Title: Elevated Attention Problems and Observed Parenting in a Sample of Preschoolers with Autism Spectrum Disorder
Description: Background. The experience of parenting children with Autism Spectrum Disorder (ASD) is generally understood to encompass higher levels of parenting stress relative to families of typically developing children and, in many instances, when viewed in comparison to children with other disabilities. Emerging evidence suggests that when children with ASD present with elevated attention problems, parents may be more likely to engage in harsh parenting during dyadic interactions (Donnelly, 2015). Despite this, few studies have examined the relationship between attention problems and observed parenting in families of children with ASD, which has been well-described in the literature as a particularly challenging context for parents. This dissertation investigated the relationship between child attention and observed parenting behaviors in a community sample of mothers of children with ASD in early childhood. The extent and nature of this relationship was further explored by observing whether parenting stress and depression played a role in mediating this relationship, and by investigating whether the relationship varied by child behavior and level of functioning.

Parenting behaviors were directly observed across three dyadic tasks selected to approximate naturalistic situations in which parents and their children interact. It was hypothesized that increased attention problems would be linked to greater parenting stress, decreased positive parenting, and increased harsh parenting. Increased understanding of how attention problems relate to parenting within an ASD population will inform the selection and design of interventions uniquely suited to meet the needs of children and their families. Methods. This sample of 42 mother-child dyads included children with ASD attending a specialized preschool, where they received Applied Behavior Analysis educational programming. Child participants ranged in age from two years, six months to five years, six months, and all diagnostic classifications were corroborated through the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., 2012). Parent and child behaviors during dyadic interactions were video recorded and then coded using the Psychological Multifactor Care Scale — ASD Adapted Preschool Version (Brassard, Donnelly, Hart, & Johnson, 2016).

These direct observations of parent and child behavior were used to examine quality of parenting, child negativity toward the mother, and child engagement in tasks during parent-child interactions. Following the interaction, mothers completed a number of self-report measures assessing demographic characteristics, Parenting Stress Index, Fourth Edition, Short Form (PSI-4: SF; Abidin, 2012, maternal depressive symptoms on the PHQ9 (Kroenke, Spitzer, & Williams, 2001), and the Attention Problems scale on the Child Behavior Checklist (Achenbach & Rescorla, 2001). Classroom teachers completed the Communication domain of the Vineland Adaptive Behavior Scales –Third Edition (Vineland-3; Sparrow, Cicchetti, & Saulnier, 2016). Results. Children with ASD and clinically elevated attention problems (n = 19) had signifiantly lower verbal ability, more CBCL aggression, and their mothers reported signficantly more stress than children with ASD only (n = 23). Observed child engagement was significntly correlated with CBCL attention problems in the overall sample (r = -.42, p<.01), although the groups (ASD only v.

ASD plus elevated attention problems) did not differ significantly (p < .06). Increased attention problems were significantly negatively related to positive parenting in this sample, even when ASD severity and verbal ability were controlled. Although a mediation model failed to support a model where attention problems predicted differences in observed parenting through parenting stress, reverse models showed increased positive parenting predicted decreased child attention problems through its effect on parenting stress. The role of maternal depressive symptoms as a mediator of this relationship was unsupported. Perhaps unsurprisingly, observed child behavior was found to be an important factor in understanding parenting behavior; however, the nature of its role was multifaceted. While observed child negativity was directly linked to lower levels of positive parenting, it moderated the relationship between child attention problems and harsh parenting, as mediated by parenting stress. In particular, attention problems were positively linked to greater stress, but this stress was more likely to be accompanied by a greater increase in harsh parenting behavior when children demonstrated negativity toward their mothers.

The relationship between child attention problems and positive parenting varied by child verbal ability. For children with higher verbal ability, attention problems were linked to a drop in positive parenting, while this relationship was unsupported in children with underdeveloped communication skills. Conclusions. Child attention problems are a powerful predictor of parenting stress and less positive parenting. While it was expected that variation in attention problems would predict differences in parenting, reverse models showed more promise in identifying and defining the relationship between these variables, where mothers who exhibited more harsh parenting and less positive parenting experienced higher levels of parenting stress and their children demonstrated increased attentional problems and decreased engagement during dyadic interactions. The strength of this relationship varied according to observed child negativity and level of functioning. Clinical implications for practitioners and future directions for research investigating parenting children with ASD are discussed.