Parental Stress and Coping in Autism Spectrum Disorder: A Network Analysis of Internalizing and Externalizing Symptoms in Children With Autism Spectrum Disorder.

Introduction: Parental stress and coping strategies play a pivotal role in shaping mental health outcomes for children with Autism Spectrum Disorder (ASD). While traditional research has examined linear relationships, network analysis offers a novel lens to uncover dynamic interactions between parental factors and child psychopathology. This study employs advanced network modeling to map how specific stress dimensions and coping mechanisms differentially associate with internalizing (e.g., anxiety) and externalizing (e.g., aggression) symptoms. Our findings provide clinically actionable insights into targeted intervention points within the parent-child stress-coping system.

Method: Parents of children aged 6-12 years (age 8.84 ± 1.86, with 78 female participants (41.94%)) with the ASD diagnosis completed online questionnaires that incorporated the Autism Parenting Stress Index (APSI), the Child Behavior Checklist (CBCL), and the Brief COPE scale. Network modeling techniques were employed, utilizing a Multivariate Gaussian Model (MGM) with a gLASSO regularization parameter (γ = 0.1) and bootstrapping with 1000 resamples to ensure the precision of edge weights and centrality indices.

Results: The network analysis revealed a significant edge weight of 0.332 between core autism-related stress (APSI.T1) and affective problems (CBCL1) and a robust connection of 0.414 between conduct problems (CBCL4) and oppositional defiant behaviors (CBCL5). Notably, adaptive coping strategies (C.1) exhibited high centrality values (betweenness = 1.537; closeness = 1.552; strength = 1.297), indicating their pivotal role in buffering the impact of parental stress on psychiatric outcomes. In contrast, maladaptive coping strategies (C.2) demonstrated negative centrality measures (betweenness = -1.132; closeness = -1.899; strength = -1.677), suggesting a limited protective effect.

Conclusion: Adaptive coping strategies served as protective factors, while maladaptive ones intensified the stress cycle. These findings emphasize the need for targeted interventions focusing on both symptom management and strengthening parental resilience.

Summary: Emotional regulation skill development through techniques like CBT and mindfulness should be the primary focus of interventions for children with ASD to tackle their psychiatric profile's core affective issues. Parental training in adaptive coping methods, such as problem-solving and positive reframing, helps protect child outcomes from the effects of parenting stress. Clinical assessments of parental stress should be conducted regularly with ASD-specific tools like APSI while examining their connections to children's internalizing and externalizing behaviors. Schools and clinical services should incorporate parent-focused stress-management programs, such as structured parenting workshops, to enhance parental resilience and improve children's emotional and behavioral health. Clinicians can optimize treatment outcomes by applying a network perspective to pinpoint and address key symptoms, such as affective and oppositional behaviors, and coping nodes specific to each family.