it is not surprising that parents of children with ASD have more stress in comparison to parents without children who have ASD, but I like how the study focuses on what more needs to be done in order to figure out what to do to aide in the stress. Trying to listen to parental concerns and incorporate them as much as possible in our therapy sessions can help us aide in some of that stress.

  3. Aubrey Apel says:

    I love that you reminded us what all of this research jargon means. I am not that far removed from grad school and it still takes me a bit to fully get make into the “research” mindset. This article review has definitely made me realize I don’t read enough research because I feel rusty! It’s a good wake up call.

    I love that you included the quote about families with children who have ASD, saying it is “…a significant experience that warrants attention and intervention.” This really is a highlight and take away point for all of the articles we have been analyzing. I do think that children with ASD are a special population that deserves attention, and this includes their families. I would love to read about studies addressing the differences in stress for these mothers and fathers. I would be curious to see if it was what we might expect, or if they may find some rather shocking results.

  4. ASD is a pervasive developmental disorder that affects many facets of family life so it is not surprising that parents of children with ASD have more stress. These families face multiple and complex challenges on a daily basis that most of us take for granted. Data and research presented in this article only confirm what we have all seen in the school system. In order to address this, parents should work with a family therapist who could help them manage stress and deal with the complex emotions associated with this diagnosis.

  5. Aubrey – I agree with your observation about the quote about ASD being “a significant experience that warrants attention and intervention.” We have a lot of research supporting the fact that parenting a child with ASD IS stressful, we need to move forward with research about how to best support families who are navigating ASD.

  6. Sarah Crady says:

    Yes! I felt the same way while reading these articles. I had to “re-set” my brain as well.
    Also, I agree that the findings are not surprising. Like you mentioned sometimes providing therapy to children with ASD is stressful. I can not imagine the stress of parenting and living with your child with ASD. I think one answer to how we help these parents is suggesting the use of a family therapist. The other article we read provided all the benefits that a family therapist could offer, including support to parents, support for appointments, support for siblings etc. Although this is a good start, I’m not sure if its enough. I also think maybe providing opportunities for families to connect. I’m sure it would be helpful to have support from other families who are going through similar things. I’m not sure what that would look like without breaking HIPPA. I know that we offer a “class” for grandparents raising grandchildren at our school. Its just our counselor and family resource giving the family support and suggestions. Maybe offering something like this would help provide some level of support at the school and allow families to connect with each other.

  7. Krista Rice says:

    I am not surprised by the results of this study either, concluding that parents with children on the spectrum experience more stress than those parents with typically developing children. Being a parent is stressful enough and to add the layer of ASD would be challenging. Even with my knowledge, training and background related to communication disorders and ASD, I can’t even pretend that I know what daily life would be like with a child on the spectrum.

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