Parental Stress Related to Caring for a Child With Autism Spectrum Disorder and the Benefit of Mindfulness-Based Interventions for Parental Stress: A Systematic Review

Abstract

Children with autism spectrum disorder (ASD) tend to exhibit more severe challenging behaviors than typically developing children and those with intellectual or other disabilities. This study aimed to review the stress levels of parents of individuals with ASD, and the use of mindfulness to decrease parental stress. The following variables of Autism, Stress, Parenting, Family, and Mindfulness were searched in PubMed and APA PsycNet databases. The studies between 2000 and 2023 with at least two of the mentioned keywords were included for further review. This review highlights the significance of further research on the severity of autism symptoms and how they are related to the level of parental stress, and it thoroughly examines the findings of pertinent studies on parental stress and autism. Furthermore, it aims to draw attention to the application of mindfulness-based interventions in reducing parental stress. Parents of children with ASD were found to have higher stress levels than those of typically developing children. Mindfulness-based interventions were found to be helpful in decreasing parents’ stress levels. Parenting a child with autism spectrum disorder is very challenging, which causes parents to experience higher stress levels than those of typically developing children.

Plain Language Summary

Parental stress in connection with the severity of ASD symptoms and the use of mindfulness for parental stress.

The current systematic review aimed to analyze the relationship between parental stress and severity of ASD symptoms by reviewing the outcomes of previous research studies. There seems to be a positive relationship between parental stress and ASD symptom severity, as reported by most of the reviewed studies. The effect of mindfulness-based interventions to relieve parental stress was also reviewed. The results revealed a positive effect of mindfulness-based interventions in decreasing the parents’ stress levels.

Keywords

autism family mindfulness parents stress

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impaired social communication and interaction as well as restricted and repetitive patterns of behaviors, interests, and activities (American Psychiatric Association [APA], 2013). Autism spectrum disorder is a developmental disorder that can lead to significant difficulties in social interactions, communication, and behavior. While it is not feasible to distinguish individuals with ASD from others, those with ASD may communicate, interact, behave, and learn differently. Their cognitive abilities can range from highly gifted to severely impaired (Centers for Disease Control and Prevention [CDC], 2020).

Parental Stress and ASD

Parenting a child with ASD can be difficult and have a negative effect on the health and well-being of parents (Seymour et al., 2012). Numerous prior studies have indicated that parents of children with autism spectrum disorder experience a higher level of parenting stress than parents of children without any developmental disabilities (DD) and parents of children with other types of developmental disabilities (Estes et al., 2009; Hayes & Watson, 2013; Rodriguez et al., 2019). Parenting stress is the psychological strain caused by the difficulties and expectations of parenting roles, which have a direct effect on parents’ emotional health, the parent-child relationship, and the child’s emotional and social growth (Deater-Deckard, 1998; Deater-Deckard et al., 2006). Multiple research studies have explored the pressure of raising a child with ASD—specifically, the impact it has on the parents and the importance of providing them with support. This is because these parents experience significant distress as a result of having a child who may face profound challenges in social communication, emotions, behavior, and encounter difficulties in accessing the necessary services (Crowell et al., 2019).

Several studies have also found that mothers experience greater levels of parental stress than fathers. The level of stress experienced by fathers was associated with the intensity of the disorder in their children. The fathers of children with more serious disorders reported higher levels of parenting stress (Soltanifar et al., 2015).

Factors Leading to Parental Stress in Relation to ASD

Parenting stress is one of the most widely studied topics in the context of families with children with autism spectrum disorder. Parenting a child with ASD can present a number of emotional, psychological, and practical challenges, all of which can contribute to parental stress related to ASD. Numerous investigations have been conducted to explore the determinants of parental stress in relation to autism spectrum disorder (ASD). Both individual and environmental factors contribute to the distress experienced by parents. The individual factors are potentially linked to the characteristics of the parent and child, while the environmental factors may be associated with social and familial support, as well as the availability of necessary resources. The correlation between autism and parental stress can be elucidated by the impact that comorbidities of autism have on the mental well-being of parents (Derguy et al., 2016).

In the literature on autism spectrum disorder, it is generally reported that the severity of ASD symptoms and the characteristics of the child are strongly linked to the amount of parenting stress experienced (Hayes & Watson, 2013). Cross-sectional studies have revealed correlations between the intensity of ASD symptoms, behavioral issues, and parental stress (e.g., Benson, 2006; Davis & Carter, 2008; Hartley et al., 2011; Lecavalier et al., 2006).

Although the cause of the connection between parental stress and child functioning is still being studied (Totsika et al., 2013), higher parental stress levels can lead to poorer adaptive functioning (Cuzzocrea et al., 2016; Hall & Graff, 2011, 2012), which can worsen the core and accompanying symptoms of ASD. Additionally, as the number of children diagnosed with ASD increases, research on the factors that influence parenting stress is necessary to assist families in caring for young children with ASD (Davis & Carter, 2008). The purpose of this study was to review and identify the gaps in existing literature regarding stress levels of parents of individuals with ASD, and the use of mindfulness to decrease parental stress. Moreover, it aimed to emphasize the significance and necessity of additional research on the relation between intensity of ASD symptoms in children and parental stress (Enea & Rusu, 2020). Investigating this relationship more thoroughly would enable future researchers to assess various interventions to reduce the severity of ASD symptoms, which would consequently lessen the amount of parental stress (Seymour et al., 2012).

To help parents deal with their stress, it is essential to further explore the ways in which children’s behavior can lead to parenting stress and how it can be managed through various strategies (Seymour et al., 2012). One is the kind of coping strategy that parents employ to handle the stress caused by their children’s behavioral issues. Ineffective, maladaptive coping strategies, such as self-blame, can result in heightened parenting stress (Hastings, 2002). Children’s external and internal behaviors can lead to potential negative developmental issues, raising the chances of psychosocial problems in adolescence and adulthood. Therefore, it is essential to further investigate and assess the connection between parenting variables and children’s problem behaviors. Parental training can improve parents’ understanding and abilities to manage and reduce problem behaviors, and various forms of parental training can lead to improved parent-child relationships (Ueda et al., 2020). Parents of children with ASD often feel isolated and lack a social support system to help them cope with the unique challenges they face, which differ from those of parents of typically developing children (Karst & Van Hecke, 2012). A previous study reported that parents who had difficulty managing their emotions were more likely to experience parenting stress, which was linked to fewer positive bonding behaviors, excessive protection, and less care for their child. Thus, the data suggest that targeted intervention programs, such as emotion regulation training, could be beneficial for the parents of children with ASD. Such programs may reduce parenting stress and encourage adaptive parenting behaviors in children with ASD (Hu et al., 2019).

The correlation between the severity of Autism Spectrum Disorder (ASD) symptoms and the stress experienced by parents has been thoroughly investigated (Kishimoto et al., 2023). Nevertheless, the impact of mindfulness on decreasing parental stress and alleviating the severity of ASD symptoms has not yet been thoroughly investigated. Consequently, this systematic review sought to expand the research on the effects of mindfulness-based interventions for parents of individuals with ASD to determine if they would be advantageous in reducing stress levels. The current review may help address the need for further research into the policy considerations for mindfulness-based interventions used for parental stress.

Use of Mindfulness for Parental Stress

Mindfulness is a mental state that can be described as a purposeful, non-judgmental, and accepting attitudes cultivated through moment-to-moment awareness (Raulston et al., 2019). When parents of children with ASD take notice of their daily lives and their children’s requirements, it becomes simpler for them to step away from culture-specific practices and objectively assess their parenting experience. Parent training programs are believed to be advantageous in teaching parents behavioral techniques to enhance their adaptive abilities and reduce the challenging behaviors of their children with ASD (Tonge et al., 2006). Consequently, mindfulness-based training can reduce parental stress by enhancing parenting practices, as mindful parents are less rejecting and less reactive in parent-child interactions (Cheung et al., 2019).

Based on the facts stated above, it is assumed that it would be beneficial to examine further the stress level experienced by the parents of individuals with ASD and its bidirectional effect on the behavioral problems of these individuals. Therefore, this study aimed to answer the following questions:

- Is parental stress higher in parents of individuals with ASD than in parents of typically developing individuals or those with other neurodevelopmental disorders?

- Is there a positive correlation between parental stress and the severity of autism symptoms?

- Is the use of mindfulness-based interventions beneficial in decreasing parental stress?

Methods

Materials

The current study is a systematic review of available academic journals/articles on parental stress among parents of individuals with autism spectrum disorder. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). In the current study, the PubMed and APA PsycNet databases were used to search for articles. Articles related to parental stress, autism, and the use of mindfulness for parental stress published between 2000 and 2023 were analyzed. The inclusion criteria for the selection of articles were as follows: (a) the article should be an academic journal with quantitative or qualitative data; (b) the article should be available in full text; (c) the article should be available in English; and (d) keywords should be included in the title and abstract of the article. The review excluded studies that did not primarily address the relationship between mindfulness practice and parental stress, or the stress that comes with parenting a child with ASD. In addition, the studies that were duplicates and articles lacking relevance or lacking complete empirical evidence but were descriptive in a narrative manner were excluded from the review.

Procedure

The current systematic review was conducted between mid-March and mid-August 2023. Both authors carried out the screening process, carefully evaluating each study on their own before choosing the ones that would be included in the review. The discrepancies were discussed and settled at weekly in-person follow-up meetings. The search query in both databases was as follows: (( AND (stress))((autism) AND (parents)) AND (parenting)) AND (family), in the Any/All Field. Two separate files were created for the PubMED and APA PsycNet searches. A total of 1,016 articles were available on PubMed, and 791 articles were available on APA PsycNet between 2000 and 2023 (See Figure 1). The search was then filtered using the English language and full-text availability, resulting in 1,685 articles in both databases (PubMed: 948, APA PsycNet: 737). After screening articles according to their titles, 376 articles (PubMed: 234, APA PsycNet: 142) were selected for further review. Abstracts of the selected articles were carefully reviewed to eliminate irrelevant articles. A total of 96 articles were selected for a detailed full review (PubMed: 62, APA PsycNet: 34).

Figure 1.

Parental stress and Autism search diagram.

Two duplicates were identified in both databases and excluded. Finally, 94 articles were selected for thorough examination and review. After a detailed review of 94 articles, 62 were excluded due to irrelevant content and 10 were not fully accessible online through the databases. Ultimately, 22 studies were included in this systematic review.

The second search was performed separately for the variable of mindfulness in parenting for individuals with ASD. The query was as follows: ((AND (parents))((mindfulness) AND (autism)) AND (stress)) AND (parenting) in the Any/All Field. During a mindfulness search, a total of 38 articles were available on PubMed, and 64 articles were available on APA PsycNet (See Figure 2). The search was then filtered using the English language, full-text availability, and publication years between 2000 and 2023, which resulted in a total of 100 articles from both databases. After a careful review of abstracts, only 36 articles were selected for further review. After reviewing 36 articles based on their summaries, 21 were selected for a full review. There were three duplicates were found in both databases and excluded. Of the remaining 18 articles, five were not fully accessible online, and two articles were removed due to irrelevant content, leaving 11 articles to be included in the review. Articles that partially studied parental stress levels in individuals with ASD were selected for further review. Individuals of all ages with ASD were included in the selection criteria for a review. However, only individuals from certain ages (18 months to 21 years) were reviewed because of the availability of studies on databases and possibly because of the limitation caused by the keywords of parenting and parents. Both mothers and fathers were included in this study. Primary caregivers were mostly mothers, some of whom were single. Data from each selected study were extracted and summarized. The articles were analyzed according to the following standards: (a) characteristics of study participants, (b) intervention tools or strategies used, (c) research design tools to measure, (d) the effectiveness of interventions; and (e) main results of the study. For these outcomes, key summary measures were taken, showing mean differences, effect sizes (when available) and observed percentages, depending on the study.

Figure 2.

Mindfulness and parental stress search diagram.

Results

The following tables display all the selected studies. Tables 1 to 3 provide a comprehensive overview of the key findings from each of the selected studies (see Tables 1 –3). Of the 376 articles screened in the first stage, 96 compared the stress levels of the parents of individuals with ASD to those of the parents of individuals without ASD. However, only 22 articles have studied the relationship between autism symptoms and parental stress. Among these, 13 articles compared stress levels in families of children with ASD and typically developing (TD) children, as well as others with different disorders (See Table 1). Ingersoll et al. (2011) reported that mothers of children with ASD scored significantly higher on depressed mood (t (163) = 2.24, p < .05) and parenting stress (t (163) = 8.47, p < .001) than mothers of children without ASD. Blacher and Baker (2019) compared the level of stress of parents with children with ASD to TD and intellectual disability (ID) and stated that while the scores of the ASD group mothers differed significantly from the TD group mothers on all measures, they did not differ significantly from the ID group mothers on any measure. Hou et al. (2018) and Estes et al. (2009, 2013) compared stress levels between mothers of children with ASD and children with developmental delay (DD). A study done by Hou et al. (2018) reported that 25.4% of mothers with children with ASD showed moderate or severe depressive symptoms, while 15.6% of mothers with DD children showed moderate or severe depressive symptoms.

Table 1.

Table of Findings for Comparison of Stress Levels of Parents of Children With ASD and Others.

Author/s and year of publication	Aim	N	Age	Ethnicity	Type of design	Type of assessment	Findings
Al-Farsi et al. (2016)	To compare the socio-demographic data between CASD and parents of non-ASD children, to explore the level of stress, depression, and anxiety among CASD and parents of non-ASD children, and to describe the relationship between ASD and level of stress, depression, and anxiety after adjusting for potential confounders.	220 (107 Fs and 113 Ms)	M-age of Ps: 39.7	Arabic	Quantitative	DASS	CASD appears to have more risk of depression and stress by 1.8 and 1.6 times compared to the CTD group. No statistical difference has been observed with anxiety between the CASD and CTD groups.
Alghamdi et al. (2022)	To evaluate the levels of depression, anxiety, and stress among mothers of children with ASD compared to mothers of children with normal development.	286 (Ms of CASD:143, Ms of CTD:143)	Ms of CASD: 76.9%, <40 years, Ms of CTD:62.9%	NS	Quantitative	DASS-21 MSPSS	The level of stress among mothers of children with ASD was statistically significantly different from that of mothers with children with normal development (p = .042). Moreover, 17.5% of mothers of children with ASD suffered from extreme stress compared with 6.3% of mothers of children with typical development.
Bauminger et al. (2010)	To investigate the relationships between internalizing and externalizing (I-E) behaviors and family variables, including both parenting stress and quality of attachment relations, in children with a high functioning ASD or with typical development.	77 (Ms of ASD: 43, Ms of TYP: 34)	NS	USA & Israel	Quantitative	PSI	In all PSI subscales, mothers of children with ASD reported higher stress levels compared to mothers of children with typical development. Total parenting stress: ASD = M (SD): 63.42 (30.31), TYP = M (SD): 49.79 (33.20), F(1,77) = 18.05, p < .001, n2 = 20
						CBCL
						IPPA
Blacher and Baker (2019)	To assess how co-morbid behavior disorders in adolescents with ID or ASD contribute to parenting stress and distress above the impact of the disability itself.	160 (C-TD: 84, C-ASD: 48, C-ID: 28)	M-age of Ms-TD: 45.5, Ms-ID: 43.3, Ms-ASD: 45.7	Caucasian (Ms-TD: 71.4%, Ms-ID: 60.7%, Ms-ASD: 70.8%	Quantitative	CBCL	ASD group mothers scored highest on each of the two distress indicators, and scored lowest on the measure of positive perceptions. While the scores of the ASD group mothers differed significantly from the TD group mothers on all measures, they did not differ significantly from the ID group mothers on any measure. FIQ negative impact-stress scores; [ASD: (m: 24.4, sd: 14.3), ID: (m: 21.6, sd: 14.2), p < .001]
						FIQ
						LOT
Estes et al. (2009)	To investigate the contribution of child characteristics, problem behavior, and adaptive functioning to increased maternal parenting stress and psychological distress in mothers of children with autism, and to compare parenting stress in mothers of ASD to mothers of DD without autism.	74 Ms (51 Ms of ASD & 23 Ms of DD without ASD)	M-age of Ms-ASD: 35.99, Ms-DD: 36.23	NS	Quantitative	QRS	Mothers of children with ASD showed significantly higher parenting stress scores than the mothers of children in the DD group. ASD (M = 2.30, SD = 0.35) DD (M = 2.03, SD = 0.36) t = 3.05, p < .01. A stronger relationship was found between parenting stress and child problem behaviors in the DD group than in the ASD group.
Estes et al. (2009)		74 Ms (51 Ms of ASD & 23 Ms of DD without ASD)	M-age of Ms-ASD: 35.99, Ms-DD: 36.23	NS	Quantitative	BSI
Estes et al. (2013)	To examine parenting-related stress and psychological distress in mothers of toddlers with ASD, developmental delay without ASD (DD), and typical development.	96 Fams (Ms&Cs) ASD = 46, DD without ASD = 25, TYP = 25	M-age of Ms-ASD: 34.84, Ms-DD: 36.66, Ms-TYP: 34.69	NS	Quantitative	QRS	Mothers of children with ASDs showed significantly higher parenting stress scores than the mothers of children in the DD group and the mothers of children in the TYP group. ASD (M = 2.08, SD = 0.33), DD (M = 1.92, SD = 0.25), TYP (M = 1.74, SD = 0.28). ASD vs. DD (t = −2.14, p < .05). ASD vs. TYP (t = −4.62, p < .001).
Estes et al. (2013)		96 Fams (Ms&Cs) ASD = 46, DD without ASD = 25, TYP = 25	M-age of Ms-ASD: 34.84, Ms-DD: 36.66, Ms-TYP: 34.69	NS	Quantitative	BSI
Giovagnoli et al. (2015)	To investigate the prevalence of maladaptive behaviors and parental stress of preschool-aged children with ASD with respect to a group of healthy controls.	214 Cs: 130 of ASD, 84 of TD	M-age of C-ASD: 42.9 months, C-TD: 42.4 months	Italian	Quantitative	ADOS-G	Parental stress through the PSI resulted in significantly higher percentages of clinical scores in the PSI total score in the group of children with ASD as compared to the group of TD. ASD [Clinical N: 44%, SD: 33.8, p ≤ .008], TD [Clinical N: 2%, SD: 2.4, p ≤ .008]
						GDQ
						GDMS-ER
						VABS-SF
						CBCL
						PSI-SF
Gong et al. (2015)	To assess stress of parents with autistic children and explore sources of stress as well as the relationship between stress and parents’ psychological status compared to the parents of normally developing children.	302 (188 of C-ASD, 114 C-TD)	M-age of Fs-ASD: 37.08, M-age of Ms-ASD: 34.26, M-age of Fs-TD: 35.99, M-age of Ms-TD: 34.35	NS	Quantitative	PSI	Parents of children with autism had higher total stress scores than parents of normally developing controls (t = 13.76, p = .000). Parents in the autism group also reported significantly higher scores on the Child Domain, Parent Domain, and all subscales of the PSI than parents in the control group.
Hou et al. (2018)	To assess the severity of parenting stress and depressive symptoms in Taiwanese mothers of young children with ASD and with DD. Also, to investigate whether children’s behavioral problems would be associated with their mothers’ parenting stress and depressive symptoms.	102 Cs&Ms (51 of ASD, 51 of DD)	M-age of Ms-ASD: 34.73, Ms-DD: 33.04, M-age of C-ASD: 31.81 months, C-DD:30.16 months	NS	Quantitative	CBCL/1½-5	Children with ASD had significantly higher scores of internalizing problems, externalizing problems and total behavioral problems than children with DD. When compared to DD group, mothers of young children with ASD showed significantly higher parenting stress and depressive symptoms. In addition, 25.4% of mothers with ASD children showed moderate or severe depressive symptoms while 15.6% of mothers with DD children showed moderate or severe depressive symptoms.
						BDI-II
						PSI
Ingersoll et al. (2011)	To examine whether higher rates of depressed mood in mothers of children with ASD compared to mothers of children without ASD can be accounted for, partially, by group differences in maternal BAP.	165 (Ms of ASD: 71, Ms of NoASD: 94)	M-age of Ms-ASD: 40.63, Ms-NoASD: 40.22	Majority White M-ASD: 94%, M-NoASD: 83%	Quantitative	CESD	Mothers of children with ASD scored significantly higher on depressed mood (t(163) = 2.24, p < .05) and parenting stress (t(163) = 8.47, p < .001) than mothers of children without ASD.
						FIQ
						AQ
Kütük et al. (2021)	To determine self-reported depression symptoms and burnout levels among parents of children with ASD compared with those of healthy children, and to assess predictors of depression symptoms and burnout levels in parents of ASD.	272 (145 of C-ASD, 127 of C-TD)	M-age of Fs-ASD: 38.4, M-age of Ms-ASD: 34.9, M-age of Fs-TD: 39.2, M-age of Ms-TD: 37.4	Turkish	Quantitative	BDI	57 Mothers (39.3%) and 25 (17.2%) fathers of children with ASD reported significant depressive symptoms. The corresponding rates for mothers and fathers in the control group were 15.0% (n = 19) and 6.3% (n = 8). Accordingly, mothers (χ2 = 18.8, p < .001, Phi = 0.27, Yates’) and fathers (χ2 = 6.6, p = .01, Phi = 0.17) of children with ASD were significantly more likely to have clinically significant BDI scores.
						MBI
						CARS
Siu et al. (2019)	To examine the role of autism spectrum symptoms (child externalizing and internalizing problem behaviors) and parenting stress between the two groups of parents of children who were diagnosed with ASD and TD children, some of whom experienced a clinically significant level of ASD symptoms but have not been diagnosed yet.	731 Ps (Ps of ASD: 177, Ps of TD: 554)	M-age of Ps: 41.5	NS	Quantitative	PSI-SF	Compared to parents of TD children, parents in ASD group reported significantly higher scores on PSI-SF of parenting stress, CAST of autism spectrum symptoms, externalizing and internalizing problem behaviors, and lower scores on prosocial behaviors in their children (all p < .001). About twice as much proportion of parents in the ASD group (39.0%) scored above the 90th percentile of PSI-SF as in TD group (21.1%, p < .001).
						SDQ
						CAST
Watt and Wagner (2013)	To compare parents raising a child with ASD to parents raising a “typical” child on a number of important constructs including parental mental health and stress as well as work satisfaction, interest, commitment, quality, time missed, and situation.	28 Canadian families (15 of Fams-ASD,13 Fams-NoASD)	M-age of Ms-ASD: 42.33, Fs-ASD: 46.33, C-ASD: 13.0, M-age of Ms-NoASD: 40.15, Fs-NoASD: 42.30, C-NoASD: 10.38	Majority Caucasians (26 Fs, 24 Ms)	Quantitative	PSI-SF	The follow-up ANOVA analyses revealed significant group differences on all of the PSI-SF scales. The ANOVAs on the DR, PD, P–CDI, DC and total parental stress scales indicated significant differences between groups, with the AS group self-reporting higher levels than the comparison group (F: 12.89, p < .000, η2: 0.692)

Note. ADOS-G = Autism Diagnostic Observation Schedule-Generic; AQ = Autism Spectrum Quotient; ASD = Autism spectrum disorder; BAP = Broader Autism Phenotype; BDI-II = The Beck Depression Inventory-II; BDI = Beck Depression Inventory; BSI = The Brief Symptom Inventory; CARS = Childhood Autism Rating Scale; C-ASD = Children with autism; C-TD = Children – typical development; CASD = caregivers of children with autism spectrum disorders; CAST = Childhood Autism Spectrum Test; CBCL = Child Behavior Checklist; CBCL/1½-5 = Child Behavior Checklist for Ages 1½–5; CESD = The Center for Epidemiologic Studies–Depression Scale; Cs = Children; CTD = caregivers of typically developing children; DASS = Depression anxiety stress scale; DASS-21 = Depression anxiety stress scale-21; DC = Difficult Child; DD = Developmental Delay; DR = Defensive responding; Fams = Families; FIQ = Family Impact Questionnaire; Fs = Fathers; GDMS-ER = Griffiths developmental mental scale-extended revised; GDQ = general developmental quotient; ID = Intellectual Disability; IPPA = Inventory of Parent and Peer Attachment; LOT = Life Orientation Test; M = Mean; M-age = Mean age; MBI = Maslach Burnout Inventory; Ms = Mothers; MSPSS = Multidimensional Scale of Perceived Social Support; NS = Not specified; P-CDI = Parent-Child Dysfunctional Interaction; PD = Parental Distress; Ps = Parents; PSI = Parenting Stress Index; PSI-SF = Parenting Stress Index-Short Form; QRS = The Questionnaire on Resources and Stress; SD = Standard deviation; SDQ = Strengths and Difficulties Questionnaire; TD = typical development; TYP = typically developing group; VABS-SF = Vineland Adaptive Behavior Scale-Survey Form.

Among these 13 studies, five also investigated the relationship between children’s behavioral problems and parental stress. Siu et al. (2019) found that parenting stress was positively associated with externalizing problems and negatively associated with prosocial behaviors, meaning that the primary source of parenting stress was not the severity of autism spectrum symptoms, but externalizing problem behaviors—conduct problems and hyperactivity. The same study reported that both externalizing and internalizing children’s problem behaviors caused an increase in parental stress in the TD group.

The remaining (9) studies investigated the correlation between the severity of autism symptoms and its effect on parental stress (See Table 2). The results of the study by Fallahchai and Fallahi (2022) indicated a significant positive association between children’s behavioral problems and parents’ parental stress (mothers: β = .41, p < .001; fathers: β = .38, p < .001). However, another reviewed study reported that the ASD severity was not significantly correlated with parenting stress and child behavior problems (Lin et al., 2021). Mello et al. (2022) and Rodriguez et al. (2019) studied the effects of children’s internalizing and externalizing behaviors on parental stress. Rodriguez et al. (2019) discovered a pattern driven by parents. In other words, parental stress positively predicted future increases in internalizing behavioral problems in children with ASD, but not vice versa.

Table 2.

Table of Findings for Autism Severity and its Relation to Parental Stress Levels.

Author/s and year of publication	Aim	N	Age	Ethnicity	Type of design	Type of assessment	Findings
Efstratopoulou et al. (2022)	To assess the complex relationship between parental stress and the severity of the ASD symptoms, behavioral difficulties, coping strategies, and social support.	75 (Ps)	Ps’ M age: 40 Cs’ M age: 8.59	NS	Quantitative	PSI-SF MBC	There were significant correlations between scores on self-regulation problems reported by the teachers and the total parental stress scores (r = .713) and the mean scores on the subscale difficult child (r = .761) reported by the parent.
Fallahchai and Fallahi (2022)	To examine whether child behavioral problems would predict parental stress; the second aim was to assess whether parental stress would predict dyadic adjustment.	233 (Ps)	Ps’ M age: 35.3 Cs’ M age: 6.13	NS	Quantitative	PSI-SF BPI-S	A model with the effect of child behavior problems on parents’ parental stress was examined. The model fits well (mothers: χ2 = 4.431, p = .322, CFI = 0.96, RMSEA = 0.02; fathers: χ2 = 5.022, p = .267, CFI = 0.96, RMSEA = 0.03). Results indicated a significant positive association between child behavior problems and parents’ parental stress (mothers: β = .41, p < .001; fathers: β = .38, p < .001).
Firth and Dryer (2013)	To examine the characteristics of ASD that predicted parental distress.	109 (Ps)	Cs’ M age: 7.89	NS	Quantitative	DASS-21 PSS SRS NCBRF GARS-2	The regression examining whether ASD child characteristics significantly predicted the PSS scores of the parents was found to be significant, F(4, 89) = 3.98, p = .005. The SRS and NCBRF total scores accounted for 11.4% of the variance. ASD child characteristics significantly predicted the DASS-21 Stress scores of the parents, F(4, 89) = 7.32, p < .0001.
Huang et al. (2014)	To examine the effects of autistic behaviors and those of individual emotional and behavioral problems on parenting stress simultaneously.	52 Cgs	Cgs’ M age: 39.24 Cs’ M age: 6.33	Chinese	Quantitative	SDQ-C PSI/SF-C	There were no significant correlations between the autistic behaviors and any domain of the PSI/SF-C (p > .05). Small to moderate correlations were found between three SDQ domains and the DC domain of the PSI/SF-C. These were emotional symptoms (r = .30), conduct problems (r = .61), and hyperactivity/inattention (r = .36).
Lin et al. (2021)	To investigate the transactional relationship between parenting stress and child behavior problems in children with ASD.	75 Ps & their Cs	M age for Cs @T1: 25.68 months, @T2: 43.99 months, M age for Ps: 34.73	NS	Quantitative longitudinal	ADOS	The severity of ASD had no significant correlations with parenting stress and child behavior problems. One significant cross-lagged path was found: the effect of the PSI total at T1 on externalizing behavioral problems at T2. However, externalizing behavioral problems at T1 did not significantly predict the PSI total at T2. The severity of ASD did not have a significant effect on the PSI total at T2 (standardized path coefficient = .10, p = .17). (See Note 1.)
						CBCL/1½–5
						PSI
Mello et al. (2022)	The assess the links between children’s level of functioning, autism symptoms, and various internalizing and externalizing behavioral problems and domains of mothers’ parenting stress	157 Ms & their Cs	Cs’ M age: 4.3	22.9% of Ps Canadian	Quantitative	ADOS-2 CARS PSI-SF	Mothers’ stress levels for Difficult Child was significantly higher than for Parenting Distress, t(156) = 5.48, p < .001, d = 0.44, which in turn was higher than for Parent–Child Dysfunctional Interaction, t(156) = 5.07, p < .001, d = 0.41. Based on mothers’ ratings of challenging behavior and emotional difficulties, 47.1% of children would be in the clinical range for total problems (47.1% Internalizing, 30.6% Externalizing); based on educators’ ratings this proportion was 59.9% (56.7% Internalizing, 48.4% Externalizing).
Postorino et al. (2019)	To examine associations between parent-reported stress and clinical characteristics in children with ASD and serious behavioral problems.	298 Ps & their Cs	Ps’ M age: 35.6 Cs’ M age: 5.8	Majority Caucasian (84.6% of children)	Quantitative	PSI	Parents reported slightly higher scores on the PSI-PD subscale for children ≥50th percentile on the ABC-SW subscale (p = .020). Parents who rated children ≥50th percentile on measures of disruptive behavior had significantly higher scores on the self-reported PSI-CDI and PSI-DC subscales. The level of child disruptive behavior was associated with higher parental stress on the PSI-CDI and PSI-DC subscales.
						Vineland-II
						ABC
Rodriguez et al. (2019)	To examine bidirectional effects between parenting stress and (ASD symptoms, internalizing and externalizing behavior problems) across four time points.	188 (Ps)	M age for Ms: 38.7 Fs: 40.7 Cs: 7.90	Majority Caucasian-non-Hispanic (88.8%)	Quantitative longitudinal	Burden interview	There were significant cross-lagged effects from early child ASD symptoms to later parenting stress in mothers at two time points (T2–T3: β = .09, p = .06, T3–T4: β = .14, p < .01). In the opposite direction, there was a significant cross-lagged effect from T1 parenting stress to T2 child ASD symptoms (mother: β = .15, p = .04; father: β = .17, p = .03). There was also a cross-lagged effect from T2 parenting stress to T3 child ASD symptoms for fathers (β = .25, p < .01). Paired sample t-tests indicated a significant difference between mother and father report of parenting stress at T1 (t = 3.16, p < .01), T2 (t = 2.88, p = .01), and T3 (t = 3.15, p < .01), and T4 (t = 2.23, p = .03) (See Note 2.)
Rodriguez et al. (2019)		188 (Ps)	M age for Ms: 38.7 Fs: 40.7 Cs: 7.90	Majority Caucasian-non-Hispanic (88.8%)	Quantitative longitudinal	CBCL
Schiltz et al. (2018)	To examine the links between challenging adolescent behaviors, parenting stress, parent mental health, and parental involvement, controlling for social skills, in a sample of adolescents with ASD.	77 (59 Ms, 15 Fs, 3 F-Gs)	Ps’ M age: 46.60 Cs’ M age: 13.58	Majority White (88.3%)	Quantitative	SIPA	Challenging adolescent behaviors were a robust predictor of parenting stress (β = 1.69, SE = 0.43, p < .01), controlling for social skills, which jointly explained 47.8% of the variance in parenting stress; F(2, 66) = 30.18, p < .001. There was evidence of a significant indirect effect from challenging adolescent behaviors to parental involvement through parenting stress and parental mental health [β = − 0.02 (CI −0.08, −0.01)].
						BDI-II
						PRQ
						SSIS-RS

Note. ABC-SW = Aberrant Behavior Checklist-Social Withdrawal Subscale; ABC = Aberrant Behavior Checklist; ADOS-2 = Autism Diagnostic Observation Schedule, Second Edition; ADOS = Autism Diagnostic Observation Schedule; ASD = Autism spectrum disorder; BDI-II = The Beck Depression Inventory-II; BPI-S = Behavior Problems Inventory-Short Form; CARS = Childhood Autism Rating Scale; CBCL/1½–5 = Child Behavior Checklist for Ages 1½–5; Cgs = Caregivers; CI = Confidence Interval; Cs = Children; DASS = Depression, Anxiety and Stress Scale; DC = Difficult Child; F-Gs = Female Guardians; Fs = fathers; GARS-2 = The Gilliam Autism Rating Scale – Second Edition; M-age = mean age; MBC = Motor Behavior Checklist; Ms = mothers; NCBRF = The Nisonger Child Behavior Rating Form; NS = not specified; PRQ = Parenting Relationship Questionnaire; Ps = Parents; PSI-CDI = PSI- Child Dysfunctional Interaction; PSI-DC = PSI- Difficult Child; PSI-PD = PSI Parental Distress; PSI-SF = Parenting Stress Index Short Form; PSI/SF-C = Parenting Stress Index Short Form-Chinese version; PSS = The Parental Stress Scale; RMSEA = the root mean square error of approximation; SDQ-C = Strengths and Difficulties Questionnaire-Chinese version; SIPA = The Stress Index for Parents of Adolescents; SRS = Social Responsiveness Scale; SSIS-RS = The Social Skills Improvement System-Rating Scales; Vineland-II = Vineland Adaptive Behavior Scales, Second Edition.

Endnotes:

Time of the initial assessment (T1), the follow-up assessment approximately 1.5 years later (T2).

Four waves of data collection that occurred over the course of 3 years, referred to as Time 1 (T1), Time 2 (T2), Time 3 (T3), and Time 4 (T4), which were spaced approximately 12 months apart.

In addition, 11 articles studied the effects of mindfulness-based interventions to reduce parental stress (See Table 3). Out of the 11 studies, three compared the effects of mindfulness training for parents with other types of training, such as skills-based and positive behavior support. Comparisons between the two groups revealed significant differences in change scores on the parental stress index-short form (PSI-SF) at T2 (change at T2), with the mindfulness group reporting greater change (t (13) = 2.99, p = .011, d = 1.59 (Ferraioli & Harris, 2013). Two studies investigated the long-term benefits of mindfulness-based interventions by analyzing parental stress levels at different times. Lunsky et al. (2017) analyzed the outcomes of two interventions, one of which was mindfulness-based. The outcomes of both the interventions were satisfactory. However, only parents in the mindfulness group reported significant reduction in psychological distress, which was maintained for follow-up at 20 weeks. Three studies investigated mindfulness-based training for both parents and children to improve the challenging behaviors of children with ASD, in turn reducing their parents’ stress levels. Salem-Guirgis et al. (2019) analyzed the outcomes of the MYMind program, which was administered to both youths with autism and their parents. However, parents did not report significant changes in the program or follow-up periods for any Depression, Anxiety and Stress Scale (DASS) subscale. Moreover, while there were no statistically significant changes in the DASS subscales during the baseline phase, there were trends indicating improvements in Depression, Stress, and Overall symptoms. Regarding adolescents, parents reported a modest significant decrease in the Behavioral Symptoms Index (BASC-2); however, the change was no longer significant at follow-up. The remaining three studies compared the stress levels of parents after completing mindfulness training with those parents in the control group who did not receive any training. Singh et al. (2021) examined the components of Mindfulness-Based Positive Behavior Support (MBPBS), and the study found that mothers in the MBPBS conditions reported more significant reductions in perceived psychological stress, followed by those in the MB (mindfulness) condition, and no significant changes in the PBS (positive behavior support) condition.

Table 3.

Table of Findings for Mindfulness-Based Interventions and Their Effect on Reducing Parental Stress.

Author/s and year of publication	Aim	N	Age	Ethnicity	Type of design	Type of assessment	Findings
Ferraioli and Harris (2013)	To evaluate the benefits of a new parent training approach (i.e., mindfulness-based) through comparison with an established intervention (i.e., skills-based), and assess the feasibility of these two 8-week programs.	15 Ps (10 Ms & 5 Fs)	NS	White (33%), Indian (27%), Asian (13%), Latina (13%), Black/African American (7%) & other (7%).	Qualitative quantitative longitudinal	PSI-SF	Between-group comparisons revealed significant differences in change scores in the PSI-SF at T2, with the mindfulness group reporting the greater change, t (13) = 2.99, p = .011, d = 1.59 (See Note 1.)
						GHQ
						MAAS
Ho et al. (2021)	To examine whether mindfulness training could improve executive function of adolescents with ASD and reduce rumination of parents.	37 Ps & their Cs	M age of Ps: 46.5, M age of Cs: 13.0	Chinese	Quantitative	CBCL	Both the MYmind and the waitlist control groups showed improving trends in PSI subscales with effect sizes range: 0.12–0.50 and from 0.03 to 0.42, also in WHO-5 with effect sizes: 0.31 and 0.34. For IM-P subscales, the MYmind group showed improvements with effect sizes range: 0.15–0.46, while the waitlist control group showed improvements to a small extent in the two subscales (listening with full attention, compassion) with effect sizes: 0.17 and 0.14. For RRS, the MYmind group showed improvement with an effect size of 0.61, while the waitlist control group showed a decline with an effect size of 0.27.
						SRS
						PSI
						IM-P
						WHO-5
						RRS
Hwang et al. (2015)	To train parents of children with ASD in mindfulness and evaluate its direct effects on them and its transactional effects on their child.	6 Ms & Cs	Age range of Ms: 34–48, age range of Cs: 8–15	NS	Quantitative	FMI	A significant difference was found between P1 and P2, levels of mindfulness increased after the parent mindfulness training (z = −2.032, p = .042). A reduction in parental stress was noted. between P1 and P2 (z = −1.682, p = .093) and between P1 and P3 (z = −2.023, p = .043) (See Note 2.)
						PSS
						FQOL
						CBCL
Lunsky et al. (2017)	To assess whether the mindfulness-based intervention led to lower levels of parent distress compared to the active control intervention (parent support and education).	50 Ps	M age of Ps: 56.6	NS	Longitudinal quantitative	DASS-21	Results indicated a significant main effect of group assignment on parent psychological distress F(1, 43) = 11.73, p = .001, Cohen’s d = 0.81 at Time 2, in favor of the mindfulness condition. To test the maintenance of the effect on the primary outcome to the 20 weeks follow-up, an ANCOVA with time (Time 2, Time 3) as the repeated measures factor, Time 1 DASS-14 score as covariate, and intervention group as the between subject variable was done. This analysis revealed a significant group effect [F(1, 38) = 10.24, p = .003], but no effect of time [F(1, 38) = 2.58, p = .12], nor a group × time interaction [F(1, 38) = 0.39, p = .84]. The intervention group difference at post-intervention was maintained until the 20 weeks follow-up point.
						FFMQ
						BMPS
Rayan and Ahmad (2016)	To examine the effectiveness of mindfulness-based intervention on perceived QOL and positive stress reappraisal (PSR) among parents of children with ASD.	104 Ps	M age of Ps: 34.10	NS	Quantitative	WHOQOL-BREF MAAS	Both PSR and mindfulness scores were significantly higher in the posttest than in the pretest [for the PSR scores: t (51) = 3.45, p = .001, Cohen d = 0.48 (a medium effect size), and for mindfulness scores: t (51) = 6.31, p > .001, Cohen d = 0.87 (a large effect size)]. A comparison of the pretest and posttest scores in the control group revealed significant improvements in the mean scores of the psychological health domain and the overall QOL post intervention. These improvements were significant at a significance level of 0.05, with a small effect size.
Rayan and Ahmad (2017)	The purpose of this study was to examine the effectiveness of MBI on perceived stress, anxiety, and depression among parents of children with ASD in Jordan.	104 Ps	M age of Ps: 36.24	NS	Quantitative	DAAS-21 MAAS	No interaction between pretest stress, depression, and total DASS21 and the group membership. However, there was an interaction between the pretest anxiety and the group membership. After controlling for the covariates, there was a significant effect of group membership on posttest levels of stress, depression, and total DASS21 score (for stress: F(1, 101) = 16.44, p < .001, partial eta squared = 0.14, adjusted mean difference = 3.83; for depression F(1, 101) = 26.33, p < .001, partial eta squared = 0.21, adjusted mean difference = 4.41; for total DASS21: F(1, 101) = 24.29, p < .001; partial eta squared = 0.20, adjusted mean difference = 11.43). In addition, the adjusted mean mindfulness scores were higher for parents in the intervention group than those in the comparison group, suggesting that they had better outcomes.
Ridderinkhof et al. (2018)	To investigate whether a combined mindfulness-based program (for children and their parents) is also beneficial for younger children with ASD and their parents, whether effects last in the long-term, and whether it reduces common comorbid problems.	45 Fams (43 Ms, 31 Fs & 45 Cs)	Av. age of Ms: 46.31, Fs: 46.99, Cs: 13.03	NS	Quantitative	CBCL	Perceived stress of parents (PSS) was reduced at posttest and 2-month follow-up with a small effect. At 1-year follow-up, the decrease in stress was no longer significant. Parents’ stress about their competence in parenting (PSI-C) significantly decreased at posttest, 2-month, and 1-year follow-up with a small effect size. Parents reported a decrease in over-reactivity in parenting (PS-O) with medium effect at posttest and 2-month follow-up. This effect remained significant with a small effect size at 1-year follow-up.
						PSS
						PSI
						IM-P
Salem-Guirgis et al. (2019)	To report on the outcomes of MYmind for adolescents and young adults (subsequently referred to as “youth”) with autism and their parents, by adding a baseline period, along with the traditional program and follow-up periods.	23 P&C dyads	M age of Ps: 50.05, M age of Cs: 15.65	71.4% White/Caucasian	Longitudinalquantitative	BASC-2	Parents did not report significant changes in the program or follow-up periods for any DASS subscale. Further, while there were no significant changes on DASS subscales during the baseline period, there were trends indicating improvements in this phase for Depression, Stress, and Overall symptoms. As for youths, parents reported a small significant decrease on the BASC-2 Behavioral Symptoms Index; however, change was no longer significant at follow-up (i.e., gains were not maintained). Parents also reported a small significant increase in BASC-2 Adaptive Skills post-program and at follow-up.
						RRS
						ERC
						ERQ-CA
						CAMM
						SRS-2
						DASS-21
						FFMQ-SF
						IEM-P
Singh et al. (2014)	To evaluate the effectiveness of mindfulness-based training paired with a focus on its applications to positive behavior support (PBS) which was designed to produce personal transformation in the parents of adolescents with ASD.	3 Ms & Cs	Age range of Ms: 37–43, age range of Cs: 12–19	NS	Quantitative	PSS-10	During the MBPBS training, the mean frequency of aggressive incidents per week was 2.63, 4.00, and 5.63. During the MBPBS practice, the mean frequency of aggressive incidents per week was 0.22, 0.46, and 0.81, The downward trend in aggressive incidents per week was statistically significant. Phi = 0.76, p < .001. For parental stress, the results were also significant, F (3, 6) = 31.19, p < .01. Statistical significance was obtained with such a small sample size due to the large effect size (partial etasquared = 0.94).
Singh et al. (2014)		3 Ms & Cs	Age range of Ms: 37–43, age range of Cs: 12–19	NS	Quantitative	observations
Singh et al. (2019)	To evaluate whether training on MBPBS will have differential effects on mothers and their children with ASD or with ID alone in terms of the mothers’ stress levels and the children’s aggressive, disruptive, and compliance behaviors.	97 (M of ASD: 47 & M of ID: 45)	Age range M: 38–59, Cs: 13–17	NS	Quantitative	PSS	The between subjects factor was statistically significant, F(1,90) = 4.98, p = .028 (η2 = 0.052). This revealed an overall group effect, with mothers in the ID group reporting significantly higher stress (M = 30.72, SD = 1.79) than mothers in the ASD group (M = 29.74, SD = 2.37).
Singh et al. (2021)	The aim of the present study was to extend the component analysis research on MBPBS and test the individual effects of MB vs. PBS vs. MBPBS, such that the specific effects of the two major components alone could be tested against their combined effects.	195 Ms	Age range M:28 to 49	NS	Quantitative	PSS-10	The largest progressive decline in perceived stress was evident in the MBPBS group followed by the MB group, with the least decline in the PBS group. ANCOVA indicated a significant effect of a group (MBPBS, MB, and PBS), with a large effect size (F2,170 = 76.64, p < .001, η2 = 0.47). There was a significant interaction between time and group (F10,170 = 196.73, p < .001), with an even larger effect size (η2 = 0.69), indicating that changes in the mothers’ perceived stress over time depended largely on type of intervention.

Note. ASD = Autism spectrum disorder; BASC-2 = The Behavior Assessment System for Children, Second Edition; BMPS = Bangor Mindful Parenting Scale; CAMM = The Child and Adolescent Mindfulness Measure; CBCL = Child Behavior Checklist; Cs = Caregivers; DASS-21 = The Depression, Anxiety and Stress Scale – 21; ERC = The Emotion Regulation Checklist; ERQ-CA = The Emotion Regulation Questionnaire-Child; FFMQ-SF = The Five Facets of Mindfulness Questionnaire-Short Form; FFMQ = The Five Facets of Mindfulness Questionnaire; FMI = Freiburg Mindfulness Inventory; FQOL = Family Quality of Life; Fs = Fathers; GHQ = The General Health Questionnaire; ID = Intellectual Disability; IEM-P = The Interpersonal Mindfulness in Parenting Scale; IM-P = The Interpersonal Mindfulness in Parenting Scale; M-age = Mean age; MAAS = The Mindful Attention Awareness Scale; MB = Mindfulness-based; MBI = Maslach Burnout Inventory; MBPBS = Mindfulness-Based Positive Behavior Support; Ms = Mothers; NS = Not Specified; PBS = Positive Behavior Support; PS-O = overreactivity in parenting; Ps = Parents; PSI-C = competence in parenting; PSI-SF = Parenting Stress Index-Short Form; PSI = Parenting Stress Index; PSS-10 = The Perceived Stress Scale; PSS = The Parental Stress Scale; QOL = Quality of Life; RRS = The Ruminative Response Scale; SRS-2 = SRS-2 = Social Responsiveness Scale, second Edition; SRS = SRS-2 = Social Responsiveness Scale; WHO-5 = WHO-5 Well-being Index; WHOQOL-BREF = The Quality-of-Life Questionnaire.

Endnotes:

1. Pre-treatment assessment (time 1), post-treatment (time 2), 3 months after the completion of treatment (time 3). Random assignment to either the mindfulness-based parent training (MBPT) or skills-based parent training (SBPT) treatment group.

2. Mothers’ scores before (P1) and after parent mindfulness training (P2), and after child mindfulness training (P3).

Of the 33 studies selected, 18 did not indicate the ethnicity of the participants. The remaining 15 studies reported on ethnicity. The majority of participants in the reviewed studies were Caucasian and White (around 80%), with the remainder being African American, Indian, Italian, Turkish, Israeli, Asian, Canadian, and Arabic.

Discussion

Previous studies have repeatedly demonstrated that parents of children with autism spectrum disorder (ASD) experience higher stress levels than parents of typically developing children and those with other disabilities (Padden & James, 2017). Most of the findings from the studies included in this review are in line with prior research.

The first aim of the current study was to investigate parental stress in families of children with ASD compared to parents of typically developing children (TYP) or children with other psychological disorders. The results indicated that mothers of children with ASDs had significantly higher parenting stress scores than mothers of children in the developmental delay (DD) group and mothers of children in the TYP group (Estes et al., 2013). One of the earlier studies found that regardless of gender, parents of children with ASD reported significantly higher levels of anxiety, depression, and parental distress than parents of typically developing children (Padden & James, 2017).

Pisula and Porębowicz-Dörsmann (2017) investigated the parents’ quality of life and their stress levels. Compared to the control group, parents of children with ASD scored much higher on parenting stress. Mothers of children with ASD were also found to have higher stress levels than fathers.

The second aim of the current study was to determine whether there is any correlation between the level of parental stress and the severity of autism symptoms and/or children’s challenging behaviors. The results indicated that children’s problem behaviors were positively associated with parenting stress and psychological distress (Estes et al., 2009). A study with an ethnically diverse cohort found that parental stress was associated with children’s comorbid symptoms, including sleep and behavioral problems. Among the problematic behaviors identified by the Aberrant Behavior Checklist, irritability was associated with significant differences in reported stress in ASD and developmental disability (DD) groups (Valicenti-McDermott et al., 2015). One study suggested that children with autism have clinically significant maladaptive behaviors, as reported by their parents. Positive relationships were found between the Maladaptive Behavior Index and the Parental Stress Index, which shows the effect of maladaptive behaviors on parental stress levels (Hall & Graff, 2012).

A study conducted on 188 families with children having ASD indicated that children with ASD symptoms lead to increased stress levels in both mothers and fathers, with the child-driven effects being more pronounced for fathers in the early stages and for mothers later on (Rodriguez et al., 2019). Consistent with these findings, ASD symptoms were positively related to parenting stress, that is, an increase in the core symptomatology of autism was related to significant increases in maternal distress (Miranda et al., 2019). However, one of the reviewed studies found that both mothers and fathers reported a higher level of stress related to their parental roles rather than the characteristics of a child or parent-child relationship (Rivard et al., 2014).

Mothers with depression may have decreased parenting abilities, which can negatively affect their children’s physical and mental health (Zablotsky et al., 2013). Therefore, it would be beneficial for families to try specific therapy options to improve the parent-child relationship.

Thus, the third aim of the current study was to determine whether the use of mindfulness-based interventions is beneficial for decreasing parental stress. Research conducted by Cheung et al. (2019) partially supported this hypothesis, indicating that parenting stress mediated between parents’ characteristics and children’s behavioral difficulties. The study found that parents with a greater disposition toward mindful parenting and lower affiliate stigma experienced less parenting stress, which was associated with fewer behavioral issues in children. Consistent with the current findings of this review, higher levels of mindful parenting have been found to be related to less frequent or severe child behavioral problems (Beer et al., 2013). Another study showed the importance of maternal mindfulness and stated that the relationship between mindfulness and stress remains even when controlling for the effects of child’s behavioral problems. The opposite relationship between mindfulness and stress indicates that increasing mindfulness among mothers helps decrease stress. These findings support the use of mindfulness-based interventions for parents of children with ASD. These conclusions are consistent with the results of previous research showing that mindfulness-based interventions may be effective in improving stress among parents of children with ASD (Conner & White, 2014). One of the reviewed studies investigated whether training mothers in a Mindfulness-Based Positive Behavior Support (MBPBS) course would result in changes in the behavior of adolescents with ASD. The results showed that, corresponding to the mothers’ training in MBPBS, their adolescents’ aggressive and disruptive behaviors began decreasing and showed statistically significant reductions during the mindfulness practice phase that followed the training. Furthermore, there were statistically significant reductions in mothers’ stress levels after training in the MBPBS program (Singh et al., 2014).

However, this study had some limitations. The search for studies was not specified by sex, age, or background for individuals with ASD and their caregivers. This review analyzed studies that examined individuals from different backgrounds. The caregivers were not limited only to mothers/fathers, and any caregiver was included in the study; however, most of the caregivers in this study were parents. Most of the reviewed studies in the current study focused on the parents of adolescents with ASD. It would be beneficial for future studies to focus on older individuals with ASD. It is essential to determine the factors that impact parents’ well-being when caring for their children with ASD. Therefore, future research should further investigate possible stressors that might elevate parental stress in individuals with ASD, along with ways to eliminate these stressors. Based on the search results of the studies, the use of mindfulness and its effect on improving the parent-child relationship seems to be understudied. Studies that want to examine the effects of mindfulness-based interventions further should consider including not only parents but also their children in the intervention to determine whether the benefits of such treatment would last longer.

This review aims to add more to the literature on mindfulness-based interventions and their benefits, for parents and their children. The information reported in the current review would be helpful for further researchers to investigate different types of mindfulness-based interventions and their potential effects on improving parent-child relationships despite the difficulties experienced by parents while raising children with special needs. Diagnostic assessment practices for ASD vary considerably across countries including assessment tools, staffing, and provision of interventions. This article reviews findings on related topics from various populations. Therefore, the main findings reported in this review may help determine the need for future practice implications.

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Agency for the Management of University and Research Grants of the Government of Catalonia, grant number 2021SGR01071.

ORCID iDs

Merve Yesilkaya

Ernesto Magallón-Neri

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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