Title: Maternal Self-Care, Attachment Style, and Observed Parenting in a Preschool Sample with Autism Spectrum Disorder
Description: Background. Mothers of children with Autism Spectrum Disorder (ASD) report high levels of stress, depression, marital strain, and divorce, with little time to devote to their own self-care due to the high demands of their child’s care. Despite their well-documented levels of stress and the relationship of stress to negative parenting, there are few observational studies of parenting in this population. Thus, it is critical to examine factors influencing maternal wellbeing and quality of parenting. Two factors to explore include 1) parental use of self-care, as self-care is related to reduced stress and better health and functioning of individuals and is easily modifiable and 2) attachment style, which, while being less modifiable, influences the degree to which an individual engages in self-care and the quality of relationships which are modifiable, including parent-child interactions. Methods. Participants were 42 mother-child dyads, with children ages 2-6 to 5-6 recruited from a preschool utilizing an Applied Behavior Analysis (ABA) approach to schooling.

Children had a classification of ASD, verified by the Autism Diagnostic Observation System – Two (ADOS--2) (Lord, Rutter, DiLavore, Risi, Gotham, & Bishop, 2012). Parenting behaviors were observed across three tasks designed to mirror naturalistic mother-child interactions, which were videotaped for later coding using the Psychological Multifactor Care Scale — ASD Adapted Preschool Version (Brassard, Donnelly, Hart, & Johnson, 2016). Mothers completed questionnaires assessing demographic variables, parenting stress with the Parenting Stress Index – Fourth Edition, Short Form (Abidin, 2012), attachment style with the Experience in Close Relationships – Short Form (Wei, Russell, Mallinckrodt, & Vogel, 2007), depression with the Patient Health Questionnaire – 9 (Kroenke, Spitzer, & Williams, 2001), and self-care with items adapted from the Promise Neighborhoods RFA Indicators and the Promise Neighborhoods Research Consortium [PNRC] Measurement System; Promise Neighborhoods Research Consortium: Measures, 2001) concerning exercise, diet, smoking, overweight, and sleep.

Results. Mothers in this sample engaged in high levels of positive and infrequent and mild levels of negative parenting. Those who did engage in negative parenting reported higher levels of stress and higher anxious and avoidant attachment. Multiple regression analysis using conditional process analysis (Hayes, 2018) found significant indirect effects of self-care on quality of parenting for both positive (r2=.61) and harsh (r2=.18) observed parenting, when mediated by parental stress. Individuals with a high degree of self-care demonstrated less stress which related to more positive, less harsh parenting. When depressive symptoms were included as a mediator in a casual model the impact of depression was significant. Self-care was significantly related to quality of parenting for both positive and harsh parenting in a mediational model with higher levels of self-care relating to lower levels of maternal depressive symptoms, which related to lower levels of parental stress, which related to more instances of positive parenting (r2=.64) and fewer instances of harsh parenting (r2=.24).

Anxious attachment was significantly related to self-care with avoidant attachment as a moderator, explaining 56% of the variance. Anxious attachment related to both positive and harsh parenting directly and indirectly through self-care and stress. Avoidant attachment was not significantly related to quality of parenting, although it interacted significantly with anxious attachment in a model of attachment style, self-care, stress, and quality of parenting. Anxious and avoidant attachment style on self-care showed mothers who were preoccupied (high anxiety/low avoidance) demonstrated the most self-care, followed by secure (low anxiety/low avoidance), dismissing (low anxiety/high avoidance), with fearful parents (high anxiety, high avoidance) demonstrating the least self-care. Regression models controlled parental race (White, Hispanic), household income, number of children in the home, and the number of adults in the home, a proxy for caregiving support, determined by the dependent variable.

Observed parenting behaviors were found to be skewed with most mothers using high levels of positive parenting behaviors and low levels of harsh parenting behaviors, Mothers in this sample reported higher levels of stress (20.5% above the cutoff) and maternal depressive symptoms (10% above the cutoff vs. 7% above the cutoff ) compared to normative samples, consistent with the literature on parents of children with ASD. Conclusions. Parent’s use of self-care is a modifiable variable related to reduced stress and depression, and better quality of parenting. Attachment is related to the amount of self-care a mother engages in as well as quality of parenting indicating that a mother’s attachment style should be considered in designing interventions.