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Clinical Psychologist 19 (2015) 39–48

Family functioning and behaviour problems in children with

Autism Spectrum Disorders: The mediating role of parent
mental health
Rachel JELLETT,1 Catherine E. WOOD,1 Rebecca GIALLO2 and Monique SEYMOUR1,2
1
Faculty of Health, Arts and Design, Swinburne University of Technology, and 2Healthy Mothers Healthy Families Research Group, Murdoch Children’s
Research Institute, Melbourne, Victoria, Australia

Key words Abstract

autism spectrum disorder, child problem
behaviours, family functioning, parent mental Background: Parents of young children with Autism Spectrum Disorders
health, parent stress. (ASDs) are often relied on to help implement therapy with their child, which
occurs within a family context. Therefore, it is important to understand and
Correspondence support families where there is a child with an ASD. Although individual parent
Rachel Jellett, Faculty of Health, Arts and
factors have received substantial research attention, fewer studies have investi-
Design, Swinburne University of Technology,
gated family functioning. This study explored the relationship between child
PO Box 218, Hawthorn, Victoria 3122,
Australia. behaviour problems and family functioning in families where there was a pre-
Email: [email protected] schooler with an ASD. Parent mental health difficulties, including stress, fatigue,
and depressive symptoms, were investigated as mediators in this relationship.
Received 27 May 2014; accepted 25 Method: Participants included 97 parents with a preschooler diagnosed with
September 2014. an ASD. Parents completed an online questionnaire reporting on child behav-
iour problems, their own symptoms of stress, depression and fatigue, and
doi:10.1111/cp.12047
family functioning.
Results: Path analysis showed that the relationship between child behaviour
problems and family functioning was mediated by depressive symptoms, but
not stress and fatigue.
Conclusions: These results highlighted one way that ASDs can impact on the
family system, suggesting that when parents are overburdened by behaviour
problems, there are implications for the family. The importance of providing
clinical interventions and support to strengthen parent mental health and
family functioning is discussed.

Key Points
1. Parents of children with Autism Spectrum Disorders (ASDs) are increasingly responsible for implementing early
intervention to their children; therefore, assessing and supporting the family unit are of importance in clinical practice.
2. Children’s behaviour problems are associated with depressive symptoms in parents, which can have flow-on
negative effects to the family system, such as difficulty supporting one another and making decisions. Although
child behaviour problems are associated with increased stress and fatigue in parents, these symptoms are less likely
to affect family functioning.
3. Clinical interventions targeting the mental health, particularly depressive symptoms, of parents may increase their
capacity to manage their children’s behaviour and the impact it can have on the overall family system. This, in turn,
is important for the family to meet the needs of their children.

Funding: None.
Conflict of interest: The authors declare there are no conflict of interests.

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Jellett et al.

Raising a child with an Autism Spectrum Disorder (ASD) ioural problems, including being withdrawn, aggressive,
can be challenging for parents and families (Sikora et al., destructive, and hyperactive (Maskey, Warnell, Parr, Le
2013). During the preschool years, parents play a key role Couteur, & McConachie, 2013). They tend to show more
in seeking assessments and diagnoses, selecting and coor- severe behaviour problems than TD children. This differ-
dinating treatment programmes, managing atypical ence has been found for preschool-aged children
behaviours, and working to improve their child’s devel- (Eisenhower, Baker, & Blacher, 2005) and toddlers (aged
opmental and educational skills (Bloch & Weinstein, 18 to 30 months; Estes et al., 2013) based on parent
2009; Estes et al., 2013). Therapy is often integrated in to report measures. These behaviours are often enduring,
home life due to financial and time constraints of parents, difficult to manage, and highly stressful for families
as well as the advantages of working with the child in a (Hastings, 2002). In fact, challenging behaviours are gen-
familiar setting (Reed & Osborne, 2014). erally more difficult for families to manage than the
Family functioning refers to the extent to which fami- severity of ASD traits (Herring et al., 2006).
lies communicate effectively, manage daily life, and foster A number of researchers have investigated the associa-
positive relationships (Zubrick, Williams, Silburn, & tion between behaviour problems in children with an
Vimpani, 2000). A well-functioning family system pro- ASD and family functioning (Herring et al., 2006;
vides support for family members, and is associated with Khanna et al., 2011; Sikora et al., 2013). For example,
positive child and parent outcomes (Renzaho, Mellor, Sikora et al. (2013) found that clinically significant exter-
McCabe, & Powell, 2013). Evidence suggests that when nalising, but not internalising, behaviours were associ-
there is a child with an ASD, family functioning is often ated with poorer family functioning as rated by parents of
affected in terms of greater strain on the family system; children with an ASD. The authors proposed that man-
less participation in recreational activities (Myers, aging externalising behaviours might lead to hyper-
Mackintosh, & Goin-Kochel, 2009); and less flexibility vigilance on the part of caregivers, exacerbating stressors
and connectedness (Higgins, Bailey, & Pearce, 2005). and limiting the family’s ability to function healthily
Numerous qualitative studies have shown that family life (Sikora et al., 2013). This interpretation requires further
comes to centre on the needs of the affected child (e.g., empirical evaluation. A better understanding of the rela-
Hoogsteen & Woodgate, 2013; Myers et al., 2009). tionship between these child, parent, and family factors is
Parents of children with an ASD tend to report less needed to most effectively support children with an ASD
effective family functioning than parents of typically in the context of a family system, particularly because
developing (TD) children (Higgins et al., 2005). This these difficulties can be longstanding.
finding has been replicated across cultures in families of Longitudinal research by Herring et al. (2006) showed
children with ASD or developmental delay (Gau et al., that behaviour problems in preschoolers with ASDs were
2012; Manor-Binyamini, 2011). Family difficulties might associated with higher maternal stress and lower levels of
be influenced by a number of individual, intra-familial, family functioning. Parent ratings on these variables taken
and social factors. For example, limited social support 1 year apart were moderately to strongly correlated, sug-
(Bromley, Hare, Davison, & Emerson, 2004; McConnell, gesting that difficulties were maintained over time rather
Savage, & Breitkreuz, 2014), socio-economic status, indi- than resolved. This difficulty adjusting during the pre-
vidual wellbeing (Georgiades, Boyle, Jenkins, Sanford, & school years highlights the need for better understanding
Lipman, 2008), children’s behaviour problems, and dif- and support (Karst & Van Hecke, 2012). There are several
ficulty coping (Khanna et al., 2011) are all factors that ways in which behaviour problems can impact on the
can make it difficult for families to function optimally. family system, and one likely pathway is via the well-
During the preschool years, families are often in crisis established negative effects of child behaviour problems
because their child’s ASD diagnosis is recent and the on parent mental health (Hayes & Watson, 2013).
challenges associated with the child’s behaviour can be
extreme during this period (White, McMorris, Weiss, &
Parent mental health
Lunsky, 2012). These behaviour problems are distressing
for parents, which could contribute to family difficulties Parents of children with ASDs report higher levels of
(Sikora et al., 2013). stress than parents of TD children, or parents of children
with other needs (see Hayes & Watson, 2013 for a
review). These parents are also at increased risk for
Children’s behaviour problems and
experiencing depression (Ingersoll & Hambrick, 2011),
family functioning
poorer quality of life (Khanna et al., 2011), and fatigue
In addition to their core deficits, children on the Autism (Giallo, Wood, Jellett, & Porter, 2013). Although fatigue
spectrum have a high incidence of emotional and behav- is a diagnostic feature of depression, research has shown

40 © 2014 The Australian Psychological Society

 Family functioning and autism spectrum disorders

that fatigue and depression are distinct, but related, con- mental health or family functioning, further work is
structs (Giallo, Wade, Cooklin, & Rose, 2011). Studies needed to integrate these areas. Clarifying the processes
have shown that behaviour problems predict stress (Estes that occur in these families during a critical window for
et al., 2013) and fatigue (Seymour, Wood, Giallo, & development and intervention (i.e., the preschool years)
Jellett, 2013) in parents of young children with ASDs. is likely to assist with informing treatment so as to
Behaviour problems are more strongly associated with improve outcomes for children and their parents. This
parenting stress than autism symptomatology or adaptive approach also reflects an ongoing push to include the
skills (e.g., Jones, Totsika, Hastings, & Petalas, 2013; family system in the assessment and treatment of ASDs
McStay, Dissanayake, Scheeren, Koot, & Begeer, 2014). (Baker et al., 2011; Karst & Van Hecke, 2012).
Studies have also demonstrated a relationship between While previous research has shown that behaviour
parent mental health and poor family functioning in problems in children with an ASD can impact on the
families where there is a child or young adult with an mental health of parents, less is known about the impli-
ASD (Baker, Seltzer, & Greenberg, 2011; Khanna et al., cations for family functioning. Building on transactional
2011). Less is known about this in the preschool years. models of child development (Hastings, 2002; Sameroff,
Furthermore, parent mental health difficulties are often 1975), the aim of this study was to investigate the rela-
conceptualised as an outcome of poor family functioning tionship between child behaviour problems and family
(e.g., Baker et al., 2011; Renzaho et al., 2013). It is also functioning, and examine pathways via parent mental
likely that bidirectional effects are evident whereby child health. The study focused specifically on parents of
and parent factors influence family functioning. No preschool-aged children with an ASD because of the
known studies have linked these experiences together in unique challenges associated with this developmental
a child-driven model in families of preschoolers with stage. Fatigue was included as an important indicator of
an ASD. parent mental health, in line with recent research
showing its salience in this population (Giallo et al.,
Transactional models of child development 2013; Seymour et al., 2013). It was hypothesised that
children’s behaviour problems would be associated with
Sameroff (1975) proposed a transactional model that
increased parent mental health difficulties (as defined
outlined the reciprocal influences that occur between
by symptoms of stress, depression, and fatigue), and
children and their environments over time. Child devel-
these in turn would be associated with less effective
opment is described as a process occurring through con-
family functioning.
tinual transactions between children and their
environments (Sameroff, 2009). In infancy and the pre-
school years, parents and families are highly influential,
as the child spends the most time in the family home Method
interacting with parents (Sameroff & Fiese, 2000).
The transactional approach has been applied to families Participants
of children with developmental disabilities (Hastings, Participants were 97 parents of children (aged 16–71
2002). Hastings (2002) proposed that challenging behav- months) diagnosed with an ASD. Sample demographic
iours influence parents’ stress levels, which in turn affects characteristics are displayed in Table 1.
parenting behaviour. This can then serve to maintain and Participants were excluded if their child was outside
escalate the child’s behaviour problems. Other factors the age range of interest (n = 3). The majority of parents
were acknowledged as contributing to this cycle, includ- were female, tertiary educated, Australian born, heading
ing parents’ beliefs about parenting and their child’s a two-parent household, and had just one child diag-
behaviour, coping strategies, and resilience (Hastings, nosed with an ASD. The majority of focus children were
2002). It is also likely that when parent mental health is male and diagnosed with Autism. As the survey was
compromised by managing difficult behaviours, the primarily conducted online, response rates could not be
family system is impacted on. The family system might determined.
then function less effectively, resulting in a reduced
capacity to provide structure and support to family
members, and meet the needs of a child with an ASD. Measures
Demographic and family background questionnaire. Informa-
The present study
tion about family composition, language spoken at
Although a number of studies have investigated the home, educational attainment, employment status, and
impact of children’s behaviour problems on either parent household income was collected. Information about the

© 2014 The Australian Psychological Society 41

Jellett et al.

Table 1 Demographic characteristics of the sample assessment of emotional and behaviour problems in chil-
Variable Parents (N = 97) dren with intellectual and developmental disabilities.
Items are rated on a 3-point scale (0 = not true as far as you
Parent characteristics
know; 2 = very true or often true). A mean behaviour
Age (M, SD) 36.08 (5.51)
Gender
problem score is computed, reflecting the Total Behav-
Female 88 (90.7%) iour Problem Score from the original measure, with
Male 9 (9.3%) scores above 0.48 indicative of psychopathology (Taffe
Family type et al., 2007). This short form has been evaluated as an
Couple 87 (89.7%) appropriate tool to estimate problem behaviours in a
Single-parent family 10 (10.3%) research setting (Taffe et al., 2007). Cronbach’s α for the
Country of birth
present sample was .84.
Australia 76 (78.4%)
Other 21 (21.6%)
Depression, Anxiety and Stress Scale (DASS-21; Lovibond
Language spoken & Lovibond, 1995) is a commonly used measure of nega-
English only 96 (99%) tive emotional states. The stress and depression subscales
Bilingual 1 (1%) (7 items each) were used for the purpose of this study.
Aboriginal or Torres-Strait Islander 2 (2.1%) The stress subscale assesses non-specific arousal, includ-
Employment status ing agitation, irritability, impatience, nervousness, and
Full-time 18 (18.6%)
difficulty relaxing. The depression subscale assesses dys-
Part-time or casual 37 (38.1%)
Not in paid employment 42 (43.3%)
phoria, hopelessnesses, anhedonia, and self-contempt.
Highest level of education completed Items are rated on a 4-point scale, ranging from 0 = did
Some high school 8 (8.2%) not apply to me at all to 3 = applied to me very much, or most
Completed high school 13 (13.4%) of the time. Scores are summed and multiplied by two to
TAFE, trade certificate or diploma 22 (22.7%) approximate the original 42-item version. Cronbach’s α
Tertiary (degree or postgraduate) 54 (55.7%) for the present sample were .83 and .88 for the stress and
Number of children in the family (M, SD) 2.25 (1.02)
depression subscales, respectively.
Number of children with ASD
One 80 (82.5%)
An adapted version of the Fatigue Assessment Scale
Two 15 (15.5%) (Michielsen, De Vries, & Van Heck, 2003) was used in the
Three or more 2 (2%) present study. The adapted version uses five items rather
Focus child characteristics than the full 10 items, based on the outcome of a con-
Age in years 4.29 (1.05) firmatory factor analysis with a large sample of mothers
Gender of children aged 5 years or younger (Giallo, Wade, &
Male 82 (84.5%)
Kienhuis, 2014). The five items are proposed to more
Female 15 (15.5%)
Diagnosis
accurately reflect the experience of fatigue among
Autism (low functioning) 16 (16.5%) parents of young children. These items are rated on a
Autism (high functioning) 35 (36.1%) 5-point scale, where 1 = never and 5 = always, with higher
Asperger’s disorder 12 (12.4%) scores reflecting higher levels of fatigue. Cronbach’s α for
Pervasive developmental disorder NOS 16 (16.5%) the present sample was .86.
Other (e.g., ASD) 18 (18.5%) Family Assessment Device – General Functioning Scale
Age of diagnosis (in years; M, SD) 3.14 (1.10)
(FAD-GF; Epstein, Baldwin, & Bishop, 1983) is a 12-item
Hours per week at childcare or kinder (M, SD) 16.47 (10.23)
Intervention accessed
subscale from the FAD that assesses the overall level of
Speech therapy 69 (71.1%) family functioning. The FAD is based on the McMaster
Applied behaviour analysis (ABA) therapy 25 (25.8%) Model of Family Functioning where communication,
Occupational therapy 24 (24.7%) problem solving, role clarity, behaviour control, affective
Respite care 10 (10.3%) responsiveness, and affective involvement are considered
ASD, autism spectrum disorder; M, mean; SD, standard deviation; TAFE, the essential components of family functioning (Miller,
technical and further education. Ryan, Keitner, Bishop, & Epstein, 2000). The items (e.g.,
“Planning family activites is difficult because we mis-
understand each other”) from the FAD-GF reflect these
child with ASD, including gender, age, diagnosis, age at key areas. The items are rated on a 4-point scale, ranging
diagnosis, and types/hours of intervention in a typical from 1 = strongly agree to 4 = strongly disagree. After
week, was also collected. reverse-scoring six items, scores are averaged, with
Developmental Behaviour Checklist – Parent Short Form higher scores representing less optimal functioning. The
(DBC-P24; Taffe et al., 2007) provides a brief (24 items) authors reported a high internal consistency for this

42 © 2014 The Australian Psychological Society

 Family functioning and autism spectrum disorders

Figure 1 Standardised parameter estimates for the model of child behaviour problems, parent mental health, and family functioning. Notes: **p < .01,
***p < .001; Residual variances between depressive symptoms, stress, and fatigue were correlated to account for salient interrelationships.

subscale of the FAD (Cronbach’s α = .92; Epstein et al., (Tanaka, 1987). The estimation method used was
1983). Cronbach’s α for the present sample was .91. maximum likelihood with robust standard errors (MLR)
to account for non-normal multivariate data. Model fit
was assessed using the chi-square test, and other practical
Procedure
fit indices including Tucker–Lewis index (TLI), the com-
The study was approved by Swinburne University’s parative fit index (CFI), and root mean square error of
Human Research Ethics Committee, Melbourne, Aus- approximation (RMSEA). Indices for the TLI and CFI
tralia. ASD-related support groups and services across should exceed .90 for an acceptable fit, and values close
Australia were contacted to assist in advertising the to or below .05 for the RMSEA were considered accept-
study; approximately 40 groups assisted. Most parents able (Hu & Bentler, 1999).
completed the questionnaire online, but 10 were mailed
a paper copy. Completing the questionnaire implied
consent. Parents with more than one child with an ASD
Results
in the target age group (n = 10) were asked to select one
child as their focus child.
Preliminary data analysis
Initial data screening showed that missing data were less
Data analysis
than 5% and were missing at random (Little MCAR test,
Path analysis using Mplus Version 7.11 (Muthén & p > .05). The expectation-maximisation algorithm in
Muthén, 1998–2013) was conducted to test the hypoth- PASW18 was used to impute missing values. Data from
esised model (see Fig. 1), where parent mental health mothers (n = 88) and fathers (n = 9) were compared on
mediates the relationship between child behaviour diffi- each of the key variables. Fathers were found to report
culties and family functioning. This regression-based significantly less child behaviour problems (F = 4.83,
approach estimates the complex relationships between a p < .05, η2 = .05) and significantly lower levels of fatigue
set of independent, intermediate, and dependent vari- (F = 7.65, p < .05; η2 = .13) than mothers. The effect sizes
ables simultaneously. This provides estimates of the direct associated with these differences were small, and so it
effects of the relationships between the variables (e.g., was decided to include fathers in the final analysis.
child behaviour difficulties and parent mental health), Furthermore, it has been suggested that despite differ-
along with indirect effects of the independent variables ences in the magnitude of difficulty reported by mothers
(e.g., child behaviour difficulties) on the dependent vari- and fathers, similar overall patterns predict parental well-
ables (e.g., family functioning) via the intermediate vari- being across both genders (Jones et al., 2013). Given that
ables (e.g., stress, depression, and fatigue). none of the demographic variables were significantly
In the hypothesised model, the number of parameters associated with the variables in the hypothesised model,
to be estimated was 17, including correlations of the no model adjustments for demographic characteristics
residual variances between depressive, stress, and fatigue were made. Normality plots showed that data for the
symptoms to account for the interrelationships between parent depression and family functioning measures were
the parent mental health variables. The sample size was positively skewed. However, no data transformations
adequate, adhering to the recommended ratio of five were conducted as maximum likelihood estimation with
participants to every free parameter to be estimated robust standard error was used. Descriptive statistics for

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Jellett et al.

Table 2 Means, standard deviations, and ranges for questionnaire meas- evidence for mediation. The indirect pathways via parent
ures stress (−.03, p = .594) and parent fatigue (−.002,
Scale Parents (N = 97) p = .952) were not significant.
M SD Range Skewness

DBC-P24 .86 .31 .17–1.71 .07

Discussion
a-FAS 16.60 4.46 7–25 −.09 This was the first known study to investigate the path-
Stress subscale 19.75 8.32 2–38 .04
ways between behaviour problems in children with an
Depression subscale 11.75 8.68 0–38 .88
FAD-GF 2.11 .59 1–3.75 .46
ASD and family functioning via parent mental health.
Addressing this gap in the literature supports the impor-
Notes: DBC-P24, Developmental Behaviour Checklist – Parent Short Form; tant need to assess and support children with ASDs in the
a-FAS, Adapted Fatigue Assessment Scale; FAD-GF, Family Assessment
context of their family system (e.g., Karst & Van Hecke,
Device – General Functioning Scale; M, mean; SD, standard deviation.
2012). Consistent with previous findings (Herring et al.,
2006; Khanna et al., 2011; Sikora et al., 2013), children’s
behaviour problems were associated with less effective
the study variables are displayed in Table 2, and the cor-
family functioning. The hypothesis was partially sup-
relation matrix is shown in Table 3.
ported, as this relationship was mediated by parental
depressive symptoms, but not fatigue or stress symptoms.
Testing the hypothesised model That is, when children’s behaviour problems contribute
The hypothesised model was an excellent fit to the data, to depressive symptoms, it can have adverse effects on
χ2 (1, N = 97) = 12.9, p = .381; RMSEA (90% CI) = .00 family functioning.
(.00 – .26), CFI = 1.00, TLI = 1.02. The model accounted While behaviour problems were associated with
for 20% of the variance in family functioning, 14% of increased stress, fatigue, and depressive symptoms in
the variance in stress, 7% of the variance in depressive parents, after accounting for behaviour problems, paren-
symptoms, and 14% of the variance in fatigue. The tal stress and fatigue were not associated with family
standardised parameter estimates for the model are functioning. This suggests that these specific symptoms
shown in Fig. 1. may have less of an impact on families than parental
As can be seen in Fig. 1, more problematic child behav- depression. Attending to behaviour problems can make it
iours were associated with greater depressive, stress, and difficult for parents to devote time to other family
fatigue symptoms in parents, and these direct paths were members, and can limit the family’s participation in
significant. Only depressive symptoms were, in turn, rewarding activities (Nealy, O’Hare, Powers, & Swick,
associated with more problematic family functioning. 2012; Phelps, Hodgson, McCammon, & Lamson, 2009;
The total indirect effect of difficult child behaviour on Sansosti, Lavik, & Sansosti, 2012). The current findings
family functioning was close to significant (.10, t = 1.78, suggest that this may be particularly so when parents are
p = .074). The indirect pathway from child behaviour experiencing symptoms of depression. Depressive symp-
problems to family functioning via parent depressive toms such as low mood, and lack of enthusiasm and
symptoms (.13, p = .02) was significant, providing some initiative, can make it harder for parents to function,
which can then impact on family life. Families may be
more likely to withdraw from pleasant activities when
Table 3 Correlations among the study variables parents are experiencing depressive symptoms. It might
be that feeling stressed or fatigued has less of an impact
Scale DBC-P24 a-FAS Stress Depression
on parents’ ability to manage family life, tasks, and pro-
subscale subscale
cesses, but further research in this area is needed. A
DBC-P24 — recent study suggested that despite their fatigue, mothers
a-FAS .37** —
continued to report being capable of completing daily
Stress Subscale .39** .54** —
Depression Subscale .31** .44** .65** —
tasks and activities (Giallo et al., 2014).
FAD-GF .26* .16 .22* .44** Behaviour problems shown by children with ASDs are
often secondary to their core deficits, such as their
N = 97.
impaired social communication or sensory sensitivity
* p < .05;
(Sikora et al., 2013), and can be unrelenting. Targeting
**p < .01.
Notes: DBC-P24, Developmental Behaviour Checklist – Parent Short Form; behaviour problems in interventions is one way to
a-FAS, Adapted Fatigue Assessment Scale; FAD-GF, Family Assessment improve the outcomes for families; however, this is less
Device – General Functioning Scale. effective when parents are stressed (Osborne, McHugh,

44 © 2014 The Australian Psychological Society

 Family functioning and autism spectrum disorders

Saunders, & Reed, 2008). Taken together, these findings conducted, a larger sample size would make the findings
suggested that supporting parents to manage their more robust.
children’s behaviour as well as their wellbeing, particu- Finally, the amount of variance in family functioning
larly any depressive symptoms, could help to minimise explained by the mediation model was modest, likely due
the impact of behaviour problems on the family to the present study having a narrow focus on just one
system. Consistent with this were the findings of a recent pathway relating to the influence of children’s behaviour
evaluation of a parent-support group intervention, problems. Although this pathway is clinically relevant for
where family functioning improved along with parent families of preschoolers, there are many other important
wellbeing post-intervention (Samadi, McConkey, & child, parent, and contextual factors not investigated in
Kelly, 2013). this study that may have an impact on family function-
Consistent with transactional theory, it is also acknowl- ing. Factors such as the quality of the parent relationship,
edged that other pathways, including bidirectional parenting practices, social support, sibling issues, and
effects, are likely when investigating the impact of indi- employment are also likely to impact upon family func-
vidual factors on family relationships (Sameroff, 2009). tioning, and warrant further investigation.
There is some initial evidence from longitudinal studies,
suggesting that increased parenting stress impacts on Implications and conclusions
future behaviour problems in a mutually escalating cycle Despite its limitations, there are important theoretical
of transactions (Osborne & Reed, 2009). The present and clinical implications arising from this study. The find-
results suggested that this commonly identified child– ings suggested that understanding and acknowledging
parent transaction also has implications for the broader parent mental health, particularly depressive symptoms,
family system. When family functioning is ineffective, it and family functioning concerns are important compo-
can have ongoing consequences for family members. For nents of assessment and intervention for ASDs. Whereas
example, increased family conflict has been associated many services take a child-centred approach, support for
with depression, anxiety, and worsening symptoms in parent mental health and family functioning is also likely
individuals with an ASD (Kelly, Garnett, Attwood, & to be important. In some cases, this may be a necessary
Peterson, 2008). Family functioning difficulties are also first step for families because being burdened by mental
associated with maladaptive parental coping (Khanna health and family problems is likely to make it more
et al., 2011). difficult for parents to engage in strategies to effectively
manage their child’s behaviour.
Limitations Current Australian good practice guidelines for early
intervention in ASDs acknowledge the importance of
There are several limitations to note. Some groups of assessing the needs of the family system (Prior, Roberts,
parents were poorly represented in the study, including Rodger, Williams, & Sutherland, 2011). However, avail-
fathers, single parents, parents of lower functioning chil- able family interventions primarily focus on parent-
dren, and parents with lower educational attainment implemented intensive behavioural interventions that
than a tertiary qualification. Furthermore, the majority of are focused on the child (Prior et al., 2011). Although
the sample accessed speech and applied behavioural these interventions can reduce stress by assisting parents
analysis therapies more than has been reported in other to feel better equipped to support their child, their effec-
samples of Australian parents of preschoolers with an tiveness might be reduced when parents are struggling
ASD (see Carter et al., 2011). These factors suggested that with symptoms of depression such as low mood and a
the families were generally well resourced. As the survey lack of motivation. A number of factors have been iden-
was conducted online, the response rate could not be tified as being protective of parent mental health, includ-
determined, making it unclear as to whether particular ing social support, exercise, self-care (Giallo et al., 2013),
families were excluded through the recruitment process. and psychological acceptance (Jones, Hastings, Totsika,
Furthermore, reliance on self-report measures introduces Keane, & Rhule, 2014). Based on the current findings,
the possibility of reporter bias, where parents with prioritising parent mental health, particularly depressive
mental health difficulties may describe their child and symptoms, would be a valuable step to reduce the impact
family less favourably as a result of feeling overwhelmed. of behaviour problems on the family system.
The self-report method also meant that the child’s diag-
nostic status was unable to be independently verified and
Acknowledgements
that family functioning estimates are also based on the
responses of one family member. Although the sample The authors wish to thank the parents who participated
size was reasonable and acceptable for the analyses in this study.

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Jellett et al.

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