The Impact of Parenting Stress on Families and Children with Autism Spectrum Disorder: A Scoping Review

Abstract

Purpose of the review:

This review aims to map the existing literature on the impact of parenting stress, with a particular focus on identifying whether studies have examined its effects not only on parents but also on children with ASD. While previous reviews have primarily highlighted parental outcomes, this scoping review also seeks to determine the extent to which child outcomes have been investigated in relation to parenting stress.

Collection and analysis of data:

This review utilized three databases: ScienceDirect, Scopus, and ProQuest. The search strategy was developed using free-text keywords including “autism spectrum disorder”, “parenting stress”, “parents”, “child”, and “quality of life”, combined using Boolean operators. The inclusion criteria were: full-text articles, written in English, published between 2020-2025, and open access. The article selection followed the PRISMA guidelines. A total of 9 articles were selected and analyzed from an initial pool of 37.865.

Conclusions:

Parenting stress has a significant impact on parents, including psychological pressure, physical exhaustion, decreased quality of life, and tension in marital relationships. It also contributes to behavioral difficulties in children with ASD, such as aggression, self-harming behaviors, and stereotypical behaviors. These findings highlight that parenting stress poses a variety of challenges for both parents and children.

Keywords

Autism spectrum disorder parents parenting stress psychological child quality of life

Introduction

Autism spectrum disorder (ASD) encompasses a range of neurodevelopmental disorders marked by enduring impairments in social communication and interaction, as well as the occurrence of restricted and repetitive behaviors, interests, or sensory-motor activities. These symptoms are often accompanied by delays across multiple neurodevelopmental domains.^1–2 Emotional and behavioral issues are prevalent among children with ASD, who commonly exhibit symptoms of anxiety, aggression, and depression.³

Epidemiological studies show the trend of ASD incidence increasing every year.⁴ The World Health Organization estimates that approximately 1 in 100 children worldwide is diagnosed with ASD, although this figure may be too conservative.⁵ According to research, men experience ASD more often than women, with a ratio of 4.2:1.⁶ A consistent upward trend in ASD prevalence has been documented over the past two decades. For example, Talantseva et al. reported that global pooled prevalence increased from 0.25% during 1994–1999 to 0.99% during 2015–2019. Similarly, surveillance data from the Centers for Disease Control and Prevention (CDC) in the United States showed an increase in ASD prevalence among 8-year-old children from 67 per 10000 in 2000 to 230 per 10000 in 2018, representing a 243% rise. These increasing prevalence rates are attributed to broader diagnostic criteria, greater public awareness, and improved access to diagnostic services.⁷

Taking care of children with autism presents parents with several obstacles. Raising a child with autism can be a life-changing experience for some parents.⁸ These parents face increased responsibilities, demands, and psychological stress in caring for their child.⁹ The impact of autism on parents can be complex, far-reaching, and long-lasting.¹⁰ This pressure may lead to parenting stress. Parents of children with ASD, particularly mothers, frequently experience elevated levels of parenting stress.¹¹ Such stress may adversely impact the parents’ well-being, the parent–child relationship, and the child’s developmental outcomes.¹² Parental stress can have a negative impact on children and adolescents, including behavioral and emotional problems.^13–14 Parenting stress can also negatively affect parents’ quality of life (QoL) and contribute to marital dysfunction.^14–15

Parenting stress is a harmful psychological reaction to the obligations of parenthood.¹⁶ According to Abidin et al., parental stress is a process involving pressure, anxiety, and tension that exceeds limits and is specifically related to the parental role and the interaction between parent and child.¹⁷ Furthermore, Deater-Deckard defines parental stress as a situation marked by adverse psychological and physiological responses stemming from attempts to adapt within the parenting framework, wherein this stress unfolds through a specific pattern.¹⁸

Although numerous studies have examined parenting stress among parents of children with ASD, the existing literature tends to focus on either the factors contributing to parenting stress or its isolated impact on either the parent or the child. Systematic reviews to date have primarily explored predictors of stress, such as behavioral problems or communication deficits, and their relationship with parental well-being, coping strategies, or mental health. However, these reviews rarely extend their scope to examine whether parenting stress has a direct impact on children with ASD. Most existing evidence focuses on parents, with limited attention to child-related outcomes. This presents a significant gap in the literature and highlights the need for a scoping review to map the available evidence and explore whether studies have assessed the impact of parenting stress on children, alongside its effects on parents. Such a review is crucial for guiding the development of holistic, family-centered interventions and informing future research and clinical practice.

Material and Methods

Study Design

This review adopts a scoping review methodology, aiming to map the existing literature, explore ongoing research activities related to the topic, and investigate gaps in the current research landscape. The scoping review involved identifying the research question, the systematic literature search for pertinent studies, data extraction, tabulation of findings, synthesis, analysis, explanation, and reporting of results. This review was guided by the primary research question: “What is the impact of parenting stress on parents and children with ASD?”

Data Collection

This review utilized three databases: ScienceDirect, Scopus, and ProQuest. The search strategy was developed using free-text keywords including “ASD,” “parenting stress,” “parents,” “child,” and “QoL.” Boolean operators (“AND,” “OR”) were used in specific combinations to ensure comprehensive coverage. For example: (“Autism spectrum disorder” OR “ASD”) AND (“parenting stress”) AND (“child” OR “development”).

The inclusion criteria were full-text articles published between 2020 and 2025. The 5-year limitation was intended to ensure the review reflects the most recent findings on the impact of parenting stress on parents of children with ASD. All included articles were in English. Articles were chosen for their relevance to the discussion on the impact of parenting stress on parents of children with ASD. Articles were eliminated if they failed to match these criteria, lacked an abstract, were not open access, or were published before 2020.

The initial search yielded 37865 records. After removing duplicates and irrelevant titles or abstracts, 636 articles were assessed for eligibility. Study selection was conducted independently by two reviewers at each stage of the screening process, including title and abstract screening and full-text review. Discrepancies among reviewers were reconciled through discussion, and if consensus was unattainable, a third reviewer was engaged. Following full-text screening and application of inclusion and exclusion criteria, nine studies were included in the final analysis (see Table 1). The screening procedure adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Scoping Review (ScR) guidelines.

Table 1 summarizes the characteristics of the nine included studies.

Table 1.

Summary of Included Studies.

No.	Authors and Year	Country	Study Design	Objective	Method	Findings
1	Wah et al., 2024.¹²	Malaysia	Cross-sectional	To examine the correlation among stress levels, self-efficacy, and QoL in mothers of autistic children, as well as the mediating effect of self-efficacy on the association between maternal stress and QoL.	Quantitative	Mothers who have autistic children experience moderate levels of stress, poor QoL, and low levels of self-efficacy. Higher maternal stress was associated with lower QoL, while higher self-efficacy improved QoL.
2	Baran´czuk and Pisula., 2020.¹⁹	Oman	Cross-sectional	To assess the levels of parental stress and depressive symptoms in parents of children with ASD in Oman, and identify associated factors.	Quantitative	Mothers with children with ASD exhibited elevated levels of stress and depression relative to those with neurotypical children. A positive link exists between stress and depression in these mothers.
3	Fallahchai and Fallahi., 2022.²⁰	Iran	Cross-sectional	To examine the relationship between parental stress and dyadic adjustment, and whether dyadic coping mediates this relationship.	Quantitative	Parental stress negatively correlated with dyadic adjustment. Dyadic coping partially mediated this relationship; partners who supported each other better coped with stress and improved relationship quality.
4	Wang et al., 2020. ²¹	China	Cross-sectional	To investigate the correlation between parenting stress, parental involvement, and family QoL among mothers and fathers of children with ASD.	Quantitative	Parenting stress in both fathers and mothers negatively correlated with parental involvement and family QoL. Mothers reported higher stress and lower QoL than fathers.
5	Zhang et al., 2025.²²	China	Cross-sectional	To assess the levels of parenting stress and burnout in parents of ASD children, and examine the mediating role of social support and coping strategies.	Quantitative	72.3% of parents reported experiencing high stress, and 36.8% reported burnout. Parenting stress positively correlated with burnout (r = 0.723). Social support and coping strategies acted as chain mediators.
6	Nadeem et al., 2024.²³	Pakistan	Cross-sectional	To assess parenting stress and psychological distress in parents of ASD children in Pakistan, and explore the effects on physical, psychological, and social well-being.	Quantitative	60% of parents showed mental health issues (SRQ-20 ≥ 8). Stress was linked to reduced physical and psychological health. Mothers, especially working ones, reported worse outcomes than fathers.
7	Ranjbar et al., 2025.²⁴	Iran	Cross-sectional	This article aims to examine the influence of parenting stress, children’s executive function, and communication skills on the emergence of challenging behavior in children with ASD.	Quantitative	Parental stress was significantly associated with the severity of challenging behaviors in children with ASD. Executive functioning was the strongest predictor of behavior frequency, while parental stress was the strongest predictor of behavior severity.
8	Park and Lee., 2022.²⁵	South Korea	Cross-sectional	To investigate whether social support moderates the relationship between parenting stress and depression in mothers of disabled children in Korea.	Quantitative	Parenting stress is positively correlated with depression (r = 0.70). Social support exhibited a negative correlation with stress (r = −0.49) and depression (r = −0.64). Social support mitigated the effects of stress on depression.
9	Lin et al., 2021²⁶	Taiwan	Longitudinal	To analyze transactional relationships between parenting stress and behavioral problems in autistic under 3 years of age, and control for ASD symptom severity.	Quantitative	Parenting stress predicted externalizing behaviors (e.g., aggression, impulsivity). Child behavior did not significantly predict stress. Early intervention targeting parent perceptions and stress may help prevent behavioral issues.

Data Extraction and Charting Information

The guideline used for article selection was PRISMA-ScR, as illustrated in Figure 1. The authors developed the database search strategy and completed the screening process. The authors also reviewed the search strategy and assessed the eligibility of articles at each stage of the screening process. Inclusion criteria for this review were articles written in English, open access availability, and a focus on the impact of parenting stress on parents of children with ASD. Exclusion criteria were articles published more than 5 years ago and sources that were not journal articles. After the final set of articles was identified, each article was summarized by mapping relevant information, including author name, article title, publication date, study location, identified methods, research design, research objective, and a summary of the main findings.

Figure 1.

Source: Page et al.¹⁹

Review Artikel

Results

Theme 1: The Impact of Parenting Stress on Parents

Parenting stress is a significant challenge faced by parents of children with special needs. Almost all of the reviewed articles found that high levels of parenting stress directly affect the psychological condition and well-being of parents.

Impact on parents’ psychological well-being

Barańczuk and Pisula reported that mothers of children with ASD had markedly elevated levels of parenting stress and depression symptoms in comparison to a control group. Notably, the study demonstrated that stress related to the parental role (e.g., perceived competence, attachment, social isolation, and emotional well-being) was closely linked to many types of maternal depressive symptoms, such as cognitive deficits, anxiety, guilt, and psychosomatic complaints. These results demonstrate the importance of directly addressing the well-being of parents, rather than just focusing on the problems they encounter with their children.²⁰

Park and Lee looked into how parenting stress affects the mental health of mothers of children with disabilities, including those with ASD. The results showed a strong positive link between parental stress and depressive symptoms, which means that mothers who are more stressed are more likely to be depressed. The study also identified perceived social support as a moderating variable. Mothers who said they had more informal social support from family, friends, or the community had fewer depressive symptoms, even when their levels of parenting stress were high. These results suggest that social support can help protect against the negative mental health effects of parenting stress in this group of people.²⁶

Zhang et al. examined the relationship between parenting stress and parenting burnout experienced by parents in caring for children with ASD. The study found that a large proportion of parents reported high levels of stress, and a considerable number also showed signs or risks of parenting burnout. Importantly, parenting stress was identified as a direct risk factor for parenting burnout.²³

Nadeem et al. reported that parents of children with ASD in Pakistan experienced significantly elevated levels of stress specific to core ASD symptoms, comorbid behavioral problems, and comorbid physical issues. This heightened parenting stress was associated with increased psychological distress, including symptoms such as reduced energy and depressive thoughts. Almost 60% of them were reported as potential risk patients in relation to potential mental health problems. This study also demonstrated the adverse impact of parenting stress on physical and psychological well-being.²⁴

Impact on parents’ quality of life

Wang et al. conducted a study examining the dynamic interactions between parenting stress, caregiving involvement, and family quality of life (FQoL) among Chinese parents raising children with ASD. Findings revealed that higher parenting stress was associated with lower parental involvement and decreased FQoL for both mothers and fathers, particularly regarding family interaction, parenting, and emotional well-being.²²

Fallahchai and Fallahi examined the correlation between parenting stress and dyadic (marital) adjustment among Iranian parents of children with ASD. The results indicated that child behavioral issues were strongly correlated with elevated parental stress, and in turn, were significantly associated with diminished dyadic adjustment in both mothers and fathers. Importantly, the study highlighted the moderating effects of dyadic coping mechanisms, particularly stress communication and partner supportive coping, as well as perceived social support from family. These factors were found to buffer the negative impact of parenting stress on relationship quality.²¹

Wah et al. found that parenting stress negatively affects the QoL among mothers of children with autism. The research indicated that elevated stress levels correlated with diminished self-efficacy, while increased self-efficacy positively influenced QoL. Moreover, self-efficacy was found to mediate the relationship between stress and QoL partially, indicating that enhancing parental self-efficacy may help buffer the adverse effects of stress. These findings underscore the importance of psychosocial support in improving the well-being of mothers caring for children with autism.¹²

Theme 2: The Impact of Parenting Stress on Children with Autism Spectrum Disorder

Several studies have also revealed that parenting stress affects not only parents but also influences child development and behavior.

Impact on children’s behavior

Lin et al. explored the correlation between parenting stress and behavioral issues in young children with ASD. The results showed that parenting stress, particularly stress stemming from how parents perceived their child’s traits, was linked to later behavioral problems in children. These results show how important it is to assess and intervene early, with a focus on parenting stress, especially stress related to children, to possibly reduce later behavioral problems in children with autism.²⁷

A study by Ranjbar et al. examined the concurrent effects of parental stress, executive functioning, and communication skills on challenging behaviors in children with ASD. The findings demonstrated that parental stress and executive functioning were both significant predictors of challenging behaviors, with executive function being the strongest predictor of behavior frequency and parental stress the strongest predictor of behavior severity. These results highlight the importance of addressing both parental stress and children’s executive functioning in interventions aiming to reduce challenging behaviors in children with ASD.²⁵

Discussion

Parenting-related stress denotes a series of events that result in negative psychological and physiological responses stemming from efforts to adjust to the obligations of motherhood. Parents of children with developmental problems or disabilities have distinct and substantial challenges in their daily lives concerning both the child and the parenting experience.¹⁸ In particular, parents, especially mothers, must invest a lot of energy and time to appropriately care for and respond to their children with ASD.²⁸ We reviewed nine articles (eight cross-sectional and one longitudinal). All of the included studies were conducted in Asian countries, including China, Pakistan, Iran, South Korea, and Malaysia. This regional focus offers valuable insights into how parenting stress manifests in specific cultural and healthcare contexts, and underscores the significant concern surrounding parenting stress in families of children with ASD within these regions.

This scoping review provides comprehensive knowledge on the impact of parenting stress on parents of children with autism. In the studies reviewed, high levels of parenting stress were associated with the incidence of depression.^20,26 A variety of parental and child characteristics may substantially affect the depressed symptoms of parents.¹⁷ Furthermore, considerable research suggests that depressed symptoms vary among individuals and encompass feelings of sorrow or hopelessness, anxiety, anger, guilt, worthlessness, lost interest or pleasure in activities, reduced energy, fatigue, and cognitive impairments.²⁹

Raising a child with a disability entails a prolonged and challenging journey, often marked by intense emotions, complex decision-making, and an ongoing demand for information and support services.³⁰ The demanding responsibilities associated with raising a child with ASD can lead to considerable emotional strain and parenting stress. When such stress persists over time without adequate coping strategies, it may result in parenting burnout. This condition is characterized by physical and emotional exhaustion, diminished motivation, symptoms of depression, and a reduced capacity for patience in fulfilling parental roles.^23,31

Parenting stress was also strongly associated with diminished parental QoL and family functioning. Higher stress levels corresponded with reduced family interaction, lower emotional well-being, and impaired dyadic adjustment.^12,20,21 Caring for children with various disabilities, including autism, has been associated with increased stress levels and decreased overall QoL. Stress can be triggered and influenced by both external and internal factors, which in turn can have a negative impact on a person’s physical, psychological, and emotional well-being.¹² Other findings also revealed that parenting stress affects the quality of the parents’ relationship.²¹

Evidence regarding the impact of parenting stress on children was very limited. Of the nine studies included, only Lin et al. directly assessed child-related outcomes, finding that parenting stress predicted externalizing behaviors in young children with ASD. High levels of parenting stress in families of children with ASD have been consistently associated with behavioral difficulties in the child, particularly externalizing behaviors such as aggression, impulsivity, and defiance.^25,27 The study by Lin et al. was the only one employing a longitudinal design, providing insight into the transactional relationship between parenting stress and child behavioral outcomes over time. The study primarily involved young children with ASD aged 18–35 months and found that parenting stress, especially stress related to the child domain (e.g., perceived child temperament or behavior), significantly predicted externalizing behavior problems 1.5 years later. These findings suggest that elevated parenting stress during early developmental periods may contribute to the emergence or worsening of behavioral problems in children with ASD. This result is partly consistent with that of Rodriguez et al. who identified a bidirectional relationship in a sample of school-aged children.³² Lin et al. argued that the inconsistency may stem from developmental differences, as parenting stress and child behavior problems may interact differently in early childhood compared to later developmental stages. Furthermore, the findings support those of Totsika et al. who suggested that behavioral problems in young children may not yet exert long-term effects on parental well-being due to the limited duration of exposure.³³ Although Rodriguez et al. (2019) and Totsika et al. (2013) provide valuable insights, they were not included in the present review because the inclusion criteria limited the timeframe to 2020–2025. Their earlier findings nevertheless contextualize the current evidence and highlight that, while some research on child-related outcomes exists, most of it predates the scope of this review. Overall, Lin et al.’s study underscores the importance of early interventions targeting parental stress, particularly parental perceptions of the child’s characteristics, as a strategy to prevent future behavioral challenges in children with ASD.

While previous systematic and scoping reviews have explored parenting stress in families with children with ASD, most have focused either on stressors or outcomes affecting parents alone, such as depression or reduced QoL. For example, Al-Oran and Khuan (2021) identified predictors of parenting stress but did not address how such stress affects children.³⁴ Similarly, Barroso et al. emphasized psychological impacts on parents, but offered limited insight into child behavior.³⁴ In contrast, the present scoping review aimed to examine both parental and child outcomes. However, only one included study (Lin et al.) directly assessed child-related effects, highlighting the scarcity of research in this area. Rather than confirming a dual impact, this review underscores the lack of evidence on child outcomes and the need for future research to address this critical gap.

Additionally, most earlier reviews were dominated by studies from Western countries.³⁵ By including studies from diverse Asian contexts, such as China, Pakistan, Iran, South Korea, and Malaysia, this review offers more culturally relevant insights, particularly in regions where access to services, stigma, and cultural norms may differently shape the stress experience. Therefore, this review contributes to a more comprehensive and globally relevant understanding of how parenting stress affects family systems living with ASD.

Although the included studies contribute to the understanding of parenting stress in children with ASD, several methodological limitations need to be considered. Most of the reviewed studies used cross-sectional designs, which limit the ability to establish a relationship between parenting stress and the impacts resulting from that stress. Dependence on mother samples also narrows the scope, with the roles and experiences of fathers still largely unexplored. One significant limitation identified in this review is the lack of longitudinal studies that can examine the impact of parenting stress over a longer period. In the scoping review, only one longitudinal study was found, highlighting the critical need for further research on how parenting stress can impact children’s behavioral issues over time.

Another limitation of this review is the restriction to open access articles only. This criterion was applied due to limited institutional access to subscription-based databases. Consequently, relevant studies that were behind paywalls may have been excluded, potentially introducing publication bias. This review excluded gray literature, including dissertations, policy reports, and conference proceedings, which could have provided further insights. These limitations must be considered when interpreting the findings. Additionally, it should be noted that not all included studies focused exclusively on parents of children diagnosed with ASD. Some studies involved broader samples, including parents of children with various developmental disabilities. While these studies still provided relevant insights into parenting stress, this heterogeneity in study populations may affect the specificity and generalizability of the findings related to ASD.

Implication of Finding

Untreated, parenting stress can result in adverse outcomes for both parents and children. Therefore, psychological support interventions for parents of children with ASD are essential, particularly those that focus on stress management, emotional support, and enhancing parental self-efficacy. The ability to detect early warning signs of parenting stress still requires skill and focus to address the associated negative impacts on parents and children.

Conclusion

Parenting stress has a significant impact on parents. It has an impact on their psychological and physical condition, but also their QoL. Parenting stress is associated with symptoms of depression and burnout, a reduction in QoL, and impacts on marital relationships. Additionally, it significantly affects children with ASD, resulting in externalizing behaviors and other difficult behaviors, such as self-injurious actions, stereotypical behaviors, and aggressive or destructive conduct. These results show that the effects of parenting stress are complex and transactional, affecting both parents and children with ASD.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Considerations

This study is a literature-based scoping review and did not involve human participants, animals, or identifiable personal data. Therefore, ethical committee approval was not applicable. The study was carried out in accordance with the principles enunciated in the Declaration of Helsinki.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Statement of Informed Consent and Ethical Approval

This scoping review did not involve human participants and, therefore, did not require ethical approval.

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