712956

research-article2017
ISCXXX10.1177/1053451217712956Intervention in School and ClinicHsiao

Current Topics in Review

Moira Konrad, Associate Editor
Intervention in School and Clinic 1­–5
© Hammill Institute on Disabilities 2017
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DOI: 10.1177/1053451217712956
https://doi.org/10.1177/1053451217712956
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Parental Stress in Families of

Children With Disabilities

Yun-Ju Hsiao, PhD1

Abstract
Parents of children with disabilities often experience a higher level of stress than parents of children without disabilities,
regardless of categories of disabilities. Understanding parental stressors can lead to appropriate interventions and supports
for these parents and their children with disabilities. This article discusses issues of parental stress by exploring what is
known about parental stress in raising children with disabilities and examining factors that may result in parental stress
for practitioners to work on so as to help parents reduce their stress. This article focuses on three strong predictors of
parental stress in families of children with disabilities: (a) problem behaviors of the child, (b) coping strategies of parents,
and (c) parenting support for families. Implications for practitioners to help parents reduce their stress are discussed.

Keywords
coping strategies, disabilities, family support, parental stress, problem behaviors

Parental stress, defined as parental perceptions of an imbal-
ance between the demands of parenting and available
resources (Raphael, Zhang, Liu, & Giardino, 2010), is one
of the many factors that contribute to the effectiveness of
parenting (Guajardo, Snyder, & Petersen, 2009). It is virtu-
ally impossible for parents to avoid experiencing some
degree of parental stress (Putnick et al., 2010). However,
when parents experience high levels of stress and are busy
responding to this stress, their parenting effectiveness may
decrease (Guajardo et al., 2009; Raphael et al., 2010); espe-
cially when a family has a child/youth with disabilities
(Blacher & McIntyre, 2006; Meadan, Halle, & Ebata, 2010;
Perry, Harris, & Minnes, 2005; Trute, Hiebert-Murphy, &
Levine, 2007). This may be because parents of children
with disabilities often experience higher levels of parental
stress than parents of children without disabilities (Baker,
Blacher, Crnic, & Edelbrock, 2002; Baker et al., 2003;
Dyson, 1996; Eisenhower, Baker, & Blacher, 2005; Gupta,
2007; Hoffman, Sweeney, Hodge, Lopez-Wagner, &
Looney, 2009; Lopez, Clifford, Minnes, & Ouellette-Kuntz,
2008) and are more likely to have a higher risk of emotional
and psychological distress (Zablotsky, Bradshaw, & Stuart,
2013). This may in turn lead parents to overreact to their
child’s behavior, react in a manner less sensitively, apply
coping strategies less effectively, or decrease their ability to
seek appropriate supports for their child, thus affecting their
child’s physical and mental health (Ben-Sasson, Soto,
Martinez-Pedraza, & Carter, 2013; Osborne, McHugh,
Saunders, & Reed, 2008; Zablotsky et al., 2013). Given that
parental stress can be one factor related to the effectiveness
of parenting and the development of children, this article
discusses stressors in parenting children with disabilities
and identifies strategies for practitioners to work on for
helping parents reduce their stress.
Factors Related to Parental Stress
As mentioned above, having a higher level of parental stress
may influence families, including both parents and chil-
dren, in many different ways. Parents of children with dis-
abilities often experience a higher level of stress than
parents of children without disabilities, regardless of cate-
gories of disabilities (e.g., autism spectrum disorders,
developmental disabilities, intellectual disabilities, learning
1
Washington State University Tri-Cities, Richland, WA, USA
Corresponding Author:
Yun-Ju Hsiao, PhD, Washington State University Tri-Cities, 2710
Crimson Way, Richland, WA 99354, USA.
Email: yhsiao@tricity.wsu.edu
2 Intervention in School and Clinic 00(0)
disabilities) (Baker et al., 2002; Baker et al., 2003; Dyson,
1996; Eisenhower et al., 2005; Gupta, 2007; Hoffman et al.,
2009; Lopez et al., 2008). This indicates that it is especially
important for practitioners to work with parents to reduce
their stress so as to help optimize outcomes for children
with disabilities and their families. Although there are vari-
ous factors related to the high levels of parental stress (e.g.,
negative social stigma associated with the child’s disabili-
ties, socioeconomic status of the family, community sup-
port; Altiere & von Kluge, 2009; Bonis, 2016; Hall, 2012;
Saisto, Salmela-Aro, Nurmi, & Halmesmäki, 2008), this
article focuses on three strong predictors of parental stress
in families of children with disabilities: (a) problem behav-
iors of the child, (b) coping strategies of parents, and (c)
parenting support for family.
Problem Behaviors of the Child
Many studies indicate that behavior, rather than cognitive
ability, of the child is highly correlated with parental stress
(Davis & Carter, 2008; Hall & Graff, 2011; Lecavalier,
Leone, & Wiltz, 2006; Tomanik, Harris, & Hawkins, 2004).
If the child’s behavior problems are considered intensive,
the level of parental stress rises (Baker et al., 2002; Baker et
al., 2003; Brobst, Clopton, & Hendrick, 2009; Eisenhower
et al., 2005; Hastings, 2002; Pentyliuk, 2002). When a child
with disabilities displays more problem behaviors, these
behaviors have substantial effects on the daily routines of
the family and the well-being of other family members,
causing social isolation of the entire family, limiting access
to supports and services (e.g., respite care, day care, or out-
of-school care), and leading to high levels of parental stress
(Hodgetts, Nicholas, & Zwaigenbaum, 2013; Kanne &
Mazurek, 2011). Baker et al. (2003) indicated that the con-
nection between parental stress and behavior problems was
transactional over time. That is, child problem behavior
contributes to higher parental stress over time and higher
parental stress contributes to worse child problem behavior
over time (Baker et al., 2003; Lecavalier et al., 2006;
Mackler et al., 2015; Neece, Green, & Baker, 2012).
Therefore, providing support or education for parents to
address their child’s problem behaviors is important and
beneficial for families of children with disabilities, espe-
cially for social skill development and behavior problem
management (Baker et al., 2002; Baker et al., 2003).
Coping Strategies of Parents
Another significant factor related to the stress of parenting
children with disabilities is the effectiveness and quantity of
coping strategies employed by parents (Hall & Graff, 2011;
Lopez et al., 2008; Lyons, Leon, Phelps, & Dunleavy, 2010;
Zablotsky et al., 2013). Parents with less effective coping
skills experience higher levels of parental stress (Raphael et
al., 2010). Coping refers to behavioral or cognitive efforts
that individuals use to minimize their level of distress or
stress (Zablotsky et al., 2013). There are several ways that
people usually cope with stress: (a) using task-oriented cop-
ing to solve problems through specific strategies that mini-
mize the influences of problems, (b) using emotion-oriented
coping by reacting to the stress or problem through emo-
tional responses, such as self-preoccupation or performing
fantasizing reactions, (c) using avoidance-oriented coping
to avoid a stressful situation through escaping, and (d) using
distraction by engaging in a substitute task (Lyons et al.,
2010). Parents often lack strong coping skills to solve real
problems, and instead, many of them use emotional coping
or avoidance-oriented coping, which lacks effectiveness
and leads to higher levels of stress (Pottie & Ingram, 2008;
Zablotsky et al., 2013). Therefore, providing support or
parental education for parents to learn more effective cop-
ing strategies is important and beneficial for families of
children with disabilities.
Parenting Support for Families
Support to family is a significant factor that contributes to
parental stress in raising children with disabilities. Although
parents of children with disabilities should not expect that
all their supports will come from their spouse or partner,
they indicated that the most helpful support is from their
spouse or partner (Hall & Graff, 2011). That is, the absence
of a spouse or partner may contribute to increased levels of
stress (Gray, 2003). Also, parents expressed that they did
not have enough family support from their extended family,
and this also leads to higher levels of stress (Mancil, Boyd,
& Bedesem, 2009; Preece & Jordan, 2007). When parents
cannot gain enough support from their family, it is impor-
tant for them to gain other support from outside. It is fortu-
nate that, regardless of the support sources (e.g., friends,
professionals, extended family), parenting support (e.g.,
advice on problems specific to their child, help with child
care) is a consistent predictor of most dimensions of paren-
tal stress (Guralnick, Hammond, Neville, & Connor, 2008).
That is, parenting support from all kinds of support sources
can help parents reduce their parental stress. Therefore,
practitioners can play an important role in helping parents
of children with disabilities gain more resources for support
from outside of their family.
Practical Implications
Because parents of children with disabilities experience a
higher level of stress and this higher parental stress may
attenuate intervention efforts and worsen child problem
behavior, it is important for practitioners to provide support
or education to help parents reduce their stress. This section
proposes practices for practitioners to address the three
Hsiao 3

Table 1.  Factors Related to Parental Stress and Strategies for Practitioners.

Factor
Problem behaviors of the child
Coping strategies of parents
Strategy
•• Consult with parents about their concerns regarding their child’s behaviors at home and in the
community
•• Provide parents appropriate and applicable behavior management skills and recommendations
for the behaviors
•• Help parents develop new and positive coping strategies (e.g., task-oriented coping) by
organizing parent counseling groups
 Pair parents who use positive or task-oriented coping with those who employ other strategies
  Provide scenarios or vignettes for parents to work on and find solutions

  Shape parents’ coping strategies

Parenting support for families •• Provide parents with information and resources of support outside of their family and school,
including
  Existing community organizations

  Local associations for the specific disabilities of their child

 Community parent support groups

  Support groups for siblings

  Respite care

  Parent to Parent (P2P) USA

strong predictors of parental stress as discussed above (see
Table 1).
Problem Behaviors of the Child
Parents of children with disabilities need ongoing support to
help them manage the behavior problems of their child
(McStay, Trembath, & Dissanayake, 2014). Teachers and
members of the Individualized Education Program team must
go beyond the classroom and school boundaries to help parents
deal with real-life situations in which their child exhibits prob-
lem behaviors (McStay et al., 2014). This involves practitio-
ners consulting with parents about their concerns regarding
their child’s behaviors and providing recommendations about
those behaviors. This is a starting point to facilitate a reduction
of parental stress as it provides parents with home- and com-
munity-based behavioral strategies. These suggestions often
improve behavior manageability, increase parents’ sense of
control concerning their child’s behavior problems, and result
in a reduction of stress and an increase in community engage-
ment (McStay et al., 2014).
To help parents manage their child’s behavior across dif-
ferent domains of family life (e.g., at home or in the com-
munity), parents must learn to separate their child’s behavior
from themselves (McStay et al., 2014). Practitioners can
work with parents to understand the essential components
of managing behaviors (e.g., antecedents or triggers of the
problem behaviors, function, consequences, and reinforce-
ment of the behavior). This provides parents with appropri-
ate and applicable behavior management skills (McStay et
al., 2014). This training can also involve the collection of
data for their child’s problem behaviors so as to assess the
behaviors and implement appropriate behavior intervention
across settings (Park, Alber-Morgan, & Fleming, 2011).
Parental involvement creates a mindset for parents of chil-
dren with disabilities that active participation in an inter-
vention results in competent and consistent intervention and
a change in behavior (Brookman-Frazee & Koegel, 2004).
Coping Strategies of Parents
Parents need to be taught how to develop new and positive
coping strategies, such as task-oriented coping. Practitioners
can organize parent counseling groups to support parents of
children with disabilities. First, parents’ current coping
strategies need to be identified. Brief COPE (Carver, 1997)
is a useful instrument that is easy and quick for practitioners
to administer and score for this purpose (Hastings et al.,
2005). Then, parents who use positive or task-oriented cop-
ing can be paired with parents who employ other strategies.
Practitioners can then develop scenarios or vignettes of sit-
uations that parents typically encounter in their daily life
and have parents come up with solutions. Parents with dif-
ferent coping styles then share how they usually deal with
the situation and compare and reflect on what they do dif-
ferently. Through these activities, parents not only shape
their coping strategies but also learn from each other. In this
group, parents can share their feelings and emotions, thus
helping them relieve some stress related to raising a child
with disabilities.
Outside Support for Families
It is extremely important for parents of children with dis-
abilities to gain support from outside of their family, espe-
cially if they do not have enough family support.
4 Intervention in School and Clinic 00(0)
Practitioners can help parents find information and resources
of support outside of their family. That is, practitioners can
provide information regarding support from the community
to strengthen the family’s support network, such as existing
community organizations, local associations for the specific
disabilities that their children have, community parent sup-
port groups, support groups for siblings, and respite care.
These supports can help parents of children with disabilities
and assist them from outside of their family and school as
well. Practitioners cannot assume that parents know this
information. For parents who cannot find local support
groups, they can also try Parent to Parent (P2P) USA (http://
www.p2pusa.org/), which matches parents to provide emo-
tional support as well as assistance in finding appropriate
information and resources.
Conclusion
Parents of children with disabilities reported a higher level of
parental stress than parents of children without disabilities
(Baker et al., 2002; Baker et al., 2003; Brobst et al., 2009;
Dyson, 1996; Eisenhower et al., 2005; Gupta, 2007; Hoffman
et al., 2009; Lopez et al., 2008). It is unfortunate that when
parents experience stress, they may be less responsive to their
child’s needs and exhibit punitive or negligent parenting
(Belcher, Watkins, Johnson, & Ialongo, 2007). Major factors
contributing to the parental stress of raising children with dis-
abilities include the child’s behavioral problems, parents’ cop-
ing skills, and parenting support to the family. Practitioners
could offer support to parents, such as (a) providing parents
appropriate and applicable behavior management skills and
recommendations to work with their child’s problem behavior
at home and in the community, (b) organizing counseling
groups to help parents develop new and positive coping strate-
gies, and (c) helping parents gain support from outside of their
family and school, thus reducing parental stress and leading to
the success of the child with disabilities. Finally, it is worth
noting that in addition to the three major factors discussed in
this article, there are other factors that may contribute to paren-
tal stress in families of children with disabilities. Therefore,
practitioners need to cautiously consider all other factors and
characteristics of the families and their children’s disabilities
(e.g., negative social stigma associated with the child’s dis-
abilities, socioeconomic status of the family) when helping
parents reduce their stress.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, author-
ship, and/or publication of this article.
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